I want you to think about something for a moment:
Let's pretend that you have just competed in an extreme sporting event- like an Iron Man or an Ultramarathon (50 miles). You finish and return home only to find out that you have an injury- perhaps a stress fracture or a muscle tear. You're disappointed but the doctor has advised and prescribed rest and rehabilitation. You comply, right? Of course you do. Silly question, hu?
So now, let’s consider what happens to the body during pregnancy, birth, and early postpartum. During pregnancy the abdominal muscles stretch and weaken and the pelvis is drawn forward into an anterior tilt (out of alignment), putting strain on the low back. These actions can weaken the pelvic floor (a sling of muscles running from the pubic bone to the tailbone that help to hold in the organs of the pelvis) and supporting musculature. Then, during delivery, the pelvic floor and supporting tissues can stretch up to three times their length- again, making them weak and unsupportive.
Additionally during delivery, our bodies are at risk for sustaining some of the same injuries we see in extreme sporting events- pubic bone fractures and pelvic floor muscle tears. After delivery, breastfeeding keeps estrogen elevated which keeps the tissues less elastic and relaxin stays elevated, keeping the joints less stable. These things coupled with the sheer exhaustion of caring for a new baby increases the chances of injury.
So let’s circle back.
Why then, that after carrying a child for 40(+) weeks, undergoing the trauma of birth (be it caesarean or vaginal), and the fatigue of carrying for a new baby, are so many of us are so eager to return to high intensity exercise so quickly? We jump back in after we’ve been “cleared” without even a mere thought of restoration or rehabilitation.
I know I did. As soon as the doctor said have at it, I went for a run. And then I peed when I sneezed and decided I wasn’t ready yet.
The general recommendation is to return to low intensity, low impact activities like walking, breath-work, and pelvic floor exercises as soon as you are comfortable. But like I was, many women are eager to return to the grind, thinking the faster they get back to their high impact exercise the sooner they’ll be back in their pre-pregnancy jeans.
What if I told you however, that the sooner we return to high impact exercise without considering the strength of the core and pelvic floor, the more likely we are to cause long-term damage (think: stress incontinence, back pain and lower belly pooch). Would you reassess your readiness to start?
If you haven’t already started back to higher impact exercise and you’re wondering if you’re ready, ask yourself these:
Are you leaking urine with low impact movements, sneezing or coughing?
Do you have a sense of heaviness in the vagina?
Are you able to hold a pelvic floor contraction against load (lifting)?
Are you holding your breath against any resistance (even light- e.g. lifting groceries or putting on pants).
Are you experiencing low back pain?
Are you sleeping regularly and feeling somewhat rested?
If you have returned to exercise and you’re experiencing any of the above and/or:
Your belly pooches out while you do crunching-type exercises or,
Despite losing all the baby weight you’re not seeing results (belly hangs over jeans, flat bum, or bra band size has increased)
Then likely, we need to step back, reassess and start restoring the pelvic floor and core.
Starting tomorrow, I’ll be talking about some of the curative exercise you can do starting soon after birth to heal and reconnect the pelvic floor and core with the rest of the body. In the coming weeks you can expect to see posts pertaining to prenatal and postpartum exercise which delve deeper into what the core is, alignment, diastasis recti, and exercises and routines you can use to both rehabilitate and strengthen the core and floor during and after pregnancy.
Remember, just because your doctor clears you at six weeks doesn't necessarily mean you are ready to return to high-impact or high-intensity exercise. You know your body best and have to be aware of the signs that things aren't normal.
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