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Pelvic HealthJan 6, 2024

Grainne Donnelly and Emma Brockwell contribute to groundbreaking return-to-running study in BJSM

Physiotherapists and physical therapists (PTs) specialising in pelvic health have a key role to play in ensuring that women are ready to return to running after having a baby and should be educated appropriately.

That is the consensus view of an international group of experienced professionals working with postpartum runners that was published online on 26 December in a British Journal of Sports Medicine article.

The article’s first author is Shefali Mathur Christopher, a PT by background from Tufts University in Seattle, and her 11 co-authors include two high-profile UK-based pelvic health physiotherapists: Gráinne Donnelly, from Cardiff Metropolitan University, and Emma Brockwell, from the private Physiomum practice based in in Limpsfield, Surrey.

Highlighting the clinical implications of their findings, Dr Christopher and her co-authors note: ‘As healthcare providers and fitness professionals – particularly birth providers, primary care providers, personal trainers and PTs – are likely to be asked questions by perinatal runners, it is imperative that these providers are educated on this topic and can refer runners to the appropriate, evidence-informed information or provider to guide running during and after pregnancy.’

Photo Credit: Shutterstock
Educating perinatal runners on postpartum recovery and exercise return is crucial

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More than 100 initial respondents

In a three-round Delphi process, used to refine the consensus view, Dr Christopher and her colleagues initially garnered the views of 118 clinicians and exercise professionals on a number of postpartum running topics. Most of those who took part in an online survey were women (97 per cent) and the numbers who took part in the second and third rounds fell to 107 and 95, respectively.

Based on their responses and drawing on current evidence, Dr Christopher and her colleagues recommended that runners should be screened for concerns or issues relating to sleep, pre-existing conditions, lactation, hydration, fatigue and mental health.

‘When possible, an appropriate multidisciplinary team, consisting of a variety of healthcare professionals with expertise in the presenting concerns (e.g., primary care providers, lactation consultants, pelvic health physiotherapists (PTs), mental health providers, physiatrists, orthopaedic specialists, obstetricians/gynaecologists, urogynaecologists), should work with the runner to address these issues,’ they note.

The authors found there was a consensus view that ‘anyone who runs’ – regardless of frequency or mileage’ – and/or that ‘anyone who self-identifies as a runner’ could be classed as a ‘runner'. Though a true consensus was not reached on the definition of ‘postpartum’, the respondents agreed that the term has relevance beyond the first 12 weeks after childbirth.

When possible, an appropriate multidisciplinary team, consisting of a variety of healthcare professionals with expertise in the presenting concerns ... [including] pelvic health physiotherapists ... should work with the runner [Shefali Mathur Christopher et al]

Ten key milestones for assessing ‘return to running’

  • pelvic floor strength; pelvic floor endurance; pelvic floor coordination
  • pelvic organ prolapse; urinary incontinence; anal incontinence
  • lumbopelvic strength; lower extremity strength; balance/proprioception; gait analysis 
  • (all the above topics reached the consensus requirement of more than 75 per cent support)

The article also offers recommendations topics such as load and impact screening, screening of biopsychosocial factor and considerations of support items, if needed. Finally, the runner’s training history, current capacity, running goals and training preferences should also be addressed. 

A pioneering study

The authors believe the study broke new ground in the field as it is the first to include occupational therapists, chiropractors and running coaches. In addition, more personal trainers, exercise physiologists and physicians were included than the current expert opinion publications on postpartum running, they suggest.


Dr Christopher and her co-writers acknowledge that they offered a narrative literature review rather than a systematic one. Most of the respondents were white female PTs, and, as a result, their findings might  not accurately reflect the opinions and experiences of other professionals – such as physicians, male providers and those potentially in lower resource settings – who might be the first contact and/or sole provider evaluating a runner.

They note: ‘Future studies should also evaluate the role of musculoskeletal strength, as well as gait and balance changes in postpartum RRI [running-related injury] risk. Evaluation of pelvic floor healing timelines in athletes is also needed.

‘Validation of all recommendations made in this consensus statement is also required. In general, more high-quality research is necessary in all areas of postpartum exercise, particularly high-impact exercise like running.’


Dr Christopher and her colleagues state: ‘Due to the complexity of the postpartum experience, a multidisciplinary team approach (e.g., primary care providers, lactation consultants, pelvic health PTs, mental health providers, sports medicine providers, orthopaedic specialists, physiatrists, obstetricians/gynaecologists, urogynaecologists, etc.) is recommended when feasible.'

They add: ‘Education of perinatal runners on postpartum recovery and gradual initiation of exercise is crucial. Further research is required in postpartum runners to identify specific tests and measures to determine readiness to return-to-running while mitigating injury risk and/or symptom provocation in this population.’

To read the full version of the article – titled Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement – click 

To read a 2023 PhysioUpdate article featuring Emma Brockwell and Gráinne Donnelly, click

Author: Ian A McMillan
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