Physical Therapy serving the Los Angeles Area
© Rehab Specialists Inc.

Post-Baby Body Blog Part 2 (Post-Partum Exercise)

Congratulations! You had a baby! 

You grew a human being in your body and then it came out of your body.  You are magnificent and extraordinary.  You are a WARRIOR WOMAN.

So – now you are ready to learn about post-partum exercise.  Hopefully you are aware that jumping right back into your normal pre-baby fitness routine is not recommended.  I’d like to start by telling you my story and then get into some basic rules for safety that can help you return to exercise with confidence.  Finally, I will give you a generic routine that you can start RIGHT NOW (if you want to!) that is safe and vetted by myself and many of my patients.

After having my baby, I remember getting the “go-head” from my OBGYN at the 6-week check-up for exercise and sex.  After weeks of watching my body atrophy from not leaving the bed for anything non-baby related and eating ice cream on the daily, I left the clinic feeling motivated.  I was anxious to return to some semblance of a workout routine.  I could feel my thighs rubbing together when I walked which was a sure-tale sign that I was not where I wanted to be.  

Now, two years later, I am running 20-25 miles per week, hitting the gym for weight and resistance training and having zero leakage/pain/discomfort/and complete recovery from my Diastasis Recti (don’t know what that is? See Blog Part 1).   Keep in mind- this was after a traumatic 36-hour vaginal delivery with an episiotomy, post-partum pre-eclampsia, two prolapses, three finger width abdominal separation, and rectal/urinary incontinence!  Not only am I giving you this advice from the perspective of a pelvic/pre & post-partum physical therapist but also as a mother who has BEEN THERE.  I GOT YOU, GIRL!

Here is my list of rules for post-partum exercise

Once you get clearance from your OB, you have stopped passing clots from birth, and have full healing of your C-section scar- you are ready.  And for all you CrossFit junkies – just because you had insane strength during or prior to pregnancy does not mean you are ready to jump back into it.  These rules apply to you too.  Side note- I see a lot of strength builders on Instagram posting insane work out videos days after giving birth.  

Please keep in mind that these women are putting themselves at risk for a lifetime of issues including prolapses, pelvic floor dysfunctions, leakage, and abdominal separation.  It’s just not worth it, ladies.  Let your “fourth trimester” be about getting to know your new bundle- your box jumps are not going anywhere.  You have the rest of your life to compete in marathons and triathlons if you want to.  Right now is not the time to do it.  Also, while exercising please watch out for dizziness, swelling, racing pulse, nausea, fainting/light headedness, headaches, heartburn, vision changes and shortness of breath.  These symptoms are your body telling you it’s time to take a break and follow up with your MD.  

Quick clarification: “post-partum exercise” refers to the period between getting clearance from your OB (usually 6 weeks post-partum) until 24 months post-partum (if you never integrated a fitness routine into your life after having a baby).  If you are 2+ years out from having a baby and do NOT exercise than I would recommend returning to fitness under the direct supervision of a physical therapist or a personal trainer who specializes in post-partum exercise.  Just to reiterate – these rules and exercises apply only to mommies that do not experience any new or pre-existing abdominal, pelvic, or orthopedic dysfunctions and that have exercised consistently prior to being pregnant and giving birth.  If you have never had anyone check your form or are new to exercise in general then find a professional to help you in order to avoid injuries and learned bad habits.

Rules for Post-Partum Exercise:

  1. Start with cardio.  Walk daily – especially in the beginning.  Other forms of low impact cardio including swimming (once C-section scars have healed and you have been cleared by your OB), elliptical, and hiking.  Do NOT start strength training with weights or high impact cardio (running on ground or in place, jumping of any kind, burpees, side-to-side lunges, etc.) until you can walk up a hill pushing a stroller wearing a 15-pound backpack for 45 minutes without leakage or discomfort of any kind. More on this later…
  1. Do not stretch to end-range. Pregnancy hormones (including relaxin, the hormone that makes your joints extra-loose) are still in your body and remain for a full year plus after giving birth.  All stretches should be held for a total of 2 minutes per day (can be broken up into 4 sets of 30 second holds) for 6 weeks to see any change in tissue length1.  
  1.  Avoid crunches to decrease abdominal separation risk.  Even if you do not have abdominal separation immediately after giving birth you are still at risk for it.  I’ve had patients experience abdominal separation months to years after giving birth.  
  1. Breathe correctly… especially while you exercise.  There is a woman named Julie Wiebe who is physical therapy wizard and has fantastic online videos (see link below for a good place to start) that you can watch from the comfort of your own home.  One of the most important aspects of post-partum exercise is learning to integrate correct breathing mechanics as it impacts your pelvic floor, abdominal muscles, and spine, to name a few.  Remember that you should NEVER hold your breath as you exercise.  Keep your diaphragm moving!

 

 

  1. Log roll during transitional movements.  Log rolling (see pics below) can be integrated into the transition from a lying flat to a seated position, as opposed to crunching (which, again, is a big NO-NO).  This can be integrated during pregnancy and during the post-partum period thereafter.  
  1. If you have the luxury of a trainer than pick someone who is specifically trained in post-partum exercise.  There are Pilates and yoga instructors and personal trainers that have additional training and experience with the post-partum community.  If you have a specific issue or dysfunction (pain, leakage, abdominal separation, etc.) than see a physical therapist who is specifically trained in post-partum rehab first before seeing an exercise instructor.  They will get your started on a home program that is safe and specific to your body as it continues to heal, as well as use manual (hands-on) techniques and modalities.  

 

Here is my post-partum fitness guide for healthy mamas.
Again, this is safe for most but not all so if you have any concerns, please get checked out in the clinic first before starting this routine.

1.) Walk consistently.  Start with walking around the block of your neighborhood for fifteen minutes each day – slowing increase by 5-15 minutes each week.  Integrate hills for more challenge.  Goal is 45-60 minutes at least 4-5 times per week.  *Pro-tip: get your little one used to the carrier and/or stroller!  You can breastfeed in most carriers and most likely the rhythm of walking will soothe them right to sleep.  If you bottle feed than that can be done in the stroller.  Get creative with it!  It’s like any routine with a baby- they may not like it right away but after multiple attempts they get used to it… this applies to naps, food, and caregivers by the way!  

Time to brush off that yoga mat… all of these can be done WITH your baby.  Again, it’s a routine you have to establish with them.  I recommend doing this in the morning after breakfast or whenever you both have some energy.

2.) Clamshells: stack the knees and feet in the side-lying position.  Baby can lie next to you. Inhale to begin, now exhale and open your knees without letting your hip rock backwards.  Inhale and bring your knees together; repeat.  Start with 3 sets of 10 and work up to 3 sets of 20.  Progression: same position as clamshells with extended top leg.  Inhale to start, exhale lift foot toward the ceiling.  Make sure top hip is not flexed. Ankle is active.

3.) Squats: begin with feet slightly wider than hip-width distance.  Baby can be on the floor in front of you.  Inhale to start and exhale as you reach your bottom out like you are trying to reach the back sit of a chair and as you stand back up.  If you look down at your knees, they should not reach beyond your toes.  Start with 3 sets of 10 and work up to 3 sets of 20.  Progression: hold baby close to your chest while you squat to add challenge.  

Second Progression: hold baby close to your chest and as you lower down extend your elbows so you are holding baby in front of you on an exhale breath.  Inhale and pause.  Exhale and bring baby into your chest as you rise to standing.  Third progression: repeat second progression but as you stand lift baby up to the ceiling on an exhale breath.

4.) Bridging!  This is one of my FAVORITE post-partum exercises! It is an excellent exercise to strengthen your pelvic floor post delivery, especially for those of us with prolapses.  This benefit is due to the pelvis being in an anti-gravity (or “inverted”) position when you lift your hips to the ceiling.  Start lying flat on your back with knees bent.  

You can put baby next to you on the floor or seated comfortably in the crease of your hips.  Inhale to begin and exhale as you reach your hips toward the ceiling and contract your pelvic floor muscles (kegel) as you lift.  Inhale and lower hips to the floor; repeat.  Start with 3 sets of 10 and work up to 3 sets of 20.  *

*Pro-tip: If you are having a hard time feeling a pelvic floor contraction, try putting a pillow or a medium ball between your legs and squeeze it with your knees as you lift.  You can also try curling your toes as you contract the pelvic floor.  *Pro-tip #2: If you are not 100% clear on how to do a “kegel” than see a pelvic therapist ASAP. 

5.) Forward and Side Planks – Scared? It’s okay! Just start with very short isometric holds. It is important that you are breathing and not holding your breath throughout this exercise.  Try 10 seconds to start and work up to 3 sets of 60-second holds.  Your kiddo will like this one, promise!  

*Pro-tip: If this is still too intense, try planking on forearms and knees.  Once you can hold this position for one-minute try moving to hands and feet.  This is also a good modification for anyone with wrist issues.  Progression for side plank is demonstrated in the picture below.  Make sure your wrists or elbows are directly under your shoulders.

Stretching: these are my GO-TO’s for new mommies.  

Whether breastfeeding or not, you are most likely sitting and holding a baby A LOT.  This wrecks havoc on your posture.  *Pro-tip: boppies are super popular but they are absolutely not ergodynamic. The trick is to put pillows under the boppy so that baby is lifted to the breast (not the other way around).  You should be hands-free with the baby at breast level.

 

1.) Upper trapezius Stretch: bring your ear to your shoulder.  Draw the opposite shoulder to the floor.  Take deep breaths as you feel your muscles melting into this position.  Two sets of one-minute holds on each side.

2.) Levator Stretch: While in the same stretch position listed above, turn your face so that you are looking into your armpit.  Again, draw your shoulder to the floor.  Take deep breaths and perform two sets of one-minute holds on each side.

3.) Rolling shoulders: each direction 20 times.  Can be done throughout your day!

4.) Thoracic Extension: This stretch can be done either sitting in a chair (easy!) or lying on the floor lying over a rolled up beach towel or yoga mat, or foam roller. You can do this stretch at different spots along the spine – move the roll higher and lower to see where it feels best.  Breathe as you feel yourself melting over the roller and perform four sets of 30-second holds.

Hopefully- this helps you mamas out there rocking those BEAUTIFUL post-partum bods. Some days are long, hard, and more exhausting than you could have ever imagined. Some days you will be holding on by a very thin thread. Other days you will feel like the best mother ever to have existed.

You are going through a MASSIVE hormonal shift. Keep in mind that you will feel new and different things every single day. If you find yourself in a serious funk, my last pro-tip is this: go outside. Put that teething, fussy baby in your ergo and go for a walk… don’t bother getting out of your PJs.

The endorphins will do wonders and the change of scenery with a dose of fresh air is usually just what the doctor ordered. And remind yourself that the days are long but the years are short.

 

References

  1. Website: https://www.ncbi.nlm.nih.gov/pubmed/12741862

 

Written by Jessica Hawley-Gamer, PT, DPT ~ heart-led mother, runner/yogi, Pilates instructor, prenatal/postpartum/pelvic physical therapist living in Encino, CA. She can be found on FB at: https://www.facebook.com/ptformoms, on Instagram as: mama_PT, or emailed at: mamaphysicaltherapy@gmail.com. Jessica works for Rehab Specialists Inc. at their Encino clinic.

 

Leave a Reply

Your email address will not be published. Required fields are marked *