Returning to Exercise Postpartum

“When can I start exercising again?”. This question tends to be a big one when talking to my postpartum patients. The pull to get back into exercise can be really strong for moms, especially if fitness and athletics were a big part of their life pre-pregnancy. The general rule coming from OB-GYNs is 6-8 weeks depending on your delivery, but what does that really mean? It seems as though you shouldn’t do any exercise for the first 6 weeks and then once cleared, can return to life as usual. Does that mean running and high impact activities are safe? How soon is too soon? What are some of the risks with returning too quickly? 

Let’s first talk about some of the changes that happen to your body during pregnancy. No matter the type of birth, pregnancy itself can lead to muscular and postural changes in the body. To keep it simple, the body must make huge adjustments to stabilize itself while allowing the baby to grow. This can lead to certain muscles becoming over lengthened and weak, while others can become overactive and tight. In any case, your abdominals and pelvic floor are going to have a lot more pressure to manage, while other muscles are going to try to help to pick up the slack. I go into much more detail about what happens to the body during pregnancy in another blog here! 

As the postpartum period progresses and you heal from delivery, addressing your muscular system is really important. Not only are your muscles learning how to support your body sans baby, you’ll also be inherently a little less stable until your relaxin levels return to normal. *Relaxin is the hormone that helps our ligaments and tissues stretch during pregnancy and can linger in the system postpartum depending on breastfeeding status.* All these factors and more (postural changes without baby, less stable supporting structures from relaxin, potential trauma from birth, and potential deconditioning of your muscles) are things to take into account when trying to get back into exercise.

Some things to consider before jumping right back in.. 

1. What was your level of activity like pre-pregnancy and during pregnancy?

Taking a look at what your exercise schedule was like pre pregnancy and how it may have changed during pregnancy can be helpful in setting attainable goals. Your body may have gone through some deconditioning as it relates to your specific exercise type, which will affect the plan to get back into it. Being kind and realistic with yourself is super important!

2. How was your birthing process?

The birthing process is unique to every person, but it is important to take your specific birth details into account. We know a vaginal delivery will have to recover differently than a cesarean section, but there can be more to it! Some relevant questions would be … If you delivered vaginally, did you tear?  If so, What degree was it? Was there additional trauma internally? Was any instrumentation used ( forceps or suction?)  Did you have an episiotomy?  If you had a c-section, did you push first? All these factors affect healing and are helpful in considering timelines. 

3. Can you activate and control some key stabilizers? 

No matter what, both the abdominal wall and pelvic floor take major hits during pregnancy. Before jumping back into any exercise, you want to make sure you can effectively contract and relax your abs and pelvic floor. The easiest way to do this is through breathing!

• As you inhale, you should feel your chest expand front/ back/ side to side as the abdomen and pelvic floor relax and expand as well.

• As you exhale, you should feel the ribs come down/ together and in. Try to contract/ lift the pelvic floor and engage through the lower abdominals through the exhale.

You may find that activating these muscles is a little harder than before. That’s totally normal!  It’s better to be aware of how your muscles are working before starting exercise so you know what to work on.  If you are having a lot of difficulty engaging either muscle group, having pain while trying to use them, or suspect you may have diastasis recti ( abdominal wall separation), reach out to a pelvic floor PT to get things checked out. 

4. Take a look at what your goal is. Can you do simple versions of the exercises you want to get back to?  

Depending on what your specific goals are, you want to make sure you can control your body with easier versions of what you want to get back to. Try body weight squatting and hip hinging, single leg balance, or lunges. If you’re able to feel solid with just your body weight, start to add in a little load or speed to the exercise. Gradual progression is key. If running is your goal, can you hop and jump with control? For more info on this, stay tuned for another blog post specific to running. :) 

5. Check in with your body every step of the way

So often injury happens when we ignore the signals our body gives us. You want to give your body the time it needs to recover. Pregnancy is a long journey for the body that is abruptly changed post labor and delivery. Give your body the time it needs to simply heal and adjust to a different posture/ overall sense of stability. Any time your tissues have been put under high levels of stress they need time to recover. Pregnancy and birth is no different, except you’re sleeping less and highly distracted with the fact that you’re trying to keep a tiny human alive! Check in with your body, and give it the time it needs to gradually get back into exercise. Your body is already doing a lot, so check in with it often. 

What are the risks associated with getting back to exercise too quickly?

There is a lot of variety in this, but ultimately any musculoskeletal injury can happen when your body isn’t able to handle the forces put through it. Thinking specific to postpartum- diastasis recti and pelvic floor dysfunction are both things we want to avoid. Pelvic floor dysfunction can present itself by way of urinary or bowel issues, pelvic pain, prolapse, or even hip or low back pain associated with exercise. Diastasis recti can happen when the right and left halves of the abdominal wall separate and don’t heal well postpartum.

In general, potential instability and weakness postpartum can put unnecessary stress on any muscle or tendon tissue when it comes to exercise. If the demand outweighs the capability of the body, wear and tear can happen. This can present as plantar fasciitis, knee or hip pain, low back pain, or other orthopedic issues.

All this being said, proper muscular retraining and a gradual return to exercise plan should be enough to avoid injury! If you have questions or feel unsure about what your plan should be, reach out to a professional. There are plenty of people who can help evaluate you and guide you through the experience so you feel strong, safe, and empowered.