Here on the Northern Beaches, we love our exercise. We spend a lot of time outdoors and often socialise through our sport. Having a baby significantly alters this part of our lives. Pregnancy is a very individual experience with some women cruising through it like nothing had changed and others unable to exercise at all from the start of the pregnancy. My previous blog on Safe exercise during pregnancy addressed these issues, but when is it safe to return to sport and exercise after having a baby?
This will be different for everyone and depends on a multitude of factors:
1. Pregnancy - how was it? were you able to exercise until your due date or were you bed ridden with pelvic girdle pain for the last 12 weeks? did you vomit or have a chest infection? did you have any complications?
2. Birth experience - did you have a perineal tear? or a long slow delivery? did you have forceps or venteuse assisted delivery? did you have a large baby?
3. Post-natal healing - did you have feelings of "everything falling out"? or abdominal "separation"? did your wounds heal well? how did your bleed last? are you getting any incontinence (of bladder or bowel)?
4. Your baby - are they settled and feeding well or colicky and constantly needing holding? are they feeding every 2 hours?
These are just some of the factors that will influence your return to "normal" activity levels.
One of the most important things to remember is that there is no set time when it is safe to return. It is totally individual to you dependent upon your experience before, during and after the pregnancy. Listen to your body and respect the changes that it's been through and is recovering from. We're conditioned to think that by 6 weeks we should be back to normal, but true tissue healing time is closer to 3 months and the hormones of pregnancy, such as relaxin, don't fully clear out of your body for up to 8-10 weeks post-partum. During this time, they are still softer and more stretchy than normal and thus more susceptible to damage if loaded too heavily.
As a society we still think we should just "bounce back" from pregnancy and birth as if nothing has happened. The media continues to portray the best bits of motherhood without recognition of the fact that it is tiring and hard work, our body has been hormonally and physically altered in shape over a period of months. It doesn't acknowledge that new Mum's are feeding for up to 8 hours a day (if you have a slow feeder like mine) before even settling, comforting, burping the baby, let alone the time needed to look after themselves, cook, shop, clean etc and all whilst waking at least 3 times a night and dealing with a massive lifestyle and emotional change.
So for some of you, you will feel fantastic after giving birth and can literally run 2 weeks afterwards, but for others it may be a year of recovery time before you can even contemplate building up into running and that is ok. This is where we, as Pelvic Health Physiotherapists, come in to guide you.
Having had your 6 week check with your GP or Obstetrician, you will typically have been told, either "yes, you're fine to get back into exercise" or "you need to wait a bit longer and do some pelvic floor exercises". You may have been told that you have a mild prolapse "but don't worry about it". But is this advice good enough?
We know that there are a number of reasons why you shouldn't return to exercise too quickly, including the following:
1. The pelvic organs rely on the non-stretch fascia and ligaments for support
2. The pelvic floor muscles give extra support to the pelvic organs off-loading the fascia and ligaments, thus preventing them from stretching out over time
3. A normal vaginal delivery stretches the superficial pelvic floor muscles by up to 250%. Normally muscle tissue would fail and tear at 150% stretch. Hormones allow this response, but as said above they can take up to 10 weeks to clear out of your system. During this time, the stretched muscles are gradually returning to their normal length and are weaker than normal. Support for the organs is less, the fascia is also softer than normal and is therefore more susceptible to be stretched under load, or at best, not be able to recover back to it's normal shortened position.
4. If you have a tear to the perineum, this is a tear within the muscle and tendon of the pelvic floor. For these tears to fully recover and function normally, they need to be recoordinated and strengthened - just as you would do with a hamstring or calf tear.
5. You can pull the deeper muscles off the bone on one or both sides during a vaginal delivery (levator ani avulsion). You may or may not have symptoms from this but your risk of prolapse in later life is significantly increased.
5. You don't necessarily have symptoms when you have physical changes. Unless you have obvious prolapse symptoms (heaviness, dragging, a sensation of "everything falling out"), pain or incontinence, you may not realise that the tissues are not yet back to normal. Without symptoms, you may return to exercise/sport relatively early unknowingly preventing full tissue recovery and possibly causing long term damage that will cause symptoms later on in life.
6. Approximately 48% of women will have some lasting physical change after birth, 1 in 3 will have some degree of incontinence post-natally and approximately 50% of women will also have some degree of incontinence or prolapse by the time they are 50.
So when is a safe time to return, that allows your body to fully recover and prevent long term pelvic health problems?
The simple answer is when your tissues have recovered sufficiently to resist the loading that you will put them under. Besides being dependent on all the above factors, this is also dependent on what activity you are returning to. Swimming is very different from running marathons, which in turn are very different from yoga and pilates or strength training such as bootcamps and Cross Fit style workouts.
In basic terms we need the following:
1. The pelvic organs in their original position / or supported by a pessary/pelvic floor muscle strength to prevent further downward movement.
2. The pelvic floor muscles coordinating with each other and the other deep core muscles (deep abdominal, back muscles and diaphragm), with sufficient strength and endurance to resist/control the loads/forces/impact involved in your chosen form of exercise.
5. Sufficient control, strength and endurance in the abdominal muscles to support your trunk in functional positions that allow the limbs to work efficiently.
6. No symptoms of prolapse, incontinence, pain (internal or external)
7. Sufficient overall strength in your limbs and trunk to control and absorb the loads applied to the body by your chosen activity.
To help you determine what stage you are at, we perform a post-natal pelvic health check either at 6 weeks post-partum, or earlier if your bleed has finished (it needs to be at least 2 weeks after your bleed has stopped). This assessment involves a discussion about your pregnancy and birth experience(s), previous medical history, symptoms (if any) and goals and a physical examination to check the pelvic floor muscle function in detail (activation, tone, length, avulsion, coordination, strength, endurance), pelvic organ position, scar/perineum, pelvic girdle/spinal alignment, abdominal muscle status and global muscle function. If everything is normal, you are given the "all clear" to exercise. If there are any deficits then an individually tailored programme will be developed and discussed with you to guide you through the recovery process.
It is a rare occasion when you are told not to do any exercise at all but you may be on a modified programme that gradually progresses up to full function over time. I am a big fan of allowing you to do as much as you can safely rather than putting blanket limitations on you.
In some cases, you may be given the "all clear" with the advice that we'll check you again at 6 months post-partum to make sure that there are no detrimental effects from the exercise.
In summary:
The answer to "when is it safe to return to sport and exercise after having a baby?" is: it depends. For some of you, it will be within a few weeks of giving birth, but for others it will be a gradual process over a period of months.
There is no pressure to return too quickly as you are likely to do long term damage if your body isn't ready.
The safest way to know for sure is by having a post natal pelvic health check.
Please note, that it is never too late to get a check up done. I see women in their 80's who relate all their problems back to the birth of one of their children. So whether you are 6 weeks or 60 years post-partum, it is still relevant.
If you would like more information, please feel free to contact me at jenni@jennidavies.physio or call on the clinic number: 0435 150136. Alternatively, if you would like to book an appointment, click on the "book" button at the top of the page and it will take you through to the online diary. You can also call the above number to make an appointment.
I look forward to seeing you soon.