We get asked this question frequently by women who are pregnant or have recently had a baby. Unfortunately, women are often left in the dark with little to no guidance on when they can return to their favorite activities and exercise.
What happens when our body has been through a traumatic injury/surgery or pregnancy/delivery and it is trying to heal and recover? How do we rehab those things?
Well, if you sustained a shoulder or knee injury/surgery (or any other musculoskeletal injury) there are very specific phases of healing and defined lengths of time in which each phase occurs which guides the rehabilitation process. Your orthopedic doctors often tell you how long a specific surgery will take to fully recover and how many sessions of PT you might need, and all of this is based on the biologic healing process that your body goes through.
If you're pregnant or have recently had a baby, the answer tends to be a little, well, less than you were hoping for...
If you want to know the details about recovering from an orthopedic injury or surgery and how different they are from pregnancy/delivery, keep reading below. Otherwise you can "TL;DR" and skip down to the section in bold "WHY IS AN ORTHOPEDIC INJURY TREATED SO DIFFERENTLY FROM PREGNANCY/DELIVERY?" If you decide to TL;DR (fine by us, we know it's a lot), just know there is a huge disparity between how orthopedic patients are managed after injury/surgery and how women are managed post pregnancy/delivery. Spoiler alert: they shouldn't be managed so differently.
First, during the acute stage or protective phase, we protect the injured tissue for a few weeks to allow it to start the healing process. That might be done with a brace, crutches, or orders for complete rest.
The second stage, or sub-acute stage, is the repair stage. This stage goes for about 6 weeks after injury or surgery. In this phase, your body is laying down new tissue. There is some light strengthening/stretching that can be done in this phase in order to aid healing.
The third stage is late stage or remodeling phase. This can be up to 3 months post injury or surgery. This is the time when your body’s newly formed tissues start to become stronger and more mature, more like the original tissue that was injured. Specific exercises are done during this phase to help your tissue meet the demands you place on it, either with daily living or exercise or athletic activities.
The last stage is the final stage of healing with ongoing repair, remodeling and strengthening of the tissue. This can last for up to a year after injury or surgery. Scar tissue and remodeled tissue will continue to strengthen and adapt to the stresses placed on it as well as any scars remodeling and becoming less lumpy, bumpy and visible. That same type of process happens on the inside as well during this phase.
So why are we telling you all of this and why do you care how physical therapists rehab injuries and post surgery patients? Weren’t we here to talk about returning to exercise after having a baby?
WHY IS AN ORTHOPEDIC INJURY TREATED SO DIFFERENTLY FROM PREGNANCY/DELIVERY?
As PT’s, we have extensive phases, descriptions of the phases, and plans to rehab people after an orthopedic injury or surgery. Giving birth/having a C-section shouldn’t be any different but what happens to women after having a baby? They are often told to “do nothing” for 6 weeks after having the baby and then at 6 weeks, they are cleared to do “whatever they want.” Now, we know this doesn’t happen every single time with every single woman and every single doctor but we do hear this experience WAY more than we should be hearing it.
In today’s world, with social media setting the tone, many women are led to believe that they should be able to return to their “normal” body and activities six weeks after delivery. We’ve all seen pictures displaying women with six-pack abs holding an infant or a side by side “before/after” photo showing how quickly their body bounced back.
Remember this though, so much of what we see on social media is not reality.
The truth is that is takes 4-6 months for tissue in abdomen and pelvic floor to recover following pregnancy. It may appear that these women are strong from the outside, but what is going on inside, may be a different story.
Moms who return to high impact exercise without adequate rehabilitation of pelvic floor and abdominal muscles are at increased risk for pelvic floor muscle dysfunction resulting in pelvic organ prolapse, stress urinary incontinence and pelvic girdle, hip, or low back pain and dysfunction. These symptoms are common, but not normal, and can be prevented with proper training of pelvic floor and other core muscles.
^^^ THIS IS NOT NORMAL ^^^
(You can fix this with a little help from a pelvic floor PT!)
It is highly recommended that every post-partum woman be evaluated by a Pelvic Floor PT no matter what level of exercise or activity they plan to engage in, but especially for those who plan to return to high impact activity such as running, jumping, and weight training. Evaluation of the pelvic floor muscles to assess strength, endurance, presence of pelvic organ prolapses, diastasis recti, scar mobility and general spine screening are essential.
The common message during pregnancy and post-partum is “DO YOUR KEGEL’S.” How do you know for sure that you are doing this exercise correctly? Studies show that you have a 50/50 chance that you are doing them right if you try to do these on your own without proper instruction.
^^^ If your Kegels look like this, you're not doing them right ^^^
In most cases, the pelvic floor muscles are too tight or “guarded” from the over-use and probable injury they have suffered during pregnancy, labor and vaginal delivery. If you have had a Cesarean delivery, this reduces the risk of pelvic floor trauma, but is not entirely protective.
The pelvic floor is challenged not only by labor and delivery, but by pregnancy itself as structures must support the increasing weight of the uterus and baby. If the muscles are too tight, pelvic floor muscle strengthening or “Kegel exercise” could make the condition worse. It is over tensing an already tight muscle causing it to be less effective, especially since it is very difficult for women to be able to learn how to relax the pelvic floor muscles following delivery.
HOW CAN A PELVIC FLOOR PT HELP WITH THIS?
Pelvic floor physical therapists are trained to evaluate, treat and provide guidance and instruction for various pelvic floor conditions including pregnancy, post vaginal delivery and post C-section. A good pelvic floor PT can be your best ally after pregnancy/delivery. They will be there to help you restore normal pelvic floor function as well as guide you through returning to your normal activity and favorite exercise.
Typical return to running/high impact exercise postpartum recommendation no sooner than 3 months and having none of these symptoms: bulging or pressure feeling in vagina and/or perineum, urinary or fecal incontinence (leakage), continued vaginal bleeding (not related to return of menstrual cycle), pain in low back, pelvis, or hips during or after activity.
If you are post partum and trying to figure out when to return to your regular exercise or having trouble returning to your regular exercise, you need to see a pelvic floor PT and we have the best one around, Sandy Gibson! She holds the highest level of certification for pelvic floor physical therapy from the Herman & Wallace Institute and has been practicing pelvic floor PT for 20+ years. If you’d like to schedule an appointment with Sandy, click here to book an appointment or call/text 615-428-9213. If you’d like to learn more about the pelvic floor, we can send your our free pelvic floor e-book, just click here.
References:
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, pp.531–539.
Bø, K. Artal, R., Barakat, R., Brown, W. J., Davies, G. A. L., Dooley, M., Evenson, K. R., Haakstad, L. A. H., Kayser, B., Kinnunen, T. I., Larsénm K., Mottola, M. F., Nygaard, I., van Poppel, M., Stuge, B., Khan, K. M. (2017) Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3-exercise in the postpartum period. Br J Sports Med 51(21), 1516-1525.