First Steps for Post-Natal Exercise
Looking after yourself as you return to exercise.
Congratulations! It is truly amazing. However now that you have a new little one to look after, you can’t forget to look after yourself. It can be a very busy time for new mothers, but there are simple exercises you can do to get started and make sure your recovery is as good as it can be.
Pelvic Floor Exercises:
From days two to three, after giving birth, you can start doing pelvic floor exercises. These involve an “engage and lift” action of the muscles at the base of your pelvis. You should not feel your abdominal muscles working hard, maximum of 20-30% activity, or a pushing or straining feeling. The main points to remember when doing these exercises is that you keep breathing normally and you don’t use you bottom muscles, the squeeze, – no one should be able to tell that you are doing your pelvic floor exercises!
Initially when doing pelvic floor exercises, you may find that the muscle contraction feels different than it did before the birth, particularly if you have had a vaginal delivery. This is a common feeling and strength will improve in time as you do your pelvic floor exercises. Strong pelvic floor muscles are important for continence as well as looking after your back and pelvis generally.
Aim to engage and lift your pelvic floor muscle and hold for as long as you are able too, ideally about ten seconds to start with. This may initially be only 2-3 seconds, but you will improve and can build to longer hold phases. You should feel a relaxation of the muscle as you ‘let go’. If you don’t feel the muscle relax, it means the muscle has fatigued and so already relaxed. Hold for less time until you can feel the ‘let go’. The key initially is to build a cognitive control, you are turning the muscle on and off which helps build your neural pathways again. Aim to build up how long you can hold each pelvic floor contraction for, ideally reaching 10 seconds by 12 weeks post-natal. It is recommended you build up to doing 10 x contractions of 10 second holds, 3 times per day.
Kneeling on all 4’s, relax your tummy while still keeping your back neutral. To find neutral arch your back and hollow your back and try to find somewhere in the middle of these two positions. You should not move from here once you start the exercise. Gently draw the lower portion of your abdomen (between your belly button and pubic bone) in towards your spine. It’s not a big movement. You shouldn’t feel all your abdominals contracting, or your bottom muscles, again we are looking at about 20-30% of your maximum engagement only. Aim to hold this contraction for 2-3 seconds to start with and just like your pelvic floor muscles, build to holding for 10 seconds x 10 repetitions. Try to do this exercise twice per day.
You can start some gentle short walks if you feel up to it, e.g. around the block. Aim to go for no longer than 10-20 minutes per walk in the first two weeks. Where possible, avoid taking the pram or carrying your newborn as this is an extra load on your body and pelvic floor while it is still trying to recover after the birth.
You can increase the length of your walks by 10 minutes each week so long as your pelvic floor muscles are able to cope with standing. You shouldn’t be leaking while you walk. Whenever you feel comfortable to sit on a stationary bike seat, you can do some cycling. Most women find this can take 3-4 weeks at least before they feel comfortable. Avoid standing up on the pedals at this early stage.
After Week 6:
Once you have had your 6-week obstetrician check-up, your wounds have healed and you have stopped any discharge/bleeding, swimming is a great way to do some cardio exercise. It is low impact and horizontal –perfect for your pelvic floor muscles.
After Week 12:
You should not consider returning to high-impact exercise until at least the twelve week mark. This is because all the ligaments in your body – including pelvis, hips, knees, ankles and back – will still be more elastic until this time. It takes time to return towards normal and then you should remember to build tissue tolerance, you shouldn’t try and stat with a 5km run. You will be asking for an injury or issue to arise. You need your pelvic floor muscles to also be strong enough to cope with any running, bouncing and impact so you don’t leak while doing these exercises.
High impact exercise includes things such as running, netball, tennis, jumping. You should be able to pass the Pelvic Floor Stress test (see below) before you slowly begin doing these activities again. Your pelvic floor should be strong enough, so you don’t leak when doing this exercise. Some women don’t feel ready to return to running for six to nine months, that is not an issue listen to your body. It’s worth remembering it took your body nine months to have a baby, so it may take just as long to return to your pre-baby fitness. If you are leaking when you return to high impact exercise, we strongly advise you seek help from a Women’s Pelvic Health physiotherapist.
The team at Body Logic Health are here to help you, we have a Women’s Pelvic Floor physiotherapist and two women’s health rehabilitation, running, exercise and Pilates experts. They can help guide you back and improve your journey back to sport and activity.
Pelvic Floor Stress Test:
Do 10 star jumps with a cough on each jump whilst having a reasonably full bladder. You should not leak when doing this. If you do leak a little, then you need to keep going with your pelvic floor exercises before returning to high impact exercise.
This information is a general overview of a non-specific nature regarding exercise. It is not intended to be diagnostic and must be considered in conjunction with the individual’s complete medical history and a comprehensive physical examination. Individuals with pain should contact their doctor and / or Women’s Pelvic Health physiotherapist.
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