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:
-heaviness in pelvic floor area
-abdominal muscle cramping
-pelvic floor muscle cramping
-feces leakage or difficult holding back gas
-low back pain
-soreness that last longer than 2-3 days
-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.
-Ab mat sit ups
-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.
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