During the postnatal period the body undergoes a number of changes. Generally speaking, the guidelines for return to exercise are derived from from tissue healing timeframes. It takes approximately 6 to 8 weeks for tissue healing and this is one of the reasons for a 6-week check with a GP. Throw in an array of hormones, sleep deprivation and a shock to the system in terms of life adjustment, and this period of time can vary wildly.
Directly after the birth I normally advise to commence pelvic floor and lower tummy squeezes within a day or two (as pain allows and after the catheter is removed). Then mothers can slowly progress their pelvic floor muscle training and add in a graded walking program and functional exercises. After all most mothers are carrying a 3-5kg baby strapped to them most of the day so they may as well practice how to do it properly!
At 6-8 weeks, after a GP check I advise all new (and old!) mothers to complete a postnatal MOT. This involves assessment of the pelvis and lumbar spine, which takes a lot of stress in pregnancy, and the tummy muscles and pelvic floor. Real time ultrasound can be used to assess the abdominal wall and pelvic floor, as well as an internal pelvic floor examination to assess muscle function and injury. Following this comprehensive assessment an individualised recovery plan is discussed.
At 6-8 weeks, after a postnatal MOT, individualised advice is given for return to low to moderate intensity exercise such as walking, cycling, cross trainer, swimming, light weights, Pilates, yoga. Spin classes and swimming are a great way to increase the heart rate without putting strain on the pelvic floor. I recommend Pilates because it teaches stability through movement and correct posture. Pregnancy places lots of strain on the body so clinical Pilates can be used a as a tool to rehabilitate the pelvic floor, back issues and tummy muscles after your delivery. Weights should be kept around the weight of your baby and progressed slowly. At 12-16 weeks (and some recent evidence argues up to 6 months) dependent on each individual’s symptoms and assessment they can return to higher intensity exercise such as running, HIIT training, heavier weights.
It is important that each form of exercise is begun slowly and gradually progressed to avoid injury and allow for tissue remodelling and tolerance. Following guidelines also helps reduce risk of pelvic floor issues such as leakage and prolapse.
If you are unsure about returning to exercise or would like to receive bespoke advice and assessment please get in touch with our Women’s Health team in Wimbledon or Hampstead.
Written by Jessica Kostos, the Clinical Lead of Women’s Health at APPI Clinic in Wimbledon.