A common question from new mums is ‘when is it safe to return to exercise’?
Due to the complexity of pregnancy and childbirth there are certain factors that we need to look at before returning to exercise safely. Factors to consider include: Did you exercise throughout your pregnancy? Did you have any issues such as pelvic girdle pain, pubic symphysis or low back pain? Did you have a chronic cough or extreme nausea during pregnancy? Your birth experience – i.e did you have forceps or ventouse delivery, how long was your labour, baby’s weight, any perineal tears? Considering post natal, do you have any incontinence, how well did your wounds heal and do you have any abdominal muscle midline separation?
Secondary to pregnancy, when looking at return to exercise after having a baby it is imperative to understand the components of the pelvic floor and their importance. There is the intricate relationship between the non-stretch fascia, ligaments and pelvic floor muscles in supporting the pelvic organs (bladder, uterus and rectum) in the pelvic cavity. During a natural vaginal delivery, the superficial pelvic floor muscles stretch up to 250%, where normally muscle tissue will fail under 150% of load. This overstretching of the muscle tissue creates less support to the organs together with the softer fascia causing the tissue to be more susceptable to stretch under load and less able to recover to its” normal”, stronger, shortened length. Sometimes, during vaginal birth there can be some serious injuries to the soft tissues. Fortunately, our bodies are wonderful at healing but sometimes we are not aware of any internal tissue compromise. This makes us susceptible for pelvic organ prolapse and incontinence particularly if we return to an active lifestyle too quickly. A prolonged second stage labour (> 2 hours), large baby head circumference and loss of sensation or control of urine immediately post -natally are possible indications of internal soft tissue injuries.
Given that typical tissue healing takes up to 3 months, together with the hormones from pregnancy that are still present up to 8-10 weeks post-partum, we have to respect this to allow the time for our bodies to heal and recover. View this time as the fourth trimester of your pregnancy. If you increase load on already soft and stretchy tissue it is only going to make the tissue more susceptable to damage. It is often the image from our peers that we need to get back to our normal activities as quick as possible. This is not true, there are no rules!!
It is a good start to get the 6 weeks clearance from your GP or OB/GYNE. As Pelvic Health Physiotherapists we also look at the immediate and long-term risk for return to exercise. We have certain measurements to take and criteria to reach to classify you as low, medium and high risk for prolapse (POP) or incontinence. With these measurements, we can also advise you what exercises are safe to commence with and the intensity. By using these tools, we are able to provide you with clear guidelines on where to start and how to manage your post natal recovery optimally.
What are our criteria to progress your exercises?
- The pelvic organs need to be in a good position,
- supported by adequate pelvic floor strength
- good co-ordination between the pelvic floor and deep core abdominals
- good co-ordination of breathing,
- have the ability to resist increase loading
- adequate endurance that needs to be translated into functional support within the trunk and limbs with no or minimal symptoms of prolapse or pain.
Naturally there are some women that do very well in the post partum period and can commence exercise within 2 weeks post natal, however for others it could take up to 6-12 months to regain their strength.
It is clear that there is no simple answer to when it is safe to return to exercise. However, by following a few principles we can provide each individual with guidance. In general by allowing sufficient tissue healing time and recovery, low impact, low load exercise will always be a good start i.e swimming, stationary cycling for cardio fitness, and scaled weight exercises. Avoiding heavy loading, HIIT, high impact exercises is sensible early on, or until you have your pelvic floor assessed or have had sufficient recovery time.
Book an appointment with on of our women’s health physiotherapists to help guide you back into exercise safely.