You’ve made it! The first month or two with a newborn is a whirlwind. Now by week six or seven postpartum you’re in a groove (sort of) and you’ve most likely been to your OB/GYN or General Practitioner. You’ve been “cleared” to exercise, but what does this mean? Just because a GP or OB/GYN “cleared” you, you may not be ready.
The standard postpartum check-up assesses your wounds and healing:
- If your C-section scar healing as it should?
- Has any tearing or stitches started to heal appropriately?
- Any bleeding?
While these things are very important, there is SO much not covered in the postpartum visit that is essential to understanding how our body functions, and if (a big if) it’s ready for movement. Your doctor will not assess for diastasis recti or pelvic organ prolapse, or be able to provide a postpartum fitness rehab program. I highly encourage all women to seek out a pelvic floor physical therapist to set yourself up for success as you re-enter the gym. I worked with a pelvic floor physical therapist for four months postpartum and was incredibly helpful.
Back to Strength Training
One of the biggest lessons I learned during my return to fitness was, “intention now for intensity later” from Brianna Battles. It may be frustrating at first to complete movements that at one point in time seemed “easy” or “beginner.” But, our postpartum bodies are different. We need to focus on building the foundation before we can add layers.
Strength training postpartum is not going to look the same as it did pre-pregnancy. The body has been through a traumatic event and the focus is on rebuilding the foundation. That’s OK. During this phase we can start introducing foundational exercises, and then gradually progress to more difficult exercises. It’s important during this time to stay in tune to how your body feels.
We are paying special attention to the four P’s (courtesy of Jessie Mundell):
- Peeing: incontinence in any way during the exercise
- Pain: Pain anywhere in the body
- Pressure: Any uncomfortable sensation in the perineum or pelvic floor. Note: some pressure is normal. However, it’s really important to pay attention to feelings of bulging, heaviness, and dragging.
- Peaking: Doming or coning through the midline. Not all doming through the linea alba/ diastasis is bad and needs to be avoided entirely. We simply need to note the degree/amount and adjust as necessary.
Respect the process. The “Return to Fitness” period is one of the most important, as now when we really focus on the abdominal and pelvic floor rehab.
1. Continue diaphragmatic breathing and establish an optimal breathing pattern
This was the hardest thing to wrap my head around after having Benji. But the way we breathe matters. Without proper guidance on breath some mamas may inadvertently put too much pressure on the weakened parts of the core (pelvic floor included). There’s also a tendency to “suck it in” all the time, which never allows our core muscles to relax and go through the full functional range of movement.
How to do it:
- Select a starting position. I recommend starting laying down on your back and knees up (a coach or chair works great). This is also a great way to keep your hip flexors relaxed so you can focus on breath alone. Another option is to sit, but make sure you posture is upright, your hips are square, and your feet are flat on the floor. Avoid crossing your legs.
- Inhale: Take a deep inhale, and visualize your lungs expanding to all sides while your belly fills with air. Think of it like breathing all the way around your torso.
- Lightly press your lips together and exhale sharply and steadily out your mouth, making an audible “shhh” noise. As you exhale, focus on the contraction of your abdominals muscles. Contraction is different than sucking in. “Belly button to spine” can be a misleading cue for many, so I like to think of it as more of a “lifting” sensation. On the exhale visualize your pelvic floor zipping upward. There are a few cues here that help me: scooping up ice cream, drawing the four corners of a diamond together and up, and sucking a blueberry up with your pelvic floor/inner vaginal wall. The focus is primarily on the pelvic floor muscles and less glutes. Those guys are important, but we’ll let them sit this round out 🙂
I promise focusing on breath and the pelvic floor will be worth it in the long run! The breathing patterns carry over to exercises we will implement in our strength training program. If we want to do dynamic exercises long-term we need to work on recovery and retraining of the muscles weakened the most during pregnancy.
2. Abdominal Rehab and Retraining
There have been major changes to the abdominal wall, pelvic floor, and diaphragm during pregnancy. As we ease back into core training postpartum, the best approach is to start with isolated exercises first, and then more into more “functional” movements. We’ll also target the deeper layers first (i.e. transverse abdominis and internal oblique) before layering on the more superficial muscles (i.e. rectus abdominis- 6 pack).
Below are some exercises we may include in an abdominal rehab program.
- Cat / Cow
- Heel slides
- Supine Marches
- Supine Hip Abduction (leg drop) – Can be done with feet flat on the ground or with knees up stacked over the hips (watch for an arch through the lower back). Inhale to fill the belly with air, exhale to engage the deep core. Once core is engaged drop one knee at a time to the side, and bring back to center.
- Bridge with Ball Squeeze
- Side lying ball squeeze
- Palloff Press – start in kneeling position and hold for 3-5 seconds. You can increase difficulty here over time by extending the length of the hold or moving into a traditional standing palloff press.
- Dead Bug – Start with knees bent over the hips and focus on the leg lower. Progress up to traditional dead bug with arms and legs.
- Planks – start with an elevated surface (bench, couch, stairs) or wall. Over time progress to flat surface. Watch for doming through the midline.
- Bird Dog: One of the most challenging for me by far. Start by moving each limb individually. Start with just raising your right arm, and then left arm. Then try moving you legs one at a time. Finally progress to a traditional bird dog with one leg and opposite arm.
3. Get back to training with simple, foundational movements
The first program back in the gym needs to be thoughtful and strategic. What are some of the exercise a new mom has to do everyday? We squat, lunge, bend, lift, reach, walk, and twist – often with a baby in our arms. Together we’ll build strength in these functional movements.
A few rules of thumb:
- Minimize / modify additional pressure on the abdominal wall with exercises like push-ups, chin ups, and various presses. Together we can prep for these exercises!
- Start with stabilizing strength moves – no plyometrics or unilateral moves that require a rapid change in your center of gravity / balance.
- Start slow. Soreness is not an indicator of progress. You should leave a training session feeling like you can do more. We are building you up, not breaking you down.
- Minimize twisting/flexion/traditional ab work (crunches)
Exercises you may see/do during this phase:
- Squat varieties
- Tall kneeling pulldown or lat pulldown (vs. chin up)
- Assisted rows
- Deadlift varieties
- Seated overhead press
- Curl and tricep varieties (a lot of flexion and extension of the elbow with baby)
- Modified push-ups
4. Improve aerobic fitness
I generally recommend a walking routine during this phase, particularly for mamas who are eager to return to running. Incline walking is a great way to engage the glutes and hamstrings, get the heart rate up, and prepare your pelvic floor for higher impact activity. This can be done on a treadmill, or outside with baby in tow.
- If on a treadmill, walk at a 5-7% incline. Start gradually for 10 minutes and progress to 30 minutes over the course of several weeks.
- When you feel you’re ready gradually build the time of your work.
- Increase the pace and then slowly decrease the decline. Build your pace as your near flat road.
- If you experience no incontinence, pain/prolapse, or heaviness/pressure in the pelvic floor you may soon be ready to start running.
I know – that was a lot of info! Returning to Fitness postpartum takes time, dedication, and lots of love and patience. As always, do what feels good in your body. There is no exact timeline and everyBODY is different.
I’m here to support you how I can.
Click here to read Phase 1: 0-6 Weeks (Rehab and Recovery)
Click here to read Phase 3: Week 19 and beyond (Bulletproof your Body)