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Post natal - Return to higher impact activity

Updated: Mar 25


 

If you’ve recently introduced a new human to the world, well lets face it you probably don’t have time to be looking up guidance on post natal return to sport and unfortunately our national services are under such high demand and strain that there is a lack of support and guidance for new mothers.

I wanted to do a blog to raise awareness of the impact of pregnancy and child birth on the musculoskeletal system and to give some advice around recovery post delivery (that is hopefully easy to understand and follow for the unsung heroes that are new mothers!)


 

So what happens to the musculoskeletal system during pregnancy? You’ve spent 9 months growing and carrying a baby, with this incredible process comes pressure from the foetus down on the pelvic floor and out onto the abdominal muscles. The pregnant body adapts by increasing collagen and elastin to allow the pelvic girdle to widen to absorb some of the pressures. The rectus abdominus muscles (‘6 pack’) begins to stretch apart and elongate as the foetus grows , this is known as diastasis, diastasis recti or divarication.




Post delivery many women experience diastasis, you can have a visible and/or a palpable gap down the middle of your stomach (it is a normal and common symptom of pregnancy and takes up to 8 weeks to heal naturally, after 8 weeks it needs a little help along the way). The location of diastasis can vary from above, below and above and below the navel. It is important to re train the muscle around the abdomen to prevent side effects that can come with this reduced core strength and muscle tension (e.g. bladder issues, low back pain, constipation and a hernia). It doesn’t matter if you’ve had a cesarian or a vaginal brith, the changes at the abdomen occur during the pregnancy and not at the birth.







 

Return to exercise should be criteria based and graded in approach. The pelvic floor and the deep core muscles work closely together to provide strength and core control. I therefore always teach clients the basics of isolating the deeper core (transverses abdominus) and pelvic floor muscles first so they can integrate this into a progressive exercise program. The danger of doing too much too soon is developing complications that come from placing strain on the body that it is not ready to absorb, leading to complications and injuries such as low back pain, bladder continence changes, hernia of the stomach etc.

Below is great overview of what should be involved at different stages produced by the Tom Goom, Emma Brockwell and Grainee Donnelly (March 2019) as well as what criteria should be achieved prior to returning to running.





 

From a musculoskeletal health point of view I recommend seeking guidance from a healthcare professional who is competent in assessing things such as pelvic floor muscle activation, basic muscle strength and diastasis to get individualised guidance on return to activity. If you are suffering with symptoms such as post natal depression or breast feeding issues I recommend seeking guidance form the appropriate professional (Such as a counsellor or nurse/midwife).

Many women think urinary incontinence is ‘normal’ post natal. Whilst a short period of increased urge, small leakages and stress incontinence can be normal, ongoing issues should be fully investigated are there are other reasons these issues can persists (such as pelvic organ prolapse, infection, nerve damage etc.).

 

Post natal - Scar management

If you have had a C-section you may have scarring around the abdomen. Scar tissue is a vital aspect of tissue healing and normal in response to tissue damage. It can be very sensitive to pressure and touch to start with. Scar tissue can take up to two years to fully heal and even then you will likely still have a faint line. During the healing period it is normal to have lack of or altered sensation around the scar tissue, this can improve with time and you can help improve your chances of de sensitising the tissue with a little proprioceptive work (getting it used to touch and pressure gently). Whilst you won’t be able to ‘break down the scar tissue’ you can aid fascial gliding between the layers of skin, fatty tissue and muscle that the scar crosses to improve mobility around the tissue. Keep an eye out for signs of infection or failed tissue healing, if you have any concerns seek advice from a professional.



 

Post natal - RED-S screen


RED-S demands a blog post on its own but here is a brief summary of why women are at higher risk of developing this post natally. RED-S = Relative energy deficiency in sport. Often this term is linked with the female athlete triad (A combination of low body weight, menstruation cycles and sporting females). However, as imbalance with energy consumption and expenditure can be seen in males the name was changed to RED-S. It is, put simply, an imbalance in the amount of energy you are using to the amount of energy you are taking on board. Why is there higher risk post natally?

  • Sleep deprivation

  • Breast feeding (you are transferring your nutrients to your baby and at risk of not maintaining enough for yourself)

  • Energy consumption for tissue recovery due to potential micro injuries sustained during childbirth (muscle injury, scar tissue, ligament and tendon strains)

  • Hormone changes

  • Talk about balanced meals as looking after baby so less likely


 

In summary, if you are unsure about any of your symptoms seek professional advice. Take your time and don’t surprised if it takes a while to get back into the swing of it. Take your time, get used to gentle small movement first and build up gradually.


 

References

https://pubmed.ncbi.nlm.nih.gov/19756341/

https://www.fitright.physio/why-do-you-need-a-postnatal-pelvic-floor-assessment/

https://absolute.physio/wp-content/uploads/2019/09/returning-to-running-postnatal-guidelines.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578190/


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