Returning to sport and exercise following childbirth
Maybe you were a keen sportsperson before the birth of your baby or maybe you feel you need to do some exercise to return to pre-pregnancy strength and fitness. Either way, there are a few things for women to consider when returning to sport or exercise after childbirth. Some of these points will be relevant whether it is two weeks or two years since the birth.
The muscles and joints of the body adapt to the growth of the baby during pregnancy and delivery of the baby and do not immediately “bounce back” to normal. In particular, these are:
- Posture, pelvis alignment and stability
- The pelvic floor muscles
- Weakness or separation of the abdominals
Posture; Lower back and pelvis alignment and stability
During pregnancy there is a change in the hormones to allow the joints in the lower back and pelvis to stretch to accommodate the growth of the baby. There will also be changes to posture that occur slowly during pregnancy and then a more sudden adaptation once the baby is born. In addition to extra flexibility of the joints, the abdominal and pelvic floor muscles will have stretched during pregnancy or delivery and may have reduced strength. This may mean your joints cannot cope with high impact loads such as running or jumping during this time.
During pregnancy or delivery there may be a subtle change in the position and control of the pelvis that does not always “bounce back” once the baby is born. This is commonly noticed at the pubic symphysis (in the front of the pelvis) or the sacro-iliac joints (just under the “dimples” in the low back) and may cause pain in these locations.
Signs of a problem will be pain in the lower back, groin or hip, or a feeling of unsteadiness when standing on one leg. All our physios at Total Physio are trained in assessing pelvic function and can check this for you.
Figure 1: Postural changes during pregnancy.
The abdominal muscles obviously need to stretch during pregnancy. This means they will have less strength and will be offering less support to the lower back and pelvis. While strength will return with time it is helpful to exercise these muscles specifically before returning to sport or more vigorous exercise to prevent injury.
Abdominal muscle strength and separation
Some women will develop a separation between the two parts of the most superficial abdominal muscle – rectus abdominis. If this is the case, it is important that the deeper abdominal muscles are working correctly to stabilise the lower back and pelvis. At Total Physio we can use the real time ultrasound to visualise the muscles and show you the most suitable exercises to begin with at home.
Figure 2: Separation of the Rectus Abdominis as the abdomen expands.
Pelvic floor muscles
The pelvic floor muscles are important in supporting the pelvic organs (bladder, uterus and bowel) as well as preventing any leakage of urine when there is downward pressure on the bladder (e.g. with coughing, running, jumping). These muscles will often be weaker after childbirth even if there are no symptoms. Resuming high impact exercise before these muscles have recovered their strength can then cause problems.
Total physiotherapists Louise Henderson, Rebecca Rutherford and Laura Wickens are trained in the assessment and retraining of pelvic floor muscles.
So, where to start:
- Specific strengthening for abdominals and pelvic floor – a few minutes of exercise a day at home. Home exercises can begin in the first week or so following the birth. After a caesarean delivery you should check with your obstetrician – basic exercises are usually allowed. You may have been shown some exercises whilst in the hospital or the physios at Total Physiotherapy can provide a home program.
- Start with lower impact exercise for fitness (e.g. brisk walk, cycle, swim – after bleeding has stopped, or light weights at the gym). These forms of exercise can be begun as soon as you feel comfortable.
- It is usually recommended to wait until you have had a 6-week check-up with your obstetrician or midwife before commencing a structured post-natal exercise class. You may like to try some one-on-one mat Pilates sessions at Total Physiotherapy with a trained Pilates physio as a starting point.
- Wait until at least 8-12 weeks before introducing higher impact exercise (e.g. running, sports with jumping, or quick changes of direction).
Other factors to consider:
- Fatigue – looking after a new baby can be very tiring so listen to your body and don’t push too hard with exercise if you are generally fatigued.
- Hydration and nutrition – especially if you are breast-feeding. Keep in mind that you may need to drink more and ensure you are eating healthily when you resume exercise.
- Pre-pregnancy fitness – if you had a high level of fitness prior to pregnancy and kept up some exercise during pregnancy your fitness will return more quickly. It is still important to ease into exercise gradually, particularly with regard to the pelvic floor.
By Louise Henderson, with thanks to Margo Joyner (ante-natal educator and post-natal pilates physio at RNSH).