One of the most frequent questions I get asked by new mums is “when can I start exercising?” After having a baby, it’s normal to want to get back to feeling like the “old you”, lose some baby weight and release those happy endorphins that we know exercise can do. Returning to exercise postnatally is incredibly important for the mother’s health and wellbeing and therefore the baby’s. However, it is essential that it is done sensibly and with the mother’s physical recovery in mind.
For most women, after their six-week check is the time they get the go a head to start exercising. A good place to start is with walking. This is natural movement that is of enormous benefit to the pelvic floor and other joints. Make sure shoes are flat and supportive and that the intensity, speed and distance walked are increased gradually.
A good guide to how hard you should be exercising at this stage is to keep an eye on your breathing. You should not be too out of breath to be able to still hold a conversation whilst exercising. Correct breathing control is vital for ensuring there is synergy between the abdominals, diaphragm and pelvic floor muscles which you need to exercise safely.
Other options for exercise in this early period could include a postnatal Pilates or yoga class or other programmes run by fitness professionals with a postnatal qualification.
It is always a good idea to get checked out by a specialist physiotherapist before returning to exercise. They will be able to give you personal advice about returning to exercise safely and may pick up things you hadn’t noticed, like specific muscles that you need to strengthen which will help you. However, if you have any concerns that your physical recovery has not been straight forward it is essential you are assessed before you start exercising. Symptoms like urinary or faecal incontinence, pain in the pelvis or low back and a heaviness or dragging feeling can all be caused by a pelvic floor dysfunction which exercising incorrectly could make worse.
Following your assessment, the physiotherapist will be able to advise you what is causing your symptoms and start you on a program of rehabilitation to help resolve them, as well as recommending how you can safely start to exercise in the meantime. They can then guide you safely through increasing your activity levels through to reaching your exercise goals.
Running and high impact exercise are associated with an increase in intra-abdominal pressure and ground reaction forces that may be transmitted through and need to be absorbed by the pelvic floor. If these muscles have not recovered from pregnancy and birth and remain weak, overactive or un coordinated, they may not be able to cope with the added pressure of running or jumping. This pressure may then cause leaking, pain or worsen a prolapse. It is essential that the pelvic floor muscles are functioning at good levels of strength and control before they are subjected to increased impact (Leitner et al 2016). As well as assessing the function of the pelvic floor muscles, a physiotherapist will also look at other areas that support them, for example, core muscle function, hip and foot biomechanics. The pelvic floor does not work in isolation and so it is not uncommon to need to do hip strengthening and even foot exercises to help improve a dysfunction.
In March 2019 new guidelines were published for returning to running in the postnatal period. They recommend that new mums can start a phased return to running between 3-6 months at the earliest and dependant on them having any symptoms of pelvic floor dysfunction. They also recommend that every woman receives a specialist physiotherapy assessment including vaginal examination before returning. The guidelines can be found on the Running Physio website.
A good phased return to running plan is the NHS Couch to 5k.
If you have had a caesarean section, it is important that how the scar has healed is considered. Usually we assume that by 6 weeks the tissues have healed however, some studies have shown the it can take 6-7 months for the abdominal tissue to regain the majority of its tensile strength (Ceydeli et al 2005). Again, your physiotherapist can assess how your scar has healed and advise accordingly.
Whilst breastfeeding there remains slightly higher levels of the hormone Relaxin in the mothers’ blood. Theoretically this can put women at risk of joint laxity and a higher risk of injury whilst exercising. Extra care should be taken if you know you are hypermobile or experience any ongoing joint pain. Breastfeeding most definitely should not stop you exercising but there are a few points to consider. Ensure you are always properly hydrated, time exercise around feeds so that the breasts are not painful, gradually increase the intensity to stop your supply being affected and wear a supportive, well fitting bra.
If you have any questions about returning to exercise after having a baby, or you’d like some help, get in touch for a chat info@themummyhub.com.
