Pre & Postnatal Training Q & A: Part II
Returning to exercise postpartum is hard. I remember wanting so badly to move the way I had pre-pregnancy, but my body felt different. I tried to run after I received the “all clear” from my OB, but my pelvic floor felt completely unsupported. I quickly stopped, made an appointment with a pelvic floor physiotherapist, and started learning and googling.
Postpartum Exercise - Information Overload
There is a ton of information available on postpartum fitness, especially as it relates to weight loss. It’s not uncommon for a new mom to be bombarded with ads for baby bootcamps, quick fix diets, and tummy support garments when googling newborn topics. The messaging can be harmful and unnecessary, especially for a new mom already feeling overwhelmed with taking care of a baby. How to bounce back / loose weight after having a baby?My goal today is to introduce postpartum questions that have nothing to do with weight loss or “shrinking” your post baby body. Every woman's pregnancy and postpartum experience will differ, from the pregnancy and labor experience, to how their body responds, to how much weight they gain and how fast (or slowly) their body sheds the extra pounds. Our experiences are unique to us, and everybody is different. I’ve rounded up common questions for making a safe return to exercise postpartum below.
Postpartum Q & A
What exercises can I do immediately after I deliver?
You will not be heading to the gym right away, but there are gentle movements and exercises you can do immediately postpartum to help your body heal well. Don’t push it! Core training needs to be done right to help heal the muscles and connective tissue that have been stretched and stressed through pregnancy, labor, and birth.The overall goal of early movement is to regain function through rest and proper rehab. Every woman is different, so some new moms may be ready to start exercises 1 and 2 below a few days after birth, and others may need a few weeks.
Exercise One: Connection Breath
Practicing the connection breath will help you learn how to gain and release tension in the abdominals and pelvic floor. Your inhale breath will release tension in your pelvic floor, and the exhale breath will help gain tension in the muscle and connective tissue. Doing tons of crunches or aggressive contractions of the pelvic floor (kegels) will not train the whole core canister.
Connection Breath Cues
On the inhale breath: you should feel like your ribcage and the base of your pelvis (around your vagina and anus) are gently filling up with air.
On the exhale breath: Breathe the air “out” of your ribcage, belly, and base of your pelvis.
Perform two sets of 10 breaths daily. Positions (from easiest to most challenging) include supine (on your back), side-lying, sitting, or standing.
Exercise Two: Half Kneeling Hip Flexor Stretch w/ Overhead ReachThis stretch will help improve stability. The stretch is a great side stretch for the diaphragm and ribcage, which can become super stiff with all the various positions in caring for a newborn. Extra bonus is this stretch is great for stability too.
Hip Flexor Stretch Cues
Start in a short lunge stance on the floor with both knees bent to a 90-degree angle. Place weight evenly on both legs.
Squeeze your back leg’s glute tightly so you feel a stretch along the front, through your hip flexor and quadricep.
Whichever knee is on the floor, reach that arm up in the air and add a gentle side body stretch over the front leg.
Perform two sets of six to eight reps on each side daily.
You can find more great stretches HERE.
Exercise Three: Squat
After gaining confidence in exercises one and two, you can add exercise three about two weeks after delivery. A squat is something you do multiple times a day as a new mom, so it’s important to introduce when your body feels ready. Squatting will help regain core stability through the entire core by controlling the movement as you lower into the squat and return up with power.
Squat cues
Stand tall and inhale as you get ready to sit back and into your hips (like you’re about to sit into a chair).
Squat “between” your legs, with your feet slightly turned out. Your knees will track outward slightly, following the line of your feet (this position will be most comfortable early postpartum). In my experience, feet position vary so widely based on comfort level with the hips.
Squeeze glutes and quadriceps to stand up, exhaling while you return to the standing position.
Perform two sets of ten reps daily, focusing on your breath.
What exercises should I avoid?
While I hate to put exercises in a “yes” or “no” category, below is a great list of what may be considered dangerous or damaging in the early postpartum period (0-6 weeks).
Belly hanging down towards the floor and you cannot control the downward pressure effectively (e.g. planks, pushups).
Anything where the belly is bulging up or out / doming (e.g. crunches, sit-ups, double leg raises). Take a look at how you get off the floor, get out of bed, and change levels. When rising from bed or the floor, roll over and use your hands to press up instead of straining through the midline.
Creating downward pressure on the pelvic floor where the core cannot stabilize the spine and pelvis adequately. This may come in the form of leaking, back and hip pain, and feeling pressure on your pelvic floor/pelvic organs during and after exercise after running, jumping, completing plyometric exercises.
How soon after my “medical clearance” can I return to exercise?
It depends. Postpartum recovery is a process. I love to reference Jessie Mundell’s 4 R’s to Returning to Postpartum Fitness: Rest, Recovery, Rehab, and Retrain. Fitness after baby will not look the same as it did pre-pregnancy - at least not yet. It’s important to respect the changes and stress your body has undergone through pregnancy, labor, and in the early stages of postpartum and caring for a newborn. At your six-week check up, your healthcare provider is assessing your physical body, c-section scar (if applicable), and may also perform a vaginal exam. They will ask about your mental health, birth control next steps, and how you are managing caring for a newborn. This check up and “all clear” doesn’t mean your body is functioning how it was in terms of core and pelvic floor health, and it doesn’t mean you’re ready to go to high intensity exercise. At least, not yet. My first recommendation is to visit a pelvic floor physiotherapist for further evaluation of your core and pelvic floor health, and extra TLC. Taking the time to rest, recover, and rehab the body are key to getting back to then retraining the body and functioning well.
Retraining = (re) developing strength and fitness. This looks like progressive, full-body strength training workouts, paired with general movement and walking. For the first few months, master bodyweight movements, basic exercises, and light loads and begin to reintroduce a more consistent routine. Training should not exhaust you, but compliment your day. The high intensity intervals will be there. A sample workout around seven weeks postpartum might include exercises like a glute bridge, straight-arm pulldown, step up, hip thrust, half-kneeling press, and one-arm split-stance row, with some breath work and postpartum core rehab.
Love this video discussion with Jessie Mundell about your six-week check-up.
I had a C-Section. Do I still need to see a pelvic floor physiotherapist?
Yes! Although you did not have a vaginal delivery, your body has gone through a lot. During pregnancy, the weight of your baby places pressure on your pelvic floor and connective tissue, and hormonal changes during pregnancy results in softening pelvic support to prepare for birth. These changes alone can lead to a pelvic floor that is more vulnerable to dysfunction. The method of birth is only one factor among many that can influence the function of the pelvic floor: pregnancy, daily life activities, constipation, and genetic predisposition are others. Another great benefit of working with a pelvic floor physical therapist is the support they can provide for your scar. What’s happening below the scar can sometimes lead to pain. Working with a PT can minimize the adhesions that often occur as scar tissue forms. They can teach you some techniques you can do at home to help minimize pain and scaring. Jessie Mundell offers a free 4-minute C-Section Massage Protocol. You can download that HERE. I could go on and on :) My big answer is yes! Seeing a PT gave me peace of mind and helped me better understand my body. I hope the experience is the same for you.
I have Diastasis Recti. How can I “close the gap?”
Diastasis recti is completely normal in pregnancy as the Linea Alba stretches to accommodate a growing baby. Because the connective tissue gets “stretched,” it often results in a separation. First off, don’t panic. This needs to happen. Through pregnancy we can try to minimize the severity of diastasis, and then work on healing postpartum. Your diastasis can be functional even if a gap remains. Meaning, it can be perfectly fine to have some degree of a gap between the abdominal muscles and you are active and pain-free. There is not one single exercise (or five) that is going to heal everybody’s diastasis. There is a full body and individual approach. Tweaks to body alignment, breathing, and strategies for lifting while under load can make a huge impact to how diastasis is healing. I recommend working with a pelvic floor physiotherapist to help your body and brain retrain your pelvic floor.
Alignment cues: Ribs over pelvis, weight distributed mid-foot, glutes slightly elevated. A tucked pelvis is very common, but doesn’t allow for the proper firing of the system (core) or glutes.
Breath: On an inhale, your pelvic floor should relax. When you exhale, your pelvic floor should lift up and in. The lift isn’t forceful. It’s control and works with your breath vs. being isolated. During exercise, exhale upon exertion is the go-to. Breathing (exhaling) through your daily movements (e.g. lifting your child, standing up, sitting down) and utilizing the exhale/pelvic floor lift, especially early postpartum, is a great strategy. Eventually this will become automatic for your system. There is no definitive timeline for how long it will take Diastasis to heal. That being said, a lot of women have great function back 12 weeks postpartum.
I was diagnosed with Pelvic Organ Prolapse. Can I still workout?
Pelvic Organ Prolapse (POP) is something that many women find themselves managing after pregnancy and childbirth. A diagnosis does NOT mean you cannot exercise or strength train. There will be a few tweaks to your exercise program that will allow you to workout safely and manage your symptoms. While I try to rule out a big “DO” or “DON’T DO” on the exercise front, there are a few things to keep in mind while training:
Limit the amount of time spent on your feet during exercise. Vary the body position: standing, seated, side lying, supine, incline, etc.
Use caution with intensity of the load (weight) with certain exercises, especially those that place downward pressure on the pelvic floor (e.g. squats, overhead presses, pull-ups)
You CAN lift weights if your prolapse is well managed, your pelvic floor physiotherapist gives you the thumbs up, and you know what sensations to be aware of.
Limit high impact during exercise, such as running and jumping.
Tune in to the sensations in your pelvis. During and after exercise is there any heaviness or pressure in your pelvic floor? If yes, move to more seated, side lying, and supine positions instead of standing.
When can I run / jump again?
Returning to running postpartum is a hot topic. But, the body needs a lot of TLC post-baby. In the early months, ensuring you have a well functioning core + pelvic floor is number one for long-term health, and a safe return to high impact exercise. In general, I recommend waiting at least 4-6 months postpartum before running. This timeline is also based on you completing 8-12 weeks of consistent postnatal-specific strength training 1-3 days/week. How do you know if you’re ready? I love this checklist from Jessie Mundell:
Solid base of strength and endurance in the pelvic floor (no incontinence, no prolapse/well managed prolapse, no heaviness/pressure/tightness in pelvic floor)
You are using effective breathing techniques and form for everyday activities and strength training
You have been doing consistent and specific postnatal strength training workouts 1-3x/week for the past 8-12 weeks
Your diastasis recti is healed with good tension and density in the linea alba (more concerned with tension vs. width)
You have had an internal assessment by a pelvic floor physiotherapist and have been cleared to run
No pelvic or low back pain (especially after exercise)
Quite a list, I know. But, all important :) As you begin running I recommend first starting with incline walking. Cue yourself to lean forward slightly on the uphill. This focuses on getting the upper body stacked over the lower body - rib cage over pelvis. From incline walking you can progress to incline intervals, resting 2-4x longer than the interval time. As an example, jog 30 seconds, rest/walk for 1-2 minutes. Then move on to flat intervals, with the same lengthy rest. After you feel confident here, move on to steady state running. You can slowly increase your distance over time depending on how you feel. Questions on postpartum exercise? I’d love to support you in making a safe return to your favorite activities after baby. I offer 1:1 training (online and in person) and my 8-Week Postpartum Program is a great place to start.
Comment below or say hi on social media! Feel good mama.
Xoxo,
Erica