Postpartum Restrictions…What should I do and not do Dr. Jenn??
I have so many questions about postpartum rehab and postpartum care from patients, friends, family members, acquaintances, personal trainers, Instagram and facebook followers and the list goes on. I wish I could say it’s clear cut A, B, C but it’s not. Everyone is different. Every woman’s delivery is different as well as her health and fitness and strength levels are prior to pregnancy and during no matter what sports area they are in. Genetics play a factor as well, as do prior birth histories, and other medical histories including a person’s pelvic health even prior to pregnancy. Really?? That matters prior to pregnancy..YEP.
The best tool for EACH PERSON is individualized care including individualized evaluation from and Pelvic Floor Physical Therapist that includes a thorough history on past medical information. I am very bias in that I think it is crucial that the pelvic floor therapist is active herself and understands physical activity and fitness as well to truly understand the patient and the demands they place on their body. I truly believe every woman should have at least one pelvic floor Physical Therapy Evaluation from a licensed Physical Therapist whether you are postpartum or not. It just gives a woman so much information on how this area, that has 5 huge daily functions, should be working and coordinated and communicating properly do the brain.
One of the BEST things a pregnant or woman thinking about becoming pregnant can do, is see and pelvic floor PT. It can help you understand how your pelvic floor is currently functioning but also ways to help you with safety during your pregnancy, modifications for your workout routine, preparation for your delivery as well as immediate plans for you to do as soon as you return home with a brand new baby for those 1st 6 weeks until cleared by MD to return to the pelvic floor physical therapist. It is then, she can guide you even more specifically for YOUR needs, goals and recovery based on your findings postpartum and the affects your pregnancy had on your body. Everyone can be similar in some ways, but also very different in others.
Depending on a patient’s pelvic floor strength, core strength pain, hip strength, knee strength, back strength, awareness, posture, weaknesses as well as their degree of ab separation (diastasis recti) , their plan and full return to physical activity WILL ALL look a little different.
However, I will share some general guidelines and restrictions for those active women that want to get back to doing everything they love ASAP. What you need to understand and I must highlight is the importance of proper tissue healing and why these restrictions should be in place. There is ALWAYS a reason. Pregnancy places a lot of stress on the human body in many ways unlike other events or injuries. On top of that, a childbirth is a traumatic event in so many ways that deeply affects the nerves, muscles, ligaments, and fascia in and around the pelvic floor. The muscles, nervous tissue, and connective tissue can all be damaged which changes the sensation, support and stability of the pelvis. Ligament laxity is also present still when a woman is breastfeeding. When stability is lost, more stress is placed in other areas including down on the pelvic floor increasing risk for prolapse, pelvic floor dysfunction, low back pain, hip pain, groin pain and even neck pain.
In general muscle tissue strains can take 3 weeks to 6 months and ligamentous strains (depending on the grade) take 3 weeks to 1 year (if a grade 3 strain) in order to heal so a lot of postpartum restrictions are most limited in the first 3-4 MONTHS with GRADUAL return to be safe, careful and allow the tissues time to heal. To be safe, gradual return should occur with test and retesting for the first 6 months at a minimum. I say 3-4 months meaning at that marker a woman could try a 200 meter run for example and see how she feels the next day. It also does not mean at 3-4 months the woman should now go as hard as she would like in a workout like she was before she was pregnant and go run 4 miles. These first 6 months should be focused more on strengthening, mobility and correcting posture with a gradual return in the 3-6 month window up to a year depending on pelvic floor strength, diagnosis or prolapse or nerve injury.
Exercises I recommend NOT to do before 2 months postpartum:
-includes box jumps, jumping rope, jumping jacks..ANY jumping
-kipping or butterfly pull ups
-GHD sit ups
-ski erg- wait at least 4-6 weeks possibly more especially if prolapse symptoms
-kipping Handstand push ups
-toes to bar
-front planks (depending on the patient)
-handstand push ups without controlled descent
Please understand this list is not all inclusive and each person may have greater restrictions.
Be safe. Train Smart. It will be worth it
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