May 18, 2020
Returning to Exercise after the Birth of your Baby
Return to Walking and Running
There is concern around when a mama should return to exercise. I am offering you my opinion on return to walking and running in the absence of a birth injury as a guideline only. There are a number of factors to consider regarding walking and running in the postnatal period.
Your fitness prior to pregnancy and birth determines your aims and your underlying fitness. It is reasonable to expect to return to that level of fitness – with patience and graduated effort.
Hormones definitely effect the integrity of the pelvic floor. Oestrogen is high during pregnancy and plummets postnatally to allow breastfeeding. Postnatally, the pelvic floor muscles and tissues lack this hormone to allow shrinkage of the vagina and uterus to return to its more normal size – but this also reduces muscle bulk. The muscles do much of the support work postnatally for internal organs. Pelvic floor muscles are at their best once periods and more normal levels of oestrogen return – typically this is when night-time breast-feeding ceases at 6-9 months – there is a lot of variation with this.
The internal structures
The ligaments of the pelvic organs are designed to lengthen during pregnancy and take time to reduce in length and increase consistency. “Remodelling” of the pelvic floor organs, muscles and other tissues is at initial maturity by 3 months. This effects wounds and all tissues.
Weight on your pelvic floor
This is a big consideration. When upright, 100% of your weight goes through your feet, and 60% passes through your pelvic floor. Movement increases the downward force on your pelvic floor. Walking increases the downward force up to 4 times your body weight and high speed running 8 (or more) times your body weight – through your feet and through your pelvic floor.
Prams and toddler
Avoid additional loads on your pelvic floor in the first 6 weeks, as much as you can – this includes pushing prams and lifting up toddlers (go down to your toddler’s level and cuddle them rather than picking them up).
Later on – perhaps beyond 4 months, the pram helps you to slow down when you run. Speed increases the load on your pelvic floor – and so does a full pram. Ideally, you would run without a pram to have good form and be aware of sensation of your pelvic floor. However, perhaps you only have time to run if you include the pram and babe(s). Please run slowly and have lots of walking intervals.
There is a great deal of opinion in Googleland. Google is not your personal expert health advisor. It is always useful – I would suggest essential - to consult a pelvic physiotherapist who understands your personal journey through pregnancy, birth and postnatally, and can see you move and provide appropriate guidelines and feedback.
Guidelines from “Hospital to 9 months”
It is not possible to combine all these factors into one formula for every Mama.
Accept these points only as a guideline and not as a personal prescription:
STOP exercising if you have any issues and SEEK help from a physiotherapist who specialises in postnatal care ASAP – vaginal bulge or pelvic pain, leakage of urine, bowel motion or wind. It won’t improve on its own. Do not accept any level of these symptoms without further exploration by an expert
DO WEAR supportive underwear or outerwear for every run
It may take 4-6 months to get to your target run of 30 minutes
Have someone with you to push the pram for the first 2-3 weeks or longer if possible
Monitor your symptoms as you increase your activity – during the walk/run, that evening and the next day
Intermit your running and walking: i.e. walk, jog and run
Progress to the next level only when the current level is easy
Do your pelvic floor exercises every day unless you have been advised not to.
In the first week – walk around the house, maybe out to the letterbox and perhaps around the block.
In the first six weeks – concentrate on walking a little further each day. Keep the exercise periods short. It is far better for your recovering abdomen and pelvic floor to do three lots of 10 minutes than one lot of 30 minutes. Extend the period just a little each day – possibly by a minute or two. Aim for a 30 minute walk by 6 weeks.
Plan to increase walking by 5 minutes a day as possible
Aim for 60 minute walk by 12 weeks.
Including Jogging and Running
From 4 months, and if you have no pelvic symptoms – you can include a “tiny” run while walking – this is a 3 step run-through intervalling with walking for 10 steps, done a few times during a walk (3-4 times)
If running is your aim; spend 1-2 weeks at each level of exercise and only increase if there are no symptoms as described above
When ready, increase the number of steps for both the run-through and the walking interval only by 1/3 at each level – staying at that level for another 1-2 weeks or 5-10 training sessions.
A physiotherapist who is a specialist in these conditions in the postnatal period can assess you thoroughly and help you with your plans for exercise.
Enjoy your baby and your return to fitness.
Please contact SHE Physio Pilates for further information and to make an appointment regarding this or any other issues around pregnancy and the postnatal period. We will be very happy to see and advise you.
Mama You've Got This
Women's Physio Expert