If you have recently given birth and are looking to get back into exercise - or start an exercise routine for the first time - you may be looking for guidance. It can be a confusing time, as your body will not react in exactly the same way as it did pre-pregnancy and postpartum exercise can be an intimidating world to wade into.
There is a lot of misinformation surrounding exercise during pregnancy and postpartum.
Studies have shown that even for women who had high fitness levels before pregnancy, getting back to pre-pregnancy fitness levels is hard. As well as physical changes, lifestyle changes such as lack of time for exercising, changes to sleep patterns and negative self-image can contribute to these difficulties.
Guidance for postpartum exercise
There is limited guidance available for postpartum exercise. Part of the reason for this is because it is so individualised, as every person’s body and needs for postpartum exercise are different. Your first step should always be to consult with your GP. At the six week postpartum check up, your doctor will complete a number of checks and this is the time to enquire whether it is safe to return to exercise. The answer will depend on a number of factors, including whether you gave birth vaginally or by caesarean section and the circumstances of the birth. Once you have clearance from your GP, you can begin to delve into exercise after pregnancy and find the program that works best for you.
Increasingly we are realising that a program of postpartum exercises requires a similar amount of consideration and rehabilitation that is needed after ligament, tendon, muscle or bone injury. As a general rule, healthy women can aim to gradually progress to 150-300 minutes of moderate to high intensity exercise each week. Any exercises that are high impact or put gravitational load on the pelvic floor must be introduced gradually.
What to expect postpartum
It will naturally take time for your body to feel the same as it did before pregnancy. Pregnancy causes many changes to the body and tissue healing is particularly affected. Pelvic floor issues are another key area to consider. Up to a third of women experience pelvic floor issues during their life. The pelvic floor muscles sit across the base of your pelvis and hold your bladder, bowel and uterus in position. Signs and symptoms of pelvic floor dysfunction to look out for include:
Leaking with activity, sneezing or coughing
Pelvic organ prolapse (a feeling like something is coming down your vagina)
There are specific pelvic floor exercises that can help alleviate the symptoms. The first step is to activate these muscles regularly with exercises known as ‘kegels’. To activate your pelvic floor muscles:
Visualise where the muscles are located - around your vagina and anus
Squeeze them by imagining you are trying to hold in urine and wind at the same time
Hold the squeeze for 10 seconds, then let go - it is important to feel a full relaxation of the muscles before starting another squeeze
What is diastasis recti?
Diastasis recti happens when the two sides of your recti (or rectus abdominus) muscle move apart and separate during your pregnancy. This is a very normal thing to happen during pregnancy and only becomes a problem if the muscles don’t go back into the correct position after birth. This usually happens about 4 to 8 weeks after you have given birth.
Diastasis recti is also called DRAM, which stands for Diastasis of the Rectus Abdominus Muscle. The reason that this particular muscle separates during pregnancy is because it is two-sided and joined by connective tissue - which naturally softens and moves during pregnancy. Diastasis recti is usually not painful - you may not even know you have it until you are assessed by a health practitioner, such as a doctor, women’s health physio or chiropractor. But over time it can lead to chronic pain in the lower back and pelvis.
Many people assume that abdominal muscle strengthening naturally means sit ups and crunches. However it is important to avoid these exercises if you have diastasis recti. In order to allow your muscles to heal properly. A simple alternative to start with is to lie down on a solid surface and draw your belly button in gently towards your sign. To begin with, hold this for a few seconds, but you can gradually increase the amount of time you hold it for - while breathing normally.
“Whole-systems approach” to guide postpartum exercise
A ‘whole-systems’ approach comes from the idea that understanding someone’s needs in a health care setting is not just about considering biological factors, but also psychological and social factors. At Thrive we take this person-centred approach to develop a plan that will suit your unique circumstances. This includes considering your pregnancy and birth, the emotional impact of pregnancy and the changes to your body, the expectations you have for your body and how it will respond and your family situation.
Other factors to consider include physical deconditioning, changes to you body mass, how well and how much sleep you are getting, whether or not you are breastfeeding, your energy levels, any thyroid or autoimmune issues, any fear of movement you may have, your overall psychological wellbeing and socioeconomic considerations.
Engaging a team of people to help you with postpartum exercise is a great way to ensure you are making use of this whole-systems approach. As well as your GP, a chiropractor and a women’s health physio are useful to have on your team as you find ways to get your body moving in a safe and effective way.
Some women’s health physios in Canberra who can help are:
Can a chiropractor help with diastasis recti?
There are a number of ways that a chiropractor can help with creating a postpartum exercise program that assists with correcting diastasis recti. This can include education on the modification of daily activities that may make the condition worse and advice on activities to avoid. A chiropractor can also help you understand how to engage your deep core muscles, which can strengthen the abdominus recti and the pelvic floor muscles. Exercises to strengthen the core can also be provided, as well as pain relief techniques for those who are suffering from back and / or pelvic pain due to the ongoing effects of diastasis recti.
Contact us or book an appointment at our clinic in Canberra.