Common Exercise Limitations During Pregnancy and Postpartum
Finding the time and energy to fit in pregnancy or postpartum workouts can be tough! Join our Wellness Contributor, Megan, as she discusses fitness after baby. Megan will dive into all things related to pregnancy and postpartum fitness over the next few weeks, including: exercises to do while pregnant; exercises to do with baby; and all of your most commonly asked questions.
A few weeks ago, I did something that I have wanted to do for quite a while. I earned my certification to become a Pregnancy and Postpartum Athleticism (PPA) Coach! This has been one of my major life goals! I love training the general population in group classes as well as one-on-one settings, but there is something that tugs at my heart when it comes to working out during pregnancy and postpartum.
How many of you reading this have heard from a doctor, personal trainer, friend, or family member that you should listen to your body, keep doing what you are doing, or don’t do *insert exercise/weight here*? Raising my hand! Not only did my trainer not know what to do with me, he allowed me to take full control of my exercises and decide what I wanted to do. So you know what I did both pregnancies? Set PR’s, worked out hard on both due dates, pushed through every single workout as if I were not pregnant. Yes, I was the badass pregnant chick that could still kick almost everyone’s butt in the gym. Fast forward 15 months postpartum after my second child. I have been dealing with daily pelvic pain and struggle with incontinence issues while doing double-unders. Had I been educated on PPA, known how necessary it was to have a pelvic floor physical therapist (PFPT), and respected the process of pregnancy and healing stage of postpartum, I may have been able to prevent some of these issues.
So why did I choose this certification? Because there is such a lack of education by trainers for women who want to work out during pregnancy or postpartum. Because this certification aligns so much with my own views and philosophies on empowering women through education, awareness, and having resources available to make the best decisions for yourself during this transformative period. Because society has told us that having a flat stomach six weeks postpartum or doing handstand push ups while pregnant is more desirable than preserving and maintaining pelvic floor and core health in order to support long-term performance and function. And finally, because someone needs to advocate and say it is okay to modify your workout, adjust your mindset, take breaks, skip workouts, take it slow, allow time for healing, look three months pregnant even though you’re postpartum (see picture of me one month after my second) and be graceful during this new chapter in your life.
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Let’s take a closer look at some of the conditions that can occur during pregnancy and postpartum. As always, please get clearance from your doctor before starting exercise.
Diastasis Recti (DR)
Diastasis is the separation of the fascia (connective tissue) of the linea alba (abdominal midline) and the abdominal muscles around it. Symptoms can include a “mom” pooch, abdominal pain or sensitivity, back or hip pain, hernia, bulging of midline, or disfigured abdomen. It is completely normal and unpreventable during pregnancy. Your body is not ruined, you are growing a little human inside your body! The abdominal wall will naturally separate (2 cm is considered within normal range) to make room for your growing baby.
Women can become obsessive over how many fingers they can fit down into their midline, so my advice is to not measure during pregnancy. Although you may be 3, 5, or 7 cm, fascia density (how well the tissue responds) of the linea alba needs to be taken into consideration. This is where a PFPT or PPA coach can help. DR looks different for everyone. What is considered normal for one woman may not be the same for the next. For women who are postpartum, diastasis may heal on its own or rehab might be needed. Overall, the healing process can take weeks or months, and in some cases, surgery might be required- each woman’s situation will be unique.
During exercise, it is common for women to worry about coning for fear of increased diastasis. However, it is not the worst thing. With pregnancy comes greater abdominal pressure. Coning is feedback from your body telling you there is a lot of pressure occurring in your midline. It can happen during movements such as pullups or getting up off the couch. Many people say that avoiding some exercises, will prevent DR. I completely disagree with this. Anyone who states otherwise is simply uneducated. First, , DR is going to occur based on genetics, connective tissue, and how a baby grows in the womb. As a trainer, my goal is to preserve the core and to reduce stress to an already stressed body. Second, there is no safe or unsafe exercise, just individual considerations. If I see coning during an exercise, I always consider risk versus reward with the exercise, ask mom how she is feeling and if she feels any symptoms. Then I adjust strategies to help distribute pressure more evenly throughout her body and proceed or stop as she feels comfortable.
Pelvic Organ Prolapse (POP)
Pelvic organ prolapse is the downward descent of the pelvic organs towards the vaginal opening. This can include the bladder, small bowel, rectum, uterus, or vagina. Symptoms can include pelvic pressure, feeling like something is falling out, bulging, heaviness, or painful sex. There are certain strategies that a PPA coach or PFPT can implement to help manage symptoms of POP, assist in the goal of preserving pelvic floor function, and support the body image issues that may accompany this diagnosis. A useful tool for those with POP is a pessary, which is a silicone device that is placed in the vagina to help support the pelvic floor and reduce symptoms. The best analogy I have heard is a sports bra for your vagina! It can be fitted for you at an urogynecologist and in some cases, your PFPT. Using a pessary and having POP has been thought of as an “old lady” tool and diagnosis. Let’s change this mentality!
One thing I learned in during my training is that it’s not uncommon for women to hear they cannot workout or lift over 15 lbs with a diagnosis of POP. Not only is this incorrect, but it can be very discouraging for women. Does this mean that once your infant passes 15 lbs you will stop holding them? Lifting the stroller out of the car? Squatting or running? Of course not! This is where a PPA coach or PFPT can teach strategies to help with your life and fitness demands.
Incontinence is a normal part of being a woman, right? Nope! Although it is common among women, it is not normal and in fact, can be managed. Incontinence is the unintentional leaking of urine by stress (running, jumping), urge (uncontrollable, overactive), mixed (combo of stress and urge), overflow (bladder doesn’t completely empty), or fecal (stool leaking). Feelings of embarrassment, shame, and accepting that it is normal are all very common reactions.
Similar to DR, we are dealing with an already stressed system. Reducing high impact exercises or those that cause increased pressure on the pelvic floor during pregnancy such as box jumps, running, squatting, and jump roping. Returning to them slowly while implementing various strategies, like position and tension, is key while working out. Especially postpartum, it is important to keep in mind the type of birth that was experienced (vaginal or cesarean, pushing, etc.) to help you slowly return to those high-demand exercises. For myself, I found my menstrual cup along with a pad would mask my incontinence during double unders. However, going to a PFPT and using my PPA strategies has helped significantly reduce my incontinence.
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Pelvic pain is all too real for me. It is pain of the muscles, joints, ligaments, and tissues in and around the pelvic floor. It can present as pelvic girdle pain, pubic pain, or hip and back pain. Symphysis pubic dysfunction is the uneven movement of the pelvic joints and is usually brought on by pregnancy. Pain is usually resolved during delivery, but if it isn’t, it can decrease slowly during the months postpartum. A pelvic brace can be worn to help the joints become more stable. This is another area that a PFPT and PPA coach can assist by managing the symptoms, teach breathing and/or movement mechanics, and create a program that can keep moms functioning, and not debilitated by the pain.
In my case, I had extreme back and hip pain that started when my first daughter was ten months old and was caused from deadlifting without being mindful of my postpartum state. It went away on its own but around six weeks postpartum with my second daughter, it came back full force, occurring day and night. I also dealt with painful sex that occurred on only the right side of my vagina. Not knowing what pelvic floor pain was, a friend of mine, who is also a massage therapist, suggested I see a pelvic floor physical therapist. After spending six weeks in therapy, going 1-2 times per week, I became pain free and had almost zero incontinence while jump roping.
If you take away one thing from this post, it is that there are resources out there to help guide you during your pregnancy and postpartum fitness experience. You are not alone! Find a good pelvic floor physical therapist if you are symptomatic during pregnancy. I especially recommend seeing one when you are 4-8 weeks postpartum. You may only need to see him or her once or twice! Also, find a PPA coach in your area that can help you exercise while managing symptoms.
Understand that each woman, each pregnancy is individualized so modifications, symptoms may vary. You don’t have to use these strategies forever, but they will help you get back on the right track to working out in a “normal” in a healthy, holistic, and rehabilitative way.