Pregnancy

Being physically active is very important for our health and wellbeing.  This is especially true post pregnancy, though it is important to start off gently and progress slowly.  There have been significant changes to your body both during pregnancy, and the birthing process, some of which can take a few months to get back to normal.

Post pregnancy, your joints and ligaments will still be soft and lax, which can take around 6 months to normalise back to a pre pregnancy state.  It is important to be careful during this period, as you are especially susceptible to tears, sprains or injuries.  This is one of the reasons why it is suggested to avoid high impact activities within the first 4-6 months.  Other factors such as tiredness and fatigue due to interrupted sleep, breastfeeding and overexertion can also increase your injury risk.  It is important that you listen to your body during this time.

Another important consideration is that your pelvic floor muscles, ligaments and fascia (connective tissue) have been stretched, torn, softened and weakened, (even if you have had a caesarean section).  These structures normally support the bladder, bowel and uterus (the pelvic organs) and with too much added strain or impact, these organs can push into the vaginal opening and cause prolapse or even incontinence.

It is important to begin contracting the pelvic floor muscles from day 1 (unless advised otherwise from your obstetrician).  You should start off doing gentle 1 second contractions, with a few repetitions (up to 10) a few times a day and gradually progress these.  You should also start gently contracting your pelvic floor muscles to brace during activities that increase your abdominal pressure like coughing, sneezing or lifting your baby.  It is important to build up your pelvic floor muscle strength and control first, so that you will be able to return to more challenging exercises later.

It is very important to contact your obstetrician or women’s health physiotherapist if you experience any symptoms of low back pain with pelvic pressure, feelings of vaginal heaviness or bulging, or leakage of urine or bowel.

We strongly recommended that you have an appointment at 6 weeks post delivery, with a specifically trained women’s health physiotherapist, to check that you are contracting your pelvic floor muscles correctly and to individualize a progressive program for you.  This appointment will also help to identify any other problems early on and begin appropriate treatments, to avoid any long-term complications.

Everyone is different, however some general guidelines are:

•  Week 0-6: Pelvic floor exercises, pelvic floor bracing, gentle walking (mainly flat surfaces)
• Week 6-8: Once you get the ok following your 6 week appointment, you are able to commence low impact activities such as; walking, swimming (only once healed and all bleeding has stopped) or a gentle exercise program (no breath holds, very light weights only and modified positions). Continue to progress pelvic floor muscle strength and bracing.  See also low impact activities below.
• Week 8-16: Gradually increase weights and intensity as your pelvic floor strength and endurance increases.
• After Week 16: Check with you pelvic floor physiotherapist prior to returning to any high impact exercises. You are usually able to return to most previous activity levels, provided you have good pelvic floor strength and no other complications.

Examples of activities to avoid.

• High impact or high intensity exercises that place a lot of downward pressure on your pelvic floor. These include:
• Running
• Jumping
• Star jumps
• Skipping
• Boxing
• Activities with stop/start or rapid change in direction such as tennis, netball, basketball, hockey, touch football.

• Heavy lifting, straining and holding your breath
• Deep squats (it is difficult to activate your pelvic floor in this position)

Activities, which are generally considered pelvic floor safe or low impact, include:

• Walking
• Swimming
• Seated cycling
• Low resistance cross trainer
• Low resistance aqua aerobics
• Walking in water
• Low impact exercise classes

For those living on the Gold Coast I  recommend Madeleine Newton .  Madeline is a highly experienced Women’s health physiotherapist with advanced training in the above-mentioned areas.  To make an appointment or for further advice/ guidance, please contact Madeleine at Pindara Physiotherapy and Sports Medicine on 55394484 or mail@pindaraphysio.com.au.  I strongly recommended that you have an appointment at 6 weeks post delivery with Madeline to check that you are contracting your pelvic floor muscles correctly and She will create an individualize a progressive program for you

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