As A Pelvic and Organ Health Therapist, one of the most asked questions is how soon can I return or start exercise. Typically, most moms get a go ahead to return to activity after their 6 week appointment with their birth practitioner without any guidelines or regard to the impacts of injury to birth like perineal tears, tailbone injuries, c-section scars etc. The term “fourth trimester” is gaining traction a period where moms continue to go through physical recovery from childbirth. Social media sometimes pressures moms to ‘get their body back’ without recognizing every birth is different.
Some common physical challenges that mom experience:
Diastasis Recti (DR)- Diastasis recti are the separation of the two rectus abdominis muscles by the linea alba, the connective tissue holding the two muscles together stretches and creates the gap. At least 60% of women have Diastasis Recti during pregnancy and after. The amount of separation and injury to the tissues during pregnancy is natural but varies so greatly. A well informed pelvic health therapist can help you assess it and specialized manual therapy and graded core exercise can help significantly.
Pelvic Organ Prolapse (POP) - A prolapse happens when the pelvis muscles and tissues can no longer support these organs because the muscles and tissues are weak or stressed. In moms, this can happen from pregnancy and the birthing process. Not bearing down with bowel movements, lifting your baby carrier without holding your breath etc. can help. Diaphragmatic breathing techniques can also help to alleviate the pressure. An expert pelvic health therapist trained in specialized manual therapy like visceral mobilization and manipulation can help significantly.
Bladder Incontinence - Bladder leakage is a common symptom after having a baby. Sometimes it may be temporary after birth or it can develop over time and occasionally be long lasting. It is not always weakness in the pelvic floor muscles that can cause this problem based on popular belief but a combination of restrictions that occur from bearing down, scar tissue from tearing, SIJ dysfunction, c-section scarring, internal muscle trigger points around the bladder, etc. It is very helpful to seek treatment from a pelvic health professional who specialized in soft tissue mobilization internally and externally, breathing techniques, body movement and exercise tips to assist these tissues maximize their recovery.
Bowel changes – constipation or changes in stool consistency. This is also a common problem after having a baby. Many moms can be depleted from birthing the baby, even losing a lot of iron due to bleeding. Having a baby is very time consuming and you may be ‘eating on the go’ and not hydrating well. Using good breathing techniques and using a ‘squat’ posture with a stool or Squatty Potty can improve bowel movements that decrease pressure on the pelvic floor muscles and organs.
Pelvic Muscle Weakness:
Many physicians and midwives recommend Kegels as a way to strengthen pelvic floor muscles and can be a helpful way of strengthening muscle after birth. However, it is not always clear how to perform them efficiently. There’s not usually much instruction to perform them except to “squeeze the pelvic muscles” or “stop yourself from peeing”. Pelvic floor muscle engagement works much better if you include diaphragmatic breathing and core engagement; these muscle groups are synergistic in the way they function. A pelvic health therapist performs a pelvic exam to determine what areas are restricted, what muscles are not engaging well and what areas are weak.
So if you would like to return to yoga/ running/ cross-fit etc, there are no specific rules but a few signs and symptoms to keep in mind are when you are performing a certain activity.
• Do you have bladder or bowel leakage (even if it's just a little )
• Do you get heaviness/ pressure/dragging in the pelvic area
• Do you have pain with intercourse
• Do you have constipation that is persistent
• Do you have separated abdominal muscles, the abdomen feels weak, you have difficulty feeling the muscles engage etc.
• You have back pain or SI pain with or without activity
Some of these symptoms are indicators that you may not be fully ready to return to your activity.
As a general rule, it is that low impact exercise is recommended for the first 3 months
Begin to introduce higher impact exercise between 3-6 months
Running with a stroller is not recommended until 6-9 months due to the heavier load that you’re pushing. Other things to consider is if you are breastfeeding the is a higher chance of having laxity in your ligaments, pre-existing pelvic floor or back problems, surgery i.e. c-section or perineal scarring, pre-existing hyper-mobility conditions (Ehlers-Danlos).
If you can complete these activities without pain, heaviness, dragging or incontinence then you may be ready to progress to higher level activities:
• Walking 30 minutes
• Single leg balance for 10 seconds
• Single leg squat 10 reps each side
• Jog in one spot for 1 minute
• Forward jumps 10 reps
• Hop in one place with 10 reps on each leg
• Single leg ‘running man’ opposite arm and hip ( flex and ext) with bent knee ( 10 reps)
(Source: Returning to running postnatal – guidelines for medical and fitness professionals managing this population – Tom Goom, Grainne Donnelly and Emma Brockwell – March 2019)
Work with an Experienced Pelvic Health Therapist!
Mangostana Pelvic and Organ Health
1020 Coal St SE, Albuquerque, NM 89106