Thanks to high-profile moms on the move, postpartum running is trending. Most notably, Olympic Marathon Trials champion Aliphine Tuliamuk had her first baby, Zoe, on January 13—and is now planning her return for the Games this August.
Tuliamuk’s Hoka One One NAZ Elite teammate Stephanie Bruce also has sights set on Tokyo. She’s training for the Olympic Track Trials while parenting her toddler boys, Riley and Hudson. And, Olympic 800-meter runner Alysia Montaño (who has three kids) started a non-profit, &Mother, that’s helping sponsor three more Olympic hopeful moms: Dawn Harper-Nelson, Sara Vaughn, and Olicia Williams.
Pros like these know the perks of getting top-notch help for any important goal, and coming back postpartum is no exception. Enter experts like Sara Tanza, D.P.T., a pelvic floor physical therapist who’s currently working with Tuliamuk. Her Santa Cruz, California, practice is called Pelvic Potential, and she’s also guided Bruce and several other elite runners from the delivery room back to the starting line.
Then there’s Celeste Goodson, of ReCORE Fitness, a medical exercise specialist with a decade of experience helping women strengthen and rebuild pre- and post-baby. Her client roster has included Bruce, Montaño, Neely Spence Gracey, Allyson Felix, and Gwen Jorgenson, as well as pro athletes in other sports.
Tanza and Goodson are moms and runners who understand the challenges of both, both personally and professionally. While research and medical guidance on postpartum running has thus far been limited, the exercise science world is finally starting to catch up, they say. And all the pros and everyday runner moms sharing their stories has helped athletes of all levels find resources and community.
“There’s so much more coming out every single day,” Tanza says. “There’s never been a better time to be a pregnant or postpartum runner than now.” Here’s what she and Goodson want runners of all levels to know about coming back post-baby.
Elite Athletes Have Unique Considerations…
Most new moms are eager to get back to running. But pros may have tighter timelines than others, since running is their job, Tanza says. Fortunately, many sponsors and coaches have become more flexible about supporting pregnant and postpartum women, but Olympic cycles and other competitions still represent a factor to consider when balancing the risks and rewards of how swiftly to return.
To their advantage, elites are well versed in prioritizing rest, which can speed recovery. “They’re also not necessarily working another job,” Tanza says. “Aliphine’s talked about how she is not trying to go back to working on her feet 40 hours a day, and getting back to running at the same time, the way some of my patients are.”
But in Many Important Ways, They’re Just Like the Rest of Us
Pregnancy and childbirth place high demands on any body, including those at the peak of their competitive careers. “Birth can be a great equalizer for pros and novices alike,” Tanza says. “A lot of times, the biggest impact on their recovery is what their pregnancy was like—the symptoms they had during pregnancy—and what their birth was like.”
Carrying a baby for nine months stretches abdominal and pelvic floor muscles (which work like a hammock to support your internal organs), Goodson says. Your pelvic bones shift to accommodate the baby, and then separate further during birth, Tanza says.
In addition, vaginal delivery often tears the pelvic floor muscles. C-sections, meanwhile, involve incisions that need time to heal. And if you began delivering vaginally but then were rushed into surgery, you essentially experienced two births, Tanza points out.
Issues that may complicate comebacks include pelvic pain, urinary or fecal incontinence, and prolapse, when organs like the uterus and bladder drop into or out of the vagina. There’s also diastasis recti, which is excessive stretching of the tissue (linea alba) of the abdominal muscles, which Bruce and Montaño have both openly discussed (Montaño had surgery, while Bruce hasn’t, offering two different examples of managing it).
Things May Not Go As Quickly As You Hope
Returning to running before you’re fully healed can contribute to or worsen these complications, as well as put you at risk of other injuries, Tanza says. After all, each step involves the force of gravity pushing up, while your organs bear down. This adds significant strain to already weak or damaged tissues.
Thinking about recovery in the context of other setbacks can help it all sink in. “If you have a stress fracture or a complete muscle tear anywhere else, like a high hamstring tear, you would know that you’d have to wait a certain amount of time. No one’s going to run the next day or two weeks later,” Tanza says. “But for some reason, we think our pelvic floor is different.”
On top of that, you’re not always getting the type of restful, restorative sleep that promotes healing. And if you’re breastfeeding, the same hormonal shifts that loosened your ligaments and other tissues during pregnancy persist for up to six months after you stop, Tanza says.
That’s why, while some doctors have—and still do—give women the all-clear to exercise after six weeks, a safe return to running may take a little longer. In fact, international guidelines published in 2019 now suggest women wait 12 weeks, or three months, to ease back into the sport.
Those guidelines represent an average; athletes working one-on-one with a health care provider may receive clearance sooner. Tanza and Goodson both recommend focused core retraining exercises first, then walking. Many of their runners, elite and otherwise, may get cleared to add runs into their walks after about eight weeks. That’s how long Tuliamuk waited, even with the Olympics on the horizon.
Though it may feel like an eternity in the moment, taking extra time to heal pays off. “I want people to know that extra month or two months or three months they wait, it’s fine, and it is something that’s going to help them in the long term,” Tanza says. “Patience is worth it.”
You Can Start Preparing Before Your Baby Arrives
Per the most recent guidelines from the American College of Obstetricians and Gynecologists (ACOG), exercising during pregnancy is recommended for nearly everyone, provided you work with your doctor on the details.
While she definitely encourages activity, Tanza advises her patients to consider limiting running to what they can do without pain in their pelvis, back, or other areas. “Let’s say they can run a certain number—say, 20 miles a week—with no pain, but if they go up to 25, they start having pain,” she says. Staying in that lower-pain zone before birth can decrease the chances of problems afterward, she’s found.
While not every insurance plan covers it, seeing a pelvic floor physical therapist throughout pregnancy can also help significantly. In addition to helping you build strength in your hips and core, these providers specialize in manual, internal therapy. It’s similar to what you’d get for your IT band or shoulder, but for your pelvic floor—a kind of prehab for birth, Tanza says.
When she’s working with athletes, including elites, one thing Tanza does is help them pinpoint the ideal birth position. “Let’s say you lay on your right side and your pelvic floor muscles are really, really tight, but then you lay on your left side and they’re super loose,” she says. While it’s no guarantee, writing that into your birth plan may help minimize tears.
After Delivery, There’s a Lot You Can Do to Brace for Impact
After birth, a pelvic floor therapist can detect and treat problems like muscle tears, prolapse, and diastesis recti. If you have symptoms like pelvic or abdominal pain, significant leakage of urine or poop, pain during sex, “coning” or bulging of your ab muscles when you sit up, or feelings of heaviness in the vagina or anus, you should definitely see one, Tanza says. But everyone could benefit from an evaluation within two or three weeks postpartum, and if necessary, an individualized plan for treatment.
For those not under the care of a PT, there’s often a gap between being cleared by your doctor and getting back to the activities you love, especially high-impact ones like running. That’s why Goodson created ReCORE. Through six-week one-on-one sessions or online programs, she guides athletes through what she calls the four postpartum building blocks: the inner core, outer core, and full body, followed by a slow introduction to impact.
She advises this type of training three to four times per week, though she also encourages new moms not to stress about it. “Work at it, do the best you can, but it doesn’t have to be very regimented,” she says. Try squeezing a few moves in the morning, during nap time, or at night. “Consistency is helpful. But if you can get it in a couple times a week, it’s better than nothing.”
- Inner core: Goodson starts by simply re-introducing women to their inner core: their pelvic floor, diaphragm, transverse abdominals, and lower back muscles. It all begins with what she calls ab sets, or diaphragmatic breathing. To do it, sit up straight on the floor and picture your inner core—from your diaphragm to the muscles that wrap around your sides to those in your lower back—as a balloon. Breathe deeply by expanding that balloon, minimizing the movement in your chest. As you exhale, contract your core and pelvic muscles before relaxing them. From there, roll to your side and then lie on your back (moving that way, instead of dropping straight down, prevents excess pressure in your still-healing abs, Goodson notes). Repeat the same motion—inhaling into the balloon, exhaling, contracting, and relaxing—about 30 times before moving on to any other exercises.
- Outer core: Once you’ve reconnected to your foundation, challenge it by involving some of the surrounding muscles. This includes your hips, which require strength to absorb shock and control the pelvis, Tanza says. Some of Goodson’s go-to exercises in this stages are bent-knee side planks, clamshells, and wall sits, which start to work your glutes, quads, and hamstrings—muscles that also contribute to pelvic stability—without excess pressure on the core. Squeezing a pillow between your knees while you do a wall sit helps your adductors—muscles in your inner thighs—connect to your pelvic floor, which can help prevent pelvic pain. Meanwhile, wall push-ups start to get your upper body involved—after all, running is a full-body sport, and strong postural muscles can also make breastfeeding easier.
- Full body core: Finally, Goodson connects all the links of the chain. Here, she introduces single-leg moves, such as Romanian deadlifts and Bulgarian split squats, where the back foot is on a bench and the front is on the ground. She adds weights once runners can do these types of moves without pain.
- Impact: Goodson likes to gently re-introduce bones, muscles, and joints to pounding, starting with partial body weight. One key move is the plank knee drive, where athletes get into a high plank position and alternate bringing one knee forward at a time. From there, they’ll move on to wall knee drives, starting slow, then picking up the pace. “This is great for runners, because they have to practice the hip drive that’s part of the mechanics of running, but they’re also getting used to the impact at the same time,” she says.
Working with a coach or trainer who specifically has a certification in postpartum fitness, like Goodson, can ensure they guide you safely through these types of exercises, Tanza says.
Walk Before You Run
Tanza starts all her athletes on a walking program first—one that honors where they are, not where they were. “Athletes are often like, ‘Oh, well I walked four miles the day I gave birth, so I’m going to go walk four miles again,” she says. “But if you broke your arm, you couldn’t do what you did at CrossFit the day before, right? You have to increase that walking way slower than you think.”
Start by walking out to your mailbox, or the first stop sign on your block. Add distance once that starts to feel comfortable. As symptoms allow, you can supplement with low-impact cross-training, such as easy biking, swimming, or pool running. “The big symptoms to watch out for are leaking urine, or leaking poop, having heaviness in your pelvis, or having pain, especially in your pubic bones or your SI joint,” Tanza says. “Those are the signs people are doing a little bit too much.”
Running involves two and a half times the pounding of walking, Tanza points out. So it’s not until her athletes are able to walk an hour and a half with no symptoms—the equivalent of a 45-minute run—that she progresses them into a walk-run program. She also checks to see if they can perform a few other activities without symptoms, including standing up with no hands; running in place for 1 minute; and doing 20 side-to-side lateral jumps.
Step It Up Slowly
Once you’re ready to introduce running, start small, with 1- to 2-minute runs interspersed by walk breaks. Don’t worry about how far or fast you go. “Take the pressure off, introduce the load, and reduce your expectations of what it’s supposed to be like when you start out,” Goodson says.
Here’s a sample progression from Tanza:
- 5 x 1-minute run, 3-min walk; increase to 10 x 1-min
- 5 x 2-minute run, 2-min walk; increase to 5 x 2-min
- 4 x 3-min run, 1-min walk; increase to 5 x 3-min
- 3 x 5-min run, 2-min walk; increase to 4 x 5-min
- 2 x 10-min run, 2-min walk; increase to 3 x 10-min
- 20-minute run
There’s no set amount of time to spend in each phase, she says: Move on when you can comfortably complete each distance with good form and without increasing symptoms. Keep in mind that progress may not be linear. “Someone might be up to a 5-minute run interval, but got a horrible night of sleep the night before and feels their form falling apart at 4 minutes. Respect your body and stop at that time,” she says.
Take one to two days of rest between each run/walk session for the first month, she says. From there, you can build up gradually to your desired routine. For instance, do a run every other day for a week; the next week, do two days back to back but take rest days between every other run; and the next week, you can add two back to back runs, provided your symptoms haven’t worsened.
Nutrition is also important for new moms, especially if you’re breastfeeding, since ramping up your running and producing milk both require significant calories. Underfuel and you’ll risk an energy deficiency that can harm your bones, immunity, and your heart health over time. According to ACOG, your body requires an extra 450 to 500 calories per day while breastfeeding, and then running adds more to your total. Ask your doctor or work with a registered dietitian on the details.
The process may seem long and daunting, and take more time than you’d planned—full recovery might take up to two and a half years, Tanza says. But, she advises runners to take inspiration from the pros’ examples.
Stephanie Bruce ran her personal-best 2:27:47 and placed sixth at the 2019 Bank of America Chicago Marathon, four years after her second son was born. Vaughn made her first world team in the 1,500 meters when her third son was a year old. And while their achievements make them extraordinary, their degree of improvement isn’t uncommon.
“You will be back to running at the level you want to run at, or possibly at a level you have never run at,” Tanza says. “It’s 100-percent possible. I think a lot of my patients are better runners postpartum than they were before.”