Return to Fitness & Exercise
Return To Fitness And Exercise
We get many questions regarding when to return to fitness postpartum, and it depends on many factors that have to do with previous fitness level, injury during labor/delivery (or not), and intensity of exercise that you are wanting to return to! In addition, this may look different if you had a cesarean versus a vaginal delivery - so be sure to talk to your healthcare provider and pelvic floor physical therapist to get the most individualized care! In this post, we are going to discuss some general guidelines to ensure a safe return to fitness post baby.
Concepts to think about as you return to exercise:
Modifications of previous exercises → typically avoid high impact activities until month 3 and watch for symptoms (see below) to modify other activities and meet your body where it is.
Pressure management → if we are breathing improperly (holding our breath, etc) and not engaging the pelvic floor appropriately during lifts, carrying, ab work we can increase pressure placed through the abdominal wall and pelvic floor and could lead to diastasis recti abdominus and pelvic organ prolapse. Therefore, during our “simplest” of exercises to the more intense exercises we have to ensure good breathing mechanics (exhale on exertion) and deep core activation.
Pelvic floor strength, endurance, and coordination training → see below on when to start engaging these muscles!
What Should I Be On The Lookout For During Or After Activity?
Increased bleeding after doing an activity → you did too much; so scale back and then gradually increase overtime. If the bleeding worsens, contact your healthcare provider.
Pressure/heaviness at vaginal or anal opening → could indicate weakness or increased overactivity of the pelvic floor
Urinary or gas/fecal incontinence → could indicate pelvic floor weakness, lack of coordination between abdominal and pelvic floor muscles, and poor pressure management
Doming or coning of the abdomen → could indicate deep core weakness, poor breathing mechanics and pressure management, and/or improper body mechanics
Pain
What Should I Focus On After Delivery?
Typically, we recommend that the first month postpartum is spent at home with the focus being on rest and recovery. However, I know many postpartum people are antsy to get moving and get back to their routine. So here is a general guideline on what to focus on week by week.
For the majority of week 1 and 2, we recommend resting and resisting the urge to do any housework, lifting anything other than baby, and prolonged walking. However, around week 2 you can start doing diaphragmatic breathing exercises and gentle core activation (kegels and transverse abdominus contractions on the exhale). This is to improve swelling, pain, and neuromuscular re-education.
By week 3, you can begin a gentle walking program and continue with your breathing and deep core activation in a variety of positions. For instance, a few positions you could try are: on your back, on your hands and knees, in sitting, in sidelying, and in standing.
By week 4, if all is going well, we recommend increasing walking distance and speed to a pace that feels comfortable. In addition, you can also increase core activities: kegel + TA with a ball squeeze between your knees, kegel + TA with a bridge, kegel + TA in a mini wall squat, etc.
By week 6, you can slowly start to return to the gym. However, this still may continue to look different than it did prior to pregnancy and even during pregnancy.
What Should I Focus On Week 6 And Beyond?
It is important to have seen a pelvic health physical therapist at this point to get further individualized guidelines on what to focus on when you return to the gym. However, getting back to the gym can be just as much an emotional and mental relief as a physical relief, so we don’t want to limit you so much, we just want you to be safe.
Continue avoiding workout classes, HIIT, certain crossfit moves (kipping, metcon, etc.), and high impact activities (box jumps, burpees, running, etc). We are focusing on modifying higher intensity activities to meet our bodies where they are and slowly push the threshold without symptoms. We want to build a foundation of deep core and breathing mechanics and slowly load this system over time to build resilience and reduce injury, strain, and prevent future problems (such as prolapse, urinary incontinence, low back pain, etc…)
At this point, you can add in resistance band exercises, free weights, and machine exercises depending on prior level of fitness. The same concepts are built into these exercises - breathing and engaging deep core appropriately throughout the movement.
When Should I Begin Physical Therapy?
We think it is super beneficial to see a therapist during pregnancy to learn how to perform an appropriate pelvic floor muscle contraction, learn how to lengthen the pelvic floor muscles, and improve pressure management and body mechanics. However, if this is not possible, we 100% recommend seeing a therapist at 6 weeks postpartum to assess the pelvic floor muscle strength, endurance, and coordination as well as incorporate this appropriately into an individualized exercise routine to get you back up and moving how you want to!