The rectus abdominis muscle is the paired muscle running vertically along the anterior abdominal wall. The linea alba is the connective tissue that runs down the middle of this muscle and is commonly separated during pregnancy and remains separated following childbirth, a condition called diastasis recti.

32% of female runners in the first 2 years postpartum report noticeable separation of the abdominal muscles. Although there is no conclusive evidence that abdominal separation results in pain or dysfunction, postpartum women demonstrate decreased strength and endurance of the abdominal muscles. Increased width the gap between the abdominals (inter-recti distance) seems to be associated with greater fatigability of the abdominals. Over 90% of women reporting musculoskeletal pain with postpartum running report low back, pelvis or hip pain. There is strong evidence that strength training is highly effective for treatment of low back and pelvic pain indicating that women in the postpartum period may benefit from strength training to reduce pain.

Deering et al (JWHPT, 2020) studied the impacts of an 8-week progressive abdominal exercise program on inter-recti distance and running mechanics in a group of postpartum runners (up to 2 years postpartum). This 8-week program was designed to take 10 minutes to perform on a daily basis and consisted of the following exercises:

1. Abdominal draw-in maneuver (ADIM)

2. ADIM + bridge on heels with ball squeeze

3. ADIM + bridge with unilateral heel raise

4. ADIM with hip flexion march

5. ADIM in quadruped with opposite leg/arm reach

6. ADIM with side plank on knees

7. ADIM with double leg squat

8. ADIM with single leg squat

The authors found that this exercise program successfully reduced abdominal separation but did not alter running mechanics. Some of the running mechanics that persisted in the postpartum runners in this study are associated with developing running related pain/injury. When returning to running in the postpartum period, it is important to work with a women’s health physical therapist that can address abdominal function as part of the larger picture of global strength and running mechanics to help new mothers make a successful return to running.

Please contact the women’s health experts at MEND for assistance or advice on return to running in the postpartum period.