Postpartum return to training for triathletes
There is a lot of advice and guidance given to female athletes on what they should and shouldn’t do throughout pregnancy but where there is a less clear approach is post-natally, the road to recovery and a gradual return to training. The general rule of anything to do with pregnancy and postpartum training must be in line with what your medical practitioner says is safe for mother and child. However, the advice is not catered to the athlete and more the generic, everyday woman. In this article, we want to explore in more detail some considerations in getting back to your sport after pregnancy and returning, dare I say it, fitter, stronger and more determined. As you will learn, it is so much more than just the six-week check-up and then “back to sport as normal” approach.
You will note that though there are guidelines and weeks, or durations often attributed to different phases of returning to sport postpartum, I don’t think that is helpful in this instance. Everyone is different. Some recover quickly, and some take longer, and of course, the type of delivery and subsequent recovery must also be taken into account. All people have different physiological strengths and weaknesses and very different recovery times. Instead of focussing on “how long” it will take, focus on getting the goal itself, the task in hand and the building blocks to get there – patience in this instance is even more key. As a general guideline, a close friend pointed out that it takes nine months to prepare the body for birth, and that seems like a reasonably good amount of time to recover from it! Interestingly, when you look at most of the guides out there, it does seem to follow that rule of thumb, so that would be a good starting point.
There are always stories of people who bounce back after pregnancy and take next to no time before racing again. We also hear stories of people who “never raced again” after childbirth. We rarely focus on what the average person does. The first rule is to avoid comparison and focus on you. The postpartum period may extend out to 1 year. The traditional 6-weeks is nothing more than a random point when considering performance sport. It is merely a guide to the acute recovery from the birth itself.
Instead, the focus and process should focus on returning to competing properly rather than returning to competing too quickly. As a coach, I’d rather see my athlete return empowered, confident and ready hit training and racing hard rather than try and race the return to competition just to say that they did it quickly. I am not in the business of forcing short cuts!
Encouragingly we are seeing more and more up-to-date guidelines on what you can do after birth but the most important and probably most challenging part for any active woman is that the first phase; to take it easy and recover.
Recovery from birth
The first phase is focussed on recovering. Your body has externally and internally undergone massive stress and change throughout pregnancy. Then there is the type of delivery, caesarean section, tearing etc. When you consider that you have a baby-sized uterus as a wound inside you, possible scarring, and tears that must heal, there is a significant period that you must let your body do what it does best and heal, and this means doing very little, bed rest, eating well, reconnecting to your breathe through diaphragmic breathing and slowly reconnecting with your Pelvic Floor. A lot of the lochia or bleeding is from the uterus as it gradually recovers and reduces back to its original size pre-birth. This natural bleeding may go on for several weeks post-birth and is an excellent future sign of stress/doing too much exercise as that will increase bleeding and hinder this vital part of recovery.
Finally, consider the duration of physical exertion of the labour. People take a few weeks to recover from a marathon, and that may be a month to recover from the physical exertion of an IRONMAN. With labour taking several hours – comparable in duration to a one or multi-day event, it would be reasonable to think of the recovery times accordingly! You have completed a phenomenal event, and you do need to recover from it. Not forgetting the reduced lack of sleep caused by night feeds, energy availability is low, and life stressors are now high.
Reconnecting with your pelvic floor muscles
Ideally, you have done loads of work around strengthening and relaxing your pelvic floor muscles before birth. You will now need to rebuild those connections between mind and muscle as well as rebuild strength endurance. This needs to be done slowly. Think about this as a typical S&C programme after (e.g.) a hamstring injury. You need to restrengthen your pelvic floor but not overload it. This will take some time and should be done gradually but can be started soon after birth. Failing to regain pelvic floor strength will impact your quality of life later on. Leakage was considered normal by older women for a long time, and this simply isn’t the case, especially if you want to return to running.
Repairing your rectus abdominis muscle
Diastasis Recti or separation of the abs is the single most significant influence that could set your training back. There is anecdotal evidence that doing less in the first 3-6 weeks, the quicker and more robust the healing process. You should carry the baby as little as possible and indeed, try and not stress your core or trunk with any asymmetrical loading (e.g., briefcase carries – or more likely – car-seat carries or slings).
Angela Jameson of Physically fit UK talks about your stomach being a zip that is not so strong or burst open. You can do it up and keep it straight, and the zip remains closed. However, the minute we move around with the zip, it opens up again. We want to do as little as possible to open that zip up and do whatever we can to help the teeth re-find themselves. I like the analogy that it is a setting bone – you want the two sides to reconnect and any movements you do that stop that alignment will make that reconnection take longer or restart the setting progress. This will take some time. It is also now recognised that the key to a successful reconnection is the strength of the fascia, the Linea Alba underneath the abdominals which means trunk strength can be steadily built upon once the fascia is engaged.
For both pelvic floor health and diastasis recti, we would urge a visit to a women’s health physiotherapist to be cleared for a return to load and a return to running before going ahead with running. A woman’s health physio should be your first clearance hurdle. They are likely to also set you a pelvic floor test too: e.g., 10x10s squeeze and hold while standing three times a day. Like all exercise, this should start steadily with, e.g., 3x3s holds and progressing gradually from there.
Rewire your breathing
As the foetus grows in the uterus, it has to use up more space. As a result, the external indication of pregnancy (the belly) is one direction that it grows. It also pushes the internal organs upwards. This has two critical implications post-birth: firstly, the organs need to descend and reposition themselves; secondly, your breathing is no longer restricted by a bump. Breathing exercises to engage the full lung capacity and improve diaphragm function is something you can work on effectively postpartum and connect your breathing with proper abdominal and pelvic floor function.
A return to training
This part is the section that most of us (male and female) know well. Most athletes have had an injury along the way, and so it is a straightforward process that we have done before:
Ensure that you have a normal range of motion
Make sure you are moving well (muscles are firing patterns are normal – use the big muscles to do the main movements, not the little ones)
Begin to load and stress the system.
Provide sport-specific functional movements
Return to sport
All this will help return to training as if it were any old injury and is a path we should be comfortable with.
The only critical difference is between phases 2 and 3, you should be cleared by a women’s health physio, and before stage 5, you want to be cleared by a sports physio (ideally one who knows your body). This clearance is often missed out by women postpartum, and it is the most important. Anyone can run, or load their muscles, but how they load may be different to how they used to, or how they should, which can mean, although the movement of the sport can be executed, the manner is wrong, which could quickly lead to an overuse injury.
Running can take a little longer due to the increased load when running and the critical milestones needing to be achieved before returning to the sport. We work off a 6–8-week programme created by the Bosworth Clinic back to regular running. However, that can only start after the athlete hits key strength targets in phases 3-4. Though we said we wouldn’t include timelines, given the work needed for recovery, there is every chance that this phase won’t start until about 2-4 months post-birth so regular run training is likely to be at 4-6 months. However, we’ve had athletes finish the Bosworth Clinic protocol and race 100km races competitively immediately after the programme. You can undoubtedly consider racing soon after starting that. Furthermore, you should recognise that running buggies cannot be used until after the baby has control of its head, and it is suggested that this should not be until they are six months old.
Finally, relaxin the hormone that loosens the ligaments and joints to aid childbirth remains in your system for some months after birth (usually until breastfeeding ceases). This means stabilising is even more challenging. You won’t be able to call on your leg’s elasticity as much meaning you put more strain on the muscles, and the joints themselves and you are unlikely to have your zip when running. Meaning you will feel “off” when running.
Logistical implications
The hardest part of returning to training is actually more around timing. Sleep will be compromised, and life begins to revolve around feeding times and “getting a baby down to nap”. Windows to train will need to be carved out but be very flexible. Everything you can do to create an environment where you can jump into a training session and jump out as quickly as possible is critical and so being organised around fuelling before, and post-workout is essential. You won’t have much time, so you need to make the most of it or be comfortable splitting session up into smaller sessions. Activities like swimming become hard not because of the exercise, but because an hour session, plus changing and travel time may mean that you run out of time between feeds. To be successful, you will need to consider the organisation to ensure you have the fuel to execute an excellent session, and everything is prepared for the session ahead of time and a supportive team around you.
Psychological advantages
Pregnancy and birth create a significant change to the body and the mind. Athletes need to recognise that the road to recovery will take time. The most significant danger they have is doing too much too soon either through internal pressure to be back to what they were and rekindle their identity or through external pressures.
Patience is one of the most useful performance skills that an athlete can call on both when raising a child and knowing that they will need to focus on the small steps to see the big goals in their sport again.
Athletes also can endure better than most, but this shouldn’t be something that you force yourself into enduring, it should be fun. Long nights, difficult babies and trying to rekindle your identity will only make endurance sports seem a lot more straightforward!
When can I race?
When you are ready.
Having worked with a few athlete’s post-birth, you need to consider both when to race and what it will look like. Putting a race in the diary can be hugely exciting, motivating and helpful. Still, it can also add stress and unnecessary anxiety –particularly if you are used to performing at a high level. Racing can be done at any time, but how competitive do you want to be and can you legitimately be? Race too soon, and you will be chasing the wave of performance and trying to hit targets you know you need to achieve to perform but haven’t yet. That adds to your training stress many months out. You will need to trust the process and not rush it no matter how much you want to see those performance times now!
Race too easy or later than necessary, and the event loses its pull factor. You need to do something you have to train for which will get you out the door and not be too easy a goal, but this is true with any significant ambition or dream.
Finally, avoid races you have done before. It is too easy to compare against and put too much pressure on you, especially on the bigger stage. Race some smaller-scale local events which can’t be used as comparisons to previous years. Avoid the big race which you did the year before because it has good memories. Comparing to your old self will make your race preparation harder, and you will be less likely to enjoy the event as it is likely to remove the positive point of all of this: you can return to race competitively again as a mum. Don’t get me wrong this doesn’t mean you shy away from competition and least of all from yourself, but you need to ensure you are positively affirming yourself, especially in your first A-race back. You want to hit the finish line and celebrate regardless of your position. The next time around, you will be able to go for it, but enjoy your first comeback race.
Simplifying a return to exercise
Here is an example of what this can look like:
Mobility and reconnection (Pelvic floor, breathing and gentle movement)
Proper mechanical function (Pelvic floor, think physio exercises, yoga and Pilates.
Light loading and cardiovascular extension (cycling and walking steadily)
Clearance by a women’s health physio to load after pelvic floor clearance test and diastasis clearance.
Challenge stability and increase load management (More normal “base” training approach)
Load clearance tests for running – set by a physio
Return to running programme
Finally, listen to your body and yourself. Everyone has an opinion on pregnancy, motherhood and training. Most of these are based on their own experiences, and no one knows how you feel which is precisely why we would never set time-phased goals but rather clearances or hoops to jump through to ensure that the athlete makes progress at their own rate but does so safely.
Childbirth is empowering and unbelievably impressive. The human body can do a lot on its own (when we remove our thoughts!) and childbirth is an example of that. Focus on helping it do its thing and don’t force a comeback; it will happen when you are ready. Gain as much of an understanding of what your body and you need to do to enable your return to high-performance endurance sports. Then you can enjoy a lifestyle which can only serve to inspire the next generation—this is not the end, rather the start of a new phase in your sport.
Philip is the founder of Tri Training Harder. He’s a British Triathlon Level 3 coach, and has been coaching for over a decade and is involved with mentoring and developing other coaches.
Philip has have coached athletes to European and World AG wins, elite racing, many Kona qualifications, IRONMAN podiums and AG wins.
Alongside the conventional development through many CPD courses, he has also been fortunate enough to work alongside experts in the fields of Physiotherapy, Strength and Conditioning, Nutrition, Psychology, Biomechanics, Sports Medicine. Putting this knowledge into practice he has worked with thousands of athletes to various degrees, from training camps in Portugal and around Europe, clinics in the UK and online coaching.
Visit Philip's
Coach profile
We’re here to help
Tri Training Harder are one of the leading Triathlon coaching providers in the UK, using our wealth of experience to unite scientific and technological research with already well-established and successful best practices, to create a formula for triathlon and endurance coaching that works.
The result is an honest, dynamic, yet simple new way of constructing an athlete’s training to allow them to reach their potential.
If you’re planning your next season, just starting out in the sport or are looking for extra guidance at the very top end of the field, we are here to help, and our coaches would be delighted to hear from you. You can contact us via the website, and one of the team will be in touch.