The baby has arrived. Mama has had her 6 week postpartum check up and has been cleared to exercise. She is exhausted, but anxious to get moving. What should her approach be to either initiate exercise or get back into it?
As a women’s health physical therapy specialist, this can be one of the most confusing times for a woman to navigate the world of exercise. This confusion is only compounded if she has sustained an injury to her pelvic floor during a vaginal delivery, is experiencing incisional pain following a Cesarean birth, or has found herself with a split in her abdominal muscles.
I routinely counsel women to consider all the variables involved that lead her into this 4th trimester. Was she active and/or how active prior to becoming pregnant? Was she able to exercise during pregnancy? Did she have orthopedic challenges (i.e. back pain, pelvic pain, numbness and tingling in the arms or hands, etc.) during her pregnancy and if so, how were they addressed? Is she experiencing any bowel or bladder leakage at present? Please repeat after me . . . “leaking urine or feces is common but never normal.” If she is currently sexually active, is it painful? Does mama have any incisional discomfort, either from a tear in the pelvic floor or from cesarean intervention? And these questions are just the tip of the iceberg.
Often times, alignment may need to be addressed prior jumping into a huge class setting or returning to a pre-pregnancy running or lifting routine. Addressing alignment issues can go a long way in decreasing load to a weak or tight pelvic floor, as well as in decreasing the stress to the body’s midline that contribute to a diastasis recti. Corrective exercises to “fix” these issues are commonly derailed without consistent adjustments to alignment. These problems can be made worse after mama jumps into a class, such as Barre or CrossFit, which tend to ask a bit more of the pelvic area than most group settings. If loads to the pelvis are currently too much for mom, she will have complaints of back pain, pelvic heaviness, or urinary leakage.
In general, slow and steady wins the day when trying to decide how to initiate and progress a cardiovascular program. If walking, jogging, or running are the preference, a ramp up over the course of 12 weeks is most advantageous. Cycling, either stationary or dynamic, can be a good choice if a bit more pelvic floor stability is needed. Swimming or aquatic exercise is a terrific alternative to land exercise to get the heart rate up and unload a postpartum body that is working so hard to find it’s way to some sort of balance.
Plyometrics, jumping with both feet off the ground, is NOT encouraged until some measure of pelvic stability is gained. Did I mention that it is NEVER normal to leak urine during exercise? If leaking is occurring during a specific exercise, it is time to back off that specific activity and focus on bringing stability back to the hips, abdominals, and low back. This goes for the ever-famous “oh my gosh I leaked when I took my toddler to the trampoline park” mom. Instead of the often heard “well, I guess I won’t do that again”, consider that the imbalances that are leading to that situation are all treatable. Often, once hip strength, stability, and proper recruitment of abdominal muscles are addressed, pelvic floor stability is vastly improved and the leaking situation that is keeping your feet glued to the ground is corrected.
Diastasis recti, a split in the abdominal muscles, is said to occur in upwards of 50% of women who are pregnant or have had a baby. Currently, there is no good predictor for who will experience such a split. Being ultra fit and having “six pack” abs does not discount mama from being included in that 50% of women. This condition should be addressed via a series of alignment corrections, proper breath work, and whole body abdominal exercises. In short, reduction of the diastasis should be the foundation of any postpartum exercise routine.
Time constraints and fatigue are often the biggest challenge in the year postpartum. Short bouts of exercise or activity will rule the day on most days, depending on how agreeable baby is to your plan. There will be those days, of course, where rest will – and should – win the day.
Finally, and most importantly, mama should be gentle in her approach to postpartum exercise. This includes putting down the People magazine that shows how the latest celebrity “got her body back after baby” and following her body’s lead. With a little bit of guidance and a measured plan in place, navigating the world of postpartum exercise doesn’t have to be a confusing place.