Are you wanting to return to exercise postpartum and just don’t know where to start?
You’re not alone! So many mums don’t have the correct information or tools available to them and either rush back into an exercise activity or program that isn’t ideal for their postpartum body, or just put it in the too hard basket and are unable to start.
Exercise postpartum can be different in many ways. Your body has changed. It’s grown and birthed a baby and you now have other demands like a newborn or older child, a lack of time, and the days where you feel so tired you need to hold your eyelids open with toothpicks!
As a general rule of thumb, each mum should follow a “3 R protocol” to aid in their postpartum recovery and return to exercise.
1. Rest & recover
If you have just had your baby, one of the best things you can do for the first month (plus) is rest and recover, particularly if you have more than one child to care for. This does not mean you can’t do any movement at all, but for the first month at least try to minimise lengthy activity to allow for optimal healing and recovery (this includes being on your feet for extended periods of time). You may feel great post birth and that’s awesome, but your body is still healing inside and out.
Pregnancy has placed additional load and stress on the core and pelvic floor due to the weight of baby, placenta and increases in fluid, not to mention labour and delivery. There are also additional changes that occur during pregnancy and postpartum that affect your body’s alignment, and hormones like relaxin soften the joints, ligaments and muscles to prepare your body for labour and delivery. Relaxin is still present in small amounts postpartum and, even though it is yet to be proven if the increase in this hormone increases joint laxity postpartum, the risk of injury for some women may be increased for reasons unknown. This includes pelvic floor injuries and in particular pelvic organ prolapse (where one on more of the pelvic organs such as the bladder, uterus or rectum drop into the vagina due to weakness from the supporting muscles and ligaments). Recovering from pregnancy and birth is no different to recovering from a major injury such as an ACL reconstruction or shoulder reconstruction and it should be treated with the same respect and overseen by your medical team and other allied health professionals. Recovery can take up to 12 months after birth!
Before you start exercising it’s important to ensure you have been cleared to exercise by your medical provider. The gold standard to ensure you have no pelvic floor dysfunction or diastasis recti (abdominal separation) is to see a women’s health physiotherapist for assessment and diagnosis.
Some key elements to rehabilitation are:-
Alignment – Alignment is referring to your body’s position. Ideally you should always try to have your ribs stacked over your hips. If you are unsure take a photo of yourself! Look closely… is your bottom tucked under (posterior pelvic tilt)? Or is your bottom sticking out (anterior pelvic tilt)? If so, move your pelvis so your hips align with your ribs. Take note of this position and, whenever you remember or catch yourself out of alignment, try to correct it.
Diaphragmatic breathing – As you breathe in your diaphragm contracts and descends, allowing your ribs to fill with air. As you breathe out your diaphragm ascends forcing the air back out, working in synergy to this is your pelvic floor. Your pelvic floor constantly responds to the loads you place on your body. As you move from sitting to standing, pick up your baby or weight in the gym, your pelvic floor is contracting to respond to the change in intra-abdominal pressure. When you sneeze or cough, which is normally something that is quite forceful, your pelvic floor responds by forcefully contracting the pelvic floor to match the increase in pressure. This coordinated system often requires reprogramming as injury, illness, pregnancy and habits we adopt tend to affect our breathing patterns which in turn affects the function of the pelvic floor and our overall movement.
To check your breathing patterns, sit on a hard chair, in neutral alignment with the ribs stacked over the hips. Place a hand either side of the ribs and take a deep breath in. You should feel your hands move with your ribs up and out to the side as the air fills your lungs. As you exhale, your hands should return to starting position. Keep your shoulders, neck and jaw relaxed as you inhale and breathe deeply – filling the ribs and belly with air. You could try this in front of the mirror, so you can see your breathing pattern.
Connection Breathing – the final piece of the puzzle is connecting your pelvic floor to your core breathing. As you inhale your pelvic floor should remain relaxed. As you exhale gently contract (about 30% of a maximum contraction) your pelvic floor. Try picturing your pelvic floor as a diamond shape with points attaching to the front of the pelvis, the back, the left and right. As you exhale gently draw those points up and in moving them closer together or picture pulling a tissue out of a tissue box or picking up a marble with the vagina and anus. If you are unsure if you are doing this correctly please see your women’s health physiotherapist as they can provide the best feedback to you to ensure you are activating your pelvic floor and breathing muscles correctly.
Your return to exercise should commence once you have been cleared and you have the above foundation set for safe and effective movement. Starting an exercise program that has a strong focus on connecting to the pelvic floor and core, and restoring function to your body in a safe and effective way, is key to ensuring the best recovery both short term and long term. Even if you had an uncomplicated pregnancy and delivery it’s important to allow time for your pelvic floor and core to heal and return to exercise in a way that doesn’t increase the load and stress on your body too soon.
To ensure your exercise program is going to help your recovery, its best to work with your women’s health physiotherapist or a pre and postnatal coach for your exercise programming. This way you are not hindering or increasing your risk of pelvic floor dysfunction by exercising incorrectly. To begin with, the exercises should be gentle, low impact and of short duration with the aim of gently challenging your core and pelvic floor to help regain connection and function. If you experience any pelvic floor symptoms (incontinence, pain, pressure or dragging sensation in the vagina) during and after your exercise then it’s important to respect and listen to these sensations and see a women’s health physiotherapist. If you experience no symptoms during or after your workout your next workout you can try increasing the intensity and the length slightly (by around 10%).
It’s important to remember that healing, recovery and rehabilitation isn’t always a linear process. At times you make one step forward and two steps back and that’s ok! Please be mindful that other factors will impact your return to exercise and your performance. Stress hormones, like adrenaline and cortisol from lack of sleep, can cause changes to performance, energy and impact your results. If you have gained excess weight and are now considered overweight this can cause an increased risk to the pelvic floor as the load and the demand has increased. Your breathing may be impaired particularly if you have not yet regained connection the pelvic floor and core with connection breathing and scar tissue from both c section and perineal trauma may cause discomfort and restrict muscle function around the scar tissue sites (your women’s health physiotherapist can help you with scar mobilisation to help reduce adhesion, inflammation, fibrosis and improve remodelling) if this is the case.
Often the journey is slow, and it may take time until you truly feel like yourself, but the slow path is the fast path in birth recovery. If you take the time, listen to your body and do all that you can to rest, recover, rehabilitate and retrain your body, you will set yourself up with long term success!
Jessica Ewing is a pre and postnatal fitness coach and the creator of the before and after the bump online fitness programs at moofitmoofit.com.au. She is a mum of two young boys and started moofitmoofit after her own postpartum journey and recovery from pelvic floor dysfunction. Jess has made it her passion to empower and educate women to start or remain active during pregnancy and assist in their postpartum recovery.