In the early postpartum period, your body absolutely deserves some TLC. Whether you delivered via cesarean birth or vaginally, growing, delivering, and caring for a newborn is really hard work. But what happens when you want to exercise again?
Do a quick google search of postpartum exercise. “Listen to your body”, “Give it time”, “Take it slow”; all great pieces of advice, but as a physical therapist who works with postpartum women daily, I have found that women want more specifics on how and when they can start exercising again.
I’ve compiled and summarized a few expert resources on exercise in the postpartum period to answer those questions.
In July, The New York Times published “How to start exercising after giving birth.”
When to start exercising?
According to Dr. Raul Artal MD and Susan Clinton PT, women can hypothetically begin very gentle exercise the day after an uncomplicated vaginal delivery if they feel up to it and their medical provider is on board. A cesarean birth is major surgery and warrants greater healing time. A time frame of eight to ten weeks of healing is more appropriate for those who delivered via cesarean. Always talk to your medical provider before starting an exercise routine
What can I start with?
Author Jessica Grose recommends building up to walking thirty minutes per day to begin based on the experts she has interviewed. If thirty minutes in one stretch is too difficult, start by breaking walking up into manageable chunks of time like 10 minutes.
Marianne Ryan PT emphasizes exhaling on exertion to protect and build your core with daily activity. Incorporate the breath work into daily activities. Susan Clinton PT points out that running after toddlers, lifting, carrying, and squatting to pick up toys are all small bouts of exercise.
Ready to start some breath work? Check out our youtube video for the umbrella breathing exercise https://www.youtube.com/watch?v=adpNszStrQo.
Pelvic Floor Physical Therapy
As a pelvic PT, I loved this article because it said more than just “listen to your body”. It pointed out specific signs of pelvic floor dysfunction to watch out for.
If you experience leakage of urine or feces during exercise, it’s time to hit the pause button. Leakage is never normal.
A heaviness/pressure in the pelvis or feeling/ seeing that your organs are bulging from the vagina is a sign of pelvic organ prolapse. Prolapse is decent of one or more of the organs in the pelvis.
If your exercise is causing pain in the hips, sacroiliac (SI) joint, low back, or tailbone, your core and pelvic floor may not be prepared to meet the demands of exercise quite yet.
The conditions above can worsen over time and if left untreated. Seek the help and guidance of a pelvic floor physical therapist as you transition back into exercise.
The Jump Test
Marianne Ryan PT recommends a “jump test” to determine readiness to start running again.
To perform the test, stand with feet hip width distance apart. Jump 20 times consecutively and then cough four times. Look for the above signs of pelvic floor dysfunction. No leakage or pelvic pressure? You are in the clear to initiate running according to Ryan (Grose, 2019).
Back in March, Tom Goom, Emma Brockwell, and Grainne Donnelly (all physiotherapists) published “Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population”
For all medical professionals reading, I highly recommend looking at the extensive guidelines. Link is here: https://www.running-physio.com/postnatal-guide/
The authors recommend sticking to low impact exercise for the first three months after delivery at a minimum. During this period “every postnatal mother, regardless of delivery mode, should be offered the opportunity to receive a pelvic health assessment (from 6-weeks postnatal) with a specialist physiotherapist to comprehensively assess the abdominal wall and pelvic floor” (Goom, Donnelly, Brockwell, 2019).
Like the Times article, any sign of pelvic floor dysfunction warrants a visit to a pelvic health specialist before proceeding.
Load Impact test
Goom, Donnelly, and Brockwell have created a series of tests to determine readiness to run. To “pass” this assessment, all movements should be completed sans leakage, heaviness, pressure, or pain.
Walking 30 minutes
Single leg balance 10 seconds
Single leg squat 10 repetitions each side
Jog on the spot 1 minute
Forward bounds 10 repetitions
Hop in place 10 repetitions each leg
Single leg ‘running man’: opposite arm and hip flexion/extension (bent knee) 10 repetitions each side
A strong trunk and legs are necessary for a successful return to running. Aim for 20 repetitions/side with good form of each of the following exercises. Have your physical therapist or fitness professional watch your form during each exercise.
Single leg calf raise
Single leg bridge
Single leg sit to stand
Side lying abduction
Some key points
Diastasis Recti (DRA)
DRA is a widening of the connective tissue (linea alba) that joins both sides of midline abdominals (rectus abdominus muscles). This changes the way your core muscles fire. Your pelvic floor can easily become overworked by compensating for the lack of stability in the abdominal wall. A physical therapist experienced in rehabilitation of DRA can help you retrain your core to stabilize properly so you can decrease your risk for injury running.
Lack of sleep has been proven to increase injury risk. How many new moms get their 7-9 hours per evening? If you’re serious about returning to exercise start by prioritizing sleep.
Moderate to vigorous exercise does not affect milk supply and quality (Cary and Quinn 2001; Davies et al. 2003; ACOG 2015). While breastfeeding, your running routine will need some modification. Avoid backache and discomfort by timing feeding with runs (Goom, Donnelly, and Brockwell, 2019).
Now let’s say you’ve “passed” some of the screens and are ready to start running or exercising.
Where to begin?
Below I’ve provided links and information to just a few of my favorite resources.
Postpartum return to running program
Emily Bliss PT, DPT created mums on the run, a community for new moms who want to run safely and a forum for questions and support. She created a free return to running sample program for new moms that can be found here https://www.mumsontherunusa.com/coaching. In addition, she also offers private run coaching through her website https://www.mumsontherunusa.com/. You can find her on instagram @mumsontherunusa.
Pelvic floor friendly fitness
Brianne Grogan PT, DPT is the leader of Fem Fusion Fitness. She has an extensive youtube channel with fitness videos that bring pelvic health front and center. Her routines range from prolapse friendly series to relaxation based routines all for free. You can find her at https://www.youtube.com/user/femfusionfitness/featured and @femfusionfitness on instagram.
Yoga for everyone
Dustienne Miller CYT, PT, MS, WCS founded your pace yoga. She combines her expertise in pelvic floor and yoga background and offers a range of yoga videos targeting pelvic floor dysfunction. Her website is https://yourpaceyoga.com/ and she is on instagram as @yourpaceyoga.
How to crossfit while keeping your pelvic floor safe
Kailie Denham PT, DPT is a pelvic PT and crossfitting mom. You can find her on instagram @herphysicaltherapy. Kailie is very active on social media and frequently posts modifications and videos for different movements you are likely to encounter in crossfit.
Postpartum life can be equally as stressful as rewarding at times. Exercise can be a wonderful way to prioritize your health and wellness, but can be intimidating as a new mom. A trained pelvic floor physical therapist can help you safely return to exercise.
For more information on our postpartum services visit us at hudsonvalleypt.com or call 914 831 9575.
-Megan Fosko PT, DPT
ACOG (2002) Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 99(1), 171–173.
Cary, G.B. and Quinn, T.J. (2001) Exercise and lactation are they compatible? Can J App Physio 26, 55-75.
Davies G., Wolfe L., Mottola M. and MacKinnon C. (2003) Joint SOGC/CSEP Clinical Practice Guideline: Exercise in pregnancy and the postpartum period. Can J Appl Physiol 28(3), 330–341.
Goom, T., Donnelly, G., Brockwell, E. (2019) Returning to running postnatal – guidelines for medical, health, and fitness professionals managing this population.
Grose, Jessica. (2019). How to start exercising after giving birth.” The New York Times Parenting.