Returning to Exercise Postpartum
Hello wonderful community that we love!
We’re so excited you’re joining us this month as we discuss early postpartum exercise! As always, drop us a line on social media or text/call us at (405)240-9575 if you have questions or concerns. We are here for you. This month we’re going to chat primarily about postpartum return to exercise because we are pelvic floor PTs and we l-o-v-e movement. We acknowledge, however, that exercise may not be at the top of your postpartum self care list, or even on your list of postpartum priorities at all–makes sense to us! If you have other topics you’d like us to cover in future months, please let us know what you want to learn more about and we’ll get to work.
Traditionally, people have been told to wait on exercise until after their 6 week postpartum check up with their ob-gyn or midwife. Then, if you got the “all clear,” it was like, ok go for it! Whatever you want. Wait a second….whaaat!?! To go from nothing to everything/anything seems absurd, doesn’t it? Athletes understand that they need to gradually work up to any activities that aren’t a current part of their training and performance regimen, if they expect to be successful and avoid injury. Postpartum bodies need the same–a gradual return to exercise, to ensure we avoid injury. Optimally, we can use gentle movement in the first 6-12 weeks postpartum–the fourth trimester–to heal our tissues and help us feel at home in our bodies again.
It’s important for all birthing parents considering postpartum exercise to consult with their healthcare team for advice specific to them, monitor for their body’s response and modify/stop exercise accordingly, and connect with their intention for exercise. Doing anything other than trying to sleep when you can, and take the best care of your baby and your family and yourself in the immediate postpartum period, is very optional. Some mommas, though, really DESIRE more than just walking and breathing for exercise those first six weeks. Maybe they “feel like themselves again” when they get some intentional movement in (that’s me!), or maybe they are eager to begin training, in whatever capacity possible, for a return to running or Crossfit or Zumba or (fill in your favorite exercise/activity here). These exercise guidelines are designed with those folks in mind. As always, talk to your physicians and healthcare team for advice that is particular to you, and observe all activity, exercise, and weight lifting precautions given by your healthcare team when you discharge from their care. This info is for a general audience and is not intended to be medical advice.
The first week after baby is born, just the activity of walking around your home as you take care of baby is plenty of activity, regardless of whether you had a c-section or vaginal birth! C-section mamas, we highly recommend learning how to use a pillow or hands to brace your abdominal incision during coughs, laughs, sneezes, and transitional moves. We also recommend learning how to limit abdominal effort during transitional movements by rolling to your side and using your arms for assistance when getting up from a laying down position. If a nurse or other clinician in the hospital didn’t teach you these things, perhaps ask a postpartum doula, call a pelvic floor PT, chat with your midwife, or utilize your nurse’s phone line for assistance.
If you have a c-section, it’s important to keep exercise specific and minimal the first 6-12 weeks postpartum, since you’re recovering from surgery. Be sure to monitor your body’s response to all activity and exercise, and call your medical team if you experience a new onset or worsening of pain (consider interference/masking of pain response from prescribed pain meds), increased or new onset bleeding (both vaginal and incisional/abdominal), or any change to your incision site (a previously healed area opening up, redness, heat, swelling, bad odor, etc.). It’s wise to observe your incision, your pain levels, and your pad if you are using one before/after any exercise or out-of-the norm activity (e.g., your first trip out of the house). C-section mamas, notice changes after exercise so you can be sure your level of activity is appropriate for you. If you’re not certain, don’t hesitate to ask for help from a trusted healthcare provider.
Deep breathing is a recommended exercise from day 1 for most postpartum c-section mommas. If you’re interested in more the first six to twelve weeks postpartum, here are some ideas. Always check with your medical team if you’re uncertain whether you’re cleared for any of these:
Shoulder circles and scap squeezes
Heel slides (move just one leg at a time!)
Pelvic tilts
Gentle knee rocks/lumbar rotation
Belly/stitch stretch
Stand against a wall and raise both arms slowly above your head until you feel the muscles in your belly stretch. Stop at THE BEGINNING of a sensation of stretch–don’t push far into the stretch, nor into pain. Hold for 5 seconds, and then relax. You can do this up to 10 times a day to boost flexibility around your stitches.
Isometrics (contract the muscle without moving–make sure you keep breathing while you hold the contraction!)
Glutes, aka “glute set” (squeeze your butt and hold for 5-10 seconds, then release)
Transversus abdominis, aka “abdominal setting” (brace your abdomen, drawing bellybutton muscularly toward the spine, for 5-10 seconds, then release)
Pelvic floor muscles, aka “kegel” (I like to do inhale relax, exhale kegel OR you could test your endurance–work on kegeling for 5+ seconds while still breathing OR work on quick contractions that go on/off like a strobe light)
Quads, aka “quad set” (squeeze the muscles on the top of your thigh until your kneecap pulls upward, hold for 5-10 seconds)
Hamstrings (dig your heel into the ground or statically drag your heel toward your bottom, hold for 5-10 seconds, release)
Walking
The first time you walk for exercise, not just around your house, start slow and short! Try for 2-5 minutes your first bout, and see how you feel after. If you feel great, go for 5-10 minutes the next time! Increase your walking endurance gradually.
If you have a vaginal birth, consider all the options for exercise above, as well as these, for the first 6-12 weeks. You will want to start any movements unweighted, monitor your body’s response, and very gradually introduce weight. For example, if unweighted seated arm movements are comfortable and do not produce unwanted symptoms, perhaps introduce 1-2 lb. weights next session and see how it feels, and increase weight in 1-2 lb. increments. Vaginal birth mommas, you will also want to monitor your body’s response to novel activities and exercise and modify/stop/call healthcare team if there is any new onset or worsening of pain, bleeding, or wound healing. For both c-section and vaginal birth parents, also watch for hard doming/coning of the midline of the abdomen or an increase in pelvic/vaginal pressure or pain. These would be signs to regress or stop the exercise you are doing.
Gentle abdominal/neutral spine core exercise emphasizing transversus abdominis and pelvic floor co-activation (start supine, progress to quadruped positions)
Gentle glute work (bridges, clams, sidelying hip abduction)
Paloff press
Side plank on forearm press ups
Squat to bench or countertop (elevate the surface as needed with firm pillows or books)
Seated front raises, lateral raises, overhead press, bench press (roll to side for transition out)
All birthing parents–really pay attention to your breathing during this early postpartum period. Most importantly: Avoid holding your breath. I like to inhale on the easy phase, exhale on the more challenging phase of the movement. Here’s some examples. Squat to bench: inhale as bottom lowers to bench down, exhale as bottom liftsup. Bridge: exhale as butt rises off the floor, inhale as butt lowers to floor. Seated front raises: exhale as arms lift, inhale as arms lower. This pattern ensures you avoid breath holding. Also, since a strong exhale is coupled physiologically with pelvic floor activation, it helps engage your pelvic floor and other postural musculature to secure your healing organs and tissues in place during the phase of the movement that involves the greatest increase in intraabdominal pressure. The uterus, lower abdomen, vagina, and pelvic floor are all healing postpartum. We don’t want to overstretch these tissues with a lot of outward pressure–which is what happens if we hold our breath while we move, or if we do activities that are too strenuous for our current phase of healing. If we use intentional breathing and progress exercise/activity gently and mindfully, we activate our postural muscles to work like bubble wrap around our precious healing tissues. The “stress” of movement that is appropriate for the current phase of healing helps align the renovating fascia along all planes of movement, and helps re-start neuromuscular connections, so we gain mobility and strength even as we heal.
Of course, this sounds great but it’s like–how do I do it? How do I phase my exercise correctly to optimize tissue healing? If you are interested in early postpartum intentional movement and exercise but nervous you don’t know how to progress yourself safely–go see a pelvic floor physical therapist! Even just for one session–it doesn’t have to be a big extended experience. An early postpartum PT visit (i.e., 5 weeks postpartum or earlier) can include assessment of abdominal or vulvar/perineal healing and screening for infection, assessment of current bladder and bowel function and toileting as well as nutritional advice to get your systems regular again and ensure you are fully emptying both bladder and bowel every day, external modified screening for signs of diastasis recti and pelvic organ prolapse and advice on how to address these concerns over time, and collaborative formation of a progressive exercise routine that considers your exercise/activity preferences and current level of fitness. Please note: Having some amount of diastasis or prolapse in the early postpartum period is super common and no need for alarm–often these issues resolve themselves in the first 6 months to 1 year postpartum, even without outside interventions. Learning how to protect a healing diastasis or prolapse is optimal, however, to ensure the condition resolves or does not affect your bowel/bladder/sexual function if it remains.