5 Signs You’re Not Ready for Postpartum Exercise

There are many so-called postpartum exercise programs targeted at new moms; from yoga and Pilates, to run workshops, boot-camps, and weight-lifting classes. But when is it safe to return to exercise after pregnancy?

New moms coming to terms with their postpartum physiques can be highly motivated to join classes or engage in other physical activities, but their bodies may not be as ready as they are.

Is postpartum exercise safety really a concern?

For some women this is a very real concern.

Pregnancy and childbirth significantly alter the position, strength and function of muscles of the inner core, as well as pelvic ligament integrity and bone position. With time, women naturally recover their pre-pregnancy physique. This recovery usually takes around 4-6 weeks, with some changes taking as long as 6 months to revert (ref1).

Unfortunately the natural postpartum recovery process is imperfect, and the extent of recovery varies.

If the natural postpartum recovery phase stalls before the body has adequately recovered strength and function of the abdominals and inner core muscles, this can leave postpartum women with an increased risk of injury, and susceptibility to low back pain (see Patient Guide: Pelvis / Sacroiliac Instability & Low back pain) as well as common postpartum pelvic floor dysfunctions including urinary incontinence and prolapse (ref2).

Exercise programs that are inappropriate for the postpartum body can further increase the risk of injury and aggravate or instigate pelvic floor dysfunction (ref3).

This flies in the face of popular opinion that exercise is always a good thing. In fact, even kegel exercises, the popular cure-all for pelvic floor disorders in women, can in some cases actually be detrimental to pelvic floor function (ref4).

Five signs that you may not be ready for postpartum exercise

If you show signs of any of the following, you may not be ready for postpartum exercise:

1. Diastasis recti. Diastasis recti is a space separating your belly abdominal muscles (your ‘6-pack’) that hinders normal abdominal function. There is typically a separation of about one finger width between the abdominals at the belly button, but a space larger than approximately two finger-widths can obstruct abdominal function. To learn more about this condition and how it’s treated, please see our post: “Diastasis Recti and Pregnancy: ‘closing the gap’ between current treatment practices and clinical evidence”.
2. Urinary leakage. ‘Stress incontinence’ is the most common form of urinary incontinence following pregnancy. It is experienced as involuntary urine loss that occurs during periods of increased intra-abdominal pressure, such as with coughing, sneezing, lifting, and exercise. This type of incontinence is generally caused by a weak pelvic floor.
3. Feelings of vaginal pressure or bulging (prolapse). Common descriptions of prolapse include feelings of pressure in the vagina or the feeling that something is in the way or protruding. Discomfort, friction or difficulty with intercourse or inserting a tampon can also be common.
4. Pelvic pain. Sexual discomfort or pain during intercourse, or any unexplained pelvic region pain.
5. Presence of tight scar tissue. Poor scar tissue mobility on the abdominal wall from a caesarean section or on the perineum from episiotomies or tearing during delivery can prevent the pelvic floor muscles from working properly.

The above conditions are very common after pregnancy, but this doesn’t mean that they are “normal” or that they will resolve on their own.

If you are experiencing any of the above symptoms, inappropriate exercise (or exercise done incorrectly) may increase your risk of pelvic and low back injury, exacerbate any existing pelvic floor dysfunction, and lead to chronic issues.

Even outwardly benign activities such as running or yoga can increase intra-abdominal pressure on the pelvic floor, and this can exaggerate urinary leakage or prolapse, or induce it in women with previously asymptomatic underlying conditions (ref5, ref6).

So how can I ready myself for a regular postpartum exercise program?

If you are experiencing any of the above signs, a targeted exercise therapy program with education (and scar tissue treatment if necessary) may be beneficial before resuming regular exercise (ref7, ref8). Seeking out the guidance of a therapist trained in pelvic floor physiotherapy can offer you:

1. Insight into the condition of your postpartum body, and the safety of physical activities.
2. A personalized home exercise therapy program to address muscle imbalance.
3. Hands on therapy if warranted.
4. Education for management and prevention of pelvic floor dysfunction.

Your inner core is a primary target for exercise therapy prior to initiating regular postpartum exercise.

If I’m not showing any of the 5 warning signs is it safe to begin an exercise program?

A rough guideline is to wait 2-3 months before beginning a regular exercise routine. But this guideline is just that. Some women needn’t wait that long, while others will need to wait longer, or may need to address inner core muscle imbalances first.

So even if you’re not currently showing any of the above warning signs for postpartum exercise, you may not yet be ready for regular strenuous exercise. So how can you determine if you’re ready? To learn more please see our “5 Steps to Know if You’re Ready for Postnatal Exercise“.

References

1. Larson-Meyer D.E. The effects of regular postpartum exercise on mother and child. Int SportMed J. November 2003;4(6):1-14.
2. Rogers R.G., Leeman L.L. Postpartum genitourinary changes. Urol Clin North Am. 2007 Feb;34(1):13
3. Swanson, S. Abdominal muscles in pregnancy and the postpartum period. Int J Childbirth Educ. 2001 16(4):12-14.
4. FitzGerald M.P., Kotarinos R. Rehabilitation of the short pelvic floor: 1: Background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2003 Oct;14(4):261-8.
5. Cobb W.S., Burns J.M., Kercher K.W., et al. Normal intraabdominal pressure in healthy adults. J Surg Res. 2005 Dec;129(2):231-5.
6. O’Dell K.K., Morse A.N., Crawford S.L., et al. Vaginal pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Dec;18(12):1481-9.
7. Hagen S., Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec7;(12).
8. Dumoulin C., Hay-Smith E.J., Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Syst Rev. 2014 May14;(5).

Acknowledgements

This article was a collaboration between Katie Hauck, PT and Ryan Davey, PhD.