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returning to activity and sport postpartum
Safely Returning to Activity and Sport Postpartum | Image Courtesy of Andrew Tanglao via Unsplash

Safely Returning to Activity and Sport Postpartum

Postpartum Recovery Part 1

Most women get the clearance after their 6 week check-up for sex and exercise, YAY! But, really? How? What does that mean? There are no guidelines on how to return to activity in a safe, leak-free and pain-free manner.

Between 6 and 31% of postpartum women experience urinary incontinence. In addition, 66% of those who experience urinary incontinence during pregnancy and/or their first 3 months of postpartum continued to experience incontinence even at 12 years after birth! As you can see, it may be common, but it is certainly not normal!

The best way to get started on exercise is to visit a pelvic floor physical therapist for a full assessment -- head to toe -- including a thorough pelvic floor muscle examination (different from an OB/gynecologist exam that checks for tissue healing), strength, muscle coordination, and posture. We can be proactive as you return to activity and exercise and prevent negative outcomes such as urinary incontinence, bowel incontinence, pelvic organ prolapse, and pain.

 As you start exercising, start small (less can be more!) and progress slowly and monitor for any symptoms of pain or pelvic floor dysfunction. Some “red flags,” to look out for:

  • pelvic/vaginal heaviness 
  • incontinence (either urinary or bowel)
  • low back pain
  • pelvic pain
  • doming or gap in the abdominal wall
  • bleeding during/after exercise 

If you experience any of the above, give your pelvic floor physical therapist a call for an assessment to help address any symptoms and increase guidance on returning to exercise safely.

At your pelvic floor physical therapist visit, we will assess:

  • pelvic floor muscle strength, endurance and coordination
  • pelvic organ prolapse
  • any distortion of the midline of abdomen (diastasis rectus abdominis)
  • musculoskeletal strength
  • scar tissue

There is a functional screening that our office follows to help you return to the activities that you love doing. We first address and treat any signs of pelvic floor dysfunction. We look at your pelvic stability, as this can be affected by cesarean or vaginal delivery, diastasis rectus abdominis, or muscle weakness. One study found that up to 39% of women 6 months postpartum continued to have diastasis rectus abdominis impairments. (Stay tuned for an upcoming article on diastasis rectus abdominis and how you can screen at home). In addition, we test your balance and ability to perform dynamic movements on one leg, which is very important for running and most sports activities. We also want to make sure you are breathing appropriately during exercise to help manage intra-abdominal pressure that can cause incontinence or feeling heaviness in the vagina. 

The below activities are just a few of the many different ways that we can assess and monitor your balance, strength, and endurance before starting an exercise or running program: 

  • walking for 30 minutes without any pain, vaginal heaviness/drag, leakage
  • balancing on one leg for at least 30 seconds
  • performing a single leg squat
  • performing 20 single leg bridges
  • performing 10 hops on the same leg in place
  • keeping pelvis stable during an active straight leg raise

Next steps in your exercise program:

If you feel comfortable progressing, try gentle jumping in place. As you advance, try increasing the endurance first, before you increase the intensity to ensure a more graceful transition (i.e. gentle jumping/jogging in place for 3 minutes v. 20 jumping jacks or continuing a walk/jog program for a longer period of time v. running). If at any point you experience pain, incontinence, or heaviness/bulge in the vagina, please know that there is help, and pelvic physical therapists can help you reach your goals, and help you get back on track (or on the track! ????). 

 

References:

Mota PGF, Pascoal AGB, Carita AIA, Kari B. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Ther 20. 2015; 200-205. 

Goom T, Donnelly G, Brockwell E. Returning to running postnatal-guidelines for medical, health and fitness professionals managing this population. Published March 2019. 

Sievert KD, Amend B, Toomey PA, Robinson D, Milsom I, Koelbl H, et al. Can we prevent incontinence? ICI‐RS 2011. Neurourol Urodyn. 2012;31(3):390-9.

Viktrup L, Rortveit G, Lose G. Does the impact of subsequent incontinence risk factors depend on continence status during the first pregnancy or the postpartum period 12 years before? A cohort study in 232 primiparous women. Am J Obstet Gynecol. 2008;199(1):73. E1-73.e4.

What Our Patients Have to Say

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Testimonial by T.C.

While pregnant with my twins, Heather took care with keeping me on my feet and pain free. She saved my back, my sanity and the holidays! I would recommend her to every “mom” looking to stay on her feet during pregnancy and post-partum.

-- T.C.

Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

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