Postpartum Exercise - Is It Working For You or Against You?
So you just had a baby, made it through your six-week checkup, and you're ready to get back to feeling like yourself again.
You couldn't run for months, weren’t able to do yoga inversions and stopped doing crunches and ab workouts the entire time you had a bump. You're more than ready to get back into the swing of things, so you put your workout clothes on and sneak away to the living room while the baby is napping. You pop open an old workout that you used to do before you got pregnant and think "well I've done this before and it's my favorite so I'll start here."
Once you start moving, you quickly realize that things are not how they used to be. Your body feels completely different, you can't tell if your abs are doing anything at all and you can barely get through a set of 10 squats without feeling sore. What the heck happened?! Instead of feeling like you're back to your old self, you're just more frustrated and confused.
I'm going to let you in on a little secret - you're not supposed to "bounceback" right away when you get back to working out. It took 9+ months for your body to change to grow your baby. It's not going to immediately come back together at 6 weeks.
What you are supposed to do is take action that is appropriate for where you are. There's different phases of postpartum rehab. Figure out where you are and learn how to progress your program so you can finally get back to your old self.
Phase 1 - Flexibility / Relaxation
You can be in this phase if you just had your baby a few weeks ago or even a few months ago! You're ready to get back to exercise, but you're not sure where to start. Or maybe you went back to exercise, but everything felt completely off and you want to be more mindful.
Things to do in this phase:
See a pelvic floor therapist ASAP - in person or virtual
Begin your pelvic floor rehabilitation program
Diaphragmatic breathing 5 minutes twice daily
Gentle core activation exercises coordinated with your breathing
Stretches to relax your hips, low back and pelvic floor
Take walks - start short, about 10-15 minutes at a time, and increase as you feel comfortable
Self-massage to pelvic floor
If you don’t take your time on this phase, it could lead to pelvic pain, pain with sex, urinary incontinence or prolapse. A lot of times these symptoms don't show up right away, but they can once you start to get more active.
Spend at least 1 week just focusing on the things above before moving on. If you feel like you need more time here, give that to yourself.
Phase 2 - Coordination
After spending a week or so working on relaxation and flexibility, you're ready to take things to the next level. This is the phase where you’ll work on improving the relationship of your pelvic floor and core. You’ll introduce kegel exercises in this phase (if needed).
Things to do in this phase:
Continue diaphragmatic breathing
Gentle core exercises where you are activating your core and moving your arms and legs to challenge stability
Such as supine marches, toe taps, dead bug variations
Increase difficulty of gentle mobility exercises (things like cat-cow, bridges) paired with your breathing
*Kegel exercises - teach your body how to contract and relax the muscles in coordination with your breathing
*Do NOT do kegel exercises if you have pelvic pain, pain with sex, or pain in your vagina, back, pelvis or hips. See a pelvic PT instead.
Things NOT to do in this phase:
Abdominal crunches - it puts a lot of pressure on the pelvic floor and we want to give the pelvic floor more time to build strength.
Very challenging abdominal work - if you go full steam ahead and push through a super hard core workout, most likely your deep core and pelvic floor will not be along for the ride. Use this phase to make sure your pelvic floor is ready to take on more challenge.
Phase 3 - Strength
Now that you know your pelvic floor is flexible and coordinated, it's time to strengthen the pelvic floor. The best way to do this is by strengthening the entire body. Time to get back to your favorite workouts! Let's see how we can do that mindfully.
Things to do in this phase:
Increase the length of time you are contracting for your kegel exercises - IF you need to be working on strength of pelvic floor and don’t have any pain or tightness in the muscles
Resistance training - start with bodyweight exercises for a few sessions before adding any weight
Focus on functional movements - squats, deadlifts, split squats, hip thrusts - paired with breathing
Start with 8-10 reps of each strength exercises for 1-2 sets, and then build up. Remember - you have never worked out in this body after baby and don't know how your body will respond. It's better to have a light day and build up rather than overdo it and have to scale back.
Things NOT to do in this phase:
Jumping
Running
Hopping
Burpees
Cardio / HIIT workouts
You can resume some of your old workouts at this point but keep both feet on the ground at all times. If your goal is to continue strength training and 20-30 minute workouts are what you’re aiming for, that is great! You’ve reached your finish line. Continue to focus on functional movements and be mindful of your breathing. In order to keep building strength, make sure your workouts leave you feeling a little bit fatigued or a little bit sore and you’ll know you’re at the right level.
Phase 4 - Endurance
You're in this phase once you're able to do a strength workout for about 15-20 minutes with no issues and your goal is to workout for longer periods of time. In this phase, you’re going to do exactly what you did in phase 3, just more sets, more reps or more exercises for a longer period of time.
Things to do in this phase:
Start increasing the length of time you are working out. It may be best to do this by increasing the number of sets / reps you’re doing of each exercise.
If you’re following apps or programs, choose slightly longer workouts or double up on two shorter ones.
Assess readiness for return to running - Your physical therapist will take you through a number of assessments to see if you are ready to get back to running. All the work you’ve done up until this point will set you up for success!
Phase 5 - Power
The phase that a lot of people want to get to - return to running and HIIT workouts! This is a phase that will be highly specific based on the individual. If you haven't worked with a pelvic floor therapist or a perinatal-trained fitness coach, now is the perfect time.
Things to do in this phase:
HIIT workouts
Jumping - jumping jacks, jump squats, switch lunges, etc.
Return to running
Here are some general guidelines for returning to running.
First make sure you have assessed if your body is ready for this challenge.
Start with a short run, about 10-20 minutes, alternating between running and walking. This will get your pelvic floor primed for running, but also give it some rest with walking in between. If this feels good, stick with it for a while.
For example: start with 1 min run : 1-2 min walk. Over time, increase the amount of time you’re running by 1 minute until you’re up to 10 min run : 1-2 min walk
Continue increasing the amount of time you’re running. If you’re comfortable with skipping the walking, then you can leave that out.
Notes: If you're training for a race or an event, please work with a professional. If you notice any urine or bowel leakage or pelvic pain / pressure / heaviness then stop. These are signs of overload on your pelvic floor.
What to do when things don't go according to plan?
One of the best things about postpartum exercise is you can do so much at home without needing a lot of equipment or access to a gym. However, that is also one of the most challenging things because you aren't going to a class or working with someone who can give you specific cues for your form.
If you begin returning to exercise and develop a new onset of pelvic pain, vaginal pain, urinary or bowel incontinence, pressure or heaviness in your vagina indicative or prolapse, scale back. Go back to phases 1-3 and be very mindful of your core activation and breathing mechanics. Continue exercising, but take some load off and make the workouts shorter.
You know what else I'll tell you too... see a pelvic floor therapist! Gosh I'm a broken record - I know y'all get the point 🙂
- Dr. Mar
P.S. I’ll be posting a guideline for postpartum exercise very soon with more specific examples of what to do in those early weeks. Be the first to know!