This study aimed to identify what Pelvic Health Physical Therapists (PHPT) are utilizing when developing postpartum return to run programming and the criteria they assess when determining the readiness of their postpartum clients.

Utilizing a cross-sectional design, the researchers surveyed and collected responses during a three-month period. They used convenience sampling by advertising to PHPTs through professional memberships, social media platforms, and pelvic health courses by the American Physical Therapy Association (APTA) Academy of PHPT.  The survey captured demographic information and frequency data on guideline/protocol use and considerations when determining postpartum patients' return to running readiness and progression. The researchers utilized a Likert scale (0-never, 1-rarely, 2-sometimes, 3-often, 4-always) for frequency-related questions. Data was compiled and analyzed for trends. Researchers used imputation with a zero/constant value for missing data.   Descriptive statistical analyses were performed in SPSS and described by percentage, mean, SD. Mann-Whitney U test described the differences PHPTs who used a postpartum running guideline to those who did not and the consideration for readiness and return to run. The p value was set to 0.05. The relationships between education, advance certification, and guideline use and consideration for readiness was assessed utilizing Pearson correlation coefficient.

The data included 102 practicing PHPTs that reported caring for postpartum runners. All 102 respondents reported feeling adequately equipped to treat postpartum patients and guide their return to running. The breakdown of respondents’ entry-level physical therapy education degree included: 63.7% Doctor of Physical Therapy DPT, 17.6% Masters of Physical Therapy MPT, and 16.6% Bachelor of Physical Therapy. Additionally, 55.8% reported obtaining additional advanced credentialing in pelvic health. When asked the number of continuing education hours in pelvic health, 3.9% of the respondents reported attending residency or fellowship training, 62.7% reported 80+ hours, 18.6% reported 41-80 hours, 11.7% reported 25-40 hours, and 1.9% reported 8-24 hours. When asked about utilizing a return to run guideline or protocol, 51% of PHPTs reported not utilizing a specified guideline or a general return to run protocol, and 49% used a postpartum return to run guideline or protocol. There was no correlation to the use of guidelines or protocol and physical therapy entry level education (r =.0006), advanced pelvic health certification (r =.04), or number of hours spent in pelvic health continuing education (r = -.16). When describing what guideline or protocol used, the 52% indicated using Goom, Donnelly, & Brockwell (2019) returning to running postnatal guidelines, 18% indicated using Christopher et al. (2022) Journal of Women's Health Physical Therapy's clinical commentary, and 30% indicated using other postpartum guidelines (15/50, 30%). Self-reported factors used by the responding PHPT when determining postpartum return to running readiness revealed higher frequency for muscle performance including strength, endurance, and power (M=3.69, SD= 0.731), load and impact management such as repetitive, high impact activities without symptoms (M=3.57, SD= 0.980), pelvic floor muscle assessment (M= 3.46, SD= 0.779), and assessment for diastasis rectus abdominus (M=3.39, SD= 0.997). Lower frequency reported factors included nutritional status (M= 2.44, SD= 1.24), ongoing or increased blood loss (M= 2.10, SD= 1.61), and adequate milk supply (M=1.55, SD= 1.41). When comparing PHPTs who used a postpartum running guidelines to those who did not, significant differences were identified for consideration of nutritional status (U(100)=821, P=.001, r=.369), psychological status (U (100)=874, P =.003, r=.328), ongoing or increased blood loss (U (100)=914, P=.008, r =.297), and load and impact management (U (100)=1073, P=.037, r=.175).

After childbirth, runners commonly report pelvic floor and musculoskeletal dysfunction and seek conservative management guidance from PHPTs. Unfortunately, the evidence for a safe return to running and high-impact postpartum exercise is limited. In the 2014 Summary of International Guidelines for Physical Activity Following Pregnancy the authors reported national guidelines lacked specificity for physical activity and recommended improved clarity.  The 2020 American College of Obstetricians and Gynecologists Committee Opinion 804 states that women can resume physical activities within days of delivery without defining what constitutes physical activity. The Journal of Orthopaedic and Sports Physical Therapy and the International Olympic Committee recommend a postpartum plan from childbirth to return to sport with 3 phases focusing on recovery, rehabilitation/training, and competition. In 2022 both the International Journal of Sports Physical Therapy and Journal of Women's Health Physical Therapy published clinical commentaries stressing an individualized approach for each patient. Both commentaries recommended a phased rehabilitation framework to include a systems review and musculoskeletal exam, followed by a screening for readiness to include impact readiness, pelvic health symptoms, and physiological barriers.  Once the patient demonstrates readiness [1], a running gait analysis and a return to run programming based on the American College of Sports Medicine Guidelines for Exercise Testing and Prescription (frequency, intensity, training time, training type, volume, progression) principle are indicated [2]. A specific return to sport protocol focusing on the musculature impacted by childbirth and running/ high impact activities likely provides the safest return and minimizes the risks to the postpartum client [1-3]. This research found a statistical difference when comparing those PHPTs who utilize protocol/ guidelines to those who do not in their determining factors for readiness and progression in postpartum clients. Despite the current recommendations, 51% of surveyed respondent PHPTs are not utilizing a postpartum return to running protocol/guidelines, yet 100% feel adequately prepared to treat pregnant and postpartum runners.

This study indicates a need for improved awareness and communication strategies to disseminate current postpartum guidelines for return to running programming amongst PHPTs.

Goom T, Donnelly G, Brockwell E. Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population. Published online March 1, 2019. doi:10.13140/RG.2.2.35256.90880/2
Christopher, Shefali Mathur PT, DPT, PhD1,2; Gallagher, Sandra PT, DPT3; Olson, Amanda PT, DPT4; Cichowski, Sara MD, FACOG5; Deering, Rita E. PT, DPT, PhD6. Rehabilitation of the Postpartum Runner: A 4-Phase Approach. Journal of Women's Health Physical Therapy 46(2):p 73-86, April/June 2022. | DOI: 10.1097/JWH.0000000000000230
Selman R, Early K, Battles B, Seidenburg M, Wendel E, Westerlund S. Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport. Int J Sports Phys Ther. 2022;17(6):1170-1183. Published 2022 Oct 1. doi:10.26603/001c.37863