Beyond “Listen to your body” – A Guide to Safe Postpartum Exercise and Recovery
With all the conflicting information out there about how to best recover after pregnancy, we have compiled an evidence based guide based on the most up to date research and our experience. The only thing we can’t know via blog is your values and experience, so please read through your own lens and customize specific to your values, experience, and goals.
Just as we would optimally recover from any “injury”, our focus postpartum is utilizing our POP Acronym:
Protect, Optimally load, and Pain management.
This looks different for every individual based on delivery type, first baby vs second/third/fourth/twelvth baby, functional level prior to pregnancy, functional level prior to delivery of the baby, at which point in the pregnancy the baby was delivered, and any birth traumas that may be at play. Our hormonal response is also different for each individual. Yes, there are general trends with regards to hormones – however, breastfeeding status, stress levels, and your body’s natural hormone regulation are all at play.
We have a LOT of things going on postpartum, especially early on. Many of the expectations that we place on our bodies are unrealistic. Take time to honor what your body has just done. You grew a human being, with its added weight, along with placenta, double your blood volume, and extra fluid placing progressive load on your pelvic floor over the course of your pregnancy. (This is why the thought of “I don’t need pelvic floor therapy, I had a c-section” is ridiculous….but that is a soap box for another day)
If you are experiencing pain, leakage of any kind, chronic hemorrhoids, heaviness in the pelvis or abdomen – please, please reach out to a pelvic floor physical therapist to assist you in safe progression of exercise FOR YOU. And, if that sentence made you unsure of your status….call and make an appointment. You won’t lose anything by having someone check and just make sure that all is well. In early postpartum, any increase in volume of your postpartum bleeding is a sign of overexertion. And any issues with clotting should be discussed with your medical provider.
This guide is conservative in nature and will hopefully take you through some safe exercise progressions to perform in the early weeks and months of learning what it is to move and love this new postpartum body of yours. We will start with “early” postpartum, just the first few weeks.
If you have delivered your child via c-section, check out our C-Section Birth Prep and Recovery Tips and Resources for some extra specific tips, but then also return here and follow these tips as well, integrating the tips from both!
Early Postpartum – Weeks 0-3
This is the PROTECT phase – our body needs optimal rest, which as a new mom you’re probably finding challenging. If you sprained your ankle or tore your hamstring, would you immediately be vacuuming your living room and doing dishes/laundry for hours upon hours on your feet….absolutely not, so don’t treat your healing postpartum body that way either. This isn’t to make you afraid of doing those things, but to empower you to ask for help. Let your body do what it is designed to do in this phase: rest, bringing good inflammatory agents to the area to promote healing – whether that is your vaginal region or a c-section incision or both, and channel energy at caring for your precious new addition. Here are the biggest areas you can initially focus on serving yourself in:
- REST: this is the time to give yourself some grace
- HYDRATE: hydrated tissues heal faster
- EAT: (nutritious foods) – healing takes calories, breastfeeding takes A LOT of calories
- BREATHE: it’s been a while since you could take in a full, deep breath
- WORK ON POSTURE: with feeding, lifting, carrying, sleep position, etc.
- 6 Pillars of Health: in these early stages this is going to look a lot different than your long term balance; at this time, just some awareness and planning to pour into these more as you recover and your family grows more independent is appropriate
The main “exercises” for this phase include reconnecting with your breath, combating postural changes that took place with your progressive pregnancy, and avoiding aggravating postures that are easy to fall into with care of a little one. Check out this video for some low level exercises to be performed in this early stage of recovery.
Postural changes in pregnancy include but are not limited to arching your low back to offset increased weight of your growing belly, with compensatory strategy of bringing your head, neck, and shoulders forward to counterbalance. Your hip mobility decreases as the baby drops down into the pelvic bowl. All of these things are NORMAL, not in excess of course, but not to be looked at as bad by any means. Here are some exercises to initiate reversing some of those postural changes that we no longer need as our body works to return to equilibrium in this postpartum season.
Posture considerations for the early postpartum period:
- When breastfeeding make sure you are utilizing pillows/props to optimize your sitting posture and the positioning of the baby – bring baby to the breast, not breast to the baby
- When bottle feeding also utilize some pillows/props to improve posture and assist in avoiding strain of holding the baby – your neck and shoulders should remain relaxed in your position
- Babywearing considerations: avoid arching low back to offset weight of baby in the front, keep baby as midline as possible early on
- Carrying/lifting: follow weight protocols given by your medical provider, also make sure that you are keeping loads in midline and as close to your body as possible in this protective phase
I hope that this information helps you with what to do in these early weeks if you are looking to jump start your recovery. However, give yourself grace as well – it is OK to just want to care for your baby and not focus on anything specific in these early weeks. If you are a few hours into motherhood, or a few weeks down the road, here is a good place to start.
Early Postpartum – Weeks 4-6
As we progress into this next phase of healing, we continue to work on protection while we lean into more optimal loading of your core system. If you have not checked out Part One above, please scroll up and then come back and catch up – there is a lot of good information and some early exercises to make sure you are comfortable with, prior to progressing into Part Two.
If you’re here, I’m sure you are either:
- Eager to get back into your workout routine and wanting to make sure that you’re following some sort of guidelines, or,
- Are not really sure where to even start
Both of which are OK. There are two mistakes when it comes to postpartum recovery – going too fast, or treating your body like it is going to break and not do anything. We like to live life in that sweet spot of the middle.
What you will notice about the next series of exercises is they focus on starting to retrain and optimally activate your core system, while continuing to address posture and protect your healing abdomen and pelvic floor regions. Keep in mind that many cultures believe that during these weeks we should still very much be focusing on rest and healing, so if that feels right for you and your body these exercises can surely be performed at a later date.
In pregnancy posture, we see a compensatory widening of the pelvis, external rotation of the hips, and hibernation of the gluteal muscles. Reconnecting with these muscles is SO important as you continue to progress the load you are lifting and carrying every day increases. Our glutes are our powerhouse, when they are not strong enough, we place unnecessary excessive load on the pelvic floor and low back.
If you are noticing some weakness in your upper body by fatigue with holding and carrying your little one, development of tightness in the neck and shoulder region, in this phase we also start to strengthen the upper body in efforts to improve how much load it can tolerate, taking away more downward pressure being placed on the pelvic floor during lifting and carrying tasks throughout your day.
A big buzz word around postpartum in this phase is DIASTASIS or Diastasis Recti Abdominis (DRA). DRA is defined by a separation of the rectus abdominis muscle bellies (six pack muscle). It is characterized by visually seeing the gap between the muscle bellies or visualizing a “doming” appearance when your core is activated. Spitznagle et al found that 66% of women have a significant DRA in the third trimester of pregnancy and there is a correlation between DRA and at least one more supportive pelvic floor muscle dysfunction – such as prolapse or urinary/bowel control issues.
Before you continue with progressing into our next phase of postpartum exercises, use this video to assess yourself and see if you have a diastasis – as there will be some special modifications or instructions pertaining to that in our series video.
Exercises for this phase include continued progression of thoracic spine mobility and reconnection with breath, gentle core activation, glute retraining, and gentle introduction of upper body strength. Perform what feels good, take note of what doesn’t feel good and why – is it a sensation that will get better with time or is it sharp pain that needs more investigation?
I will reiterate here from part one: if you are experiencing pain, leakage of any kind, chronic hemorrhoids, heaviness in the pelvis or abdomen, etc – please, please reach out to a pelvic floor physical therapist to assist you in safe progression of exercise FOR YOU. And, if that sentence made you unsure of your status….call and make an appointment. You won’t lose anything by having someone check and just make sure that all is well. In early postpartum, any increase in volume of your postpartum bleeding is a sign of overexertion and any issues with clotting should be discussed with your medical provider.
I hope that this series helps bridge the gap in these early weeks and has you going into your six week follow-up with confidence!
Intermediate Postpartum – Weeks 6-9
In this next phase of recovery, we are going to progress with functional movement pattern retraining. As moms, we lift, push, pull, and carry – all day, every day. Optimally retraining our bodies (or maybe even training for the first time) to perform these tasks in quality ways, we limit our risk for injury during childcare activities, but also as you progress back into your exercise/fitness routine – even, if that is just being able to run around and play with your kiddos.
The video below discusses retraining a hip hinge/deadlift motion (lift), squatting (lifting – especially getting those littles off the floor), plank variations for continued core loading (push), scapular muscle retraining (pull), and functional carrying technique.
REMINDER: honor your body. If you are still bleeding, have a progression of bleeding with these exercises, or any of them do not feel “right” in your body – please regress and/or seek care. Keep in mind that a pelvic floor physical therapist is a great resource – see above links to find one in your area.
Intermediate Postpartum – Weeks 9-12
Continued progression of functional movement retraining from week 6-9, focusing more on single limb loading and asymmetrical loading through the core system. Many of these exercises are imperative to master prior to return to run, if that is in alignment with your postpartum goals – assisting to decrease risk of secondary injury to the low back, hip, knee, or ankle region. Continue to monitor your diastasis or prolapse (if present) during these exercises and seek help if there is difficulty in managing those symptoms.
Stay tuned for more instruction on exercise progressions to perform in later phases of recovery.
Mothering alongside all of you,
Dr. Cassie McDonald Ross, PT, DPT
Doctor of Physical Therapy / Pelvic Health Specialist
