What a Pelvic Floor PT Wants You to know about returning to exercise postpartum
Getting back to exercise after giving birth can feel daunting, and we often aren’t given very much guidance in how to do it. However, with some knowledge and guidelines it can feel more safe and manageable. Below is what an orthopedic and pelvic floor physical therapist wants you to know about returning to exercise postpartum.
First off, it’s helpful to be aware of areas that might be struggling or need more attention as you get active again. Your abdominal muscles are a good place to start. During pregnancy they have been stretched, and stretched muscles don’t work as well. They may need more time and basic exercises to feel strong again as they return to a more normal length. It’s also very helpful to know if you have diastasis rectus abdominus (DRA), which is where the connective tissue in between the abdominal muscles becomes stretched and leaves some separation. The biggest sign of this is if you do a sit up and you see a doming anywhere along the center of your belly (a pelvic floor physical therapist can screen you for this). If you do have DRA, you should avoid abdominal exercises that involve twisting, crunching, or both legs in the air. This separation can be trained back together, but you will likely need some help from a physical therapist before you’re ready to dive back into full abdominal workouts.
Another big area to be mindful of is your pelvic floor. If you had a vaginal delivery, then these muscles stretched quite a bit. If you had perineal tearing, then there was some additional healing in this area. Due to stretch and/or injury, the pelvic floor muscles may also be a little weaker postpartum. This usually presents as stress urinary incontinence (SUI), where urinary leakage happens in high pressure situations like coughing, sneezing, or jumping. Exercise can be a time when this becomes apparent, as people try out activities like running or higher impact exercise again. If you’re having leakage with exercise, then your pelvic floor muscles may need some retraining to be able to handle those loads. A pelvic floor physical therapist can help you with this!
When you feel ready to get back to exercise, you can use the following principles to help you do it confidently and safely:
Allow time for the full healing process
Basic tissue healing takes 6-8 weeks
Movement is good, but higher intensity exercise should wait your body has had a chance to recover
Start slow
Focus on muscle activation → body weight exercises → loaded exercises
Start light with cardio and build from there
Consider how long it’s been since you last did this kind of exercise
If you haven’t done something since before you were pregnant, then it has been at least 10-12 months since your body has done it and you will need to ease in
Act like a beginner
You’ll likely be the most successful if you start at a more beginner level and progress from there
Your postpartum body may feel different and won’t necessarily be ready for the level you used to do right away
Repeat the same difficulty level a few times before progressing
Our bodies are not the same every day, so repeating exercise at the same difficulty level a few times allows us to get a better sense of how we’re tolerating it
Emphasize good form to feel good
Exercising with poor form can lead to injury, while exercising with good form can help our bodies function better
Consider what you need to do in your daily life and train for it with exercise
Exercise in the postpartum phase can be a wonderful thing. It can help us feel better both mentally and physically, and better able to handle the demands of parenting. For those of us who love to exercise, it can make us feel like ourselves again. I hope the above information and guidelines helps you feel more prepared to get active again. If you feel you need more rehabilitation or direct guidance, please seek out a pelvic floor physical therapist to help get you started!