Post Partum exercise and return to activity

In a follow up blog to my critically acclaimed post regarding exercising during pregnancy, I move towards tackling what to expect and watch out for when returning to exercise in the post- pregnancy stage of life.

This is not coincidental timing, as my wife has just recently given birth to our 1st born child(daughter), and after holding off on various forms of activity during the pregnancy period, she’s eager to get back into all the things she’s missed out on over the last few months.

I will note it is important to have a thorough assessment by a medical or health professional to ensure that you are fit to return to your desired activity prior to embarking on such activities or tasks.

This is due to the fact that after having a baby, the pelvic floor is often weak and injured in most women and may need instruction and supervision to be able to perform a correct pelvic floor muscle contraction, especially in those women who did not train these muscles before birth (Bø et al. 2017). Along with the pelvic floor, many women encounter weak spots in their abdominal wall known as rectus diastasis. Both areas mentioned above are components of the “core” and weakness in one or more areas, could result in added compensatory pressure from others in order to help maintain proper function. 

I should also note that returning to sports where running and increased loads are a requirement, is not recommended prior to 3 months post pregnancy, should there be any evidence of pelvic floor dysfunction. This allows sufficient healing time of the injured regions, but also time to re-establish control and strength of certain muscles that have been stretched out or weakened as a result of the pregnancy. 

If you happen to experience any of the following symptoms before or after attempting a return to activity, it is highly recommended that you seek a consult with a pelvic health therapist or doctor to assist in guiding you back to resumption of your activities.

The signs or symptoms include: 

• Heaviness in the pelvic area

• Leaking urine or inability to control bowel movements

• Noticeable gap along the midline of your abdominal wall.
  (This may indicate Diastasis Rectus Abdominis (DRA))

• Pelvic or lower back pain

• Ongoing or increased blood loss beyond 8 weeks postnatal that is not linked to your monthly cycle

Should you be symptom free and decide to embark on a return to activity program, a few exercises that you could attempt early on post-partum include gentle core and pelvic floor strengthening that DOES NOT result in increased intra-abdominal pressure or straining (NO exercises where you bear down and create pressure as if pushing during a bowel movement).  Examples include but again are not limited to:   

• Kegel exerecises

• Core (TA) activation with various combos of heel slides or leg lifts

• Stability work while laying on a foam roller

• Seated on a stability ball and lifting alternating legs off the floor or arm exercises while maintaining a balanced posture.

• Mini-Squats and lunges (ensuring they are not loaded too heavily)

• Other various arm strengthening exercise (at a reduced load to avoid overstraining in the abdominals)

• If comfortable, stationary cycling

 If you are progressing well with your core strengthening exercises,  you can consider trying a few of the exercises found below. They are functional and more vigorous exercises that should be performed to stress the body whilst monitoring for pain, heaviness, dragging or incontinence. If tolerated well, then one may consider progressing to more impactful exercises such as running. 

• Walking 30 minutes

• Single leg balance 10 seconds

• Single leg squat 10 repetitions each side

• Jog on the spot 1 minute

• Forward bounds 10 repetitions

• Hop in place 10 repetitions each leg

• Single leg ‘running man’: opposite arm and hip flexion/extension (bent knee) 10 repetitions each side

Before I let you go, I want to hi-light a few other contributing factors to consider before returning to activity.  

• weight- females with increased weight or Body Mass Index (BMI) are at a higher risk of pelvic floor issues.

• breathing- it is recommended to start slow and gradually build up your intensity from a point where you can still maintain a conversation.

• Diastasis rectus abdominus- running prior to regaining functional control of the abdominal wall may be counter-productive and result in overloading or compensatory strategies in the pelvic floor. (Goom et al. 2019)

• breastfeeding- there are theories that due to lower levels of estrogen and the possibility for slightly raised levels of relaxin, post-partum women are at higher risk of joint laxity resulting in injury and dysfunction, although this is not proven. (Marnach et al. 2003) · Sleep- Sleep deprivation in athletes is associated with increased injury risk (Milewski et al. 2014), lower general health and increased stress (Biggins et al. 2017). Sleep loss is also thought to reduce muscle protein synthesis and impair maximal muscle strength (Knowles et al. 2018).

So before you jet out for a run or get back to the bootcamp, get in to see a pelvic health therapist to ensure that everything is in proper working order to reduce the risk of future injury.As always, if you have any questions or concerns, you can find me on Facebook (Aras Ruslys -Physiotherapist) or on instagram (@Ahh_rass_physio) or via email (arasruslys@gmail.com).

Live active and prosper.

Aras Ruslys
Registered Physiotherapist