You delivered a baby 6 weeks ago, and just met with your OBGYN for your 6-week follow up visit. You sigh a breath of relief when you learn that you are not showing signs of infection, and that you are cleared for exercise. However, a new myriad of questions race through your head. “My OBGYN said I was cleared to exercise. What does this mean? Can I go back to my full workout routine or should I ease into it? And how do I ease into it safely?” The 6-week OBGYN clearance is the starting line. This checkpoint tells us that you are free of infection, gives us a general idea of what injuries you may have endured during labor and delivery, a general assessment of prolapse, and whether your incisions are healing well. The 6-week check up appointment does not tell us what your body can tolerate in terms of load, how your pelvic floor muscles are moving and coordinating, and it definitely does not give us a plan for healing injuries or prolapse.
Pregnancy poses an enormous demand on the musculoskeletal system. For 40 weeks, your body goes through several changes. As your pregnancy progresses, your center of gravity shifts forward, your hip flexors shorten, and your glute muscles have a harder time firing. Your ribs are not able to expand, making it difficult for your diaphragm muscle to move appropriately. Furthermore, your pelvic floor muscles are taking on the job of the compromised glute and hip muscles, and now have the additional job of supporting a growing pregnancy. Furthermore, a hormone called relaxin is released during pregnancy, which is responsible for “loosening” joints, which puts increased strain on muscles to create more stability. Lastly, whether you have a c-section or a vaginal birth, your body needs more than 6 weeks to heal fully.
Postpartum, these changes take weeks and sometimes months to heal. There are several factors that impact these timelines including prior activity level, breastfeeding status, and even genetics. It’s important to know that these timelines are variable and different for each person. Generally, research shows that the hormone relaxin takes up to 12 weeks to get resorbed postpartum. If you had a vaginal delivery, the deepest layer of the pelvic floor muscles takes up to 6 months to recoil, meaning that your pelvic system is working harder to perform functions like maintaining continence or providing support. Furthermore, the muscles of the abdominal wall take time to heal and coordinate with each other. During pregnancy, the connective tissue between the rectus abdominus muscles elongates, making it difficult for the abdomen to manage pressure, contract, and coordinate appropriately. This condition called diastasis recti or linea alba elongation takes up to a year to heal postpartum. Finally, muscle imbalances during pregnancy may take up to 6-8 weeks of retraining to improve as well.
During the postpartum period, you are not set up for success as you heal. Your body is healing as you are experiencing sleep deprivation and navigating a colossal life change, all while your baby is getting heavier. Pelvic floor physical therapy allows you to return to exercise via a step-by-step and individualized approach, considering what your body needs. A physical therapy plan of care takes into consideration the appropriate healing timeline based on your unique findings, your specific concerns, and your movement goals. Your physical therapist will screen you for injury from birth, assess your movement, strength, breathing, and posture, and design a customized, step-by-step plan for you to meet your goals effectively and efficiently. Click here to learn more about postpartum physical therapy at Kaya or shoot us a message about your specific concerns and goals.
