Postpartum exercise: when to begin your journey
Most of my prenatal and postpartum patients have heard (or seen on social media) mixed things about postpartum exercise. Can you start doing some type of exercise right away? Should you be staying in bed for the first 5 days? Should you be back to your pre-pregnancy exercise routine by 6 weeks, or are you supposed to start exercising at 6 weeks? All of these questions (and so many more) come up in these appointments. Let’s unpack this topic!
What can you do right away?
I encourage my expecting moms to plan on starting some breathing exercises as soon as they can postpartum. Breathing exercises have SO many benefits, including relaxing your nervous system and retraining your diaphragm muscle. Your diaphragm can get limited during pregnancy with postural changes and the uterus reducing space in the abdomen for the diaphragm to descend. This is important because your diaphragm plays a major role in pressure management and pelvic floor function. Breathing is step 1 in postpartum rehab! Check out the video below for some diaphragmatic breathing information and exercises.
You can also start walking pretty early in your postpartum journey. I personally do not recommend the 5-5-5 approach in early postpartum (5 days in the bed, 5 days on the bed, 5 days around the bed). Movement helps to reduce the risk of blood clots, helps your lymphatic system reduce swelling throughout your body, and keeps you from losing strength and mobility.
I recommend starting very light, with an easy 5-minute walk. This can be around your house, on a walking pad or treadmill, or outside. If you are feeling good and don’t have any increased pain or bleeding following, gradually increase your walking each day by a few minutes. Be sure to listen to your body and if you’re not sure if you are doing enough or too much, consult with your pelvic floor therapist.
When should you add in core exercises?
As I said above, core and postpartum rehab starts with breathing. Master breathing first, then you can add in some gentle TA bracing and pelvic floor awareness. Reconnecting to your core muscles can take time and practice, so be patient with yourself! If you notice any discomfort, are feeling exercises in your back or hip flexors (instead of your core), or feel pelvic heaviness, pressure, or leaking, definitely consult with your pelvic floor therapist. Check out this video on TA bracing and pelvic floor coordination as a starting point.
What about strength training?
I recommend for most of my postpartum moms to start doing more “functional”, full body exercises (like squats, hinges, lunges, balance exercises, etc) around 4 weeks. Some moms may feel ready a little earlier, while others may not feel ready at 4 weeks (and that is OK!). Start with body weight movements, master the movement (sometimes things feel different postpartum), then progressively add weight when you’re able.
What should I be able to do by 6 weeks postpartum?
Nothing magical happens at 6 weeks that makes us all of the sudden ready to return to exercise. Every postpartum journey is different, and it is important to consider your own personal experience and factors when it comes to return to exercise and managing expectations. For example, if you have a c-section, you will want to be mindful of your incision and any pain in your abdomen or incision with movements/exercises.
At 6 weeks your body has done a LOT of healing (you have probably noticed you feel better and better each week), but you still have a ways to go, too. There is no need to rush back to pre-pregnancy work outs at 6 weeks postpartum. Although some women may be able to do that, I find it is rare and many women who try to get back to heavier weights or higher intensity exercise at 6 weeks postpartum will have symptoms such as leaking, pelvic pain, pelvic heaviness or bulging, or low back pain.
How should I monitor my postpartum fitness progress?
My recommendation is to spend the first 8-12 weeks really focused on moving, healing, and connecting to your body. You are likely also spending that time a little sleep deprived, and focused on adjusting to your new family member. Supporting your body with healthy meals and good hydration will help, but know that sleep is just as important in healing and rehab as the exercises you are doing.
From there, I like to look at progress in 3-month increments over the next 12-18 months. Depending on what level of fitness you are looking to return to, and how your labor, delivery, and early recovery process went, it may take a longer or shorter amount of time to return to your pre-pregnancy fitness level compared to someone with different goals and experiences. It can be hard not to compare to others, but it is important to know that your journey may be different – and that is OK! As long as you are noticing improvements at each 3 month check in, you’re doing great. If you are struggling to see progress or are experiencing symptoms such as pelvic pain or pressure, leaking, diastasis recti, or back or hip pain, I highly recommend scheduling an appointment with a pelvic floor therapist.
If you want to learn more about what to do to prepare for labor and delivery, how to support your body during early postpartum recovery, and how to return to movement and exercise, join the interest list for my upcoming prenatal prep course here.
Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS