The 6 Week Return To Exercise Myth
For as long as I can recall the guidance has been women can return to exercise at 6 weeks postpartum wether you have had a c section or vaginal birth. Until I gave birth, I held issue only with post c section return to activity based on the fact that I could abdominal surgery whether c-section or anything else is never addressed from a rehabilitation perspective. Our core is our center of movement, breath and life force. How can it not need a proper reboot after surgery? Once I had my daughter, I realized that post partum recovery and return to sports is an individual process and NO blog, website or exercise guru give a guideline that is applicable to all.
The Guidelines Provided By the Return to Running Guideline
The Guideline suggests that running begin no earlier than 3 months postpartum when there are no symptoms of pelvic floor dysfunction (see Return to Running Part 1). It also recommends a pelvic floor assessment for all postpartum women to complete more formal testing of the abdominal wall and pelvic floor and functional movement. From a functional perspective it is recommended that women can walk a brisk 30 minutes without symptoms prior to running. It recommends grading the return to run with 1-2 minutes of running followed by walking for a few minutes prior to running again for 1-2 minutes, etc. This is slower than many moms want to go, but, I have to say, there is nothing better you can do for yourself than protect your recovery to prevent long term health issues. The guideline also takes into consideration breastfeeding. Evidence suggests that a woman's hormone profile leaves them more at risk of injury when still nursing. If you are a woman who considered yourself "hypermobile" prior to pregnancy, you may want to take it slowly and better yet, see a PT for evaluation prior to running.
The Bottom Line
Unfortunately, mommas, this manual does not give a global prescription to provide you with regards to a solid guideline for return to running or any high impact sport. This is the same answer I give at every talk or postpartum check up I perform. Everyone's body is different and their pregnancy and delivery is different. How your body responds to a return to exercise may be different than your best friend. The easy items to check off your list would be to make sure you are optimizing sleep, wearing supportive clothing including good sneakers, and good nutrition. The take home message is to take the pressure off of yourself to do it all the minute you are cleared to exercise and to seek out specialists to make sure you are covering all of your bases to protect your long term health!
A long time ago I wrote a blog about my return to running post baby #1. I learned some pretty significant lessons about the reality of postpartum return to exercise 10 years ago. I ran and did strength training to the last minutes of pregnancy (not high mileage or fast, so maybe a jog?) I learned that despite being in great shape prior to pregnancy I won no free passes in the healing process post baby. I learned that the path to recovery is NOT an event, but a process. (I say that about many things, but, it
There Isn't One Answer That Fits Every Postpartum Momma
Many of my clients are so eager to hit the road and return to pre-baby exercise and body ASAP after baby is born. I was there too. I get it. But, not everyone has the same pregnancy, delivery or postpartum experience. In an age where googling an answer to everything is possible, it isn’t fair to yourself to do that with postpartum recovery. It is really hard to hear that there isn’t a one answer fits all response to postpartum return to exercise. To be honest, I have felt a bit over-conservative at times. But, now there is a publication that lends support to the clinical reasoning I have shared with my clients over the years.
What Research Has Found About The Effects of Delivery on a Momma's Body
There is a group of rock star clinician’s who have dedicated endless hours into reviewing research and reaching out to other clinical experts to create a template for returning to running or high impact activity post baby! I am so grateful to these clinicians for organizing the hard work many of us clinicians have tried to do over the years on our own and taking it a step further to create a template for decision making. I am going to take a few weeks to go through some of the highlights with readers to help them better understand the importance of a postnatal wellness check, overall pelvic health and individualized return to high impact exercise. Read further moms that have big baby’s now. This info will help you understand your body too!
What happens to your body during labor & delivery (PS- this is not an exhaustive list. I could go on for pages about the potential short and long term effects of pregnancy and delivery on a woman’s body.)
This just highlights some facts to support my earlier blog about return to exercise post baby. Many of us need it for our mental sanity. But, we definitely need to ratchet back our expectations according to the signs our body is giving us. There is NOT a one size fits all return to exercise plan for all new moms. There isn’t even one for Veteran Moms who may finally be finding the time to exercise 3,5, or 10 years out. The faulty mechanics that can arise from birthing or injuries years ago might impact a women’s plan to return to exercise.
Signs That Your Body Isn’t Ready To Run (from Return to Running Postnatal Guidelines..):
Ceydeli, A., Rucinski, J. and Wise, L. (2005) Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 62, 220–5.
Goom, Donelly, Brockwell, Return To Running Postnatal Guidelines for Medical, Health and Fitness Professionals, 2019
Hamar, B.D., Saber, S.B., Cackovic, M., Magloire, L.K., Pettker, C.M., Abdel-Razeq, S.S., Rosenberg, V.A., Buhimschi, I.A. and Buhimschi, C.S. (2007) Ultrasound evaluation of the uterine scar after cesarean delivery: a randomized controlled trial of one- and two- layer closure. Obstet Gynecol 110, 808–13.
Stær-Jensen, J., Siafarikas, F., Hilde, G., Benth, J.Š., Bø, K. and Engh, M.E. (2015) Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol 125, 531–539.
Mom's Want Answers. Here's 3 Things to Keep in Mind With Regards to DRA
I am a science minded practitioner, I could spend the better part of a day going down a rabbit hole of investigating new science related to a myriad of topics I love. DRA (diastasis recti abdominus) is one of those topics. DRA is a thinning of the central abdominal tissue that can occur with pregnancy. Mom’s often worry because they feel that they look pregnant after baby is born. Some moms experience back pain, urinary incontinence or feelings of vaginal heaviness as well. It is something many moms are concerned with these days. There are a ton of programs to prevent and eliminate DRA. Let’s be real for a second. There is not enough science to have exact answers or guidelines for every type of client that walks into my office. There isn't a hidden answer that fits all moms. I just completed a Women’s Health 8 day 2 hour/day Webinar series and I would love to share with my community of amazing moms some current thoughts about the topic of DRA.
As of right now there are a limited number of studies that examine DRA recovery and even it’s clinical significance with regards to long term function. Some studies look at DRA and apply treatment principles but fail to examine how the severity of the DRA impacts treatment outcomes. So, for example how does a large DRA respond to exercise vs a small DRA. How about the make up of the woman’s collagen? Some of us get wrinkles earlier in life and some older. Some got stretch marks during pregnancy that went away and some still have them. Our collagen make up dictates much about our post natal recovery with respect to DRA. In addition, bowel dysfunction can add pressure to the abdominal system that impedes the ability of proper breath to be strong enough to overcome the outward pressure of gas and bowels. DRA does not happen overnight. It takes a long period of sustained abdominal pressure for a DRA to form. Men and even kids can have it too! Bottom Line: There is not one program or one exercise that will help all people with DRA or prevent DRA with 100% assurance.
So what’s a mom to do?
Number 1: Whether you have DRA or not, I cannot recommend enough getting a postnatal breathing and movement assessment. Proper breathing mobilizes your spine and organs! It also allows for optimal pressure management of your core for stability and organ health. When you learn about your specific breath pattern you can then best incorporate new strategies to optimize restful breathing so it works for you.
Number 2: Learning how to exercise properly for your body is critical! If you have signs of doming (popping out of your belly) during exercise classes, post exercise back pain or vaginal heaviness, maybe you need a modification or two to participate in class best. Maybe that means you need to revisit how you lift, breath and function during basic daily activities because let’s face it- just being a mom is a workout! To activate a system that creates good tension throughout the front of your belly and around the thorax is critical for lifelong abdominal health.
Number 3: Remember- there is not one magical cure. We need to relax and understand that as much as we would like, there isn’t a one answer fits all block that can help you in the same way it helped your best friend. We need to recall that DRA doesn’t occur overnight so it won’t go a way overnight. Proper assessment and understanding how your body is currently functioning and how to best promote proper function is key! Recovering from birth is not an event that occurs at 6 weeks, it is a process.
Since May is Mother's Day I am offering 15% off of first visits! call today! 9783933736
Everyone’s body comes to this planet with different strengths and weaknesses. To use a phrase from my PT professor, “It behooves” us to understand our individual body’s strengths and weaknesses in order to manifest our best long term health!
Spring is the time for a body tune up; a chance to reconnect with your body and tune in to what it might be telling you it needs. Falls on ice, illness, overuse injuries, carrying kids and groceries or that intermittent back pain that seems to eventually go away, can leave us at risk for injuries or costly compensatory techniques. Those old ankle sprains from college might actually have long lasting effects you haven’t even noticed! Those subtle changes in our body can leave you at risk of injury and maladaptive compensatory movements. So many people tell me they "fell apart" at 40 or 45. They didn't fall apart. In truth their body finally could not keep up with all of the compensatory strategies to cover for a lifetime of injuries.
With the onset of spring, many are renewing the vow to exercise more. As runners and bikers increase their mileage or gym lovers increase their workout intensity, many go without thinking about the changing needs of their body. Our needs change with age and diversity in our fitness plan is essential to long term health. You would benefit from a tune up if you have agree with any of these statements:
Because I want every person to understand how their individual body works best, I am offering $20 off of your Spring Tune Up at Newburyport Wellness. Understand your body like never before! You will leave with an understanding of your body that will leave you feeling empowered.
Do you ever feel like the medical care and family response to your health goals are lacking? For certain, there are situations where women get better care than men and there are times when men get better medical care than women. By and large however, studies are based on men and some dysfunctions that only females face are sparsely or no where to be found in research literature. How are we to make sound decisions about our body without adequate information? How can we expect our healthcare practitioners to adequately guide us without this information? We need to be our own best advocates. We need to teach our daughters to do the same.
It is all too often that female issues are negated by medical professionals. I think back to my own childhood and recall being told by an MD to “act more like a girl, get a Barbie Doll and give up on sports.” In college the ligamentous laxity (looseness) resulted in a greater workload on my postural muscles to hold me together. I had severe back and hip pain and was told it was in my head because my range of motion was totally fine. I had to learn on my own that staying strong meant less pain and eventually no pain. I sprained my ankles over and over due to the same condition. NO one pointed out that this lead to dysfunction all the way up to my core and left me at a higher risk for new sprains and other injuries. NO one guided me in a PROPER return to exercise post partum. If this is my life, I can’t imagine how many others have suffered the same or worse.
Fast forward to marriage and kids…. I distinctly recall several times when I REALLY needed a break and didn't get one. I felt bad for my husband to have to do more than he already was doing. I felt like I wasn’t doing my part if I took a break and felt like it was my duty to "suck it up". I felt like I was failing, not that my body was right and needed a break. Some of what we need to do to ensure adequate healthcare is to start by valuing ourselves enough to take a break before bad gets worse. Set boundaries. It is OK to do so! If we marginalize our own symptoms, how will someone else take them seriously?
How do you fight this marginalization of symptoms and concerns?
1-value your intuition
2- Use a new strategy to convey your concerns (writing them down isn’t always enough.
3- encourage your daughters to listen to their body from a young age
4- Categorize your concerns
5- Seek out medical professionals that will listen
6- set boundaries and stick with it
Do you want a handout to help strategize your conversations with medical professionals? Do you want to know a bit about how many medical professionals process the information you provide and how/why they ask certain questions? Come to Women’s Wellness Night, March 29th at 7pm at the Tannery where you will receive specific strategies and tools to help to ensure you get the care you deserve. RSVP today! www.facebook.com/events/521778148344830/
If you deny ever having something get in the way of your planned workout, stop reading. You aren’t human! As a mom, I can count more times that my workout has not unfolded as I planned than times that it has. When my kids were little, they could hear the click of the treadmill (why do kids need to have super power hearing?). As toddlers they would wake up early from nap, be sick or climb all over me. It was a never ending barrage of interruptions. Now, work, kids, school events and keeping up with my house can be deterrents to a great workout. So what is a mom to do?
First of all, unless we have a great family support system or send our kids to daycare without running off to work, it takes a brain shift to make working out meaningful and positive when we are juggling life as moms, wives and workers. Waiting for the day that you have a full hour or more to commit to exercise may never come.
When Work or Life Overtakes Your Workouts as a Woman Without Kids
So you have no kids, but, you miss a day at the gym and that can easily turn into 3 or 4 or 1 month! Don't let yourself skip. Even if you have had the worst day at work, make yourself do 5 minutes of something so you can pick up where you left off the next day. You are less likely to experience full on abandonment of your exercise program if you make yourself do a little bit on even the craziest of days.
When You Have Babies-Toddlers
I can remember the frustration…. Sneaking downstairs to workout, getting dressed and starting my routine to hear the cry of a little one. Don’t throw in the towel. Make them happy, get them cozy and exercise in front of them or take a walk pushing/holding them. I would walk besides the stroller doing lunges- forward, back, sideways. Push ups to standing up and kissing them. Take the program you had in mind and talk to your baby as you go. Hold them in front of you and do squats if you can support that added weight with good form. I would even do squats while pumping! Maybe you don’t get in an hour, but you can get in a lot!
When You Have Bigger Toddlers
This was my favorite stage of child development. Language emerging and new physical skills popping up every day. I would do the same routine as above when my daughter was willing to sit in a stroller. If not, she went into the baby swing and I would do squats or lunges between pushes, sprint across my backyard or park between pushes and encourage them to try some basic moves with me. Chase is always a great way to get your heart rate up! Because I was faster than my toddler (yes, that may be the only time in my life I have been faster than anyone!) I would stop and do push ups on my way to get her or monster walk to work my hips. My daughters also loved when I made them an obstacle course that kept them busy for me to squeeze in reps of my own exercises.
When You Have School Aged Kids
Now I have a 6 and 9 year old. “Fishy fishy Cross My Ocean” never gets old! (Hello Pelvic Floor Control!) Plank challenges and dance parties are fun for all! The other night we had a Hoola Hoop Contest and Dance off that was hysterical and a great work out. My daughters love to play “Superman” where I press them up to the sky with my feet while I hold onto their hands. This can be a good leg workout.
The more you include your kids in exercise, the more they see it as a part of life and the more time you can spend together doing something fun. If your plan to make it to the gym was thwarted by life, don’t give up. Even if today is a wash, tomorrow doesn’t have to be.
If you are struggling to balance work and home life, don’t let yourself get crossed off the priority list. Maybe you get in 10 squats and a couple of sprints up the stairs or a set of push ups before you read to your kids before bed. Your body will appreciate the small gestures of acknowledgement and self care.
BOTTOM LINE- DON’T WORRY ABOUT LOOKING SILLY! GET THE JOB DONE!
Ayla and I post hike.
If you were like many, you started a new exercise plan, joined a gym or group class or upped the ante of your current regime this new year. Challenging your body is a must when it comes to improving fitness. However, there is such a thing as too aggressive when it comes to challenging your body properly. I have spent years listening to friends tell stories of jumping in to an aggressive workout program and then cry when they get off the toilet for a week and abandon their new exercises regime within 3 weeks due to frustration or injury. Similarly, I have met some who are so afraid of feeling terrible after a workout, they avoid strength training and a challenge all together. Neither is a good plan or an optimal path to success.
It is normal and good to be a bit sore after a workout. But, being so sore that you can't get off the toilet or put on a bra for a week is not good. Jumping in to an overly aggressive workout can really put your goals at risk. Here's why:
1. Working past the point of maintaining optimal form can result in overuse injuries of primary or supporting muscles.
2. Continuing to workout with super sore muscles invariably leads to compensation and altered mechanics which can lead to injury.
3. In rare cases, severe overtraining can lead to a condition called rhabdomyolysis where muscle breaks down and can cause kidney failure. Rhabdomyolysis typically occurs with traumatic events, but, there have been more cases of this occurring with high intensity exercise.
1. Under-training fails to challenge the muscular system to gain strength or endurance. 2. You may not see the results you want, get frustrated and abandon your exercise plan.
3. You are missing the great benefit of bone building/sustaining benefits of exercise.
While I can't stress enough the benefit of a fitness and movement analysis prior to beginning a program, you can do a self check for some basic movements and activities.
1. Stand against a wall. Can you raise your arms overhead completely without arching your back or straining through your neck? If you can't you should check in with a PT to find out why and fix that before overhead strengthening or downward dog activities.
2. Squat and lunge in front of a mirror. Does your knee or knees move in towards each other or wobble out to the side? Make sure you have good form without weights before adding weight.
3. Incorporating a new program should leave you sore for a day or two. If you are sore for longer, backoff a bit and build up a bit more slowly. Focus on form not reps or sets to start off.
Consider a full body wellness assessment at Newburyport Wellness where you will learn the ins and outs of how your specific body works. Learn what muscle groups are strong, what needs strengthening and how to identify any potential errors in form during your new workout!
Happy work outs!
There is no shortage of fitness programs, running protocols or fitness centers to choose from. Many of us look to the new year to begin an exercise program, revamp our current routine or take on a new challenge. For some of us, the current routine fits and it is hard to push ourselves to try something new. As we get close to a new year of wellness goals, I've listed a few guidelines, thoughts and suggestions!
Runner's and Spinners & Road Cyclists
If you love running and spinning you have a great cardio base routine and even a great workout for some muscles in your legs. However, here's what you are missing:
core strength and stability
Outer leg strength and control
Upper Body Strength
Core strength and stability helps to improve running efficiency and protects your back for longer bike rides. Inner core dysfunction can lead to leaking urine when you run, back hip or knee pain. Outer leg strength is totally missed in a running or cycling dominant program. The outer hip muscles are critical for shock absorption when running (do you have a collapsed arch in your foot, hip or knee pain?). Building these muscles also help to shape your butt! An upper body program is really important to build and maintain bone density in the upper body (Who wants to be high risk for wrist fractures as they age?). Lastly, we now know that building & maintaining bone density in the hip takes more than running or jumping vertically. To work on the femoral neck (where many fractures occur) we need to target bone building with more than running or jumping.
Exercise Video Workout or Boot Camp Enthusiasts
There are so many workout videos and classes to choose from. If you love an intense workout that is great! I do want to offer a few thoughts about these types of workouts. I love a hard workout, don't get me wrong. But, it is hard to know when your body is substituting and using helper muscles to get the job done or when you are using a faulty pattern to accomplish a physical task. (Do you ever feel your hip flexors on fire during a core workout?) When we use helper muscles or faulty patterns we leave ourselves at risk of injury or negating the very reason you are doing the exercise. Be mindful of your form throughout the workout and stop when you feel your form declines. The inner core is often bypassed by outer ab muscles when doing stability work. This can lead to leaking urine, back pain and more. Make sure you aren't holding your breath during a repeated exercise (think pushups) or bypassing certain exercises because you know they will cause pain or other dysfunction.
New Exercisers Or Those With Pre-existing Aches and Pains
It is critical to be mindful about your exercise plan. Don't think the ache or pain you have now will go away with exercise. Know what is going on and how to support a weakened area will set you up for long term success. Did you know that dysfunction in posture and inner core can result in shoulder pain? Start off with a focus on form with any exercise program. If you are scrambling to keep up or you feel muscles working that aren't target muscles for that particular exercise, your form is likely on the decline and the risk of injury goes up. Make sure you incorporate a plan that challenges all of your body's major muscle groups.
The Benefit Of A Fitness Assessment
Newburyport Wellness specializes in helping people reach their fitness goals. Whether you just starting out or a veteran athlete a fitness assessment helps to identify your areas of strength and weakness and how those factors may influence your wellness goals. Determining what your body needs for optimal strength and stability helps you to attain not only your immediate fitness goals, but also helps to keep you strong and healthy for life. A personalized assessment identifies the muscles that may not be working optimally and the muscles that may be compensating. A functional assessment allows you to have a clear picture of where your start point is for the year relative to the goals you want to achieve.
Many of us have a PCP and perhaps a chiropractor and favorite massage therapist. Some of us have just a PCP we see for check ups or for when something goes wrong. Optimally, our healthcare team should be fluid and change somewhat as our emotional and physical needs change. NO matter what, we should feel like the members of our team are TRULY listening to our words and working their best to help us navigate the path to attain or maintain optimal health. We should NEVER keep a team member when it just doesn't feel like they truly hear you. The world is still working to hear and value our intuition with respect to knowing what our body needs. We have become so disconnected from our body's that it can be difficulty to value what we innately know we need. But, you should value your intuition. It may be that a healthcare practitioner steers you in a different direction, but, they should explain their reasoning.
Our teams may all be comprised of different people. The massage therapist that is best for you may not be best for your best friend. That is ok. Keep your ears open to the options and share that information with your friends and family when they need to add a new clinician to their team. Your own healthcare team may and should evolve as your health changes. Remember that every healthcare team member should be giving you homework and/or educating you about your body. Are you gaining knowledge and insight on how to improve and maintain your own health. Are you being shown the path necessary to take charge of your health? You are the strength in your healthcare web. The clinicians are just the support system. They are there to support you and guide you not to do the work for you.
At Newburyport Wellness, LLC, it is my goal to hear you clearly and work to teach you how to be a stronger, have less pain and achieve your fitness goals. Using manual therapy, exercise and education my number 1 hope is that you complete your therapy knowing your body better- knowing how to care for the imbalances (Yes, we all have them!) and to lead your best physical life. While physical therapy is my background, my goal is to help people avoid frank injuries and remain healthy and happy!
Just like a spider web, you are unique, resilient and strong. The branches you see supporting the web can come and go, but the true strength is in the web you weave.
Fall Is A Time To Nurture Ourselves and Our Children
I love fall for the bountiful garden crops, fresh food and crisp fall air. It seems so natural to nourish our bodies with good food throughout the summer and fall. It is also a time to take stock of where your body is physically. Most of us have small aches and pains that we ignore or push off, thinking it will go away. Every time the season’s change it can serve as a reminder to ourselves to reassess our body and think about what is working well and what maybe needs to be addressed.
As we begin this fall, take the time to ask yourself a few questions about your own health.
While every ache and pain or mini injury isn’t a reason for huge concern, if you find yourself making excuses for recurrent aches, pains or alterations in your body habits, it is time to listen.
If You Think You Don’t Have Time For Self Care, Here Is Why Your Should Make The Time
Let’s face it… The American Way is to work and give…. Never ask for help unless it is an emergency. Take care of everyone else first… This is not a healthy habit and it is surely one we don’t wish for our children. Be the model of change for your lovely children! I think we would all agree there are only a small percentage of people who are connected with their body well and listen to it’s signals for rest, proper nutrition, exercise and medical intervention. We should want all of these things for our children. We have to lead by example. If you are a new mom, take it from a veteran mom, ask for help when you need it. No one can do it all well alone!
How To Teach Our Kids To Be Good Guardians Of Their Body
Is a mom of two, life long exercise enthusiast and women's health coach & physical therapist.