“When can I start exercising again?”
This is a very common question we hear in the clinic as pelvic health physiotherapists.
What is the answer? The answer you may have received from a doctor or other healthcare professional is one can return to exercising after six weeks post-partum, whether via vaginal or C-section delivery. But how and where do we start at the magical 6 weeks?
The answer to this question can also be challenging to find because there is a variety of conflicting opinions depending on the resource.
From a pelvic health perspective, one can generally start exercising six weeks, however, the type of exercises one begins at six weeks post-partum is likely to look very different to pre-pregnancy and during pregnancy. What this means is one is beginning the process to return to exercise at pre-pregnancy levels in a way that respects the pelvic floor and the phenomenal job it has gone through across pregnancy and birth (vagianl or C-section). The pelvic floor has worked hard during pregnancy both with the weight of the growing baby and with supporting a more mobile pelvis. During a vaginal birth, the pelvic floor is stretched 250% of its normal length to birth a baby. Additionally, the abdominal muscles have also been stretched to accommodate a growing human. So after your 6-week check-up, we recommend that you start with more easy and gentle exercises that increasingly become harder over the course of time.
It is important to remember that each birthing person is different in their pelvic floor recovery and thus, the timeline to return to exercise will vary, where it may require more patience for some than others to achieve post-partum exercise goals. It is less about following a timeline and more about making sure one can complete particular exercises.
Basic timeline for return to exercise
So, what does exercise look like after birth? Return to exercise can be broken down from birth to 12 weeks post-partum, however, it is important to remember many people can take more than three months to return to exercise.
0 to 6 weeks post-partum
Lots of rest - particularly lying down
Pelvic floor exercises/ ‘Kegels’
Start walking to build cardiovascular fitness
Low impact and gentle movement
Whilst one can start some form of gentle exercise during this timeframe, the most important aspect in the first six weeks is to optimise recovery and healing of the pelvic floor, surgical incisions and tearing. This could mean walking around the block is not ideal depending on how the pelvic floor feels during and afterwards.
We also strongly recommend having lots of short rest breaks throughout your day where you lie down to off-load your pelvic floor and tummy to help them recover.
6-12 weeks post-partum
Pelvic floor exercises/ ‘Kegels’
Low-impact cardiovascular exercise
Retraining functional core with pelvic floor
Increase intensity of low-impact exercises
Train functional exercises in line with your exercise goal e.g. lunge, press ups, fast calf raises for return to running (not yet starting to run)
12 weeks + post-partum
Exercises as in 6-12 weeks with increasing intensity/load
Gradual increase in high impact exercise/ exercise of choice
E.g. jogging with walking dispersed between the running to incorporate rest to increasing the duration of more continuous running
As a pelvic physiotherapist, we consider some of the following before progressing you further in an exercise program. Can you complete the following?
Pelvic floor exercises in standing
Strength 10 reps, 10 second, 3 sets
Power 30 reps in 1 minutes
Endurance 8-10 reps, 10 second holds AND 1 rep, 1 minute hold
Cardiovascular function at a good baseline
Functional exercises that line up with your exercise of choice (some examples below)
Squats
Lunges
Jumping
Hopping
An additonal test for those wanting to run post-baby is the pelvic floor "stress test":
with something in your bladder (it's cheating to empty your bladder before this test!) can you:
Do 10 star jumps
Then cough hard twice in a row
This is to help you work out if your pelvic floor is up to the task of impact exercise.
What should I NOT feel when exercising?
Some important points to remember whilst starting your journey back to exercise is that one should not experience back pain, pelvic pain (e.g. pubic or sacroiliac joint), vaginal heaviness, urine leaking or bleeding. If any of these are present, this indicates the exercise you have been completing may be, for now, ‘too much, too soon’. This includes walking despite this activity being highly recommended as the first exercise to begin post-partum.
Other considerations
It is also important to remember your journey back to exercise is unique and may not necessarily follow the 12-week timeline. It could take six months, one year or perhaps longer to reach your exercise goals. There is a new human in your life who depends on you for just about everything and whether this is your first or third, it is again, a period of adjustment for yourself and your family. Sleep is different too, how the day might be organised is different. Things may feel more chaotic than usual. And so, returning to your pre-pregnancy exercise may very well be the last thing on your mind. That is okay.
I want to start exercising - what’s next?
If you’re ready to start exercising again, we highly recommend seeking out a pelvic floor health assessment at six weeks and once lochia (post-partum bleeding) has ceased. This will assess your pelvic floor health strength, endurance, power, signs of prolapse and management of diastasis recti abdominal muscle separation. From here, your pelvic health physiotherapist will work together with you to create an exercise and pelvic floor rehabilitation program tailored to suit your current needs and goals.
Returning to exercise is not always as simple as one might think. It is a journey unique to your pelvic floor, pregnancy, birth and post-partum experience. When you are ready to return to exercise, seek out the help of a pelvic health physiotherapist who can guide you to your exercise goals.
Our return to exercise checklist
GP general health check e.g. post-partum bleeding, healing of tears
6 week pelvic health physiotherapist check up: pelvic floor health screen, prolapse check, management of diastasis recti abdominal muscles
Pelvic floor exercises in standing
Strength 10 reps, 10 second, 3 sets
Power "quick flicks" 30 reps in 1 minute
Endurance 8-10 reps, 10 second holds at maximal strength AND 1 rep of a 1 minute hold at 50% strength
Cardiovascular function at a good baseline
Functional exercises that line up with your exercise of choice
Squats
Lunges
Jumping
Hopping
Resources: