The importance of specific post-partum exercise

-by Tanya Rowenhorst, PT, DPT – specializing in women’s health at Orange City Area Health System Physical Therapy

Hello There! I’m back again to talk about postpartum exercise! I’m excited to soon begin postpartum exercise classes at Orange City Area Health System beginning this week! This will be offered to any woman who is beyond six weeks postpartum and has been cleared by their physician to resume exercise as tolerated. Today I’d love to share WHY I believe this exercise class is important, and WHO this class would benefit. First of all, as a physical therapist, I’ve had the pleasure of working with at least a couple hundred women postpartum. At our hospital, each postpartum mother is offered the opportunity for an appointment with one of our women’s health physical therapists, usually at the same time as their first well-baby visit (about a week postpartum), to go through a quick assessment of any orthopedic issues they may be experiencing yet from their pregnancy or during labor and delivery. Clinically I would say about 75% of women have a positive test for a rectus diastasis (abdominal separation), so we always test for this, and then each patient is shown how to correct it. They also receive some basic core exercises that are safe to begin (modified for post-cesarean), postural exercises, and education on return to activity, among other things. I always enjoyed these visits and received so much positive feedback from women who thought the visit was very helpful in their postpartum recovery. Speaking from a new mom’s perspective (as I’ve had four children), the postpartum period can be overwhelming. Not only do you have a new baby to care for, you may be learning how to breastfeed, possibly taking care of other children, potentially adjusting to a time of being home full-time, and surviving on very little sleep. On top of that, you have a body that is recovering from the changes that occurred during pregnancy, as well as any healing that needs to occur from a vaginal or cesarean delivery. Many women that I talk to are concerned about their postpartum bodies and whether things will ever go “back to normal.” They are encouraged to walk but otherwise lay pretty low with more aggressive physical exercise and activity until their six-week follow-up. At this point, if they are cleared by their physician to exercise, a couple things can happen. I’ve seen women who are either obsessed with exercise or obsessed with losing weight as quickly as possible jump right back into whatever they were doing prior to pregnancy, whether it be marathon training or crossfit. I’ve also seen many women who don’t know what to do and feel overwhelmed by life’s new circumstances decide to avoid exercise altogether. I encourage a more middle-of-the-road response, for a couple reasons. First of all, there ARE a lot of adjustments that new moms are going through, and when you are not getting enough sleep, exercise can feel like the last thing you want to do. So definitely working back into an exercise routine at a slow pace and offering yourself lots of grace is essential! But the main reason I suggest taking things slower is because your body, though healed, is not in a place to jump right into aggressive exercise. Just like a new runner would not start out running five miles, nor should a new mom jump back into an aggressive exercise routine. Here are a few reasons why:

1. If an abdominal separation is not corrected, certain exercises could actually worsen this rather than helping it. Even core exercise could actually worsen it. This separation contributes to the lower abdominal sagging that many women experience postpartum.
2. Most exercise classes and videos have quite aggressive abdominal exercises that even healthy, strong adults can’t do correctly! Often times they are substituting with other muscles to accomplish the exercise and have no idea that they are not even doing the exercise correctly. I see this over and over again clinically as well as in classes and on videos.
3. Aggressive exercise often involves jumping, running, etc. that can cause some stress incontinence (leaking a little or a lot of urine) if pelvic floor muscles have not been strengthened properly. This can be a major annoyance to many women, but often times women just shrug it off as “the way it is.” I don’t think I can emphasize enough that, though common, stress incontinence is NOT something that you have to live with or put up with. Often times proper training can correct this very easily, but I believe the BEST time to deal with it is early postpartum!

Finally – WHO is this class for? It may seem that on first glance, this class is obviously for women who have recently had a baby and fall into that post six-week time period. But really, this class is for ANY woman who has EVER had a baby but has struggled to get back in shape, especially if there is some definite core weakness present. So really, this class can be for the new mom or for the 40-year-old woman who wants to get back in shape, but feels overwhelmed with where to start. In addition, if you are experiencing any pelvic floor muscle weakness or an abdominal separation that is not improving, this class could be perfect for you! I’ve seen 40-50 year old patients who come to the clinic with complaints of low back pain, find on testing that they have an abdominal separation from having babies 10-20 year’s ago, and we are still able to correct this issue at that point…and improve their back pain! Want to know what the research says about postpartum exercise?

1. Several studies show the incidence of low back pain up to six months postpartum was over 40%! Working on core strength can certainly help with this!
2. Potential benefits of postpartum exercise – improved cardiovascular fitness, improved mood, decreased anxiety and depression, increased energy, decreased stress incontinence, improved sleep, and improved chronic disease risk factors
3. Clinical Practice Guideline: Exercise in Pregnancy and Postpartum Period – Joint Section of Obstetricians and Gynecologists of Canada, and Canada Society of Exercise Physiology, 2003 stated:
   1. Initiation of pelvic floor exercises immediately postpartum may reduce risk of future urinary incontinence.
   2. Moderate exercise postpartum while breastfeeding does not affect the quantity or composition of breast milk or impact infant’s growth.

I hope this class fills a void that we have in our community – to help women transition back into exercise in a safe way – while avoiding injury, pain, or stress incontinence. If you are experiencing any of these symptoms and are questioning whether this class is appropriate for you, I encourage you to contact your physician, and you can also contact me with questions about what the class all entails. I’d be happy to answer any questions you have!

Prenatal & Postpartum Exercise Classes

• Taught by Tanya Rowenhorst, PT, DPT – specializing in women’s health • Location: Lower Level of Orange City Area Health System’s Downtown Campus at 400 Central Avenue NW • November 28, 30 and December 5, 7, 12, 14, 19, 21 • Prenatal class (all trimesters): 11:45am-12:15pm • Postpartum class (at least 6 weeks following birth): 12:30-1pm • $80 for 8 sessions (due at first class session

Call today to register for our prenatal or postpartum exercise class: 712-737-5367