If you are concerned about returning to exercise postnatally or just have questions about the best way to proceed, please come to see one of our Physios with a special interest in Women’s Health.
Here are some things that we will discuss with you, assess for, and take into account in your personal situation:
- How many weeks since your delivery?
- Did you have any pre-existing pelvic girdle or Lumbar pain?
- Ligamentous laxity
- Presence of Rectus diastasis?
- Was it a vaginal delivery or Caesarean Section?
- Any complications during delivery or in the post-natal period?
- Other orthopaedic problems since being pregnant- eg sore thumbs (deQuervains), carpal tunnel syndrome
- What type of exercise do you want to return to? For high impact or running there is a special pelvic floor assessment we can for this.
- Pelvic floor status: have you had any problems passing a motion, pain, incontinence? Do you have any concerns?
If you had low back or pelvic girdle pain during pregnancy and it persists, we take into consideration the number of weeks you are post birth.
Guide for your prognosis post partum:
Pelvic pain with initial onset during pregnancy tends to be more likely to become chronic the more pelvic joints are involved.
- Pain in Pubic Symphysis only ->There is a 10-15% chance of this persisting at 2 months
- Pain in 1 SIJ only -> There is a 20-30% chance of this persisting at 2 months
- Pain in 2 SIJs -> There is a 30-40 % chance of this persisting at 2 months
- Pain in all 3 joints -> There is a 60-65 % chance of persisting at 2 months and (There is a 20% chance of these persisting >2 yrs)
Pubic Symphysis pain alone is the least likely to become chronic
- Only 15% persisting at 2 months
- The good news is that almost 100% of these are resolved by 6 months
So we guide your exercise taking all of this information into account to tailor your suitable return to exercise plan.
Ligamentous laxity means increased “looseness, elasticity, length” in your ligaments. Laxity is evident in the peripheral joints as well as the pelvis. There appears to be some relationship between ligament laxity and Pelvic Girdle Pain (PGP).
- There is some evidence to suggest that asymmetric laxity is associated with PGP (we can try treating the relatively stiff side to relieve pain)
- Peripheral joint laxity e.g. knees, ankles, shoulders increases in the 3rd trimester and hasn’t returned to normal by 6 weeks postnatally.
- Ligamentous laxity appears to persist for months after a pregnancy
- Breast feeding may help reduce it as it suppresses oestrogen production
Do you have a Diastasis rectus?
This is a gap between the 2 sides of the abdominal muscles (DRAM). This is important to know because there is evidence to show that this gap can be reduced in the first 8 weeks post-natally, so we must act early in the first 2 months if we are to effect a change.
These muscles need to be strong to support our backs, make our cough effective, support our abdominal contents and improve our posture.
- Some studies have shown Transverse Abdominus/drawing in exercises can widen a DRAM
- Very little research done on how to manage DRAM
How do we manage a DRAM?
- Abdominal support for large separation: tubigrip double layer
- SRC pregnancy recovery shorts for 8-10/52 but can wear longer if want
- Try a variety of exercises & we pick the one that gives the greatest reduction of the DRAM for you to do as your home program
- Minimise herniation
- Check for fatigue point -> herniation begins to increase and stop just before then
- Retest every week as the muscle orientation changes so re-assess the muscle action with each exercise
What type of exercise do you want to return to?
ACOG (American College of Obstetricians & Gynaecologists) committee opinion 2015 on physical activity & Ex during pregnancy & post partum period:
- If uncomplicated pregnancy or birth, encourage aerobic and strength conditioning.
- 20-30 mins/day, most days if not all days (150 mins/wk)
- Eventual goal of moderate intensity (equivalent of brisk walking)
Many women will want to do more than this which is fine if there are no other problems present eg urinary incontinence with running or carpal tunnel which limits ability to grip making weights programs difficult. These will need to be discussed, assessed and then a treatment plan worked out so we can help you get back to doing what you love in the time frame that suits your lifestyle. We want to set you up to succeed.