RETURNING TO EXERCISE AFTER PREGNANCY

Emily Stephens

May 26, 2022

The female body goes through major changes when carrying and delivering a child. These changes may include changes in body weight, hormonal changes that may impact on muscle and tendon strength, posture and energy levels, just to name a few. There must be a period of healing to ensure that the changes observed can return to a pre-pregnancy level. Recent studies have found that there is a marked decrease in the amount of moderate to vigorous exercise undertaken by women as they transition into motherhood. This can be attributed to women not having the confidence to return to their preferred method of exercise or confusion about what they should and should not be doing. Returning to exercise can be a scary thought, and you can often feel time poor, tired and restricted in your physical capacity. Enlisting the help of a health professional who specialises in Women’s Health can give you the confidence and guidance to continue with your exercise journey.

Carrying and delivering a baby places significant strain on the pelvic floor muscles. As with all muscles there is a time period that they will generally need in order to recover. This is taken into consideration when returning to activity following childbirth. Depending on the type of delivery, the risk of developing pelvic floor issues is slightly different. There is a common misconception that caesarean section delivery protects from pelvic floor muscle damage but the pelvic floor muscles have still had to endure the increased weight associated with pregnancy throughout the preceding 9 months. During vaginal delivery there is an increased risk of damage to the pelvic floor muscles if instrumentation is required, large birth weight or tearing of the muscles occur.

Exercise Following Delivery

During the early stages of post-partum, it is important to allow your body to recover and for you to adjust to your new role, being a mother. Each woman will recover differently, and therefore exercise should be individualised. Women’s health physios can program exercises to address the individual needs of the mother. The general guide for recovery in the post-partum period involves the following:

  • During the first 2-weeks women should focus on pelvic floor muscle contractions and gentle walking if tolerated.
  • During weeks 2-4 women can progress walking gradually and add functional movements such as squats and lunges which will be part of normal daily life.
  • Weeks 4-6 can see the introduction of low impact exercise such as stationary cycling or cross trainer. Women should monitor for symptoms throughout this stage and if there is any increase in pelvic pain, heaviness or dragging feelings then activities should be reduced slightly.
  • At 6 weeks it is recommended that women see a physiotherapist with knowledge in Women’s Health to screen for possible pelvic dysfunction and progress exercises over the next 6 weeks to prepare for returning to running or high impact activities. During this assessment the diastasis recti or separation between the abdominal muscles may be checked 
Post natal Pilates class at the clinic

The Pelvic Floor and Exercise

The Pelvic Floor experiences high levels of pressure and force when running therefore strength and control of the pelvic floor muscles is super important to counteract the high impact forces. During the first 6-12-weeks post-partum, the focus is a gradual strengthening program to increase core and lower limb strength necessary for running. Education and understanding of the pelvic floor is really important during the time off running or activity as mum’s will have some degree of muscle strength loss and therefore it is important to rebuild this to prevent running related injuries. Joining a supervised post-natal exercises or Pilates class can be a great way to build running specific strength and address any strength, control or mobility deficits.

Returning to running is generally recommended to begin around 12 weeks following delivery, this may be achieved by some women, where others may take longer. It is recommended that return to running occurs through a graduated running plan such as the Couch to 5K program or a physiotherapist can guide on a return to run program. You should continue to monitor for symptoms (such as dragging/ heaviness or incontinence) throughout the return to running phase and adjust activity levels accordingly.

As a general guide

0-2 weeks

– pelvic floor exercises focusing on strength and endurance

– basic core exercises such as pelvic tilting and side lying hip abduction

– gentle walking

2-4 weeks

– progress walking and pelvic floor/core exercises

– introduction of squats, lunges and bridging, in line with functional requirements for day-to-day life

4-6 weeks

– Introduce low impact exercise such as static cycling or cross trainer

6-8 weeks

– scar mobilisation

– power walking

– increased duration or intensity of low impact activity

– resistance work during core and lower limb activities

8-12 weeks

– introduce swimming (given wound healing)

– spin cycling

12+ weeks

– Couch to 5K program

– Goal specific

– Gradually build volume

Summary:

Timeframes of returning to running are going to vary between individuals and should be guided by strength and symptoms and individualised. A progressive increase in activity combined with monitoring of symptoms, pelvic floor strengthening and endurance and running related lower extremity and core strengthening are paramount to a successful return to run program.

About the Author:

Emily has a strong interest in treating pregnancy related pain/ pre and post natal patients and is currently completing  post graduate certification in both Pelvic Floor Physiotherapy and Exercise & Women’s Health at Melbourne University. Emily takes both pregnancy, GLA:D and Clinical Pilates exercise classes.

References:

Abbasi, M. & van den Akker, O. (2015). A systematic review of changes in women’s physical activity before and during pregnancy and the postnatal period. Journal of Reproductive and Infant Psychology, 33(4). Retrieved from https://www.tandfonline.com/doi/full/10.1080/02646838.2015.1012710?scroll=top&needAccess=true

Continence Foundation of Australia (2021). Continence health: pelvic floor muscles. Accessed online 20/01/2022 from https://www.continence.org.au/about-continence/continence-health/pelvic-floor.

Downs, D.S. and Hausenblas, H.A. (2010), Women’s Exercise Beliefs and Behaviors During Their Pregnancy and Postpartum. Journal of Midwifery & Women’s Health, 49. 138-144. Retrieved from https://doi-org.ez.library.latrobe.edu.au/10.1016/j.jmwh.2003.11.009

Goom, T., Donnelly, G., & Brockwell, E. (2019). Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population. Retrieved from https://www.researchgate.net/profile/Grainne-Donnelly/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population/links/5de13bca4585159aa453d963/Returning-to-running-postnatal-guidelines-for-medical-health-and-fitness-professionals-managing-this-population.pdf