The MamasteFit Podcast Episode 144 – Timeline & Tips for Returning to Exercise Postpartum

Gina: One of the top questions that we get is, “When can I return to exercise after giving birth?” In this episode, I’m going to break down what does that timeline look like? How do you know that you’re ready to return to exercise, and what should you do if that timeline gets hindered by normal things that are happening in the postpartum?

Hey, my name is Gina. I’m a perinatal fitness trainer and birth doula, and I’m a mom of four- so I have gone through birth to postpartum return to fitness four times now! But in addition to my own personal experience, I have also supported hundreds of in-person clients and thousands of online clients navigating their postpartum return to fitness journeys. So I think I have a lot of experience with navigating others through this timeframe, and I’m going to share how to know you’re ready to return to workouts and some considerations that we need to have while navigating this timeline.

The first thing that I’m going to start with is: postpartum is an opportunity to reset and to rebuild in a way that kind of helps us to overcome movement habits that we had previously that may be hindering our performance and also contributing towards injury. So it’s a really cool opportunity to start with a blank slate in a way that you normally would never do outside of this timeframe. And so I want you to use this opportunity to rebuild in a way that improves your movement patterns, that improves your ability to handle load, so that you can lift heavier, you can run faster, you can perform better than before you even had kids- which is the case for me, and for a lot of our clients.

And so postpartum is a patient timeframe, and that is another thing that I really want to encourage you to have for at least the first year after giving birth, is to be very patient with the process. It may feel very slow and agonizing, like you really want to get back to the workouts that you were doing before, but I really encourage you to take your time with it and I promise that it will be worth it if you do take your time and you are patient with it. If we rush the process in our postpartum return to fitness timeline, it could actually hinder your performance and hinder your healing.

The first thing is how do we know that we are ready to return to workouts? Do you have to wait for your provider to give you that all clear at like four to six weeks postpartum? What do they even do at that appointment that assesses your ability to return to exercise? In general, that four to six week timeline is the appropriate time before you should return to exercise, just based solely on the tissue healing timeline. Now, this doesn’t take into consideration any birth complications that you had, any postpartum complications that you had that could be hindering some of the healings, or prolong it a little bit. But in general, most of us follow the same kind of four to six week tissue healing timeline, regardless of your fitness level before you gave birth. So even if you were a high level athlete or you were really working out pretty hard all the way up to birth, we all still have a very similar tissue healing timeline after giving birth.

The first week postpartum is going to be typically the inflammation phase, and now this can be as little as 5 days, it can be as much as 14 days- so there is a lot of fluctuation within each of these phases. Within that initial healing phase, the tissue is going to be more swollen, there’s a lot of blood flow, and we’re really trying to help that tissue rapidly heal in a very short period of time. You’re also going to have the heaviest bleeding at this time, in addition, you’re probably going to feel like you just got hit by a truck. So we’re usually not trying to go back to the gym at this timeframe, and it’s also not appropriate to. We are in a very early part of tissue healing, where we really just going to rest, stay off your feet as much as you can, really focus on nutrition, hydration, and maybe some gentle compression with like a belly band or some perineal support. But typically the first 5 to 10 days postpartum, we are not thinking about workouts or doing anything structured. We’re really just focusing on resting and giving our body the opportunity to heal.

Now, in that first week, you can do some gentle breathing and some gentle mobility, ’cause just laying still in bed is also not beneficial, but we don’t want to be returning to the gym and doing structured exercise at this point, either.

After the inflammation phase, we’re going to move into the proliferation phase of tissue healing. And now this can start anywhere from five to seven days postpartum, and go up to 21 days, up to 28 days. So typically this is going to be weeks like two through four, maybe all the way up to six, so it can be a pretty big window that’s happening here. During the proliferation phase, you typically begin to feel better than you did during that first week, which really anything after that first week, you typically feel better from. For me personally, I felt like I got hit by a truck after I gave birth, and so really anything after that felt phenomenal. However, we do want to be mindful that our tissue is still in an early tissue healing timeframe. And so if we begin to load this tissue too early, we could actually prolong our healing. During the proliferation phase, we have type three collagen that is being laid down, and it’s essentially disorganized and very weak compared to the type one collagen that will develop in the next phase. And so if we load this tissue too early with our workouts, with structured exercise, we are probably going to overwhelm it, because it is not quite ready to take on that heavy load yet from our workouts.

So type three collagen is thin. It’s really flexible, it’s weak, and it’s also kind of all over the place, so it’s randomly oriented. When we begin to load this tissue too early, we’re telling our body, I don’t really know what direction I want this tissue to go, just do whatever you can. It’s also going to activate our nervous system because this tissue is not ready to take on that load, and so we’re going to start to clench or to guard a little bit. And this can also cause some microtrauma to the tissues that are not yet ready to take on this load, which can then activate an inflammation phase, and we kind of enter into this constant cycle of healing and trying to repair, and then healing and trying to repair. And so this is going to impact our healing long term. So if you are loading tissues with structured exercise before four weeks postpartum, this is probably going to make that tissue stay disorganized, it’s probably going to maintain a weaker state than if you had been patient with the process. And that tissue is going to have a harder time to transition to type one collagen, which is much stronger. This tissue is also still very much in a healing state, and so when we overload this tissue beyond its capabilities we’re also going to be impacting its ability to lay down new collagen by interrupting that cycle. So when we have excessive load, it’s going to outpace its ability to deliver oxygen to that tissue because those blood vessels are still being reformed to that new tissue, which is going to impact the ability of fibroblasts to create collagen, which is then going to reduce tissue quality. So it is really important in that first month of postpartum that we do not return to structured exercise, that we don’t return to heavy lifting into lots of loading and workouts because it’s going to impact your tissue’s ability to heal and to become strong again.

And like I said, this is also going to impact your nervous system. Your nervous system is going to feel unstable because the tissue is not yet ready to take on that load. It’s going to cause the supporting muscles to guard, which is going to cause clenching, which is going to impact your ability to manage pressure, which is a huge aspect of lifting and returning to exercise in the postpartum in a way that is going to help to enhance your performance.

So in that first month postpartum, we’re going to start with that inflammation phase where the tissue is going to be a little bit more swollen- there’s lots of blood flow to try to emphasize that healing in that early timeline. We typically want to stay off our feet, maybe do some gentle breathing and mobility.

After that in the next three weeks, we’re in the proliferation phase. And so you typically feel better than you did the first week postpartum, but we still want to be mindful with how we are loading the tissue and not overloading it- ’cause it can impact the ability of that tissue to get stronger. So at first it’s disorganized, it’s weak, it’s that type three collagen- so it’s kind of all over, over the place- and we want to kind of gently load it and not overwhelm it so that it can become that type one collagen in the next phase. And so in that first month, we don’t want to do structured exercise. We don’t really want to do a ton of weight bearing or high intensity activity because we don’t want to interrupt our healing timeline.

However, this doesn’t mean that you should do nothing. We can still do some gentle movement to help support our healing process without overwhelming the system. And so this can include going for short walks. After your walks, monitoring for any increased bleeding. If you notice increased bleeding, this could be a sign that we did a little bit too much. Or if after your walk so you notice like you feel a lot of pelvic heaviness, you’re feeling discomfort or pain, lower back pain, this can also be a sign that we’re doing a little bit too much. So being mindful of the symptoms that your body is communicating to you, knowing that it’s okay, it doesn’t mean that you’ve ruined your healing timeline by any means, it’s just a sign from your body to kind of ease off a little bit. So if you went for a 20 minute walk, you notice increased bleeding, your pelvic floor is starting to feel heavy, your lower back is hurting- maybe we’re going to spend a little bit more time resting, we’re going to wear our belly band or our perineal support to help support the pelvic floor, and we’re going to focus more on being off our feet to allow our body to heal again. But again, if you do notice increased bleeding or discomfort, it doesn’t mean you ruined your timeline. It just means that we need to listen to what our body is communicating to us. In addition to the walks, you can continue to integrate mobility and diaphragmatic breathing to begin to reconnect with your core and pelvic floor. And you can usually start to integrate some body weight movements that are like floor-based core exercises- again, to integrate that connection to your core and pelvic floor. We do have a free early postpartum recovery course that you can join that includes these exercises and recommendations for when to start each of them as well.

So when it comes to when should I return to exercise in the postpartum, my top recommendation is: do not return to structured exercise, especially if it’s going to be weight bearing, within the first month postpartum- simply based on the tissue healing timeline.

But you also need to take in consideration what happened at your birth. If you hemorrhage, this is going to prolong that initial timeline as well, because your body has to recreate all of that blood. You’re probably more fatigued, you’re probably really low on energy, so that is going to prolong that timeline. If you had any complications during your birth, such as a Cesarean birth, if you had a lot of damage to the perineum, this can also prolong that timeline in a little bit as well. And so just being mindful of, okay, what happened at my birth that I have to heal from? Is also going to be really important. Were there any complications postpartum? Did you have postpartum preeclampsia? Did you have a postpartum hemorrhage? These are things that are going to impact your healing in the postpartum as well.

If you had pretty significant injuries from birth it can also be beneficial to work with a pelvic floor or physical therapists or occupational therapists before returning to structured exercise as well, because you may want to have a deeper look at, “Well, what is going on with my pelvic floor, with my core?” before you begin structured exercise in a more individualized approach.

And again, it can also be helpful to work with your provider to assess, “Am I ready to return to exercise?” As well. They can do an assessment on any perineal damage that you had. They can do an assessment on like your iron levels, if you had a hemorrhage. If you had any other complications they can give you a medical assessment to ensure that you’re ready to go- and this is something that you may have to specifically ask for, but it should be something that they can do for you.

All right, so now let’s go into, after the proliferation phase, we are moving into the maturation phase of tissue healing. But it doesn’t mean that you’re immediately ready to return to everything that you did pre-pregnancy, and it’s not even, “Hey, let’s just return to what we did before with lighter weights.” There’s a lot more to it that we should be doing in this next tissue healing timeline.

After the first month postpartum, we’re then going to move into the maturation phase of tissue healing, which is roughly weeks 4 or 6, until about 12 or 16. So this is a pretty big time block of time that we’re going to be spending in this next phase. This doesn’t mean that we’re just going to return to what we did before we gave birth or before pregnancy, and it doesn’t mean that we’re going to return to what we did before, which is lighter weights, either. There is a progression that we should move through that progressively loads this tissue in a way that helps to support healing, that is mindful of symptoms, and that helps us tissue to transition from that type three to the type one collagen that is a denser, that’s thicker, and that’s more organized and stronger so that it can take on that load for us if we want to return to running or higher impact activities around the 12 to 16 week mark.

In addition to being in the next level of tissue healing, we also need to take in consideration other factors involved with postpartum- because you probably have a baby and or other children that are hanging out with you now that you need to take into consideration when it comes to approaching your workouts. First, you’re probably a little sleep deprived. I have not had a full night of sleep in probably eight years, so I’m a little tired all the time, and that is going to impact your ability to do your workouts and to recover from your workouts. We need to think about our nutrition. If you’re like me, you’d probably forget to eat because you’re taking care of the kids and you forgot that you are also a person that needs to eat as well. We need to think about our hydration levels. We need to be thinking about is there any other stressors going on in our life? Are we dealing with any mental health issues that we need to be working through? So there’s a lot of other stuff that is going to impact how we approach our workouts, and it’s going to make healing not this linear path. It’s going to be a little bit ebbing and flowing as you go. And so in the postpartum, we also need to take that into consideration when it comes to approaching our workouts after we give birth.

So now we’re going to move into what symptoms can we be looking for and what exercises can we be doing to test our readiness to progress our workouts in the postpartum.

Gina: Now let’s discuss some strategies to know that you are ready to return to exercise, and that you are ready to progress said exercise. And now you may find like a ton of lists of, “If you can do these 10 movements, you are ready to return to running,” “If you can do these five things, you’re ready to do whatever you need to do.” While these lists can be helpful to give you like a framing of what type of movement patterns may be beneficial, it’s more important to monitor the symptoms that you are feeling, or not feeling, within your own body, to assess whether or not a movement is appropriate for you yet. And I do want to make a note that just because you have symptoms or you have a condition or a diagnosis, like, you’ve been told you have diastasis, you’ve been told you have prolapse, that you’re leaking, or you feel pelvic heaviness or back pain- does not mean that you should not exercise. But, what we may need to be mindful of is how we approach the movements. So it’s not necessarily do this list of exercises, but rather how are you doing those movements and how does it help you feel in your body? And so this will hopefully be more helpful for you, it’s to understand if you feel these symptoms, we may need to modify or adjust the way that we are doing the movement so that we can find a way that feels more appropriate for you.

Now the first thing that we want to assess is: how do I feel within like the pelvic floor area? Do you feel any heaviness either during the workouts, shortly after, or maybe even several hours later in the day? Are you feeling like there’s something there? Do you feel more pressure? It feels just kind of like thicker down there? There’s a different, a bunch of different ways that we can describe heaviness in the pelvic floor, but it just feels kind of heavy down there, like something’s there. If you’re feeling that during your workouts or shortly after, it could be related to pressure management. So how are we breathing and kind of changing the pressure within our abdominal cavity and our thoracic cavity during exercise? If you’re feeling it like way later in the day, it could be related to fatigue. So we may be doing too much at that time.

So during our workouts, the way that we want to breathe is we want to inhale into our rib cage with the eccentric portion, or the portion of the movement that we’re moving with gravity; and exhale against gravity with the concentric portion. You can also inhale at the top and maintain that increased pressure as you lower and then exhale as you come up. And so there’s different strategies that you can use, depending on your fitness level.

So the first thing that we want to assess is can you do diaphragmatic breathing? And typically the easiest way to do this is going to be in a supine position with your feet up on a bench and your back on the floor. So the first assessment that we can do is, can you diaphragmatically breathe? And so you can start with your feet in like a 90 degree angle, resting on top of an elevated surface. You can place something underneath your hips, and then I am going to place like a ball or a block between my thighs, just to increase a little bit of that inner thigh activation. So with the thing underneath your hips, it’s going to bring you into a slight tilt, which for a lot of us, we tend to favor more extension in our spine, and so finding this slight round can help you to breathe more into the back space. So when I inhale, I want to feel my ribs expand out laterally and my back push into the floor- not my belly expand outwards. So we’re not belly breathing, we’re doing diaphragmatic breathing. So I’m going to inhale into my hands that I can place on my ribs, and then feel my back push into the floor. And then when I exhale, I’m going to press my heels down into the elevated surface without really lifting my hips up out all, and then squeeze the block. And I’m going to think, lift up in the front of my pelvic floor as I pull that rib cage down. Almost like you’re trying to bring pelvis and rib cage closer together. So a big inhale. And then exhale. Big inhale, and then exhale.

Now the next step to diaphragmatically breathing after you’ve kind of done like 10 or 20 breath cycles where you’re feeling the expansion with the inhales and feeling the lift and activation with the exhales is we can start to integrate some movement to it. So I’m going to think exhale to keep that rib cage down as I extend the arm overhead, and then inhale to come back up. So, exhale. And then you can integrate that into other core exercises that we include within our postpartum programs and within our early postpartum recovery program.

So with that breathing pattern in mind, we want to think about that with the exercises that we’re doing. And so we want to think inhales are down, and then exhales are lifting up and in to help counter increased pressure. So if you’re noticing that you’re doing your workouts and you’re just kind of like breathing whenever, that can be the first thing that we do to help modify the workout to help support our healing, instead of just kind of inhaling and exhaling wherever, we’re inhaling up and then exhaling to bearing down. Just learning how to breathe with movement can be super helpful. So if I was doing my squat, for example, you can place something between the thighs for a little inner thigh activation. We can squat down to a box to decrease the loading, so I can inhale to lower down and then exhale to stand up. So that can be one thing that we can integrate if you’re feeling heaviness during your workouts, or shortly after, is, can we breathe better with our movement?

The other thing that we want to consider is our positioning. So if you’re doing all of your lifts with your back really extended and arched- so you’re pressing weight overhead, you’re doing all your squats and your really arched- this is also going to distribute pressure unevenly within your pelvic floor, and probably put more pressure to the front half, which is also going to contribute towards more of that heaviness feeling. And so we can also think about, okay, can I bring my rib cage down as I do my movements? You can almost think like, I’m rounding in my back, and that’ll probably just bring you to neutral and that is going to help to more evenly distribute pressure across your pelvic floor. So a few different strategies that you can utilize with like your lifts, for example, if you’re finding that you’re really extending a lot in the spine is we can do different things to help kind of bring us more forward. So first you can think maybe we squeeze a block or a ball in front of us to do our squats. This typically is going to bring you into a little bit more of a round, so I can inhale to lower. I don’t have to do full depth, and then exhale to come up, so that little bit of rounding can bring us out of that extended spine position.

So if you are finding that you are arching excessively with your lifts, there’s a number of strategies that we can utilize to bring us out of this arched position. The first is going to be to increase activation on the front side of the body. And now you can do that by like squeezing something in front of you, either between your hands, or you can even bring it into your chest to squeeze- and this is typically going to bring you out of that arched position. So you’re thinking, I’m kind of hugging this thing, and then you can do your squat or your hinges from here, typically going to bring you out of that extension. We can load to the front, so this also tends to round us a little bit in our back as we do our squats, or as we do like our hinge type motions. If you’re doing seated exercises, placing a wedge underneath the hips can help you find a more stacked position as well, and then we can do our pressing motions to press overhead while keeping that rib cage down.

So if you’re feeling heaviness during your workouts or shortly after, it’s typically a pressure management issue. And so we want to think about: how am I breathing? Am I inhaling down and exhaling up? And then am I coordinating that breath to the movement that I’m doing? So I’m inhaling either at the top and holding my breath with the eccentric portion or the movement with gravity, and then exhaling to lift up out of that movement; or, I’m inhaling with gravity and exhaling against gravity to counter pressure. And then we want to think about our positioning. Are we in a more stacked position or are we like super arched in our back during our squats or presses and all of our lifts? If we’re excessively arched in a lot of our movements, this is going to unevenly distribute that pressure on the pelvic floor and you’re going to feel more pressure to the front half, which is going to cause a lot of that feeling of heaviness. And so during our lifts, we want to focus on how am I breathing and how am I positioning myself, so that we can find a movement modification that feels best for us in our body and decreases those symptoms of heaviness and discomfort.

And we offer a lot of different modifications and variations within our postpartum return to fitness program that’ll walk you through each of these progressions, because we don’t necessarily need to start with a barbell back squat- we can start with like a kneeling squat, and then we can progress towards a box squat, and then we can progress towards like a banded box squat. And there’s different variations that we can do that kind of progressively load the tissues and bring us back to those movements. And so an easy way to think about it is, what are the base movements in that lift that I need to relearn how to do, and how can I do those in a way that allows me to progressively load the tissue without feeling increased symptoms?

And so during your workouts, if you’re feeling symptoms, this is a good clue that we need to modify or decrease the loading and the type of movement that we’re doing- maybe regress the movement to an earlier variation. If you’re not feeling symptoms, go ahead and try to increase the intensity, increase the weight, increase the challenge of the lift, and see how it feels. If it feels good, that means we’re on the right track to progressing the movement. If you feel increased symptoms with the progression, maybe we need to bring it back just a little bit. So if you felt really good with kneeling squats and then you progressed it to a box squat and you still felt really good, and then you progressed it towards some weights with your box squat, but then you felt more increased symptoms, maybe we just lower the weight a little bit. Instead of doing 20 pounds, maybe we do 10 pounds. Does that increase symptoms? No. Then we’re going to sit there for a little bit until our body feels ready to take the next step. And so we’re going to monitor symptoms as a clue to know whether or not we should progress movement, regress movements, and to let us know when we’re ready to do different things in the postpartum.

So having symptoms does not mean that you should not exercise, by any needs- it just means that we have to be more mindful and intentional with the way that we approach exercise in the postpartum to help support our healing timeline. And then again, this may feel really overwhelming. This is a lot of information and a lot of different things to kind of put together. And so we do have a postpartum return to fitness program that guides you through this entire process, so you don’t have to figure it out all by yourself. But having a better understanding of the why behind it and why it’s important to take our time and to be mindful with this progression is incredibly beneficial, and is really going to help to serve you as you return to fitness after birth. You’re going to feel stronger, you’re going to run faster, and you’re going to feel so much more functional than you ever did before- if we are patient with this process.

If you want more support from us in the postpartum, check out our postpartum maternity fitness programs. The first 24 workouts of our fitness program includes follow along videos, in addition to self-paced workouts. And then the last 40 workouts are sport specific. So if you want to get back to running, to Olympic weightlifting, if you just want general strength and conditioning, we have a program for you, in addition to our C-section program as well. So you can check them all out on our website at mamastefit.com and use code YOUTUBE10 to get 10% off any of our online offerings. And all of our fitness programs come with lifetime access, so you can take as much time as you need to move through the workouts. Some folks move through it really quickly, some folks take a longer period of time, but you won’t lose access to the program as long as the program exists.

So thanks so much for joining me for this video. If you enjoyed it and you want to learn more from us to support your pregnancy, your birth, or your postpartum, be sure to subscribe to our channel. We’ll release new workout videos every Tuesday and new educational videos like this every Wednesday