Returning to Running after Cesarean Birth

Today’s episode talks about returning to running after a Cesarean birth - but don’t be fooled by this seemingly narrow focus. The episode is chock-full of essential information about pelvic floors, scar tissue, and exercise that is useful for those pregnant, not pregnant, non-runners, and several years postpartum alike! Dr. Sarah herself learns a lot from Diane Rizzardo, a registered physiotherapist and founder of Elevate Pilates & Physio, about the essential steps to returning to activity after pregnancy and birth to lower the risk of injury, and ensure maximum benefit from exercise both mentally and physically, as your body recovers from the musculoskeletal injury of giving birth. Diane also shares with us the essential checklist of functional exercises you should be able to perform before returning to running - tune in and try them out for yourself!

What sort of considerations should be taken by someone after they've had a cesarean birth? Diane breaks it down into the following three steps. But she likes to start at the beginning by thinking of the relationship between pregnancy and exercise. Many people stop exercising in pregnancy because they are experiencing nausea, sickness, or discomfort - but many also experience mental inhibitions. Fear that they are going to injure or do damage to the baby or themselves can also play a huge role in the psychological aspects of returning to running or exercise postpartum. Acknowledge that those thoughts or feelings can be the first thing inhibiting us to go back to exercise after birth, and if you do recognize them, consulting a pelvic floor physio can reduce anxiety and give us both the mental and physical strength to get back on that trail, track, or treadmill!

1. Rest

It cannot be said enough that the first step after a cesarean birth is rest. The “normal” estimated recovery period of about six weeks should not be taken to mean that at that mark you are fully healed and ready to jump back into activity. In those first six weeks, your scar is just beginning to heal so rest, pain management, such as a little bit of icing, splinting, holding a pillow to your incision if you're laughing or coughing etc, and a little bit of breath work can really play a big role in helping you return to activity. By not rushing the process and potentially injuring yourself, you lessen the risk of demotivation and prolonged healing time. 

2. Scar Tissue & Healing

At six weeks, the strength of the scar is just starting to form. It really takes closer to six to nine months before that scar is fully or almost fully at the tensile strength you want it to be for activity. Once you've been cleared by your doctor, if you've had dissolving stitches and they're totally healed up and any scabs are gone, then we start to look at things like scar desensitization. Rub items such as a washcloth, feather, or spoon, along the area about an inch above and below the scar. Introducing the scar to different feelings will help the nerves regenerate and become less sensitive. Scar tape is also a great tool to protect the scar and help smooth it out. There's many different types and brands out there, including some with vitamin E, silicone, or paper tape. Here are links to a few of our favourites!

Coupled with desensitization we recommend breath work. The diaphragm and pelvic floor share a connection during breath, like a piston, where when the diaphragm rises the pelvic floor lowers or expands to let in air, and then they both draw back together on the exhale. The baby obstructs and alters this mechanism slightly during pregnancy, causing shallower breaths higher up in the chest, so coming back to those deeper, belly breaths is also a necessary step in returning to activity.

Last but not least, scar massage is also helpful! Tissue heals almost like a web, and it can start to get a little bit sticky. By moving the tissue in the way that we want the tissue to move, it encourages it to heal better. Follow Di on Instagram and check out her scar massage video!

3. Returning to Activity

It is not recommended returning to more intensive activity like running before three months postpartum, and ideally not before being given the clearance by your pelvic physiotherapist. Once you feel psychologically and physically prepared, a physio will check for any heaviness, dragging, or any kind of pelvic or vaginal discomfort, or uncontrolled (non-menstrual) bleeding - if you’re experiencing any of these issues, your physio may refer you back to your primary care or maternal health provider. Issues such as urinary incontinence or pain during intercourse might also need to be addressed before being cleared to run. If all of these do not present issues, the next step is performing a series of functional exercises to check the state of your pelvic floor. As you return to running, focusing on some abdominal and core exercises, body weight exercises, specifically on the hip musculature, and strengthening your core, low back and pelvis will go a long way to helping prevent injuries commonly seen postpartum. 

To recap: the best steps are to rest, ensure your scar is healing well, do a pelvic floor assessment and evaluation, and then slowly reintroduce more impactful activity such as running by taking care that your pelvic floor and core are regaining strength. Tune in to today’s episode for even more tips and advice from Dianne, including which functional full-body exercises you should be able to perform before returning to running (ie. can you balance on one leg for 10 seconds?), the importance of well supported bras, and tips for running with a stroller! And remember - not rushing back into running will help lessen your risk of injury and ensure greater enjoyment in body, mind, and spirit.

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