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Sunday, 22 October 2017 12:25

Exercise After Pregnancy

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So you pumped! Baby is here and although you're full of love for your new little family member you're starting to think about ways to get back to loving YOUR body, after all, it's been through quite a lot in the past 9 months! While I want to encourage all new (and seasoned) mums to get back to moving as soon as possible post their birth, there are some considerations to take into account. Everyone is different and everyone's birth story is different. Understanding your birth experience and making decisions that are guided based on your body is imperative for a successful and enjoyable return to exercise after pregnancy! 

The basic time frame given by most Obstetricians and Physiotherapists post pregnancy is the 3 - 8 - 12 - 16 week guideline. Which states;

0 - 3 weeks = gentle walking and pelvic floor exercises avoid abdominal exercises 

3 - 8 weeks = if all is well gentle low intensity fitness begin gentle abdominal bracing exercises 

8 - 12 weeks = if all is well gentle increase body weight exercises and endurance of abdominal bracing exercises 

12 - 16 weeks = if all is well gentle increase 

16 weeks beyond = return to previous physical activity levels 

and while this is a nice starting point, Im sure you feel as I do, that it leave a lot of room for interpretation. What is I had a C - section? What if I had stitches? What if I was incredibly fit right the way though my pregnancy? What if I have never exercised before? What if I have back pain / neck pain / wrist/hand/elbow pain since the birth of my newborn? And probably the biggest question of all, how do I know if I am doing my pelvic floor and abdominal bracing exercises correctly?!?

The Best Advice

The best way to being your journey towards your return to your 'pre-pregnancy' body is with the guidance of a Womens Health Physio (even better if they happen to also be a Pilates Instructor!) There is simply no substitute for an accurate self assessment that will show up the strengths and weaknesses of YOUR body as it is right now. Stats, averages and estimates a great for making sweeping judgements, but every body, every pregnancy and every birth story is different and as such there is no room for a 'one size fits all' approach when it comes to returning to movement after birth. To give you an example of the varieties of situations I see in my day to day work as a Physiotherapist and Pilates instructor let me highlight for you two ends of the spectrum.

Mum A - is 2 weeks post the birth of her first child and comes to visit me for her post pregnancy assessment. I know mum A well as she has been doing Pilates with me well before her pregnancy and carried on doing it through out her 1st 2nd and 3rd trimester. She was also an avid runner and generally looked after her body. Her birth story involved a natural birth with a few stitches but otherwise no complications. Her and bub are doing well and intact bub comes with her to her post pregnancy assessment! We use the real Time Ultrasound to check her pelvic floor recruitment and transverses control in a variety of positions and discover that while she has great PF and TA control in 4 point kneeling and sidling, when she is lying on her back it is not so well controlled and intact her pelvic floor slightly depresses instead of lifting. We also assess a variety of every day movements, walking, sitting, stairs and while her general biomechanics are good she is still feeling quiet loose in her joints at the end of range of some of her movements. 

Mums B - is 8 weeks post the birth of her 3rd child (previous 2 natural births) and her 3rd was an unplanned C - section. Her 3rd birth story also involves some back and hip pain as well as some rectus diastisis separation and she admits with two other little ones she was not as diligent with her exercises throughout her 3rd pregnancy as she was with the previous two. I have never seen mum B before, so we take a full history of her movement and past injuries prior to her pregnancies and throughout the last 5 years of her birth stories. Her biggest concern is, although she has been active before and through out her pregnancies, she doesn't class her self as a 'gym junkie' rather she enjoyed walking, yoga and the occasional spin class. She is now concerned that when she looks in the mirror her body does not resemble her pre pregnancy form and although she has tried a few times in the past few weeks to reinstate some activity, she felt concerns with the increasing back and neck pain she is now experiencing. We use the real Time Ultrasound to check her pelvic floor recruitment and transverses control in a variety of positions and discover that while she has great PF and TA control need a little bit of work. We also assess a variety of every day movements, walking, sitting, stairs and find there are some general postural corrections and weakness we could begin to work on. 

What I am hoping you understand from these two very different examples is that the 3 - 8 - 12 - 16 timeframe will be drastically different for these two mothers. Gaining an understanding of where you lie on the spectrum early on and understanding what unique strengths and weaknesses your body has experienced will go a long way towards effectively choosing a return to exercise program that will work best for you. 

Some Warnings

Having highlighted the differences it is also important to acknowledge there are a few 'global rules' that most women should take into consideration post birth. These include;

  1. Abdominal 'Crunch' like movements really should be avoided for the first 8-12 weeks. This is because there is a certain amount of stretching that occurs, especially in the last trimester, of the abdominal muscles which are target in a crunch. Allowing these muscles time to shrink and close the gap is important when trying to avoid prolonged abdominal separation.
  2. High Load and increased Intra-Abdominal Pressure should be avoided for the first 6 - 12 weeks. During pregnancy the anatomy of your thoracic canister has gone through significant changes. One of these is the stretching of your uterus to accomodate your growing baby. These muscles and organs do not just snap back to their original shape and although baby may no longer be inside you the weight, size and shape of these organs will take time to come back to their 'normal' shape and size. For this reason it is important to avoid activities which cause increases in intra-abdominal pressure such as running, jumping and some types of heavy weighted exercises. 
  3. Joint Laxity while you may have been aware of the stretching of ligaments in your body during pregnancy it is important to remember that these ligaments also need time to regain their previous tensile strength. So while you might be getting itchy feet remember to take into consideration movements that involve deep end of range movements such as deep stretching, fast direction changes and unstable surfaces and all these things require your body to be performing at optimal balance and coordination which may still be 12 months away for some women! 

Fatigue and Tiredness

I hate to break it to you, but if you thought the fatigue and attacks of tiredness were all behind you now that you have given birth, don't get to excited. A new baby means often a new (and drastically reduced) sleep routine. And while this is often just accepted in the world of motherhood, it's effects on exercises are not to be overlooked. If your feeling tired, try sneaking in a quick nap while baby sleeps BEFORE you work out. Sometimes a even a quick 20min shut eye is enough to rejuvenate your body and make your exercise more effective and not to mention safer! If you are struggling to get motivated to return to exercise, try choosing activities that include incidental exercise such as walking to your local cafe, mums and bubs classes which teach you how to safely use your body with your new born, mum and bubs time in the park, even just consciously increasing the number of times you walk up and down stairs with your bub in hand! 

All in all, this is a beautiful time for you and your new born, be kind to your body and give it the time it needs to heal and strengthen while not forgetting that movement has many great endorphin and bonding benefits. If in doubt get expert advice! If something doesn't feel right, don't ignore it even if you have friends and family telling you 'it's ok' and 'safe' for you to start exercising. In the same way if your feeling good, challenge yourself, increase slowly and alway listen to your body and use it as a guide! After all, it will let you know if it's enjoying your new movement routine or not!