Healing and time for appropriate strengthening and stretching is needed after having your baby. Each Mom is different and it is important for you to take the time you need and not feel pressure to return to heavy training immediately.

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How to Begin Exercising After Baby

That being said Postpartum exercises should begin after having a baby, but in a gentle, progressive manner. Waiting till your 6 wk ck is not necessary. If you have stitches due to tearing at the perineal or vulvar area, please wait at least 2 to 4 wks so the necessary healing will have occurred.

Begin with PFM exercises where you do a gentle 20-40% sub max contraction of slow holds and quick contraction, only 5-10 at a time.

Focus on engaging your low abdominal muscles called the Transverse Abdominus. We call them your hands in your pockets muscles. Work to elicit these abdominal muscles with pelvic tilts, hip ER, knee fallouts, marches, single limb standing, hip exercises, and walking on the flats.

Then walking and core training add further advance to bridging and begin sit to stand and light
holds, lunge, squat, and single leg standing with upper body movement.

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Timeline for Postpartum Exercise

At 4-6 wks begin more aerobic training with other modes as long as PFM are engaged correctly such as static cycle, no spinning yet, elliptical etc.

6-8 wks Begin hill walking, uneven terrain, increased time frame for all low impact activities for endurance, deadlift 10#, then barbell. Begin Scar mobilization at 6-8 wks.

Please see your MD and your pelvic health physical therapy specialist before returning to high impact sport to ensure the correct engagement of the core esp the floor to prevent long term pelvic organ prolapse (POP)!

Vaginal vs C-section Healing

You can start at 3 months if you know how to engage the core muscles correctly. C-section healing takes more time than vaginal delivery. The scar had 50-60% of its strength at 6 wks after delivery but it took 6-7 months for the scar to be 70-90% of its strength.

Usually by 4-6 months after having your baby the Pelvic floor muscles, nerves and muscles are healed and the endopelvic fascia will re-establish it proper alignment. With High Impact Exercise there is 4x more likelihood of pelvic floor dysfunction than with low impact training.

Know how to engage your core esp your pelvic floor muscles, abdominal muscles and diaphragm before you return to training heavy. It’s all about knowing how to do this correctly.

Return to Activity Postpartum Checklist

You should not return to high impact sport activities if you have:

1. Pelvic or abdominal pain
2. heaviness, pressure with activity or afterwards
3. bladder incontinence whether urge or stress
4. bowel incontinence- constipation or leaking
5. pain with sexual activity
6. Abdominal weakness- DRA
7. Back pain

Things you should be able to do before return to high impact sport

Pelvic floor isolated contractions- MMT over 3+/5 with:

• Squeeze, lift, hold of floor muscles.
• Pelvic floor muscle contraction
• Laying down60 sec PFM holds at 40-50% max contraction
• PFM slow sustained holds 3×10
• PFM fast contractions 3×10
• Pelvic floor muscle contraction
• Standing60 sec PFM hold sub max 30-50%
• 8-12 reps of 6-9 sec max contraction
• 10x fast reps

Activities:

• Walking 30 mins- activation of core!
• Single leg balance 30 secs
• Single leg heel raise 20
• Supine bent knee single leg bridges 20
• Single leg squat 20
• Curtsy reverse squats 10
• Single leg forward reach 10
• Forward jumps 10
• Hop on one leg 20
• Jog 1 min
• Running simulation 10 times each side
• Hip extension, abduction, adduction, flex, rotation MMT good, 30 reps

Any weakness in any of these tests indicate return to high impact activities isn’t advised. You can use a vaginal pessary if you have a POP or other assistive support EVB shorts etc. Guidelines adapted from consortium of data available.

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Sheree DiBiase, PT, ICLM
Lake City Physical Therapy, PA
Owner