Post-pregnancy high impact and high intensity exercise
Today more women than ever participate in activities that can be described as high impact and/or high intensity such as competitive sports, strength/conditioning with heavy weights or endurance events such as marathons. Many more also exercise regularly, enjoying activities that can be high impact, such as aerobics, cross-fit, boxercise and similar class work. Even normal gym work or exercise classes can be high impact/intensity depending on the exercises undertaken!
As these activities often represents an important part of your fitness regime, or even your life as a whole, a very common question Women’s Health physios such as myself get from postnatal women is ‘when can I start again?’.
So that is what I’m going to talk about in today’s post.
Firstly, the literature is not completely consistent in what constitutes high impact/intensity as there can be large individual variation, but from a Women’s Health physiotherapy point of view, anything that could be considered to cause significant increase in intra-abdominal pressure could fall in this category. This pressure comes from using your core muscles around your pelvic floor and diaphragm as well as your deep abdominal and multifidus muscles. This pressure typically increases on impact (so jumping, bracing, and landing) or when exercising at such a high level of intensity that your core muscles can no longer maintain their strength.
Secondly, there are some common risks associated with high impact/intensity exercises post pregnancy which are worth considering, such as:
- Stress Urinary Incontinence (SUI) or wetting yourself when you exercise (can also happen when you cough or sneeze).
- Tissue/Ligament injuries.
However, don’t be afraid. The vast majority of women return to full activity in time.
The first general advice is to think about what you want to achieve and see if you can replace any high impact/intensity exercises with low-impact exercises until you have fully recovered.
I would recommend to immediately after birth starting with gentle exercise such as walking (assuming it is comfortable and there are no other complications), then working your way up to swimming (once you stopped bleeding) or using an exercise bike or similar (many gyms also have full seat exercise bikes if the thinner saddles are painful to use) – Swimming and exercise bikes in particular are safe and low-impact exercise that can still give you a very good workout. Another option to increase your activity level is brisk walk in nature, preferably with hills, or on a treadmill – avoid running at an early stage as your pelvic floor may not be ready for this.
A key concern is the increased elasticity of tissues post-pregnancy (caused by low oestrogen levels due to breastfeeding) and the possible fatigue many new mothers feel in the first few months. This has been linked to injury as many women try to return to their pre-pregnancy levels of exercise too quickly and before endurance is back and the tissues have recovered. The common explanation I hear is ‘but I could do it before I gave birth’ – and while that is certainly true, post-pregnancy can be a case of hurrying slowly, getting back a little bit at the time as over-doing is more likely to lead to injury compared to many other times.
In addition to walking, swimming and biking, Yoga and Pilates are both excellent ways to begin your route back as nearly all exercises can be adapted in difficulty by a competent instructor and they can also be altered in case you are suffering from any other difficulty. An additional advantage is also that they provide ample opportunity for rest and to adjust the session yourself.
The second general advice is to work up until pain/discomfort, but do not work through it. Stay with low impact and gentle exercise, particularly in the early months and work with holding pelvic floor contraction against load (such as lifting). We are stronger than you think so if you are doing gentle exercise without side-effects (no leakage, no sense of heaviness in your lower regions, able to breathe ok through the exercise) try progressing slowly but surely until you return to normal levels. A good advice is to never increase your training levels with more than 5-10% per week (in time, weight, distance, repetitions etc.) – this should allow you to improve with minimum risk of injury.
If you are unsure, there are other complications, or you are returning to very high level of activity (contact sports, high level competition, endurance events and similar) I would recommend seeing a Women’s Health physiotherapy before going back fully. This way a full assessment can be made, checking your pelvic floor and core for strength, co-ordination as well as any lingering injuries. This assessment can also check for signs of prolapse, diastasis as well as tissue and ligament issues. This would allow a physio to put together a plan for your return to full fitness, tailored to you and would allow you to progress with confidence. In particular, a (Women’s Health) physio would look at any muscle tears or stress fractures that may have happened during the birth and use these as a guide to whether you can return to your normal activities. Similarly, your muscles stretch during birth, so assessing this is also a possibility in order to judge where on the path to fitness you are.
If you have any questions, please let me know!