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July 4, 2016

So you’ve had your baby, recovered from the birth and now you’re ready to reclaim your body and do something that’s just for you. Women’s health physiotherapist Nicol Ranger explains how to ease yourself back into exercise safely.

Finding some time to exercise is a great idea for your mental and physical wellbeing, but it’s really important to be aware that every woman’s body is different and the demands we place on our bodies vary greatly. Every pregnancy is different too, as are our birthing stories. Prescribing exercise postnatally is therefore never a ‘one size fits all’ approach. The key thing is to start gradually and listen to what our bodies tell us.

What should we be aware of before we exercise?

Pain from over-stretched ligaments and muscles, bladder- and bowel-related problems and pelvic organ prolapse are the most common problems we see in physiotherapy. Most of these problems can be treated effectively. Unfortunately, if not addressed, they do impact upon your ability to return to exercise. If you experience any of the following issues, see a women’s health physiotherapist before embarking on more vigorous exercise:

  • Pain in the lower back or pelvic area (particularly if it worsens with walking)
  • Ongoing pain from stitches (excluding infection)
  • Incontinence or urgency from the bladder or bowel
  • Ongoing pain with intercourse
  • Symptoms of pelvic organ prolapse, which include a feeling of heaviness or dragging in the pelvis, the sensation of something in the vagina, or incomplete emptying of the bladder or bowel
  • Ongoing abdominal separation (you will notice a bulging abdomen on performing a gentle sit up)
  •  Relaxin is a pregnancy hormone that softens our smooth muscles and ligaments, allowing them to stretch as baby grows. Small quantities of relaxin remain in our bodies postnatally for at least three months (longer if breastfeeding). The presence of this hormone makes our joints more vulnerable during exercise and, coupled with weakened muscles, is why we find it so much more difficult to perform exercises we would normally find easy. Allow for this when considering exercise.
  • One in three women experience urinary leakage and women who leak are less likely to exercise. Also, 75 per cent of women will develop some degree of pelvic organ prolapse within their lives.

What are the safest exercises?

Walking 

Walking is low risk and can usually be started straight away. Begin with 5-10 minutes and build up slowly. For the first six weeks, or when experiencing pelvic pain, avoid hills and uneven surfaces.

Running and team sports 

While running is considered a high risk exercise, many women can return to it safely after 12 weeks. If you have any of the problems highlighted earlier, it is recommended you seek advice prior to running.

Cycling 

Seated cycling is low risk from six weeks or when comfortable with the saddle. Standing cycling exerts a lot more pressure and is more moderate to high risk (in the case of a caesarean it is best to wait 12 weeks).

Swimming 

Swimming is a low risk exercise from six weeks postnatal. Ensure any stitches are fully healed and any bleeding has stopped.

Yoga 

Yoga classes are safe from six to eight weeks, although remember that the ligaments are looser. Therefore, no stretching to strong resistance for at least 12 weeks.

Pilates 

Pilates can be done from 12 weeks onwards. It is essential to have good technique and to have good ‘core’ control prior to beginning more vigorous abdominal work. The core muscles include the diaphragm, pelvic floor, deep abdominal (transverse abdominals) and deep lumbar (multifidus). Abdominal separations should be less than two fingers apart. It is recommended to begin with an individual consultation or a very small class initially, to ensure good supervision of technique. Joining a postnatal class will give you safer alternatives to more complex exercises.

Gym 

It is essential to achieve activation and coordination of the core muscles first, usually at around 12 weeks. Abdominal work is safest in a lying position. Crunches are low risk. To ensure a safe technique, exhale during a crunch and gently tense your pelvic floor. Never hold your breath.

  • Weights should always start low; 10kg weights exert double the pressure of a 5kg weight and the pressure is increased further with deeper squatting and breath holding. Always tense your pelvic floor prior to lifting weights. Hydraulic weights are higher risk than free weights.
  • Jumping jacks are very high risk and beware of the trampoline!
  • Boot camps and CrossFit (due to their nature) can cause more severe damage if done incorrectly. If you are inexperienced with this kind of exercise, begin gently. Remember bladder leakage is never normal and should be addressed.
  • For some women, referral to a gynaecologist is recommended (a pelvic floor therapist or GP can recommend one). Many women find a vaginal pessary can allow safer return to higher risk exercises and a health professional can advise
  • further on this. ′

Resources

pelvicfloorfirst.org.au
continence.org.nz
physiotherapy.org.nz

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