With a new baby to take care of thoughts for our own bodies may not extend past amazement for producing such a miracle. But I often speak to ladies who, motivated by bursts of energy and pre-baby goals have hit the road running, literally, in the first precious weeks post-natally. If post-natal healing and exercise advice was more readily available during pregnancy, perhaps these mistakes would not be so commonly made.
The first goal of our post-natal rehabilitation plan is Protect. I often get asked about running and how soon after having baby can mums take on their first run. With no guidelines set in stone I base my recommendations on what is set in stone … Tissue healing times. Pregnancy and childbirth stretches our bodies to it’s limits, and sometime past! Much like a hamstring muscle strain, or Ankle joint sprain – we need to allow the muscles and joints of our pelvis to heal. Not only do they need to ‘heal’, 3-6 weeks, but undergo remodelling to ensure the stretched structures are just as strong as before, 6-12 weeks. So the absolute earliest we can consider impact loads, to avoid pelvic floor and pelvic injury, is 12 weeks…HOWEVER… If there has been any muscle damage; episiotomy, grade 2 or more perineal tearing, a c-section…Then we need to grow more muscle, so it’s even stronger than it was before. Much like breaking your leg – you wear a cast and allow it to heal, the cast comes off and your muscles would have wasted and your strength diminished. You then start the rehabilitation phase or else this would forever be your “Bad Leg”. We can assume a further 12 weeks for this phase. Which brings us to 24 weeks…
Now that’s not to say we do nothing for the first 12-24 weeks, far from it. But to gain the benefits of your rehabilitation we must not undo the hard work by too much too soon. If we again take my analogy of a broken leg; if you take the cast off every now and again and give your leg a good shake, it will take a lot longer to heal!
So now to the ‘cast’ itself - Stabilise. As mentioned our pelvis’s, pelvic floors and tummies are stretched to their limits during pregnancy and it will take time for them to stabilise. Bigger babies, more children, traumatic deliveries and close together pregnancies may mean that the stretch and challenge to our pelvic stability is even greater. If our pelvis is unstable then so is the pelvic floor. We can encourage stability by ensuring the pelvis is aligned optimally, the pelvic floor healing well and symmetrically, wearing pelvic belts, abdominal taping and preventing troublesome constipation. In addition pelvic stability starts with isometric exercise – static holds which control/limit the amount of movement around a joint. I’ve put together a sequence perfect for weeks 1-6 post-natally:
Rehabilitate from this program through to global strengthening and gradual return to full function and sports. Our progression is based on achieving our strength gains and not on the passing of time. If we consider the goal of a marathon; you would break this down into progressively longer, manageable runs to slowly build your strength and endurance in time to reach your end goal. Whatever your “marathon” you should tackle your goal in the same way. Gradually increase the load on your body with increasing time, then intensity. Break down a bigger goal – such as running and strengthen first, at home or in specific classes, the important muscle groups to ensure your body is ready. Post-Natal Pilates is a great place to start – setting your foundations, ensuring your “core muscles” are strong before we build up our bigger muscles over the top. Progressing to something like Strength & Conditioning for Mums where we focus on pelvic Ring Closure through loaded strength work.
If we consider our pelvis and pelvic floor like any other area in the body, what it needs to recover becomes easier to recognise. Pregnancy and childbirth are feats often compared to the most intense of athletic events. And your post-natal rehabilitation should be tackled with the same patience and persistence.
Four Sides Womens Health Physiotherapists Megan and Kasey specialise in ante and post natal rehabilitation and physio treatment. Book now to schedule a Post Natal Check Up or Womens Health session