Beyond the musculoskeletal system: considering whole system readiness for running postpartum

Postpartum women frequently engage in running. In the absence of official guidance on returning-to-running postpartum, physical therapists rely on clinical experience alongside the available literature. Subsequently, the traditional evaluation of postpartum readiness for running tends to focus on musculoskeletal factors. This clinical commentary addresses how to evaluate and manage postpartum return-to-running in a systematic order by discussing relevant whole-systems considerations beyond the musculoskeletal system, whilst also highlighting possible interactions between relevant considerations. Discussion: Using a whole-systems biopsychosocial approach, physical therapists should consider the following when managing and evaluating readiness to return-to-running: physical deconditioning, changes to body mass, sleeping patterns, breastfeeding, relative energy deficiency in sport, postpartum fatigue and thyroid autoimmunity, fear of movement, psychological wellbeing and socioeconomic considerations. Undertaking a risk-benefit analysis on a case-by-case basis using clinical reasoning to determine readiness to return-to-running postpartum should incorporate these considerations and their possible interactions, alongside considerations of a musculoskeletal evaluation and graded exercise progression. Conclusions: Return-to-running postpartum requires an individualized, whole-systems biopsychosocial approach with graded exercise progression, similar to the management of return to sport following musculoskeletal injuries.