"But I saw my obstetrician for my postnatal check up... that means that I am ready to go back to Boot Camp, right?"
It's time that the word got out there - being medically well at 6 weeks postnatal is great, but it does not necessarily mean that your body is ready for the vigour of higher end exercise like kettle bells and burpees.
Was your abdominal muscle separation assessed at your medical appointment? Your ability to control your pelvic floor muscles with a set of 20 crunches? Do you know whether you should be doing weighted squats or planks yet? Probably not - because this musculoskeletal assessment is the domain of specialist Women's Health and Continence Physiotherapists.
At what point should I have a check up with a Women's Health & Continence Physiotherapist after having a baby?
A check up would be ideal at 6-8 weeks postnatal, but if that time is too hectic, then it can be later. Just make sure it is before you get back into any higher level physical activity (high impact, abdominal work and loaded exercise with weights are the important exercises to avoid before being properly assessed), or before you get pregnant again. If you were lucky enough to have access to a physio in hospital, they should have explained to you that physical activity in the first 6 weeks or so should be limited to pelvic floor exercises, gentle stretches and strengthening exercise and gradual return to 30-60 minutes per day of low impact cardio exercise like walking. You can see the FitRight videos on Postnatal Rehab: The First Six Weeks for more information on early optimal rehabilitation.
What will the Physio do at my appointment?
A physio will go through a number of questions about your pregnancy and birth, your medical history, your bladder and bowel functioning, your muscle and joint functioning, your exercise history and what sort of exercise aims you have to get back to.
The physiotherapist will then assess your pelvic floor muscles, which is important even if you have had a caesarean section delivery. This may be off-putting to some people – aren’t internal examinations over and done with now that the baby is born?! But it doesn’t necessarily have to be done via a vaginal examination. A screening test can be done with an ultrasound through your lower tummy, which shows the physiotherapist how well you can elevate and relax those muscles – and you, the patient, can see this on the screen too, which is great for feedback and learning. A vaginal examination, however, is the gold standard and a lot more information can be gained such as pelvic floor muscle strength, tone and the presence of pain or a vaginal prolapse. This more thorough examination is even more highly recommended if you have any symptoms of pelvic floor dysfunction, such as bladder or bowel incontinence, a feeling of vaginal heaviness, or any pain in the vaginal area.
Then your abdominal muscles will be assessed. The presence of a Rectus Abdominis Diastasis (RAD) will be determined, which means whether or not your ‘six-pack muscles’ and the connective tissue in the midline, has returned to normal after being stretched in pregnancy. This stretching of the two muscle bellies apart from each other is completely normal if you carry a baby to full term. But did you know that natural healing only occurs in the first 8 weeks? If the tissue in the midline isn’t back to being thick and strong by that stage, you will need to do specific exercises to rectify it.
It will also be assessed whether you can activate your deeper ‘core’ abdominal muscles, and your gluteal muscles, which together with your pelvic floor help to support your lower back and pelvis. Your posture will be assessed, as will any specific joint or muscle dysfunction.
So when can I get back to higher loaded and impact exercise?
From this assessment, a plan of attack will be put in place as to the best way to achieve your exercise goals. In this way, it is a very individual approach to postnatal exercise – there is no ‘recipe’ that you should be able to achieve a certain level of activity at a certain number of months postnatal. I can’t tell you how many times I hear something along the lines of ‘but I waited until 3 months before I did sit ups, so I should have been fine’. We can never assume that one woman’s muscle activation, hormonal changes, and birth trauma are the same as the next woman.
Think of return to exercise like building a house, and if you don’t firstly build strong foundations, you will always have issues building your house on top of it. Therefore, spend the first weeks or months preparing your ‘foundations’ or your ‘core’ – this is what a Women’s Health Physiotherapist specialises in. When your joints, muscles and pelvic organ support have been assessed, you can work together to plan a graduated returned to higher intensity and loaded exercise. Ideally the physiotherapist would liaise with your personal trainer or coach to formulate this plan.
This may be anywhere between 6 weeks and 12 months + after childbirth, depending on what your goals are, how you present at that initial assessment and how quickly you progress. Even when you graduate to higher level exercise though, it is still so important for all women to incorporate pelvic floor and deep abdominal exercises into their routines – keep your foundations strong!
There is nothing that makes me sadder than when a woman comes to see me months or years after giving birth, suffering with worsening urinary incontinence, back pain, or vaginal prolapse symptoms, and when I ask them about their return to exercise, in retrospect they went too hard, too soon, without ever getting the right information. It happens more often than you would think!
Don’t be one of these women – get your postnatal assessment done with a Women’s Health Physiotherapist FIRST, and build on strong foundations.