Do you really have to wait until your 6-week follow up to return to exercise postpartum?
Most of the time when you think of returning to any form of exercise postpartum the 6-week mark comes to mind. Many women believe they have to wait until the “all clear” from their OB or midwife before returning to exercise. However, what many women do not realize is that there is a DIFFERENCE between your 6-week medical clearance and musculoskeletal clearance! More on this later! I am excited to let you know there are exercises that ARE safe to initiate in the first 6-weeks if you take your time, have proper guidance, and listen to your body. This can improve your overall recovery!
After reading this post, you should be able to determine:
1. How you may know if you are able to initiate exercise earlier than 6 weeks.
2. Warning signs to look out for!
3. What are the intentions of each week and WHY? We will use the word intentions for each week vs goals because mom-ing is HARD! I do not want you to feel like you are failing if you do not meet a “goal”. Go at your own pace!
4. Reference Instagram posts where you can find specific exercises by week for vaginal delivery! Cesarean Delivery (coming soon!!)
Disclaimer: Although I am a doctor of physical therapy, I am not your doctor. This information is for informational purposes only and should not substitute the advice from your healthcare professional. Various kinds of exercise can be potentially dangerous, and those that do not seek guidance appropriately assume the liability for any injury that may occur.
Again, it is always good to communicate with your medical providers before starting any exercise postpartum however, your providers should include a PELVIC FLOOR, PHYSICAL THERAPIST!
So what is the difference between medical clearance and musculoskeletal clearance?
Medical Clearance, which you will likely receive between 4-6 weeks with your OB or midwife includes:
- Checking your uterus and cervix to make sure they are back to normal size - Checking vaginal tearing, episiotomy incision, or surgical scar for healing or any signs of infection
- Postpartum Depression Screening
- Birth Control Plans
Your OB or midwife does NOT usually check your pelvic floor integrity, strength or coordination nor do they usually check for prolapse under varying positions such as lying, standing, squatting, hip hinge, etc.
Musculoskeletal Clearance is performed by a Physical Therapist who specializes in Pelvic Health:
-Detailed history of the birth story
-Current symptoms
-Full musculoskeletal assessment to include:
-Postural assessment
-Functional movement assessment
-Orthopedic assessment
-Abdominal assessment
-Pelvic floor internal/ external assessment this MAY include a standing pelvic floor assessment depending on symptoms
-Patient Education
-Treatment & Home Exercise Program
-Plan
You CAN see a pelvic floor physical therapist PRIOR to your 6-week follow-up!
First, some considerations to have when returning to exercise are what type of delivery did you have? Was it vaginal or cesarean? Did you have any tearing? Were there any complications?
Secondly,
1. Were you active pre-pregnancy?
2. Did you maintain some activity level during pregnancy?
3. Did you see a pelvic floor PT prior to delivery?
4. Did you have an uncomplicated delivery?
One thing to remember is EVERYONE’s postpartum recovery is different. You may be ready within the first week for the GENTLE exercise or you may need more time. Listening to your body is the number one thing to always remember!
Signs that you are exercising too soon or doing TOO much are:
- Delayed wound healing
- Increased bleeding or clotting
- Increased pain
- Increase in symptoms such as heaviness, urinary incontinence, fecal incontinence, urgency, pain, etc.
According to The American College of Obstetricians and Gynecologists (ACOG), if you have a healthy pregnancy and normal vaginal delivery, it is safe to begin exercises a few days after giving birth!
So let's start with WEEK ONE: ( Again, this is for a vaginal birth. We will discuss cesarean recovery in another post.)
This week is for recovery and rest. These exercises are specific to aid in that recovery! You may have experienced tearing or an episiotomy. We want to prevent any stress in the area.
All exercises should be performed in bed, as it is not suggested to get on and off the floor just yet!
Our intentions for WEEK ONE
1. Very short walks in the home—STOP, if you have symptoms.
2. Diaphragmatic breathing
3. Gently try to isolate or contract your lower abdominals
4. Gentle initiation of pelvic floor contraction or kegel—We want to make sure that we are not contracting anything but your pelvic floor. SO, you should NOT feel or see your glutes, thigh muscle, or abdominals contracting.
5. Gentle thoracic mobility to help with any back discomfort with nursing and/or feeding Visit: @drkatesmith_pfdoc for more information and exercises.
With pregnancy, there are MANY changes that occur in our bodies. It is important to lay the foundation of breathwork & diaphragmatic breathing FIRST! WHY?
When you INHALE your pelvic floor relaxes, when you EXHALE your pelvic floor contracts. This will promote recovery of your pelvic floor muscles, decrease potential swelling, promote pelvic floor length, strength, and coordination, promote proper activation of abdominals and decrease rib angle. ALL necessary for the prevention of pain and symptoms for return to exercise!
WEEK TWO
We still want to stick with completing exercises in bed to prevent getting on and off the ground.
Week TWO is continued rest, recovery, and bonding time with your little one but with our intentions to…
1. Progress mobility
2. Continue breathwork
3. Continue gentle activation of core
4. Initiate gluteal strengthening for return to exercise postpartum!
Visit: @drkatesmith_pfdoc for more information and exercises.
Yes, we want to gradually start to strengthen those glutes as mom butt is a real thing! (personal opinion). However, one thing to be mindful of is to NOT clench your glutes when performing any small/light activities around the house. This can lead to more tension. I know from personal experience this is VERY common to do when healing from a perineal tear. Your body naturally
wants to protect the area. This can not only lead to more tension in your glutes but in your pelvic floor too, leading to symptoms.
WEEK THREE
OK. Now we are starting to move around a little bit more. You may venture down to the ground or you may not. I would highly suggest you have something near you for support such as a chair, automan, or couch!
Our intentions:
1. Progress mobility
2. Progress core and glute strengthening
3. Gradually start to incorporate a little more stretching!
Visit: @drkatesmith_pfdoc for more information and exercises.
WHY are we stretching? As mentioned above, early postpartum our bodies tend to want to guard in response to injury such as gluteal clenching. Childbirth is a significant athletic/orthopedic event that can be traumatic both physically and mentally. So, we want to start to initiate gentle stretching to decrease tension but also still protect any suture sites if perineal tearing or episiotomy occurred!
WEEK FOUR
Mobility should be starting to improve as healing continues to occur. You may be feeling a little more confident with moving around the house!
Our intentions:
1. Progress mobility
2. Progress core and glute strengthening
3. Initiate asymmetrical movements
4. Initiate functional movements
5. Initiate a wider range of hip mobility!
Visit: @drkatesmith_pfdoc for more information and exercises.
WHY? As new moms, we have to navigate how to keep baby calm and/or entertained but also get sh*t done! This is where it is important to start to train in asymmetrical patterns. For example, as your baby grows you will need to manage to pick up the baby and car seat with one side or arm, navigate getting dinner ready while your baby is on the other, or attempt to bend to lift an object off the ground with your baby in the other!
WEEK FIVE
Our intentions: Continued progression of asymmetrical and functional movements, mobility/ stretching, and strengthening!
Visit: @drkatesmith_pfdoc for more information and exercises.
WHY? Again, we need to be able to squat, lift, and maneuver objects while holding onto our little ones as they grow!
WEEK SIX
Our intentions: Continuing to build on the weeks prior.
Visit: @drkatesmith_pfdoc for more information and exercises.
This week you are likely going for your 6-week follow-up with your OB or midwife. This is where you will receive the medical clearance we discussed above. Hopefully, perineal healing has completely occurred and the sutures have dissolved.
Something to consider, just because you may be “all cleared” to resume sex and pre-pregnancy exercise, this does NOT mean your body is ready!
6-weeks is an ideal time to receive a Pelvic Floor Physical Therapy evaluation to determine where your body is at from a musculoskeletal standpoint to assist with progress toward your pre-pregnancy exercise routine without risk of injury!
https://www.acog.org/womens-health/faqs/exercise-after-pregnancy
