If you spent 9 months with your leg in a cast, would you go for a run as soon as you remove the cast? Probably not. Your leg muscles will be weak, and you will have lost some motor control of them. (Motor control of muscles deteriorates if we spend a length of time not using those muscles).
Would you attend physiotherapy sessions to help you re-gain gentle strength in your leg muscles and re-connect with them? Probably yes. This would actually be prescribed by your doctor.
So why is it then that women who spend 9 months pregnant and go through birth are not prescribed physiotherapy? Why is it that women want to jump straight back into high impact, high intensity exercise, without first regaining motor control and some base strength in their core?
The pressure on a woman’s core during pregnancy and birth is very often underestimated, even by women themselves. During pregnancy, your abdominal wall stretches (and as a result weakens) to make room for the baby to grow. Your pelvic floor carries the weight of the baby and then opens up and allows the baby to pass through during birth. As a result of all this, your lower back is also under a lot of strain, as it has to work even harder to compensate for all the other changes going on.
Since the abdominal wall muscles stretch so much during pregnancy, they also weaken, and many women don’t activate their abdominal muscles at all during pregnancy, hence losing motor control of them. You don’t need to perform a bunch of crunches to activate your abdominal muscles. A simple standing activation is enough to keep you connected with them throughout your pregnancy. Also, to accommodate the growing baby, the linea alba (the strip of connective tissue that links the two sides of your ‘6 pack’) needs to stretch too. This is a normal part of pregnancy. For most women, this separation of the abdominals (called diastasis recti) will just heal of its own accord after birth. But for some others it might get more complicated. There are a number of possible reasons for this including: poor breathing strategies, poor nutrition, poor hydration and suboptimal lifestyle habits during and after pregnancy (including jack-knifing out of bed or doing planks and crunches too soon). I’ve seen many women, who post-birth, were never checked for diastasis recti and some never even heard of it!
As you can see, when your core goes through all those changes and all that pressure, it’s really not a good idea to jump straight back into a high-impact, high intensity fitness routine as soon as your gynae gives you the all clear at your 6-8 week check-up! Your body is NO-WHERE close to recovered at 6-8 weeks! The recovery process is actually still at its very early stages. Studies show that it takes minimum 1 year for a woman’s body to fully recover from pregnancy and childbirth, and in some cases it may even take up to 2 years. In fact, it’s possible for pelvic organ prolapse to present itself in the early months after birth because a woman has done too much too soon!
1. Visit a woman’s health physiotherapist
Your first priority after having your baby should be going to get checked by a Woman’s Health Physiotherapist (WHP). Just like a general physio will help you to rehab your broken leg, a WHP will help you to rehab your core after pregnancy and birth. The WHP will check how well you know how to activate your abdominal muscles, will check to see if you have any diastasis recti which needs healing and will also check the motor control and strength of your pelvic floor. The WHP may give you some specific core exercises to help with you rehabilitation and any other advice which may be relevant.
2. Re-connect with your core
This is done firstly via your breath by practicing deep breathing using your diaphragm. Your diaphragm is one of the muscles that makes up your core and is just as important as your abdominal wall and your pelvic floor!
During pregnancy your diaphragm gets less space to move up and down as the baby grows. As a result, it’s easy for you to forget how to use it properly when breathing. Your chest should remain quite still and you should see your belly moving out with each inhale, and back in with each exhale. Also, when you inhale, you should feel your pelvic floor relax, and when you exhale you should feel it very slightly returning back up to its original position.
The first few times you do this exercise you might not notice much happening. But as you practice and tune-in to your body you might start to feel this activity in your core when you breathe and this means that you are connected with it.
3. Re-learn how to switch on your abdominal muscles
It’s also important to re-learn how to tense up your abdominal muscles so that they can provide you with gentle support in your day-to-day activities. Stand in front of the mirror and put your hands on your tummy. First relax and see what that feels like with your fingers, and then afterwards tense them up and you should feel them go hard. Do not mistake this with sucking your belly in. This restricts your breathing and does not mean that your muscles are activated! If you’re still not sure whether you’re properly tensing up your abdominals, you could say the word ‘SET’ with a big emphasis on the ‘S’. This should automatically get your abdominals tensed up and that is the feeling you should look for when doing this exercise. Once you’ve got it, practice holding that gentle tension in your abdominals while breathing normally and start to use this gentle tension whenever you’re moving loads around in your every day life.
4. Gentle exercise
Once you’ve mastered all this, you can start doing some exercise. Be careful with what you find on the internet. Planks, side planks, crunches, burpees and basically any traditional ‘core’ or high impact exercise should be avoided. Try and find some specialised post-natal classes in your area that you can attend. Most people don’t realise how much damage could be caused by prescribing the wrong types of exercise to a post natal woman, so make sure that the trainer you choose is appropriately qualified in post-natal exercise.
If you’d like to learn more about how to optimally recover after having your baby get in touch with Angele, our pre and post natal specialist and check out our specialized services and classes – Early Days Mom, Active Momma and Baby On Board.