Return to Exercise Post Baby: A New Perspective

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:

• Sperstad et al found 32% of single parity (one childbirth) women presented with diastasis recti one year post partum.
• Conklin et al (2015) reports 50% of a 229 primiparous (women who have delivered a child 1x) sample of women had back pain at 8 weeks post partum.
• Smith et al (2013) found 31.2% of 2,754 multiparity women had perineal trauma during delivery. 9.4% of nulliparous women were found to have trauma. 
•  National Hospital Discharge Survey reported that more than 65% of women who experienced vaginal birth also experienced some degree of perineal/genital tract laceration.

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!