Returning to Exercise Postpartum

Dec 15, 2019

If we had a dollar for every time we read that title line... I mean really. How many times have you seen: 

“Get your pre-baby body back.” 

“Return to exercise after birth.” 

“Love your postpartum body.” 

They are EVERYWHERE. I did an IGTV on this not too long ago about how you want to be cautious about who you buy one of these programs from. You want to be sure that you find one that has a pelvic PT involved in some way. Otherwise, the knowledge of how your pelvic floor, core, and all the goods in the middle is just not there. Without that knowledge, you can do more harm than good. 

Anyways...before going down another rabbit hole, I wanted to chat a bit about getting back to exercise postpartum. Last week we talked a lot about exercise during pregnancy, so what better time than now for this topic!  

I want to start by saying.... everyone is different and this is not medical advice. I am simply answering questions I’m asked and getting you information that you otherwise wouldn’t know. Remember I’m a doctor with a lot of information about down there! 

It is said that birth is similar to having an acute injury (like rolling your ankle or something like that). What that means is, you need to treat your body like you have an injury. You’ve just birthed a live human from a tiny hole (or a cut in your lower abdomen). It’s important you care for your body appropriately afterwards! Perspective is key. 

Returning to sport after giving birth is a very complex thing, hints the reason I say you should have a pelvic PT on your side. It must take into account returning to participating in rehab and movement strategies, returning to sport with similar activities you would utilize in sport, and then returning to performance where you actually compete again.  

If you have exercised regularly prior to and during pregnancy, the likelihood of getting back without dysfunction is higher than if not. After you deliver, your VO2 max (remember this was described in the last post) can actually return to pregnancy or higher levels, IF YOU exercised during pregnancy. 

Endurance 

You should start very low impact here and progress gradually. If you are doing this on your own, without help, be sure to start with endurance exercises that might not require a ton of exertion. Endurance exercise can include: walking, running, cycling, swimming, weight lifting, and many more. You can start low impact endurance/aerobics around the 6 weeks postpartum mark (I often have clients start at 5 weeks depending on how their birth went) at a very low level.  

If you have symptoms of pressure, peeing at all, or pain you want to modify the activity and work with a pelvic PT to help you get back safely. 

Strength Training 

I like to say, start with your pelvic floor first. You want to have a pelvic floor assessment by a pelvic floor PT to see what your muscles are doing there. Then you want to be sure you start here before getting back into any lifting. If your pelvic floor is not functioning and you go to lifting heavy quickly, your likelihood of having pelvic floor issues and dysfunctions will be way higher.  

Work on your pelvic floor and when the coordination improves here, you can move back into the things you were doing before. You need to be able to work with your pelvic floor during exercises and know when to contract, when to relax, etc. Pay close attention to symptoms, core, and back with strength training! 

It is often said to “kegel” and you’ll get better. It is way more complex than that. You not only should be able to kegel (as long as there is no pain), but be able to coordinate your breathe, bracing, and the exercise with the proper time frame of the kegel or the relaxation of the pelvic floor.  

Breastfeeding 

Yes, you can exercise while breastfeeding. You will have an easier time losing weight and feeling better if you do exercise while breastfeeding. However, understand that the hormonal changes and the changes that have occurred during pregnancy and giving birth may change how your exercise and the amount of energy you have. 

This is where it is important to listen to your body and be sure you do not push too hard. You need to account for the increased energy you will need in order to breastfeed and exercise at a high level. This is where nutrition is significantly important!  

At this point, clients always ask me when they can expect to be back to their competitive level of exercise. It does depend but typically I would say around the 6 month mark you will be back in the gym at your normal levels IF YOU HAVE NO SYMPTOMS or issues.  

When returning to exercise postpartum, it is so important that you pay attention to any signs and symptoms of: 

  • Postpartum anxiety or depression 
  • Pelvic floor dysfunction (urinary incontinence, constipation, fecal incontinence, pelvic pain, diastasis recti, pubic symphysis pain, prolapse or heaviness, infection) 
  • Low back pain 
  • Increased weight loss 
  • If you experience any of the above postpartum, there are so many professionals out here to help you. Pelvic floor physical therapists are equipped to make a referral for you or treat for any of the above issues. 

The main thing is: 

Yes, you can get back postpartum. Often stronger and better than before. But that will not happen without listening to your body and giving your body grace to heal. 

I hope you now have some information on returning to exercise postpartum and if you have any questions or would like to work with me one on one to get back to your routine, go to my contact page and I will contact you at your allotted time! 


Information can be found at: 

Bø K, Artal R, Barakat R, et al 

Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women 

British Journal of Sports Medicine 2018;52:1080-1085. 

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