Fitness Post-Baby

Jan 3

Guidelines for Optimal Recovery

Congratulations! You have made it to the end of your pregnancy and welcomed your precious bundle of joy to the world! As you adjust to a new life and routine including your little one, you may find yourself in the company of so many others who wish to return to previous fitness routines or sports. But how do you know when to pick back up? What do you need to look out for?

To accommodate that growing baby (or babies), our center of gravity shifts slightly forward, so our posture and structure must adapt. Our bodies undergo physical and structural changes during pregnancy and postpartum, including:

Flaring of the lower ribs
Significant stretching of the abdominal muscles and fascia
Increased pressure on pelvic floor muscles , diaphragm and lumbar spine
Widening or flattening of the feet
Disruption of the myofascial system of the abdomen (during c-section) or pelvic floor (during vaginal delivery)

While this is natural and normal, many postpartum people are dismayed to find that their postpartum body doesn’t function quite the same as it did before. There is often little guidance from birth professionals on these issues, which can lead to returning to activity too soon or neglecting to strengthen appropriate muscles. Both of these can lead to increased risk of injury, developing compensatory strategies or chronic pain. At the very least, it can lead to suboptimal performance and decreased power output.

Our pelvic floor is often referred to as the “floor of our core”, as it works together with our deepest core muscles:

1) the transversus abdominis
2) the lumbar multifidi (the deepest spinal muscles), and
3) the diaphragm to maintain the pressures in our abdominal cavity and create the stability needed to move.

Many of the common complaints that arise during the pregnancy/ postpartum period such as pelvic pain with movement, intercourse or bowel movements, changes in sexual function, or urinary leakage, aren’t traditionally caused by the pelvic floor muscles themselves, but rather are symptoms of a greater stability problem.

Now we’ve discussed how the body changes, let’s dig into an action plan for your postpartum recovery:

First Six Weeks Postpartum:

Rest up! First priority in those initial weeks should be letting your body heal, getting into a rhythm with your baby and sleeping when you can.
Retrain your diaphragm to help you move in those initial days. As I mentioned earlier, the diaphragm is an essential part of our dynamic stability system, and is impaired during late stages in pregnancy. Since the core is overly stretched following pregnancy, it can feel physically harder or painful to move, particularly if we’re recovering from a c-section or have perineal stitching. Begin in bed as soon as you feel comfortable by taking slow, deep breaths visualizing getting air equally into each portion of your lungs. Try to feel the movement coming from your lower ribs. Using a technique often called “huffing”, exhale and try to engage that deepest core layer before moving to decrease strain on those healing parts of your body.
Begin gentle core strengthening by practicing a gradual but sustained exhale as if you are blowing out a candle. See if you can feel your deepest core activate by placing your fingers on your abdomen. If this is difficult to feel or coordinate, don’t worry! A skilled pelvic health physical therapist can help!
Avoid any exercise or activity in quadruped, or hands and knees position.
When your body feels up for it, start including some walking at a comfortable pace, beginning with shorter distances and working up gradually. Let your body be your guide. If you experience a significant increase in bleeding or soreness afterward, you may want to scale back temporarily.
Assess your pelvic floor. On an exhale, gently draw in your pelvic floor muscles, and slowly but completely relax them with your next inhale. Try this a few times, making note of how it feels. If there is any pain or difficulty coordinating the contraction, contact our office for an evaluation.
Though a pelvic PT typically does not do internal muscle assessments until after six weeks, we can absolutely provide assistance with beginning scar management, breastfeeding mechanics, or early core restoration exercises.
If at any time during the first 6 weeks, if you are experiencing back, hip pain, or shoulder pain from breastfeeding, contact your physical therapist to help address the issues. In most states, you don't need a referral from a doctor to see a PT.

After Six Weeks:

While you are with your physician or other qualified healthcare provider, make sure you address any concerns you may have postpartum or issues with recovery. You may want to keep a list when you see them to ensure you don’t forget to ask any pertinent questions.
Once you resume exercise, it is important to not expect to jump right back in where you left off! The speed at which you can return to your previous fitness level depends on several factors. Begin with some gentle core strengthening exercises, such as bridges incorporating your breath. Avoid sit ups and crunches, at least initially, and ideally until after having an evaluation.
Gradually begin incorporating basic versions of your previous exercises. Give your body a day or two in between to fully assess for pain or symptoms before continuing. For higher impact activities such as running or CrossFit, you may want to wait until at least 12 weeks postpartum.

Every post-partum person should consult a pelvic therapist, physical or occupational. At any point, make an appointment for an evaluation if you experience:

Persistent pelvic pain, or pain with movement

Discomfort, injury or pain in one or both legs, abdomen or back, particularly if not present prior to pregnancy
Increased urgency to go to the bathroom or persistent leakage during activities
Heaviness or increased vaginal or rectal pressure

In Summary

Keep in mind, this is a very general framework. I recommend getting an evaluation with a pelvic health therapist during postpartum to assess for and address many common complaints, as well as to reactivate crucial core muscles altered during pregnancy and postpartum.