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So many changes happen during pregnancy and childbirth, so how do we safely return to running?

Amy has always been a runner, but after having two kids within 19 months, she needed a bit of extra help to get back out there. (Supplied: James Grabowski)

It's 5am and Amy O'Halloran is lacing up her runners.

The 33-year-old is on a deadline. She has to be back to get her kids off to daycare and herself ready for work.

It's a rush and she's tired, but Amy knows her day will be better for it.

"It makes me a better mum. It makes me a better person if I just get out the door," she said.

Amy has always been a runner; it makes her feel free.

But after pregnancy and childbirth, like so many other women, her body wasn't ready to move like it used to.

So how did she navigate getting back to running after having kids?

Amy now runs about 100 kilometres each week and is in training for a marathon. (Supplied: James Grabowski)

Two words – floor and core

So you've just grown a tiny human (bravo!) and naturally your body has transformed to accommodate it. Then there's the birth.

After weeks of being holed up in the newborn bubble, you might think you've recovered.

According to Arna Opperman, physiotherapist and director of Bump Physio and Co, even if you feel like you're ready to get back out there, you may not be.

Opperman focuses on helping women in the pre- and post-natal period, and says you shouldn't be going for a run within three months of giving birth.

Current advice is that women shouldn't start to run within three months of giving birth. (Unsplash: Picsea)

When it comes to physical health, the two big ones to look for are pelvic floor strength and abdominal separation (rectus diastasis).

And a warning …

Amy had Henry (3) and Jemima (1) within 19 months of each other.

Henry (left) is now three years old and Jemima (being held) is one. (Supplied: James Grabowski)

She experienced pelvic floor issues and abdominal separation with both.

She now runs about 100 kilometres every week, but it took a fair bit of conditioning.

Your pelvic floor might need a bit of love

The pelvic floor is a combination of muscles and ligaments that sit at the base of the pelvis.

Their job is to support the bladder, uterus and bowel.

It experiences quite the load during pregnancy, not only supporting those abdominal contents but a baby too.

Three months post-partum with Jemima, Amy walked to the park with her husband Ben and tried to run.

"My pelvic floor was definitely extremely weak," she said.

Amy had to see a physiotherapist to strengthen her pelvic floor and core, before she started to run again. (Supplied: James Grabowski)

It's a feeling many women get, according to principal physiotherapist and pelvic floor specialist at Secret Women's Business Physiotherapy Natasha O'Brien.

And when strength declines, there can be leakage.

"About 50 per cent of women can experience incontinence of the bladder or bowel post-delivery," she said.

"It is quite significant."

O'Brien describes the pelvic floor through pregnancy like a hammock on descent.

"We'll sometimes compare that in that 38th week of pregnancy to a 100-kilo man standing on a trampoline," she said.

And then there's giving birth.

"One of the biggest forces that we'll ever put through a pelvic floor will be a vaginal delivery," O'Brien said.

You'll know that floor will need strengthening if you get a heavy, dragging feeling — kind of like your insides might fall out.

Or you pee when you cough, sneeze, jump or run.

"Moderate running can be an impact of up to two-and-a-half times our body weight."

Running puts quite a significant force through a sometimes stretched pelvic floor. (Pexels: Tirachard Kumtanon)

So what can I do to strengthen my pelvic floor?

The pelvic floor can stretch up to three times its length to deliver a baby, but sometimes we need help with the recoil.

It also doesn't matter how long ago you gave birth; you can still work on those muscles.

A physiotherapist can assess the strength of your pelvic floor, its co-ordination and check for muscle tears.

Prior to running, Opperman says try this:

Walk for at least 30 minutes, hop, jump forward, jog on the spot and do a single leg squat.

You need to be able to do all these things without heaviness, dragging or incontinence.

"A pelvic floor physiotherapist should be consulted for a thorough assessment if those exercises can't be achieved," she said.

They'll be able to give you exercises that involve squeezing, lifting and holding those muscles to bring back strength. Think trying to stop a wee mid-stream.

The difference a $60 device can make

Along with strengthening exercises, there's also these nifty things called pessaries that can help with prolapse or incontinence.

Prolapse can happen when the bladder, uterus or rectum drops into the vagina due to those weakened pelvic floor muscles and ligaments.

"What a pessary is is we insert it, just like we insert a tampon," O'Brien said.

"It basically enables some women who are really keen to get back to exercise but do have some symptoms of prolapse or some ongoing pelvic floor issues, to keep exercising without the heaviness or leaking," she said.

If you're really keen to get back to exercise but still have issues, pessaries might be the way to go. (Freepik)

The other big one – rectus diastasis

This is abdominal separation, another thing to come out of Amy's pregnancies and quite common.

According to Opperman, it occurs in more than 60 per cent of pregnant women.

It happens when the connective tissue between your six pack muscles stretches or separates.

You can feel it by putting your fingers between your abdominal muscles and doing a slight sit up.

Pre-kids, the measure between those muscles is about one centimetre. It often goes to around two centimetres post-birth.

Amy's went even larger, to three.

Amy noticed a reduction in her core strength while she was running after having her kids. (Supplied: James Grabowski)

And that strength is particularly important when running.

"Even now, I know when I'm running too much," Amy said.

"My hips will drop because I've lost so much strength throughout my core."

Problems associated with abdominal separation can be lower back pain, poor posture, gut issues (constipation and bloating), a visible stomach bulge and continence issues.

Physiotherapists recommend walking to get back into condition, before graduating to intermittent running. (Unsplash: Arek Adeoye)

You can do specific exercises, use compression garments or binders and avoid activities that'll make it worse.

A physio will be able to do a test and tell you what to do.

A few other weird things no-one tells you

If you're breastfeeding, you'll have raised levels of the hormone relaxin in your body and this can change pelvic biomechanics.

You might be super thirsty, and will probably need a more supportive bra.

Check your shoes still fit, sometimes your foot size changes with pregnancy.

Amy waited three months before running after the birth of her children and set herself small goals. (Supplied: James Grabowski)

And be wary of sleep deprivation, Opperman says it's associated with increased injury risk.

Be mindful of what you're actually running on too. Start with grass before pounding the pavement or running on soft sand.

And walk before you run.

Opperman says a gradual increase in distance and plenty of walking should be done to start with.

“Running 1-2 minutes at an easy pace with walk breaks in between,” she said.

These days Amy is training for a marathon and she's part of an online group called Running Mums Australia, who she says provide so much support.

"I know it's hard to get out the door," she said.

"But if you put your shoes on and get out there and find your sense of freedom where you're not a mum, you're not a worker, you're not the cleaning lady, you're just you, I think that's so important."

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