One of the most common questions that I am asked as a Women’s Health Physiotherapist is “when can I return to my exercise regime after giving birth?”
The answer to this question can vary. It depends on what exercise you are planning to do, how you gave birth, what injuries that you sustained during the birth, and how many children you have had previously. In addition to these questions, if you have any ongoing health concerns such as a previous history of incontinence, any lung conditions where you might cough regularly such as asthma or hay fever or a history of back pain an effect the advice that you could be given.
- Remain Positive (but sensible).
It is no secret that the effects of pregnancy on the female body can be alarming. This coupled with the endless stream from social media and pictures of celebrities ‘’amazing recovery in 6 weeks” can put pressure on new mums to get back to shape as quickly as possible. The most important piece of advice that I can give you is “comparison is the thief of joy”. Every body is different, every birth is different and worrying about how you look can result with you feeling bad about your body. This usually ends up with new mums either pushing themselves to much and causing injury or thinking that they are worthless. If you are experiencing this negative feelings towards yourself, please seek professional help or access online websites such as www.depression.org.nz. When you are in the right frame of mind- exercising is fun, will make you feel amazing and help you to recover.
- Pelvic Floor Exercises
Your pelvic floor (Kegles) are the muscles at the base of the pelvis. They encircle around your vagina and anus like a figure of 8 and are very important in maintaining continence, support of your pelvic organs and can assist with preventing lower back pain. To contract them lift your pelvic floor as if you are stopping yourself from urinating (do not stop yourself from urinating unless under the guidance of a therapist) or passing gas. It is important to start these exercises from day 1 (if you can manage it). We recommend that you start with lifting for 1 second and relaxing for 3 and working your way up to holding for 10 seconds. It is especially important if you have a tear during a vaginal birth to regain strength. It is very strongly recommended that you do not return to high-impact exercise (running, jumping, skipping) for the first 6 months. This advice is based on the fact that your muscles need 3 months to recover and 3 months to get to a good amount of strength before being put through their paces.
- The First Few Weeks
Most tissues in the human body have developed a stable scar by 6 weeks (the only exception being ligaments). Up until then it is good to avoid unnecessary stress on those tissues. The best thing that you can do in the first few weeks is walking; frequent but small distances. It is low impact, it helps with exercising the cardio vascular system and can improve your mood. Walking on the flat is best, and take someone with in the first week just in case you feel tired. Other exercises you can start with is basic abdominal stability exercises. This involves bringing your tummy towards your spine and guiding your legs and arms in different positions i.e. beginner Pilates. If you have had a C-Sections you should wait for 7 days before starting these.
- Rectus Diastasis
A rectus diastasis occurs when the two muscles at the front of the abdomen (Rectus Abdominus) move apart to make room for the baby to grow. This happens in a lot of women and usually resolves within 6 weeks as the fundus returns to its normal size. The traditional advice is to avoid sit-ups and crunches for 6 weeks, however there is some new research with ultrasound machines that indicates when done correctly that it could actually assist with reducing the diastasis. This research is still in the primary stages, so I would still recommend that you avoid sit-ups and crunches, but the advice may change over the next few years.
- Back Care and Lifting
Your abdominal muscles are responsible for supporting your spine. After birth those muscles are at very best stretched and in the case of a C-Section they have been injured with the incision. Your back is therefore very vulnerable in the first 6 weeks so avoid lifting any thing heavier than your baby. In the case that you need to lift a heavy object (such as another child) keep your back straight, bend at the knee and holding the heavy object close to you should minimise the risk of developing back pain.
- Returning to exercise
After 6 weeks you should be able to slowly return to your former exercise regime. Start off with small weights and low impact and gradually build up. Post-Natal Pilates and Yoga is a great place to start. For all those runners who would be missing that runners high- exercises such as swimming and aqua-aerobics, rowing and the stair machine can help to obtain that feeling. If you have had limited pelvic floor injury (and you are feeling brave) a stationery bike would be a good place to start working up to mountain biking. If you take your time and allow yourself to recover well you should be able to safely return to your former regime (sleep-deprivation allowing) in minimum 6-8 months with no problematic effects.
If you would like further assessment and information please feel free to make an appointment with me at Willis Street Physiotherapy. I am trained to assess pelvic floor strength and I have a clinical interest in working with people experiencing incontinence when exercising.