5 steps to know if you’re ready for postnatal exercise

This article describes how to assess your pelvic floor and inner core muscles to see if you are ready for regular postnatal exercise.

New mothers can be very motivated to return to regular exercise after pregnancy, and there are a lot of so called ‘postnatal exercise classes’ marketed to this group. But when the conversation of exercise preparedness come up, the answer is typically: ‘I feel pretty good, so I think I can start’. Or: ‘It’s been a couple of months now, so I should be ready’.

Is there a better way to know when your body is ready for postnatal exercise?

Yes, but first let me give you some background.

Why it may not yet be safe for you to exercise after pregnancy

Pregnancy and childbirth cause amazing muscular changes to the ‘inner core’. The inner core is made up of the diaphragm (main breathing muscle), multifidus (a deep back muscle), transversus abdominus (the body’s equivalent to a corset), and the pelvic floor muscles. These muscles must work together in concert with larger mover muscles to effectively transfer load through the pelvis during physical activity.

Most of the inner core changes tend to revert naturally within 4 – 6 weeks following childbirth. Although some changes can take months longer to return to normal. This is why you may hear recommendations to wait a month or two, or three, before starting a regular exercise routine.

But sometimes the pelvic and abdominal region do not completely recover on their own after childbirth. This can increase the risk of injuries and pelvic health issues, in particular during exercise. Before the body can begin engaging in exercise, the pelvic floor needs to be strong enough to support the body.

Postnatal exercise activities such as running, boot camps, Pilates, yoga and weight lifting all increase force and intra abdominal pressure on the pelvic floor. This can cause problems if the inner core has not sufficiently recovered or is not yet working in unison with the other muscles of the inner core. In fact, keep in mind that pelvic floor disorders including urinary incontinence are surprisingly common in athletes, including those who have not given birth (see Top 4 Causes of Athletic Incontinence in Female Athletes).

In women with good inner core function, pelvic floor muscles appear to activate automatically before or during moments of physical exertion. The pelvic floor works in concert with the diaphragm and rest of the inner core to provide a sturdy foundation for movement, in particular exercise. For women with a pelvic floor dysfunction, this normal activity doesn’t happen effectively (ref1). If the pelvic floor isn’t ready for physical activity, pelvic and inner core dysfunction can be created or worsened.

Common problems created or worsened by premature exercise after pregnancy:

1. Urinary incontinence
2. Prolapse
3. Diastasis recti (see: “Diastasis Recti and Pregnancy: ‘Closing the gap’ between current treatment practices and clinical evidence“)
4. Pelvic and low back pain and instability (see: “Patient Guide: Pelvis / Sacroiliac Instability & Low Back Pain During Pregnancy“)
5. Pain with intercourse

These problems typically arise when women begin an exercise program:

1. Too early, before their inner core muscles have had enough time to recover sufficiently on their own.
2. Without realizing that the natural recovery of their inner core muscles was incomplete, leaving them with a functional imbalance or weakness. In other words, muscles of the inner core are not working together, causing the pelvic floor to be overwhelmed. This can lead to injury or pelvic health disorder.

What’s the typical recommendation for when to return to exercise after pregnancy?

Waiting 2-3 months to begin a regular postnatal exercise routine is a sensible general recommendation that you may have heard. (Although gentle exercise such as walking can begin right away as long as it doesn’t produce discomfort.)

Waiting 2-3 months before starting an exercise routine gives enough time for the average person to progress through the natural recovery phase following childbirth.

So on average this is sound advice, but it’s certainly not the best advice for everyone. Indeed, some women are able to return sooner. Unfortunately, some women are not able to return to certain physical activities no matter how long they wait, unless they first address an underlying muscle imbalance. In such cases a Pelvic Health Physiotherapist or other specialist may be needed to provide the necessary guidance and treatment.

So a better recommendation is to wait 2-3 months and then go through the steps I outline below to help determine if your inner core is really ready for regular postnatal exercise.

Signs that your inner core is NOT yet ready for postnatal exercise

First off, make sure that you aren’t showing signs that you’re NOT ready.

There are clear signals that you are not yet ready to start regular postnatal exercise. Basically, I’m referring to symptoms that are indicative of abdominal dysfunction or pelvic health disorders (see our post “5 Signs You’re Not Ready for Postpartum Exercise”).

Unfortunately, instead of helping the recovery process, fitness programs done incorrectly can actually create further imbalances in the system and reinforce muscle compensations that may have developed. Fitness programs done incorrectly can thus increase injury susceptibility and exacerbate symptoms of pelvic floor dysfunction.

Presence of these symptoms would indicate that you would likely benefit from pelvic health physiotherapy including manual therapy, targeted exercise, and lifestyle tips prior to returning to exercise. For example, learning to perform a rapid and effective pelvic floor contraction on command can help prevent pelvic dysfunction such as urinary leakage caused by a rise in intra-abdominal pressure during exercise.

You’ve waited 2-3 months, and don’t show any warning signs. How do you know if your inner core is now ready for regular exercise after pregnancy?

Basically, you want your pelvic floor to be able to contract and lift when it’s called upon to do so, with normal endurance and timing.

Determining the preparedness of the inner core muscles is hard to self-assess, particularly when it comes to the pelvic floor muscles. This muscle group has fewer sensory nerve fibers than many other muscles you are familiar with, which makes it more difficult for you to feel what these muscles are up to, or even where they are.

The gold standard for assessing pelvic floor strength and control is through an internal examination that can be performed by a trained Pelvic Health Physiotherapist. For some women this is simply impractical and overkill.

Barring an examination by a specialist, the best way for someone to know if they have sufficient inner core function to safely exercise is to follow these steps:

5 Steps to determine if your inner core is ready for regular postnatal exercise:

1. Make sure that you aren’t showing warning signs that your inner core is NOT ready (see “5 Signs You’re Not Ready for Postpartum Exercise”)
2. Does your body feel ready? I know I just finished describing how difficult it is for people to assess their own pelvic floor functionality, but this is still a very useful question. If you think that jumping up and down will probably cause leakage, or hurt your back, etc., then there is a really good chance that you’re right. So you’re probably not ready for that aerobics class. Some new mothers eager to exercise find it difficult to listen to what their body is telling them.
3. Try the exercise, but ONLY gently at first. Even if you feel strong and confident. People just do not have a good sense of their inner core health and function. If running is your goal, start with walk-run intervals and gauge how you feel. If crossfit is your sport, try a couple of double unders or deadlift with much lighter weight than your norm. Consciously focus on your pelvis and low back region. Was there discomfort, leakage or feeling of vaginal pressure during your run or lift? Did your low back or pelvis feel weak, painful, quivery, or generally questionable? Such signs could be easy to brush aside under regular circumstances, but to a new mom these can foretell incomplete inner core recovery and the potential for injury or dysfunction.
4. Build up your exercise tolerance by progressing slowly and watching for symptoms. Remember how hard it is to tell if your pelvic floor and broader inner core is fully functional and working together as a coordinated unit? Just because your first run or yoga class felt fine does not mean that your inner core is what it used to be. You may still be predisposed to pelvic or low back dysfunction or injury. Consciously choose shorter exercise duration / intensity / frequency than you might otherwise, and gradually progress back to the level of exercise that you were once comfortable with, or would like to achieve. While you do this, watch for often subtle feelings of discomfort, pressure, or leakage.
5. If you are experiencing symptoms back off, and decide if you need help. You may not need to stop exercising, and you may not need any professional help. Reduce your activity to a level that does not aggravate your symptoms. Depending on your symptoms and their underlying cause, this may work, and with time you may be able to gradually increase your activity levels again. In other cases there may be a downward spiral of symptoms, where even very modest levels of physical activity exacerbates them. Or you may hit a barrier and not be able to progress through it.

Regardless of their intensity, if you experience symptoms you should consider seeking out the advice of a Pelvic Health Physiotherapist or your family physician. A physiotherapy assessment will help you understand the cause, educate you on your risks, and give you prevention and treatment strategies including appropriate strengthening exercises.

Remember to cut yourself some slack

Most importantly, give yourself permission to rest postpartum and allow for a gradual return to your regular physical activities including favourite exercise program. A rough guideline is to wait 2-3 months before starting back to most forms of exercise, and when you do, follow the steps I outlined above and you’ll be hitting the gym hard again before you know it.

References

1. Dumoulin C., Hay-Smith E.J.C., Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;5.