Today we have a guest post from Megan, a physical therapist passionate about women’s health, pregnancy and postpartum care. I reached out to see if she would share some general background and knowledge about physical therapy in pregnancy and postpartum periods. She’s happy to chat more in person if you have additional questions and concerns – her contact info is at the end of the post! Enjoy (and thank you Megan!).
It’s your 6-week appointment. You have anxiously waited for this appointment to be “cleared” for all things that will make you feel “normal” again, like being cleared for sex and exercise. You see your provider and are given the thumbs up. You are excited to start working on “getting your body back”.
But what does that 6-week postpartum “cleared for exercise” really mean? Well, it means that tissue healing has likely occurred after both vaginal and cesarean deliveries, as long as there were no postpartum complications like infection. However, this does not mean that your pelvic floor and core are ready for things such as “normal exercise” or even sex. This is where a pelvic floor physical therapy evaluation can be extremely beneficial. Pelvic floor physical therapy is a specialized form of physical therapy that includes both a musculoskeletal evaluation and an evaluation of your pelvic floor. Pelvic floor PTs (physical therapists) specialize in conditions such as diastasis recti, pelvic girdle pain, incontinence, low back pain, hip pain, coccyx pain, and much more. Not only do Pelvic Floor PTs specialize in pain and dysfunction, but they are also exercise specialists with extensive education and training in proper activity modification and exercise progressions. They are a valuable resource during this chapter of your life.
As patients, it is so important that we speak up to let our providers know what is going on with our bodies at that 6-week mark. Leaking urine after having a baby is NOT normal. Low back pain, hip pain, and/or pelvic pain are NOT normal after having a baby. Pelvic heaviness is NOT normal after having a baby. Some of these things may be COMMON but NOT NORMAL! And providers, ask about these things at your postpartum checks. Refer to pelvic floor PTs more often than you think you need to. There is research that supports symptoms of pelvic floor disorders may not occur until 5-10 YEARS AFTER birth, especially vaginal birth. So, taking a preventative approach to pelvic floor evaluation and treatment with postpartum patients can significantly impact long term pelvic health.
So how do I get back into exercise if I just don’t return to my normal routine?
Well, working on a solid postpartum rehab program will help you build a strong foundation for years of safe exercise. Whether you had a cesarean or vaginal birth, your body has been through trauma! During the first phase of rehab from 6—12 weeks postpartum there is a lot of great strength work to be done. Pelvic floor PTs can help reintegrate your breath, core, and pelvic floor on the very first visit. Slowly working through a progressive core strengthening program, hip strengthening program, total body mobility program (because let’s face it, things get stiff postpartum!) is so important during these early weeks. Low impact cardio tends to feel good – things like walking, swimming, stationary bike, and even elliptical can be great sources of cardio during this early phase of rehab. Pelvic floor PTs will also check in with you to see how your sleep and fatigue levels are, nutrition and if you are breastfeeding, stress levels, and if you have any fears of movement as all of these things can affect your physical healing.
What about running? I specifically did not mention running during that first phase of rehab. The current literature supports return to run progressions starting no sooner than 12 weeks. Why is this? Well, there is a lot that goes into running that we all don’t think about. For instance, while we are pregnant our center of gravity shifts as we have this big belly growing. This in turn changes our balance. Single leg balance needs to be retrained postpartum, because guess what, when you run, you spend a lot of time on one leg! Pelvic floor PTs are trained to do a impact readiness screen with patients. This includes a series of questions about leakage, heaviness, and pain. It also includes a physical screen of things like: can you do 20 single leg bridges, 25 single leg calf raises, 10 single leg squats on each leg, run in place for 1 minute without symptoms, jump for distance, single leg hops, and more! This gives us solid objective data if you have the strength, endurance, coordination, and mobility to return to running and more advanced high impact activity. As PTs, we are here to promote long term health and wellness, and that starts with educating patients and providers on what we do, and we can work as a team to achieve this goal of long-term health and wellness while reducing risk for injury.
Does all this postpartum exercise talk make you think about prenatal exercise as well? Well, there is even LESS concrete evidence out there for prenatal exercise. You will hear all sorts of things from don’t lift more than 25# to don’t let your heart rate elevate more than 140 beats per minute, to stop running all together. There is no one size fits all when it comes to prenatal exercise. Every pregnancy is different and the risks are different with each pregnancy. This is where a pelvic floor PT can help you navigate this journey and collaborate with your provider to keep you moving safely. In general, ask yourself “CAN I do this activity vs. SHOULD I do this activity?” Can you run a marathon at 7 months pregnant because you are low risk and feel great? Sure! But should you? Is it the best choice of exercise for long term pelvic health? I am not here to TELL you what to do, I am here to EDUCATE you on pros and cons and let you decide! I will say this, research shows that 71% of pregnant individuals have low back pain! 77% of postpartum individuals have low back pain and the biggest risk factor for low back pain postpartum is: low back pain during pregnancy! The same holds true for urinary incontinence. Those who have urinary incontinence during pregnancy also have a higher likelihood of experiencing these symptoms postpartum. So, whether you have symptoms, or want further education and assistance with exercise modification, pelvic floor PTs are here to guide you!
It is never too late to seek support from a pelvic floor PT, no matter how far postpartum you are! I encourage you to check in with one, even if you don’t have symptoms, to make sure you have a strong, flexible, and coordinated pelvic floor and core they can work effectively for years to come!
Megan Jones, PT, DPT
Board Certified Orthopedic Clinical Specialist
Certified Pregnancy and Postpartum Athleticism Coach
Owner, Reclaim FXN
Back in 2020, I did a whole post on “What’s pelvic floor physical therapy?” The post has lots of resources as well as my own personal experience after my second birth (spoiler – it was wonderful!).
Megan recommended these trusty resources that also offer great courses:
These are the resources for physical therapy from the RESOURCES page for anyone looking for more info:
- APTA Pelvic Health
- Find a physical therapist
- Patient education
- Carrie Pagliano’s Physical Therapy
- MyPFM – My Pelvic Floor Muscle
- Article: Musculoskeletal Dysfunction During Pregnancy and After Childbirth
- Article: Pelvic Pain: Causes, Symptoms, Physical Therapy Treatment
- Article: Questions to ask your physical therapist
- Article: Tips for Improving Urge Incontinence and Bladder Health
- Article: Physical Pain with Sex
- Article: 10 Step Guide to Putting Your Pelvic Floor First
- YouTube channel: ChoosePT
Thank you for reading – don’t forget to follow Megan on instagram.
1 year ago on the blog…Friday Five (#41) < the Five’s were a thing back before there was a newsletter!
2 years ago on the blog…Women Ask Wednesday: How do I manage back pain during pregnancy?