PRE & POST PARTUM PHYSIOTHERAPY AT THE INJURY CLINIC

PRE & POST PARTUM PHYSIOTHERAPY

At The Injury Clinic, we have physiotherapists with a special interest in post-partum return to activity (including high impact activity such as running). We understand that this is a unique time in a woman’s life; the demands and pressures put on the body both during pregnancy and in the post-partum period are extraordinary! We know that it takes time to heal and regain strength, not only in the pelvic floor and abdominals but in many muscles that have been loaded differently during pregnancy. We will work with you to identify any areas that need to be retrained to achieve your goals. 

WHAT TO EXPECT

During a post-partum assessment with our physiotherapists, you will likely be asked a series of questions, many of which may seem slightly intrusive or personal. These help us gain insight into any potential problems and assess where your baseline may be. From this information it may be decided that we need to refer you to a Women’s Health Physiotherapist for further assessment prior to starting treatment at The Injury Clinic. 

 

Questions may include (but will not be limited to):

How far post-partum are you?

What type of delivery did you have (vaginal vs caesarian)?

Were there any complications?

Were you able to continue exercising during your pregnancy? If so, how often, what type of exercise etc. 

Have you had any urinary/faecal incontinence or increased urgency?

Have you had any pain with intercourse?

Have you returned to any exercise post-partum?

Have you been completing pelvic floor exercises? If so, how did you learn these and what ‘cues’ have you been using?

Have you had any heaviness/dragging through the pelvic floor area? 

Are/have you breastfeeding/breastfed? 

Do you have any pelvic or lower back pain? 

 

A functional assessment will then enable us to identify a baseline and establish a plan. This, for example may include a strengthening and return to running program. We will also be able to identify and address any pain or injury concerns you may have. 

POST-PARTUM FREQUENTLY ASKED QUESTIONS…

Does abdominal separation cause back/pelvic/hip pain?

While it is frequently thought abdominal separation causes back, pelvic and/or hip pain, there is no evidence to suggest this is the case. While it may be a contributing factor, there are many aspects to back, pelvic and/or hip pain, particularly in the post-partum period. 

 

How soon after I have a baby can I return to running/sport? 

This is one of the most frequently asked questions we hear. Unfortunately, there isn’t a specific timeframe as there are so many variables. Things that affect how long it may take you to return to sport include (but are not limited to);

How active you were during your pregnancy, and what type of activity you were able to maintain during your pregnancy?

Did you have a vaginal or caesarian delivery? 

Are you breastfeeding?

Have you started any exercise since the delivery of your baby?

Have you seen a Women’s Health Physiotherapist? 

 

Should I see a Women’s Health Physiotherapist after having my baby? I don’t think I have any pelvic floor problems… 

At The Injury Clinic we suggest all women consult with a Women’s Health Physiotherapist Post Partum. Even if you don’t have any symptoms that indicate a potential problem, we frequently see women many years post partum who end up having concerns that need to be addressed by a Women’s Health Physiotherapist. We feel it is best to address these concerns before they become a problem. In saying this, The Injury Clinic Physiotherapists are always happy to consult with you and begin addressing any post-partum concerns you have even if you haven’t consulted with a Women’s Health Physiotherapist. 

 

High-impact vs low-impact exercise… should I wait longer to get back into high-impact exercise?

In short, yes. There are many different loads and forces that travel through your body with high impact exercise. The tricky thing to establish is when it is appropriate to return to high impact exercise; this is where The Injury Clinic Physiotherapists will be able to help you! 

 

I’m breastfeeding… Are there things I need to be wary of or avoid?

While breastfeeding isn’t a reason to avoid exercise, it does pay to try and time feeds prior to your workout, wear a supportive bra (this means being specially fitted for a sports bra post partum) and ensure you drink plenty of water. There is some evidence to suggest there can be lactic acid in breastmilk after maximal exercise, but it is not thought this affects the nutrients available nor does it harm the baby in any way. In mild-moderate exercise there is no increase in lactate. 

 

I had a caesarian section… Are there different ‘rules’ for me? 

In short, no, there aren’t a specific set of rules for post-partum mothers who had a caesarian delivery; however, there isn’t a ‘one-size fits all’ approach to the return to exercise post-caesarian. Similar to a vaginal birth, a woman’s recovery will vary significantly so it is always best to ensure you don’t compare your recovery to someone else you know. Considerations must be given to healing of the scar, which not only passes through the skin and uterus but also through layers of abdominal muscles. This abdominal muscle tissue and fasica will have only regained approximately 50% of its original strength at 6-weeks post partum, and 73-93% of the original strength at 6-7months post partum.



When can I start to exercise after I have my baby? And what kind of exercise should I start with?

Returning to exercise post-partum will be slightly different for each woman. It will depend largely on what type of birth you had (vaginal vs caesarian) and how you recover. The other factor to consider is how active you were during your pregnancy; often those who are able to remain active throughout their pregnancy are able to return to exercise sooner than those who were more sedentary (but not always). As a general rule, before you have your 6-week check-up you should only be completing your pelvic floor exercises and gentle walking. With walking, remember to start gently and build slowly – this might mean a 5minute walk on the flat pushing the pram initially. 

 

For the majority of women, at their 6-week follow up appointment they will be ‘cleared’ to return to exercise. This does not mean you should go straight from gentle walking the usual exercise you did prior to becoming pregnant. The build should continue to be gradual, with gentle strengthening exercises introduced. It is at this point that Physiotherapists at The Injury Clinic would recommend seeing a Women’s Health Physiotherapist. They will be able to ensure you are completing your pelvic floor exercises correctly, and give you any other exercises that will aid your recovery. Once you are feeling comfortable with these and feel you need something to challenge you further, Physiotherapists at The Injury Clinic will be able to guide you with appropriate exercises that will gradually progress until you are able to return to your full, normal exercise and activity.

EXERCISE DURING PREGNANCY

While it has been established that in most cases it is safe to exercise during pregnancy, fewer than 15% of pregnant women achieve the minimum recommendation of exercise (150 mins per week of moderate intensity).

It seems that women find activity difficult to achieve, are unsure what to do, or are unsure if it is safe. 

Unfortunately, it is difficult to implement a ‘one size fits all’ approach to exercise during and after pregnancy. This means general guidelines can be provided, however, it is always best to consult with your Obstetrician, Midwife or Physiotherapist to find out what is right for you.

 

BENEFITS OF EXERCISE DURING PREGNANCY

Habitual prenatal exercise decreases the risks of complications during labour. 

Prenatal exercise reduces the odds of excessive gestational weight, which may reduce the risk of instrumental delivery. 

Prenatal exercise can reduce the severity of pain during pregnancy and post-partum.

It is suggested that exercise during pregnancy reduces the degree of biomechanical change occurring as pregnancy advances;

Decreasing loads on the spine

Increasing joint stabilisation

Contributes to better segmental control and motion

May help reverse trunk muscle imbalance 

May initiate a pain de-sensitisation process leading to increased pain detection threshold

 

RECOMMENDATIONS ON EXERCISE DURING PREGNANCY

1. All women without contraindications should be physically active throughout pregnancy.

Exercise is thought to reduce the odds of gestational diabetes, pre-eclampsia, gestational hypertension, prenatal depression and macrosomia WITHOUT increasing the odds of adverse outcomes including preterm birth, low birth weight, miscarriage and perinatal mortality.

This recommendation includes women who were previously inactive.

There are also benefits for those who are overweight and have gestational diabetes.

2. Pregnant women should accumulate 150min of moderate intensity exercise each week to achieve clinically meaningful reductions in pregnancy complications.

3. Physical activity should be accumulated over a minimum of 3days per week, however, being active every day is encouraged

4. Pregnant women should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may be beneficial.

5. Pelvic Floor muscle training may be beneficial and may reduce the odds of urinary incontinence.

6. Pregnant women who experience light headedness, nausea, or feel unwell when lying flat should modify their exercise position to avoid being supine.

 

SO WHAT SHOULD I DO?

While physical activity is encouraged during pregnancy, the type of exercise is dependent on what type of exercising the woman was completing prior to becoming pregnant. 

 

Pelvic floor strengthening is also encouraged during pregnancy. There is some evidence to show that women who complete regular, supervised pelvic floor exercises during pregnancy may have reduced risk of urinary incontinence postpartum. It is important to make sure you are doing these exercises correctly, as it is thought about 50% of women who learn how to activate their pelvic floor from a pamphlet or website are doing them wrong. If you aren’t sure if you are doing these correctly, book an appointment to check with your Physiotherapist. 

 

Activities/exercise that are considered unsafe include:

Those with abdominal trauma or pressure (eg. Weight lifting)

Contact or collision sports (eg. Soccer)

Sports with hard, projectile or striking components (eg. Hockey, cricket)

Falling (eg. Skiing)

Those that require extreme balance, coordination and agility (eg. Gymnastics)

Heavy lifting (greater than submaximal)

High intensity training at altitude greater than 2000m

Those lying on your back (including some yoga positions) especially in later stages of pregnancy 

Those done at high temperatures (eg. Bikram Yoga)

 

With the correct guidance and in the right environment, exercise during pregnancy is safe and encouraged. Regardless of your previous amount of activity, discussions regarding exercise during pregnancy should always occur with your primary carer (ie. Obstetrician, Midwife, GP or Physio).