Articles in Category: Yoga & Fitness

Why I Don’t Hate Crunches, CrossFit and Bootcamps for Moms

Exercise after Pregnancy

As a Pelvic Health Physiotherapist working at a pre and post-natal centred clinic (The WOMB – Milton), I see multiple clients a week navigating through the fourth trimester of pregnancy – the first 3 months AFTER birth (we also see clients throughout pregnancy - I wrote a blog about exercise in pregnancy here). The fourth trimester is a HUGE time of change.  You, as a new mom, are learning how to be a Mom – navigating how to eat, sleep and nourish yourself and your new baby (or babies!). During this time, your body is undergoing a huge amount of change as well – your organs are repositioning themselves after giving up most of their space to Baby for 9 months, your abdominal wall is re-tensioning and you may be healing from some stretching or stitches in the abdomen (from a caesarean birth) or pelvic floor (from a vaginal birth). You might have some leaking (incontinence) or maybe some back or pelvic pain. Plus, now you are constantly juggling a floppy newborn Baby – standing, carrying, feeding in seated or lying down (or somewhere in between!), picking up toys, food, disregarded soothers, car seats, strollers, and all on 2-3 hours of sleep…. Phewf! You and your body are going through a lot! Fortunately, the reality is that our bodies are strong, reliable and so dynamic! Here is what you can do to set yourself up for an optimal recovery AFTER Baby.

Phase 1: Week 1-3: Adjusting to Motherhood and Getting Back to Basics

Focus #1 – Baby
Focus #2 – Get some sleep yourself!
Focus #3 – Breathe.

During pregnancy Moms tend to breathe up into the chest because Baby is in the way, preventing full, deep breaths. Your body has learned this pattern over a matter of months and may automatically continue breathing this way unless you give it a little conscious thought. When we are using our diaphragm to breathe our abdomen rises and our ribs move out to the side and our chest is the last thing to move. This breath pattern, called “diaphragmic breathing”, naturally helps the pelvic floor to function optimally and get back on board after Baby.

I often suggest Moms try to fit this in as they feed – this is something you usually do multiple times a day and once Baby is set up you can concentrate on your breath. This is a bonus because this can also be a little mini-meditation and some quiet time to regroup.

Focus #4 – Posture

During pregnancy your weight distribution changed through the pelvis and legs as Baby grew. After pregnancy your body may be used to standing as if you were still pregnant – this is typically with the ribs back and your tailbone tucked under you. Check out an easy way to set up a more neutral posture after baby is born.

Yes, for most new Moms this will feel like you are leaning forward or sticking your booty out like Beyoncé. This is just because your body is used to being shifted back so it thinks being stacking ribs over pelvis is forward. If you keep your weight in the middle of your feet and look in a mirror as you set up your posture like in the video then you will see that you are indeed upright – if your weight is over the toes then yes, you may be leaning too far forward.

Phase 2: Week 4-6+: Returning to Activity

Around this time you might be starting to feel like you are getting into the groove at home, might be going a little stir crazy and/or want to do some exercise. (Or you might still be adjusting to new life with Baby – in which case take your time in Phase 1, no rush!). You might have your appointment with your OB or midwife where they might give you the go ahead to return to activity… with little instruction after that. Does this mean you can jump back in to running, Bootcamp, Body Bump, CrossFit, HITT, 21 Day Fix, etc?

The short answer is, it depends.

Did your OB or midwife look at your birth region (abdomen or pelvis) at your appointment? Maybe. Did they test for strength, relaxation or activation patterns of the ab muscles and pelvic floor? Probably not. Imagine you injure your bicep. Your Doctor’s job is to tell you that you have an injury, stitch you up if needed, make sure you don’t have an injection, maybe give you some meds and refer you to an expert if needed. It is your Physiotherapist’s job to assess the biceps functionally (does it work so you can lift things?) and give you some stretching and strengthening to do to help you recover. This is what Pelvic Health Physios (like me!) do for your abs and pelvic floor (and back and hips, too). We take a look to see if you have Rectus Diastasis (AKA abdominal separation AKA Mummy Tummy), we help address any incontinence (bladder or bowel leaking) issues and ensure you don’t have any prolapse (abdominal organ shifts). We also help educate you about why your might have pain with sexual activity and what you can do about it (and there is a lot we can do about it!) and help you get back to whatever form of activity you want to get back to – whether that is walking, yoga, power lifting, boxing, Crossfit, pole dancing... etc! This might be something you can get back to quickly or it might be something we will work up to as your body continues to change and recover - it really changes person-to-person.

bumppilatesIn general it is wise to start at a lower intensity and build up – for some this may start with short walks outside and build up to jogging, for others this may mean doing modified WODs with lighter weights. Your body is still adjusting to life with Baby on the outside, you might be allocating more body energy to breastfeeding, your hormones are still fluctuating and you are probably running on less sleep than before. Be patient with yourself – “know your limit, play within it”, is a great phrase to remember during the third trimester. My job as a Pelvic Physio is to help you know what your limit is.

What about sit ups, planks, Russian twists?

Again, it depends. When working well, the inner core (diaphragm, abs and pelvic floor) work to support our outer core (“6 pack” rectus abdominus, the twisting obliques, back muscles, glutes [bum muscles]) through all our movements and tasks. If your inner core is working well then sure, do all of these activities! How do you know when your inner core is working well? In general, your abdomen will automatically flatten not bulge when you do movement (this is not clenching), you will have no leaking, no pressure or heaviness in the pelvis, and no pain. However, you can definitely still have suboptimal inner core function without these symptoms that might creep in over time. One study has shown that women can develop incontinence 5-7 years after birth. Personally, my inner core coordination was off and I didn’t realize until I started running over 5km and then had hip pain. This resolved once I saw a Pelvic Health PT and did some simple rebalancing exercises.

What about CrossFit or HITT?

These forms of exercises are awesome for full body workouts - we definitely want to build you up to returning to these exercises we just have to ensure you’re working from the inside out. Learning how the inner core supports you through these exercises and how to brace for heavy lifts properly will help to prevent any issues from arising from your sport, and usually results in improved PBs (personal best) as well.

Overall, most people can return to their preferred form of exercise safely after birth as long as the inner core is serving you well. How much rehab you will need to build you up to these activities varies from person to person. As Pelvic Health Physios, we help you reconnect with your pelvic floor and inner core muscles to ensure everything is ship shape to support your through lifting and chasing after your kids as well as any other sports or exercises you want to pursue.

If you have any questions, please don’t hesitate to set up an appointment to meet with us at The WOMB or check out our Mummy Tummy workshop.

jennytc

Jenny Telfer Crum is a pelvic health physiotherapist at The WOMB. She specializes in preparing the body for birth and then helping women return to exercise after pregnancy and has taken advanced courses to help high intensity weekend warriors return to their training of choice.

The WOMB offers Mummy Tummy Workshops, Pfilates classes (pelvic floor pilates), Momma & Baby Core classes and when you’re ready Mommy Bootcamp.

Exercise During Pregnancy

When & What? Advice from a Pelvic Health Physiotherapist

A common question I get as a Pelvic Health Physiotherapist is: “What kind of exercises are safe to do during pregnancy?”. The short answer is that most forms of exercise are safe and advocated. Maintaining fitness, preventing health issues such as gestational diabetes and preparing the body for an optimal birth and recovery are a few of the reasons why regular exercise is important. Of the different types of exercises, “core exercise” is often a hot topic for pregnant women. Although your deep core muscles do assist in breathing and pushing efforts during birth, your uterus does most of the work so you don’t need abs of steel to to have a smooth birth (another blog to come on this topic). Engaging in different types of exercise will keep you well in pregnancy and beyond.

pregnancy pool

Safety: When shouldn’t I exercise during pregnancy?
In rare circumstances there may be reasons to more drastically modify standard exercise recommendations or avoid exercise all together. If there is an underlying condition involving the uterus, placenta or your overall state of health, your primary care provider will typically indicate when this is the case. Refer to this link for more information.

What kind of exercise should I be doing?
General exercise guidelines still apply during pregnancy – cardio for lung and heart health 30 minutes, 5 times a week; muscle strengthening 3 times a week; and stretching daily. There is also a lot of new research outlining the importance of daily mindfulness to counteract the chemical stress response that most of us have in our busy lives. Try a 15 minute guided body scan (lots on YouTube), meditation, prayer or gratitude journaling.

Some women find during the first trimester symptoms of morning sickness limit them from doing strenuous activity. Be patient with yourself and give your body some time. Starting with a gentle walk for 15 mins 2x/day just to get the blood pumping and muscles moving is still beneficial. The same principles apply if you are new to exercise – start slow and gentle and progress as you are able.

What about Kegels?
A “kegel” is a sustained and repeated pelvic floor activation named after the OBGYN who started advocating for them in the 1940s (Dr. Arnold Kegel). Yes, we want our pelvic floor muscles to be strong but we also need them to be flexible; they need to be able to relax, and to be coordinated with our muscles. As a Pelvic Health Physiotherapist, I can help you set up an inner core program incorporating pelvic floor muscle training that will support you through your pregnancy, during exercise, throughout labour and into your recovery post partum. 

What about Yoga?
Prenatal yoga can help with flexibility and relaxation during pregnancy and also has the added benefit of meeting other Moms-to-be for you to connect with during pregnancy and into motherhood. Yoga is a great compliment to your strength and cardio program. Note that hot yoga is not recommended during pregnancy as the increases in core temperature can impact fetal development.

prenatal yoga

High Impact Exercise: What about Running? Crossfit? HIIT? Power Lifting?
In the media there tends to be an all-or-nothing approach to pregnancy – either all you do is yoga or you continue to power lift until the day you birth your baby. If you were performing high intensity or high impact exercises before pregnancy it is typically safe to continue these, but the intensity will taper down during pregnancy. Here are some things to remember:

You must acknowledge that your body will change during pregnancy and it is wise to honour these changes. There are a number of physical adjustments that affect your posture, breathing and your muscles' ability to generate power as the length of muscles change and the relationship of structures adjusts. Good form when executing high-impact exercise is always very important and simply put is more difficult to do when pregnant. Unfortunately, most trainers do not have the adequate knowledge to guide women through these high impact exercises in a safe and appropriate manner. Sit ups, curl ups, toes to bar, V sits, boat pose, Russia twists and double leg lowers are examples of traditional core exercises that increase abdominal pressure and overrecruit our external core which can contribute to rectus diastasis or “Mummy Tummy”. To prevent pelvic floor issues and abdominal wall issues, you are best to touch base with a Pelvic Health Physiotherapist who can appropriately guide you through the exercise program you desire.

pregnant running

Don’t forget that pregnancy is a time for maintaining your strength and endurance then tapering the intensity as your needs change. The goal is not to develop fitness at this time through max lifts or personal bests, so an adjustment in your approach to exercise and fitness is important. During pregnancy you should be able to talk throughout your workout, recover quickly and modify your movements easily.

I hear I am supposed to listen to my body – what am I listening for!?

  • Pain – of any kind, especially in the back or pelvis.
  • A feeling pressure or heaviness in the pelvis
  • Loss of control of urine – leaking with lifting, running, coughing, sneezing, laughing
  • A “tenting” or “coning” through the front of the abdomen with any movement
  • A tendency to to hold your breath to perform a movement
  • Development of hemorrhoids or varicose veins

These events signal there is a muscle and pressure imbalance through the body that needs to be addressed. Again, as a Pelvic Health Physiotherapist I can help you connect with these imbalances and educate you as to how to manage them going forward.

Take Home Message: Exercise is Medicine in Pregnancy and Beyond!
Exercise during pregnancy is safe for most women and should be fun, engaging and rewarding – physically and emotionally! You can start at a low intensity and build your way up, or continue with the work you were already doing and make modifications along the way. At the WOMB we have workshops, fitness classes and our Pelvic Health Physiotherapy team ready to support you through your pregnancy and into motherhood. 

jennytc

 

Jenny Telfer Crum is a Registered Pelvic Health Physiotherapist at The WOMB. She has a special interest in helping women exercise safely during pregnancy, prepare for labour and return to their exercise intensity of choice after birth while honouring their body along the way.

 


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