Postpartum Guidelines

As research progresses, guidelines change.

As I grow and learn the new research, I have started to change how I treat my postpartum patients/clients.

I wanted to discuss new postpartum guidelines and apologize if my blog from 3 years ago in any way created fear in those of you returning to the gym/exercise postpartum. That was never my intention. My intention was to educate you and help you be as smart as you can with return to the gym. We have to recognize everyone is different.

What has not changed is tissue healing. We still need to make sure we are giving tissues adequate time to heal.  With still need to treat postpartum recovery like we just had surgery because birth is a MAJOR event. It is still trauma to the pelvic floor or core depending on vaginal delivery versus C-section. BOTH require rehab. They just look a little differently so we must recognize that. If you had a C-section, your pelvic floor is still involved and the core is absolutely involved which ties in with the pelvic floor anyways.

We need to focus on STRENGTH early on and slowly building strength back. Strength comes BEFORE impact. Think more strength creates more stability as well as our STRONG foundation to build on. This means we will build from body weight load to weight lifting BEFORE we start jumping.

Some ladies may be able to start light jumping at 8 weeks, some may wait until 12 weeks and some, depending on symptoms may be longer. It is important to be PERSON SPECIFIC but general guidelines can help women be smart as they slowly return.

Understand that return time can be faster based on many factors like prior strength, birth factors like tearing and length of delivery, genetics, number of births, rehab done between births etc.

There are a series of tests I go through with mommas in my office to clear them to return to light jumping movements like pogo jumps, penguin hops, jumping jacks, then running, then to higher impact like box jumps and double unders. We are also keeping in mind volume and intensity. We want to build to the volume a person goes back to and eventually the same intensity they want to get back to.

One of the best pieces of advice is, LISTEN TO YOUR BODY. There are certain signs and symptoms your body can communicate when you are doing a little too much too quickly.

Here are those signs and symptoms:

-urine leakage

-heaviness in pelvic floor area

-abdominal muscle cramping

-pelvic floor muscle cramping

-pelvic pain

-feces leakage or difficult holding back gas

-low back pain

-soreness that last longer than 2-3 days

-vaginal bleeding

-constipation

-excessive doming or coning with activity

These are the common areas or movements I see moms go back to a little too early on and they complain of these symptoms or we see these symptoms present.

-Running

-Box jumps

-Jumping jacks

-Planks

-Sit ups

-Ab mat sit ups

-Pull ups

-T2b

-Kipping movements

-Double unders

-Ski jumps

-Skater jumps

-Deadlifting too heavy too quickly

-Back squatting too heavy too quickly

-front squats & wall balls w/ improper breathing

Keep in mind you may have no symptoms with these and be ready for some of these movements before others. Impact movements, I do not recommend before 8 weeks postpartum but some of these movements like planks we can start as early as 2-3 weeks postpartum depending on a patients core control, diastasis, # of pregnancies and positioning for the plank. Sit ups, I see value in starting as early as possible WITH assistance or some form after relaying the foundation of core control and breath control.

If you had a vaginal delivery, it could take you longer to get back to the impact movements like running and jumping. As for a c-section, it typically takes longer to gain all of your gymnastics or core, ab exercise movements back without symptoms.

It is super helpful to work with healthcare professionals, personal trainers, and coaches that understand this and these guidelines as well as what SYMPTOMS to watch for.

If you are a coach and personal trainer and are unsure, please reach out to me.

If you are postpartum, I would recommend seeing a pelvic floor PT, like myself,  for at least ONE visit.

Virtually or in-person sessions are SUPER beneficial and the research is showing patients are getting better through telehealth which is awesome!

Let me know your feedback

-Dr. Jenn Frankoski

O’Dell KK, Morse AN, Crawford SL, Howard A. Vaginal pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Dec;18(12):1481-9. doi: 10.1007/s00192-007-0387-8. Epub 2007 May 22. PMID: 17982711.

Gephart LF, Doersch KM, Reyes M, Kuehl TJ, Danford JM. Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity. Proc (Bayl Univ Med Cent). 2018 Apr 9;31(3):289-293. doi: 10.1080/08998280.2018.1446888. PMID: 29904290; PMCID: PMC5997050.

I have 3 finger diastasis width, what am I supposed to do?

Is there treatment for Diastasis Recti??

Simple Answer…YES

First off, the width of your diastasis recti is not the ONLY component that should be addressed. Don’t freak out if someone tells you that you have a 3 finger separation.  There is HOPE! It is normal to have some diastasis recti during the 3^rd trimester of pregnancy and for 6-12 weeks after pregnancy because your rectus abdominus muscle must separate in order for the belly to expand to make room for a growing baby.  The problem occurs when women do nothing to protect the healing process, they stress it more by doing particular movements too soon, they never retrain their core, pelvic floor, and posterior chain correctly, or there were imbalances present prior to pregnancy that could have contributed to the current issues. It is also important to recognize that during pregnancy we need to be smart with our training to not overload the rectus abdominus and pelvic floor and modify movements appropriately.

Trained health professionals, especially pelvic floor physical therapists, can be trained to assess width, depth, breathing, core control, the posterior chain, pelvic floor coordination AND load transfer testing.  We should check basics but BUILD on them.  A health care professional that knows how to treat diastasis recti SHOULD be looking at all of these components.

So what matters most?

All matter because they all are linked together. How you stand and sit aka posture all affect how your diastasis recti can heal or not heal. Your shoulder, ribs, hips and back positioning all affect your core and your pelvic floor. If you have a muscular imbalance in any of these places, it can create abnormal stress on the trying to heal diastasis recti. For example, a rib flare can create more tension on the abdominal muscles, low back and shoulder. Or a hip that is “tighter” than another can causing more pulling through the core muscles and back if the person is a runner and they do not have equal hip extension motion.  Even walking can place more stress on a DR if a patient has poor coordination and body awareness.

So what are some ways to protect the diastasis recti or help with healing?

–          Retrain OR learn how to engage your whole core including lower core including transverse abdominus, obliques and understand when you are using a rectus dominant pattern

–          Strengthening all the muscles of the core starting with gentle movements showing you can control basics and build on it

–          Typically no full sit ups right away (you can eventually get back to these) or planks but it depends on the patient. I have some patients I allow to do these earlier or immediately with assistance because they actually can engage everything correctly and they are not bearing down or out and they can control the #coning.

–          Strengthening everything around the core

–          Make sure you are breathing correctly

–          Correct poor posture

–          Not jumping back into front loaded exercises like push ups, planks, ski erg, pulls ups, toes to bar, or muscle ups too quickly or without being assessed first

–          Correcting baby holding mechanics

–          Understanding how to contract and relax core through various movements including rotational movements, dumbbell and barbell movements

–          Having a pelvic floor physical therapist that understands and treats diastasis recti help evaluate you, find the source or cause of non healing diastasis recti and guide you along the way to recovery.

– Work with a trained professional during your pregnancy to prevent overloading the rectus and worsening diastasis postpartum.

Just understand it is not the end of the world if you have some “separation” and lots of other assessments should be performed before you freak out OR go back to particular movements too quickly if you are unsure. Don’t be scared to move or fear all these movements.

Seek correct and proper guidance to get you back to doing what you love.

Got more questions?  We love helping our pregnant and postpartum athletes train smart before, during and after pregnancy. Call or text to schedule an appointment.  980-221-9687

photo credit: http://www.vibrant-photography.com/

#diastasis #diastasisrecti #postpartum #postpartumcare #postpartumfitness #crossfit #burnbootcamp #postnatalfitness #fitmoms #momfitness #postnatalcare #pelvichealth

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 1^st 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:

-running

-jumping

-includes box jumps, jumping rope, jumping jacks..ANY jumping

-kipping or butterfly pull ups

-sit 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

-heavy lifting

-front planks (depending on the patient)

-handstand push ups without controlled descent

-snatches

-muscle ups

-tumbling

Please understand this list is not all inclusive and each person may have greater restrictions.

Be safe. Train Smart. It will be worth it

-Dr. Jenn

#postpartumfitnesss #postpartumrecovery #diastasisrecti #postpartumrestrictions #postpartumrehab #pelvicfloor #pelvicfloorPT #PFPT #concord #charlotte

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279110/

https://www.sciencedirect.com/science/article/pii/S0161475410001211