Return to Fitness & Exercise
Return To Fitness And Exercise
We get many questions regarding when to return to fitness postpartum, and it depends on many factors including but not limited to: previous fitness level, injury during labor/delivery (or not), and intensity of exercise that you are wanting to return to! In addition, this may look different if you had a cesarean versus a vaginal delivery - so be sure to talk to your healthcare provider and pelvic floor physical therapist to get the most individualized care! If you’re looking for more information on what recovery actually looks like and what you should expect - read our blog post here! At NOLA Pelvic Health, we offer a Hybrid Physical Therapy program so you can have a concierge PT in your pocket to begin safely moving and exercising at home before your 6 week check in.
In this post, we are going to discuss some general guidelines to ensure a safe return to fitness post baby.
Concepts to think about as you return to exercise:
Modifications of previous exercises → although this isn’t a hard and fast rule for everyone postpartum, before an assessment, we typically instruct you to avoid high impact activities until 12 weeks and watch for symptoms that will guide you to modify other activities to meet your body where it is.
Pressure management → we want to ensure you are breathing appropriately, engaging your core and pelvic floor efficiently, and managing the pressure through your abdominal canister well. Pressure is not inherently a “bad” thing for your pelvic floor - but if the load of pressure is higher than the effort your pelvic floor/core/breathing mechanics can manage then it could lead to issues such as diastasis recti abdominus, pelvic organ prolapse, low back pain, urinary incontinence, etc. Therefore, we like to start rebuilding the foundation of your core with “simpler” exercises and progressing to more intense and high impact exercises.
Pelvic floor strength, endurance, and coordination training → see below for a general postpartum return to exercise progression.
What Should I Be On The Lookout For During Or After Activity?
Increased bleeding after doing an activity → you did too much; so scale back and then gradually increase overtime. If the bleeding worsens, contact your healthcare provider.
Pressure/heaviness at vaginal or anal opening → could indicate weakness or increased overactivity of the pelvic floor
Urinary or gas/fecal incontinence → could indicate pelvic floor weakness, lack of coordination between abdominal and pelvic floor muscles, and poor pressure management
Doming or coning of the abdomen → could indicate deep core weakness, poor breathing mechanics and pressure management, and/or improper body mechanics
Pain → again, this doesn’t mean you have to stop what you are doing cold turkey. It’s good to have a discussion with your PT about your pain and we can modify or improve what you are doing so pain is reduced or non-existent.
Postpartum Exercise Progression Week 1-6:
Typically, we recommend that at least the first two weeks are primarily spent in bed to focus on rest and recovery. Week 3 and 4 are focusing on increasing your mobility and postural control, and week 5 and 6 are creating a space that allows for improving functional strength and movement. Below is a general guideline on what to focus on week by week but a lot depends on the type of delivery you had and what you were doing while you were pregnant.
For the majority of week 1 and 2, we recommend resting and resisting the urge to do any housework, lifting anything other than baby, and resisting prolonged walking. However, you can start doing diaphragmatic breathing exercises and gentle core activation. This is to improve swelling, pain, and neuromuscular re-education.
By week 3, you can begin a walking program and gentle mobility while continuing with your diaphragmatic breathing and deep core activation in a variety of positions.
By week 4, if all is going well, we recommend increasing walking distance and speed to a pace that feels comfortable. In addition, you can also increase the difficulty of your core exercises and hip exercises.
By week 6, you can start to slowly return to the gym. However, this still may continue to look different than it did prior to pregnancy and even during pregnancy - so give yourself some grace.
Postpartum Exercise Progression After Week 6:
At this time, it is important to have started our Hybrid Program and/or be seen by one of our postpartum trained pelvic health physical therapists to get individualized guidelines on what to focus on when you return to the exercise.
After week 6, we are focusing on modifying higher intensity activities to meet our bodies where they are and progressively overload our muscles and tissues. Hopefully, with guidance we have built a foundation of deep core and breathing mechanics and now the goal is to load this system over time to build resilience and reduce injury, strain, and prevent future problems (such as prolapse, urinary incontinence, low back pain, etc…).
When Should I Begin Physical Therapy?
We believe it is beneficial to see a pelvic health PT during pregnancy to learn how to perform an appropriate pelvic floor muscle contraction, learn how to lengthen the pelvic floor muscles, and improve pressure management and body mechanics. However, if this is not possible, we 100% recommend starting our hybrid program as soon as you feel comfortable (around 2 weeks is what we recommend) and then seeing a therapist at 6 weeks postpartum to assess pelvic floor muscle function as well as incorporate this appropriately into an individualized exercise routine to get you back up and moving how you want to!