Trail Notes | Female Athlete Health

the trail will still be there

Coming Back

After Pregnancy and Birth.

Return to running after pregnancy is not about how fast you bounce back. It is about building a foundation that lets you run well and without injury for the next ten, twenty, thirty years.

One of the most consistent experiences in Her Trails is athletes returning to the community after pregnancy who feel pressure to get back quickly, and then feel shame or confusion when they try to run and it does not feel like it used to.

Sometimes there is leaking. Sometimes there is pressure in the pelvis, or heaviness, or pain. Sometimes the breathing is harder. Sometimes the legs feel like they belong to someone else. Sometimes the running itself feels fine but the identity that came with it before does not fit in quite the same way anymore.

All of this is normal in the sense that it is common. None of it means you just need to push through, or that this is simply what motherhood does to a runner. It means your body has been through a significant structural and hormonal transition and it needs a progression, not a rush.

Trail Note  ·  01

What your body has actually been through

Pregnancy changes every tissue system in the body. The linea alba (the connective tissue running down the midline of the abdomen) stretches and thins to accommodate a growing uterus. The pelvic floor carries increasing load across forty weeks, then in a vaginal birth sustains significant stretch and potential trauma during delivery. Even in a caesarean birth, the abdominal layers are surgically separated, and the pelvic floor has still carried nine months of load.

Relaxin, the hormone that increases joint laxity during pregnancy, remains elevated in the postpartum period, especially during breastfeeding. This means connective tissue is softer and more susceptible to overload than your pre-pregnancy baseline. The abdominal and pelvic systems that provide stability for running have been structurally reorganised and need time to coordinate effectively again.

Running is a high-impact activity. Each footstrike sends a ground reaction force through the body that is absorbed partly by muscle and partly by the connective tissue and pelvic floor complex. Returning to running before that system is ready to manage that load can lead to pelvic floor dysfunction symptoms (leaking, prolapse, heaviness, urgency) and other injury. These are not signs of weakness. They are signs the loading was too much, too soon.

Trail Note  ·  02

Why 6 weeks is not a clearance to run

The 6-week postnatal check is a medical appointment that assesses general recovery from pregnancy and birth. It is not a functional assessment of your readiness to return to running. Many GPs and obstetricians will clear you to exercise at 6 weeks, and that clearance typically means low-impact activity, walking and gradual return to movement, not trail running or high-impact sport.

The 2019 UK clinical guidelines for return to running postpartum (Groom, Donnelly and Brockwell) recommend waiting a minimum of 12 weeks before returning to running after vaginal delivery, and potentially longer after caesarean section or perineal trauma. These guidelines also recommend a pelvic floor physiotherapy assessment before returning to running, not as a formality but as a functional check of pelvic floor strength, coordination and endurance under load.

This is not about waiting. It is about building. The 12 weeks before returning to running are not empty. They contain specific work that makes the return safer, faster and more effective when it does happen.

Trail Note  ·  03

What to do in the first 12 weeks

The early postpartum period is about restoring basic pelvic floor and abdominal function, managing load on healing tissue, and building aerobic and strength capacity gradually. It does not feel like training. It is training, just at a level of specificity that rarely gets discussed in running communities.

Trail Note  ·  04

The pelvic floor physio referral: what to expect and why it matters

A women's health physiotherapist or pelvic floor physiotherapist can assess the strength, coordination and endurance of the pelvic floor, check for diastasis recti (separation of the abdominal muscles at the midline) and help you understand whether your system is functionally ready to handle impact. This is not the same as a GP clearance. It is a functional movement assessment of the structures that running depends on.

A good pelvic floor physio will not only assess but teach you how to manage intra-abdominal pressure during running (coordinating breath, trunk and pelvic floor rather than simply holding everything tight), how to progress load, and what signs mean you need to back off. This education is as valuable as the clearance itself.

Pelvic floor physiotherapy is not a luxury or a specialist concern. For a trail athlete, it is basic infrastructure maintenance. If access is a barrier, Telehealth sessions can provide basic guidance, and some women's health physios offer group postnatal programs as a lower-cost entry point.

Trail Note  ·  05

Symptoms that mean stop, not push

Some symptoms during or after postpartum running need to be heard as a stop signal, not a discomfort to work through. These are not signs you are weak or not recovered enough. They are signs the load is exceeding the capacity of your recovering tissue.

Trail Note  ·  06

Breastfeeding and trail running

If you are breastfeeding, your hormonal environment includes elevated relaxin and lower oestrogen. This extends the connective tissue laxity that increases injury risk, and means energy and hydration demands are higher than normal. Running while breastfeeding is not contraindicated and many athletes do it successfully, but it requires additional attention to hydration, fuel intake and breast comfort.

A well-fitted, high-impact sports bra is not optional during breastfeeding. Breast engorgement can make running uncomfortable. Feeding or expressing before running helps manage this. Some athletes find milk supply drops on high-volume training days, which may require increasing fluid and calorie intake rather than cutting training, depending on circumstances.

The general principle while breastfeeding and training is that you are fuelling for two demands, not one. Under-eating in a breastfeeding and training context creates the same risk environment as under-fuelling in any other period of high demand, and has additional implications for milk supply and your own bone and energy health.

Trail Note  ·  07

The return to trail specifically

Trail running places higher demands on the pelvic floor and abdominal system than road running. The uneven terrain requires constant small stabilisation adjustments. Descents produce significantly higher ground reaction forces than flat running. Uphill running, especially with poles or a pack, changes the intra-abdominal pressure requirements. Technical sections demand single-leg stability under rapid, unpredictable load.

This means that returning to trail after postpartum should follow the same readiness criteria as road running, and then extend beyond it. Before returning to technical trail, you should be comfortable on easy road or fire trail for multiple sessions without symptoms. Before returning to descents, your single-leg strength, coordination and pelvic floor endurance should be specifically progressed.

There is no defined timeline for return to technical trail, ultra distance or race performance after postpartum. The evidence base simply does not include that level of specificity yet. What we do know is that women who rebuild foundations well, address pelvic floor function specifically and load progressively almost always return to high performance. The women who rush the early phases are the ones who face ongoing symptoms and injury that ultimately extend their total absence from the sport.

Trail Note  ·  08

The identity layer no one talks about enough

Coming back to running after having a baby is not just physical. Many of us find that running carried a specific meaning before pregnancy, and that meaning shifts when we are trying to return while managing sleep deprivation, feeding schedules, changed body composition, changed pain thresholds, and a completely reorganised sense of self.

The runner you were before is still in there. But she may need to come back differently, not by trying to replicate what existed before but by building something new that fits who you are now. This is not a loss. For many athletes it becomes one of the most significant and honest relationships with running they have ever had.

If you find that the emotional experience of returning to running is harder than expected, that is worth taking seriously. Running as a coping strategy, an identity pillar or an escape can become complicated postpartum when those needs are pulling in different directions. Talking to someone, whether a coach, a community or a professional, is not weakness. It is smart self-management.

rebuild the foundation, trust the trail ahead

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