Stepping Back into Physical Activity Postpartum

A trendy topic in the fitness world is pelvic health; more specifically - returning to exercise after giving birth.

For those beginning their postpartum journey, using social media to access information can be a blessing and a curse. On one hand, it allows people to connect with the community and disseminate information. However, on the other hand, it can breed false perceptions and inaccuracies of “normal” expectations. 

Recovery Isn’t One-Size-Fits-All

One research area in which there are significant gaps is the “normal” timeframe and process to return to physical activity postpartum. The current guidelines are based on the best available evidence, combined with clinical opinions. 

Returning to an active lifestyle during the postpartum period should be encouraged because of the significant benefits for cardiovascular health, psychological health, and weight management. 
The types and frequency of physical activity can be different for individuals based on lifestyle factors and preferences. Everyone's personal comfort with self-initiating a return to physical activity varies. 

Beginning Your Postpartum Recovery Journey

It is recommended that patients speak with their medical provider for clearance and to discuss any absolute or relative contraindications/precautions when returning to physical activity.

2. Determine a base-level: 
Begin to figure out where your recovery is on the spectrum. There are many changes that occur during pregnancy that involve the musculoskeletal system affecting strength, flexibility, balance, muscle coordination, neuromuscular control, endurance, and tolerance to high-impact forces. 

• Do you have muscle pain?
• Are you getting enough sleep?
• How is your posture? 
• Have your breathing mechanics normalized? 
• Where do you feel you have lost the most strength? 
• Any pelvic health symptoms?

3. Know what to look for and when to seek additional help: 
If any of the following signs/symptoms are experienced prior to, or after attempting to return to running, then a referral to a pelvic health PT would be beneficial. 

According to the publication “Return to running postnatal-guideline for medical, health and fitness professionals managing this population,” there are key signs/symptoms of pelvic floor and/or abdominal wall dysfunction that people should be looking for¹:

• Urinary/fecal incontinence 
• Urinary/fecal urgency that is difficult to defer
• Heaviness/pressure/bulge/dragging in pelvic area
• Pain with intercourse
• Obstructive defecation
• Diastasis rectus abdominus/decreased abdominal strength
• Musculoskeletal and lumbopelvic pain

4. Start walking and strengthening exercises:
It is recommended by both publications, “Returning to running postnatal-guideline for medical, health and fitness professionals managing this population”¹ and the Journal of Women's Health Physical Therapy² that someone should be able to progress up to a 30-minute walk without symptom exacerbation, before running is considered. 

The Journal of Women's Health Physical Therapy publication listed key areas to focus strengthening on to help minimize symptoms that may arise²:

• Abdominals: Studies have shown that following childbirth, the anterior trunk muscles demonstrate decreased strength and steadiness of contraction and increased fatigability. Birthing persons may also experience Diastasis Rectus Abdominus (DrA) and poor pressure management/difficulty transferring load across the low back, pelvis, and hips. Rehabilitation of all muscles of the abdominal wall is essential.  Stabilization has been shown to be widely impaired following childbirth.
• Hip: Extra attention should be placed on the hip abductors, particularly the gluteus medius, due to its role in stabilizing the pelvis and its association with low back pain in pregnancy. Hip abductors are responsible for being able to bring your leg out to the side. Strengthening these, along with the pelvic floor muscles, has been shown to reduce stress urinary incontinence. 
• Pelvic Floor Muscles: According to the Cochrane Review done by Hagen and Stark in 2011³, pelvic floor muscle training increases the chances of improving the stage of pelvic organ prolapse or dropping of the pelvic organs into the vaginal canal, by 17% - compared to no pelvic floor muscle training. Many trials also found improvement in bowel and bladder function with pelvic floor muscle training.
• Feet: The support and structure of the feet can also change during pregnancy - leading to altered biomechanics and pressure patterns. Many birthing persons will notice a change in the size, arch, or positioning of their feet. If you have experienced a new onset of foot pain, it could be related to your pelvic floor and pregnancy. Strengthening the feet and calves, balance training, or new footwear may also be beneficial. The foot has important roles in running, including impact absorption at contact and propulsion. 

5. Re-evaluate symptoms and progress often:
Do not give up! If confusion arises or progress is not trending in the right direction, seek professional guidance. 

Finding Help with Postpartum Recovery

Disclaimer: The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis.  If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.  

References:
1.    Goom, Tom & Donnelly, Grainne & Brockwell, Emma. Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population. March 2019 .DOI: 10.13140/RG.2.2.35256.90880/2. 
2.    Christopher, Shefali Mathur PT, DPT, PhD1,2; Gallagher, Sandra PT, DPT3; Olson, Amanda PT, DPT4; Cichowski, Sara MD, FACOG5; Deering, Rita E. PT, DPT, PhD6. Rehabilitation of the Postpartum Runner: A 4-Phase Approach. Journal of Women's Health Physical Therapy 46(2):p 73-86, April/June 2022. | DOI: 10.1097/JWH.0000000000000230
3.    Hagen S, Stark D, Glazener C, Dickson S, Barry S, Elders A, Frawley H, Galea MP, Logan J, McDonald A, McPherson G, Moore KH, Norrie J, Walker A, Wilson D; POPPY Trial Collaborators. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014 Mar 1;383(9919):796-806. doi: 10.1016/S0140-6736(13)61977-7.