Most of us are told we can return to abdominal exercise at 6 weeks post partum. That is the common rule of thumb in the US. However, as a physical therapist and mom of 2, I get a twitch in my brain when I think about this. Let’s pretend you had ACL surgery. Are you allowed to return to Olympic lifts and tennis at 6 weeks? Rotator cuff surgery? Do you get to bench press the minute you have healed 6 weeks? NO! Why then do we get cleared to exercise our abdominals and pelvic floor without limitation at 6 weeks post partum? Recovery from childbirth is NOT the same for all of us. The injuries vary and, therefore, so does the recovery.
Here are the facts:
So What Does This Mean?
The reality is that we don’t have all of the answers proven in science yet. But, I will break it down from a science based perspective:
A vaginal delivery does not impose a frank tear to the abdominal musculature but it may result in a frank tear of the perineal tissue. The pelvic floor is an integral part of the inner core (transverse abdominals, multifidous back muscles, diaphragm, and pelvic floor muscles). The inner core must function well for optimal long term physical health. Nevertheless, our abdominal muscles have been stretched out past their optimal length for contraction throughout much of pregnancy. A
C-section results in a frank breach of the abdominal wall.
When we partake in traditional abdominal exercises like crunches, we are bearing down on the abdominal organs and asking your abdominals to lift your upper body. When we are jumping, we are asking the pelvic floor to absorb shock and support our organs. Asking your abs to contract at a high level exercise like a crunch or a burpee is asking a lot of your muscles. In 17 years of doing orthopedic PT, I have never treated someone post operatively that was allowed to do any strength exercise they wanted at 6 weeks post operatively. Injured tissue repairs best with guided and progressive increases in load. Why then are women cleared to one of the most demanding abdominal wall exercises at 6 weeks post partum?
Not all women will experience negative effects if they return to a high level of exercise once cleared. It depends on previous level of fitness, birth trauma and collagen make up. Many women do, however,experience back pain, hip pain, knee pain or incontinence. This may very well be the caused by dysfunctional activation of the inner core and weakness of outer abdominal muscles resulting in poor form and muscle activation patterns with activity. If you have symptoms (even if you had your kids years ago), I implore you to reach out and explore the possibility of inner core dysfunction. If you are a new mom, I urge you to resume workouts thoughtfully!
So I have been missing my runs lately. Kids are crazy busy with sports and squeezing in a run is hard. I am missingthe days when I could throw my daughter in the jogging stroller and go. As I watch moms run with their jogging strollers I am filled with jealousy. The feeling of a super hard workout pushing my kid, her 50 pounds of snacks and the stroller.The subsequent freedom of running when I could run without a stroller. I felt faster and a bit stronger. And then….
I suddenly see the list of side effects that jogging with a stroller can create. When you walk, jog or run a lot with a jogging stroller, you are drastically changing the mechanics of how you move. Normally when you walk or run, yourtorso rotates to help balance the rotation of your pelvis with each stride. Rotation of the torso allows for your abdominal wall to freely expand on inhalation and recoil on exhalation. A slight pitch forward of your body helps with propulsion. When you use a jogging stroller you eliminate the slight pitch forward, torso rotation and a true freedom of breath. I watch people either hunched forward pushing the beast of an object in front of them or almost overly upright. Whether you hold the stroller with one arm (or two), you are eliminating the normal trunk and pelvic rotation that occurs with running. Because you are pushing, your abdominal muscles are likely to be actively stabilizing the entire time. Well at least that is a plus, right? Well, not so much. When your abdominal muscles are on overdrive during a run, it is changing the way the body is creating and distributing internal pressure. Hello back pain or pelvic floor dysfunction! Hello altered mechanics when you walk or run without a stroller. And to really fast forward, a lack of trunk rotation is correlated with an increased risk of falls as we age!
So now what?! This is how our generation has and continues to survive the early years of our children’s lives. Clearly giving up running or the jogger is a no go. However, how great would it be if you could really learn how your body should move so that when you aren’t pushing a stroller, you can revert to the pre-jogging stroller way of moving? How great would it be if you had all of the information necessary to make the best choice for your body?
As I write this I want to assure you that you don’t need to give up running with your jogging stroller. Please, if you need the stroller to get out and move, do so. Many of us need it for sanity's sake as much as physical wellness. I write this to educate about the plusses and minuses of the jogging stroller. I write this to educate. Knowing how your body works and why dysfunction occurs is powerful information.
When you can, run without the stroller and be aware of how your body is moving. Pumping your arms is not the same as rotating your torso. When you are using the stroller, be sure to try and allow your belly to expand when you inhale. Be aware of back pain, incontinence or hip pain. Don’t wait to address it! The longer a problem exists, the longer it can take to remedy the situation!
As we finally embark on some good weather, go out and enjoy your runs. Keep your mechanics in mind and breathe!
Until we can run with this form , we will do the best we can!
We have all been there…. Do you remember buying your first car? The excitement, pride, and pure desire to keep it in perfect condition. I remember obsessing over the maintenance book that stated when I would need to get my car serviced. I was never late getting these ever so important tune ups!
Fast forward 10 years into my career. Endless accounts of disbelief from my clients as to why their back is “suddenly” in extreme pain instead of the occasional ache. Anger and frustration that they can no longer push through that pain to get in their usual workouts. The list is endless. From a personal stand point, I did what many moms do. I got lost in my kids and my daily 1 hour workouts diminished to biweekly or triweekly 30-45 minute events….. if I was lucky.
I get it! It is hard to carve out time for yourself and when you do, you want it to count! For many of us that means some pampering (massage, pedicure, etc) or a great workout where you REALLY sweat! However, behind those small aches and pains or subtle postural changes are a message. The message is this: “Your body is changing. It is time for a tune up.” Equate this to the squeak of a car when it is time for a new belt or new brakes. “Pushing through it” means compensating and setting up faulty patterns. “Pushing through it” means you are setting yourself up for the potential of future breakdown. Nothing stays the same forever, so that small amount of pee that you leak when you sneeze will likely become a bigger problem if left unattended. The same is true for the chronic aches and pains and postural changes.
Know anyone with forward shoulders? A rounded lower spine?
There are many ways to think about a tune up. Energy rebalancing, massage or a chiropractic adjustment are two ways that people often choose to align their bodies. My approach is entirely from a functional point of view. Reset the motor plan for your body and keep that plan active with a few specific exercises. Learn the short cuts that your body wants to take to avoid areas of weakness and create a plan to keep your body strong in all the ways it needs to be to do the things you love. The truth is, our bodies are just intricate machines. Nevertheless, we expect our body to go on forever without a real tune up. Unfortunately, it just doesn’t work that way. 17 years of practice has shown me that the path to long term health means looking at the small details and creating a personalized plan of action. Think of it like this: not every tune up is the same. Sometimes you need an air filter, brakes and new tires and sometimes you just need your tires rotated. I encourage you all to think about your bodies in a new way. Don’t put things off for another day. The time to optimize your wellness is now!
Ok. So we all have heard it before. "Just do your Kegels." Well, the truth is that it's not quite that simple. Studies show that a verbal cue alone is not enough to get the right action. Let's face it, when you work out, do you think, "Ok, now let's do an exercise for my pelvic floor." Did you give your pelvic floor one half of a second of thought before injury or giving birth? We get visual feedback for most of the other muscles we use in our body; especially when exercising. (ie. Bicep curl: I watch my hand pick up the weight, and bend my elbow. I feel the weight and see my arm move. I can even see my bicep contract!) But, most of us have not watched our pelvic floor in action! There is no feedback loop to help you know that something is off because you never knew what it looked like or felt like when it was working right. So, for many of us, finding a good standing posture and actively doing a Kegel is not the magical key to incontinence prevention and pelvic floor recovery. Thinking you know where the muscles are and knowing where they are will make all the difference. Furthermore, if you don't get personalized feedback about how your body is working, how do you really know what you need? Now, there is so much more awareness about pelvic health. That is great! Some exercise classes include pelvic awareness into their regime. I have taught those classes myself! But, I have learned despite all of my efforts to describe the goal of the exercise, the feeling of contraction and even with promoting good posture first, women and girls still have a hard time achieving a great PF contraction. I have learned that more often than not, a PF contraction performed during a class or during a one on one session prior to appropriate training, quite often targets the posterior muscles of the vagina and anus. Most of us want to target the front muscles around the urethra (where you pee from)! It takes just a few minutes to identify and activate each of the ever so important components of the pelvic floor. Once you get the training you have achieve that magical connection with your pelvic floor! And the good news is, there is no internal exam needed to get started!
Is a mom of two, life long exercise enthusiast and physical therapist. She combines her two passions to promote female health and fitness.