Q: WHEN IS IT SAFE TO RETURN TO EXERCISE AFTER PREGNANCY?

This depends on what birthing experience you had, the degree of abdominal or pelvic floor injury sustained and the advice of your treating medical practitioner.

It is generally safe to recommence pelvic floor exercises day 1-2 after giving birth but does depend on your level of comfort, what birthing process you had and what your levels of pain are. Your Midwife or Obstetrician will be able to guide you in this decision making progress but I will say that early pelvic floor exercises will assist with regaining your strength, improving continence, and reducing swelling in the perineum. Something else that can be helpful for swelling and pain is icing your perineum. Again, I'd ask your Midwife or Women's health Physiotherapist to chat to you about this technique. 

Following a natural vaginal birth with a grade 1 pelvic floor tear you may walk as much as feels comfortable for your body. The best rest for your pelvic floor is horizontal bed rest. Take 30 minutes to lie flat during the day... it goes a long way in your recovery.

Following a grade 3-4 tear or episiotomy you may wish to wait for 4-6 weeks for the tissues to fully heal. In this case you often remain under the care of a obstetrician and will be cleared for exercise around the six week check up. If there are no concerns with your continence (faecal and urinary) then your exercise tolerance is largely dependent on pain tolerance, swelling and bleeding.

Following a natural vaginal birth it is generally recommended that you should not enter into a public pool or spa for six weeks or until vaginal discharge stops.

Following caesarian section you should wait for six weeks before lifting >2kg, driving a car and returning to exercise. This recommendation does not restrict you from doing isolated lower abdominal and pelvic floor muscle contractions or gentle stretches within your range of comfort. You may also walk as far as feels comfortable. What you'll notice in the first four weeks of the post-pregnancy program is that the exercises focus mostly on flexibility and pelvic floor and abdominal exercises. So before you decide you're not ready to exercise, just have a look and see if there is anything there that inspires you or you feel is achievable. If not, then join in when you are ready, but be sure to always begin at week 1. 

The reason there are restrictions on lifting after surgery is to allow for the incision site to heal. Particularly with driving, the reason you might not be covered by insurance is that the wound often makes it too difficult to brake suddenly. So ask yourself the question 'If a child/animal ran onto the road, could you suddenly slam your foot on the break and steer the wheel away?' If the answer is no, don't get behind the wheel. No matter how safe you are, you can't avoid all accidents.

Q: WHEN CAN I RETURNING TO HIGH IMPACT AND CONTACT SPORTS?

Returning to running is generally not recommended until a minimum of three months after childbirth. From my clinical experience, many mothers don’t regain enough strength to feel ready to run until six months after giving birth. It takes several weeks to adjust to the lifestyle changes, sleep changes and physical changes of being a mother.

If returning to sport and running is a high priority then I would strongly recommend having a physical examination and pelvic floor examination from your doctor, gynaecologist, midwife or physical therapist.

The things that need to be assessed for in a physical examination are:

  • Strength and endurance of pelvic floor muscles. 
  • Pelvic floor stress test.
  • The amount of abdominal muscle separation and the strength of the abdominal muscles.
  • Often the abdominal and pelvic floor muscles can be visualised and assessed using Real Time Ultrasound (RTUS) - which is an assessment your Women's Health Physiotherapist can provide.
  • General strength of the pelvis, hips, shoulders and spine for sustaining the loads of sport and running. This may include tasks such as balancing on one leg, single leg calf raises, single leg squats, bridges, planking etc. to assess what your baseline strength and endurance is.
  • Full pain free spinal movement in the lumbar, thoracic and cervical spine.

For returning to running specifically, here is a general rule to follow to see if you are strong enough.

  • Can you do 20 calf raises?
  • If so, can you do 20 single leg calf raises?
  • If so, can you hop on one leg 20 times?
  • If so, can you skip for 10 minutes?

Skipping is a great way to slowly introduce high impact jumping into your exercise routine. If you feel any pain throughout the body or heaviness in your pelvic floor when skipping, then running is not recommended. Skipping can also be performed in a controlled environment for short amounts of time where as running often lands up being too long and can cause injury.

When getting back to running start with interval training. A possible routine for building up to 30 minutes of running might include:

  • 6 minutes of walking to warm up.
  • Jog for 30 seconds
  • Walk for 60 seconds
  • Repeat 4 times (6 minutes)
  • Jog for 45 seconds
  • Walk for 45 seconds
  • Repeat 4 times (6 minutes)
  • Jog for 60 seconds
  • Walk for 30 seconds
  • Repeat 4 times (6 minutes)
  • 6 minutes of walking to cool down.

Keep a note of how many minutes and how far you run each week and only increase that load by 10% each week to avoid developing an overuse injury.