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Running Postpartum – How Long Should You Wait?

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Running after baby pelvic floor postnatal

I get asked this question a lot, so I think it deserves a blog!

Unfortunately there is no simple answer, because EVERYBODY’S DIFFERENT! So you need to start listening to those motivational memes on Facebook telling you not to compare yourself to others- it doesn’t matter that your friend was back running 3 months after giving birth. Someone who was fit before and during her pregnancy, and had a quick labour with no tearing will recover a lot faster than someone who isn’t a regular exerciser and/or had a difficult labour. This is about what’s right for you.

It Takes Longer to Heal Than We Realise

postnatal recovery

I have seen it advised that it takes at least a year for the pelvic floor to return to full strength , and if you look at the graphic above, you can see why that is! Connective tissues, such as tendons and ligaments, have a slower healing rate than muscle, and there’s a lot of this within the pelvic basin.

This doesn’t necessarily mean you can’t run for a year though!

Here are some guidelines to help you decide whether to start running yet, and signs that you need to slow down.

We’ll start with a hormone called relaxin which is released into your system in the early stages of your pregnancy. Its job is to relax your ligaments to help prepare your pelvis for childbirth, but relaxin doesn’t just affect your pelvis, it affects every joint in your body. And it stays in your system for up to 6 months after birth, or until you stop breastfeeding.

As a result your joints aren’t as stable as they once were. When you run, your entire body weight lands on 1 leg with a G-force of 2-3. So there’s a lot of impact going through those unstable joints. Plus, for those of you who no longer have relaxin circulating: I’ve assessed a lot of clients over the years, and most people have poor alignment in a 1 leg stance. If you wobble when standing on 1 leg, how well will you cope with impact?

Next up is your pelvic floor.

If hasn’t recovered yet, chances are, you’ll wee yourself the first time you go out for a run, and could do yourself some everlasting damage. Even if you don’t suffer any incontinence, if you feel a heaviness down there: stop.

Unfortunately incontinence is accepted as normal by many women. Common, yes, but not normal, even if you just leak a “little bit” when you sneeze or jump. In the majority of cases it can be resolved, so if you have any doubts about your pelvic floor see a Women’s Health Physio and follow an appropriate exercise routine. And no running! If you place pressure on a dysfunctional pelvic floor it’s never going to heal.

Do you still have diastasis recti?

Your abdominal wall forms a sort of pressure system with your pelvic floor, low back muscles and diaphragm. And if you have diastasis, there is a weakness in that system, which means your back is going to be less supported while you run, and potentially there’s going to be more pressure on your pelvic floor too. So focus on restorative core exercises before starting anything high impact.

I know the idea of no running can be hard.

For many it’s not just the physical side (although it does feel good to go for a good run and feel like you’ve worked) but the mental side, as it relieves stress and gives you time to yourself. But remember: this is a phase of your life. It will pass, and it is so small compared to the bigger picture. At some point you will be able to run and jump again, just as long as you don’t rush things now.

Jenny Burrell of Burrell Education explains this brilliantly: You brush your teeth every day, even though you could get dentures implants if all your teeth fell out, but there is no replacement for your pelvic floor!

So, you can start running again, if:

  1.  Your pelvic floor is in check.
  2. Your diastasis recti is healed.
  3.  You’ve done a couple of months’ worth of work on restorative core exercises, and some whole body strengthening.
  4. You’re at least 4, if not 6, months post partum. This is a minimum- some will need longer.
  5. You’ve invested in a good sports bra (always a must with impact exercise, but especially when breastfeeding!)

What if you’re not yet ready to run?

I have a few blogs to get you started- this one has training tips to get you fit to run, and this blog has my top 5 postnatal core exercises. You can also download my top 10 tips for getting in shape after having a baby here.

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No Housework And Regular Massage: Postnatal Traditions From Around The World.

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postnatal traditions recovery fitness

I have some vivid and precious memories from the first few months after my sons were born, despite being in a bit of a daze at the time. It’s such a special time, and one of enormous transition: physically there’s a lot of healing needs to take place, there are hormonal changes, bonding, learning to breastfeed, and relationships adjust.

And I can’t help but feel we don’t honour this time as we should. We’re pretty good about pregnancy, but once baby arrives, the mum doesn’t always get so much attention anymore. And with paediatrician appointments,  endless nappies to change, baby clothes to wash and visitors to see baby, self-care can take a back seat.

 postnatal recovery traditions

But is this good for our recovery?

In a word: no. Which made me wonder- do other cultures take better care of new mums than we do?

Confinement.

Many countries have confinement practices where the new mum stays at home, with no visitors except close family until the confinement period is over. For Malaysian women this usually lasts for 42 to 44 days, for an Indian mum, it’s about 40.

Wouldn’t it be wonderful if we could follow a similar practise in the UK, treating the postpartum period as a time to cherish and give mum extra care? Unfortunately it is just not practical for most of us: how many have family members who can tend to us for that long? There is the option of hiring a doula though, who often provide support beyond the birth itself and can advise on self-care and even help with household chores, or postnatal support from someone like Karen at Parents & Co, who can provide overnight care too.

No washing your hair!

This is a Chinese one, and linked to an overall practise of staying warm, because loss of blood and energy is thought to make mum ‘cold’: in Vietnam they practise nam lua (‘mother-roasting) where a fire keeps the mother warm for a month.

Other warming practises include bathing in warm, herb infused water- I don’t think any of us want cold baths or showers, so this one is pretty easy to follow!

postnatal traditions

Is this a valid concern though? Apparently so! One study found people who dipped their feet in icy water for 20 minutes were more likely to develop a cold than those who didn’t.

Given that new mums often experience increased sweating (getting rid of the extra water retained during pregnancy) these warming traditions do seem like a good idea!

No TV or reading!

Ok, I would have struggled with this one. I get the reasoning- strain on the eyes and potentially tiring- but I’m not sure I could stay in the house for that long without books. Unless I ran up a MAHOOSIVE bill at audible.com. Is it acceptable to ask for itunes vouchers instead of baby clothes as a gift?

Other activities considered to be stressful and avoided include shouting, crying, and too much conversation. I may have struggled with the crying (hormones!), however talking to fewer people may have helped…

No housework

Awesome. Also, no bending at the waist to prevent back injuries. In India new mums are sometimes helped by a dia (or even a maid) who will help with cooking, laundry, and bathing the baby.

In some cases, where the birth has been particularly difficult and there may be problems such as a prolapse, this is great advice. In others, it may feel impractical: bending over baby to play, for example.

Also, whilst I’m all for rest, some exercise, such as gentle walking, can be really beneficial in encouraging the core to repair. It will increase circulation which will increase the nutrients being delivered to mums muscles, aiding her at a cellular level.

However, there’s something else that aids circulation…

Massage.

postpartum traditions healing massage

Also awesome. In India the dia will do this too (maybe even daily), or in Malaysia a bidan massages the abdomen. Pregnancy and the strains of a new baby can leave mum with tight areas, and  a tight spot pulling you out of alignment can affect posture, and therefore abdominal healing (diastasis recti).

Release work doesn’t have to be done with massage, I give clients techniques they can use at home for this, but massage would be my method of choice!

Abdominal binding.

Many cultures practise some form of belly wrapping to aid with healing the core. In Malaysia they use a special postnatal corset (bengkung), and India a long cloth to bind it. They can give extra support to weakened abdominal muscles, reduce postnatal swelling, and encourage them to close back together.

In the UK Physiotherapists can recommend abdominal support for women who are having trouble healing. But whereas across the pond in France new mums see a Women’s Health Physio as standard, subsidised by the government, here you have to be referred by your GP if, or search for a private one. The difference this would make to recovery, and incidences of pelvic floor disorders such as incontinence and prolapse, is immense.

Diet: warming ginger, good; windy onion, bad.

The keeping warm theme continues here, as in many countries (including China, India and Malaysia) some foods, such as ginger, are believed to promote better blood circulation and strengthen the joints, while other cooling foods are avoided. Cucumber, cabbage, young coconut and pineapple fall into this catagory, the ‘cooling’ elements thought to cause rheumatism, arthritis and weak joints in a mother.

I’m not at all convinced by this, and would have recommended pineapple myself, as the enzyme bromelain in it is thought to aid digestion! However other advise I came across, such avoiding ‘windy’ foods like as onions and jackfruit, seems pretty wise! And bone broth/ soup is a staple of the postpartum diet in many cultures, which is great for recovery.

nutrition postpartum tradition soup

Not all these practises are followed rigidly; even for the confinement, some mums will end early if they feel they need to. I don’t think I would: the prospect of a month of massage and having my meals cooked is almost enough to make me want another baby!

If you’re struggling with your diastasis recti find out about my postnatal personal training packages here.

References

http://www.hyphenmagazine.com/magazine/issue-23-bittersweet/motherhood-rooted

http://www.babycenter.com.my/a1021145/confinement-practices-an-overview
http://www.babycenter.com.my/a1042118/indian-confinement-practices#ixzz3ZlkB5GUy

http://www.babycenter.com/0_postpartum-sweating_11720.bc

 

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What Do Ab Curls REALLY Do To Your Postnatal Tummy?

Should postnatal mums do ab curls?

I’ve talked a lot on social media about crunches and sit-ups being a no-no when you’re postnatal, but a video I shared on my Facebook page recently seemed to really hit the mark. Aside from the comments and shares, I had quite a few mums tell me how clear it made things for them.

So I thought it was about time I wrote a blog on this. Unfortunately there’s a lot of bad advice out there when it comes to postnatal exercise, and many new mums do crunches to try and flatten their tummies, so we need to keep spreading the word that IT DOESN’T WORK!

Before I carry on, here’s the video:

 

Sit-ups, or any variation of this movement that works the six pack muscle, can cause more harm than good.

So, if you’ve recently had a baby and you’re doing sit-ups, STOP them immediately!

During pregnancy the first thing your six-pack muscle (Rectus Abdominis) does is lengthen, vertically. Then, as your pregnancy develops, and your baby grows and your bump gets bigger, this muscle starts to separate around your belly button.  This is referred to as Diastasis Recti. The abdominals can take time to re-align after your baby has been born, so for several weeks and indeed months (or for some, years) after birth, your six-pack muscle remains in a lengthened, separated state.

The first thing we need to do regarding this area is actually focus on connecting to your pelvic floor which is a bit like a sling of muscles supporting you from underneath, and the deep abdominal muscles which lie under your six-pack muscle.  This deep muscle is known as the Transversus Abdominis (TVA).

Strengthening the abdominals after birth, and specifically the TVA and pelvic floor, is a bit like building a house.

If your house has a solid framework and foundations, it will always be strong.  If you work on strengthening the deepest muscles first, then focus on the next layer, then the next layer after that, then your abdominals will re-align to their original structure.

What do crunches do?  They strengthen and work the six-pack muscle.  During pregnancy, we know that this muscle has lengthened and separated.  If you don’t have a solid foundation underneath this six-pack muscle before you work it (I’m talking about your core and pelvic floor here), then by doing crunches, you’re actually going to make your separation worse.  In other words, any separation you had after birth, will now be wider, because you’re forcing the muscle to strengthen, when it’s still in a weakened, separated state.  The amount of abdominal pressure placed on the six-pack muscle when performing a sit-up, forces it to separate further apart. As shown in my video.

And here’s what the pressure can do to your pelvic floor:

 

I follow a system with postnatal clients which involves locating the TVA first.  We connect to and strengthen that, along with lots of focus on the pelvic floor.  Once function in these muscle groups has been gained, then strength work can be done.

So, I hear you ask: “Why do people do sit-ups?”.  Well, in most cases, people do sit-ups in the hope that they will get themselves a toned, flat stomach and a noticeable six-pack.  I’m here to tell you that doing sit-ups AREN’T going to help you (as a postnatal woman), or anyone you know, male or female, get a six-pack.  Your body needs to be extremely lean to do this, which has nothing to do with sit-ups! (See this blog for my thoughts on having visible abs as a fitness goal.)

As a final point: I don’t even use sit-ups for clients who don’t have diastasis recti. As explained on athletic coach Eric Cressey’s website here:

“World-renowned low-back researcher Dr. Stuart McGill says that we have a finite number of flexion/extension cycles in our back until injury is caused. That number is different for every person, but the bottom line is that by performing exercises like crunches and sit-ups, you’re increasing your risk for injury with every rep!”

Plus, they’re promoting a rounded posture, which is the very one I’m usually trying to get clients out of, after too much time sat at a desk!

I do sometimes use crunches, but never in the early postnatal phase, and doing a crunch where you are engaging your transverse abdominis is very different to an uncontrolled crunch. So I recommend having a professional (physio, trainer) teach you how to do one properly, and also assess whether you need to do them.

Please share this blog and forward it to anyone you think might find it useful, as unfortunately I still see a lot of ab dominant work recommended for postnatal women- this myth needs busting!

For help with your postnatal fitness click here to find out more about my next Restore My Core course, or get my 10 Tips for getting back in shape here. You can also read what core exercises ARE safe and effective when you’re postnatal here.

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Why we need to stop saying this to mums.

“You don’t look like you’ve had a baby!”

It’s a ubiquitous comment, meant in kindness to reassure a new mum she looks great. There’s no malice there, and I’ve said it myself in the past.

It begs the question though: what does someone who’s had a baby look like exactly? This is meant as a compliment, but it acheives this with the implication that looking like you HAVE had a baby is a negative thing.

What’s so bad about looking like you’ve created life? I suppose ‘you don’t look like you’ve had a baby’ could be referring to looking radient despite sleep deprivation. It could be a lack of stretch marks (although again, what’s wrong with stretch marks?). But I think we all know it’s really about size: well done, you’re small again.

Telling someone they’re small is still a compliment, and I’m not sure how I feel about this. Naomi Wolf’s words spring to mind for a start:

postnatal baby weight

“You don’t look like you’ve had a baby!”

Something else about this comment nags at me though- it only works as a compliment if you’re comparing yourself to other women. Which we do. We’re in this monster of a competition that none of us signed up for, one that reaches its tendrils into every aspect of our lives.

Women and girls are often made out to be bitchy, as if it’s just one of our characteristics, but this isn’t inherent to our nature; society continually pits us against one another, from using each other’s insecurities to feel better about ourselves, to failing to give each other the support we deserve in the workplace, having been led to believe there’s not enough space at the top for us all.

“You don’t look like you’ve had a baby!”

Thing is, and what I didn’t expect, isn’t how having children affected how I look. It’s how it has affected how I feel.

I feel stronger, more confident. I feel more concerned with how my body feels than how it looks. I feel more concerned with the person than the vessel. We’ve gone through labour, known love like never before, sleepless nights and exhausted days, and still found the energy and patience to answer the endless questions about who is stronger, Hulk or a T-Rex?” (Well, most of the time anyway. And it’s definitely Hulk).

Recently this amazing post on Facebook came up on my newsfeed.

“No one is comfortable in their own skin 100% of the time. Constantly labelling people and piling expectations associated with these labels on them is harmful to everyone…including those doing the labelling.

What we should be worrying about is if people are ok, not what they look like.”

And she’s right. There’s nothing wrong with complimenting a mum (or anyone) and making them feel good, but I’d like to do it without pushing a standard of what society considers ‘good’ on them. Without making it sound like showing signs of being a mother is a bad thing, and without reinforcing the idea that how we look is what’s important when you’ve just given birth. Without putting smallness before health.

From an early age this focus on appearance is ingrained into us, and then we unconciously perpetuate the problem. We’re so used to our bodies being subjected to an ongoing stream of public scrutiny and commentary, from how we look to how we use them (think breastfeeding in public), that it barely even registers anymore.

What if we stop focusing on how we look and start focusing on how we feel? We are not our bellies (or any other body part), and whilst I know to many of us it really does matter what we look like after childbirth, do we want our children thinking women should to look a certain way (usually for the male gaze), regardless of whether it’s healthy?

Remember that what matters, what people see when you walk in to the room, is not a woman whom they love because she looks like she hasn’t had a baby, or whom they judge because she does, but a wonderful person whose smile lights up the room, or whose laugh is infectious, or whose shoulder is always there to lean on, or whatever amazing qualities make you, you.

Imagine a society that focused on what women’s bodies are capable of, rather than what part needs ‘fixing’, or what we could achieve if we got our brains focused on other things, and our confidence up as a result. I know it seems a small thing, but perhaps thinking about how our daily dialogue influences this is a good place to start. First and foremost asking how someone feels, and really listening to the answer.

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Do You Have Diastasis Recti?

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Maybe my first question should be have you heard of it? Because unfortunately many mums haven’t. But you know that poochy tummy some women are left with after having a baby? This can be the cause.

And those who have heard of diastasis tend to focus on closing the gap thinking then all will be well, but there’s a bit more to it than that, so read on to learn more…

What is Diastasis Rectus Abdominis?

The six-pack muscle (rectus abdominis) runs from your breast bone to your pubic bone and is joined together with a strong fibrous sheath called the linea alba.  In some pregnancies, the linea alba becomes a little darker in colour and is visible on your stomach. This is called linea negra which simply means “dark line”.

You may have heard people talk about your abdominal muscles “splitting”.  Your muscles don’t “split” because they’re already in a separated state and held together by the linea alba.  A split muscle is like a torn muscle, so if you’ve ever torn your hamstring, for example, you’ll know what this pain is like!  What happens to the abdominal muscles during pregnancy is completely painless, you aren’t aware of it, and I like to refer to it simply as abdominal “separation”.

The rectus abdominis stretches vertically (up and down your stomach) to accommodate your growing baby, and when it can’t stretch any further up and down it starts to separate horizontally (from left to right).

diastasis recti

I guess it’s a little bit like the linea alba is heavy duty cling film stretching apart. And when you’re growing a baby in there, it will stretch apart! When this happens, it’s called Diastasis Rectus Abdominis. It’s not clear how many women get this in pregnancy, as there isn’t a huge amount of reseach to go on. The latest research suggests that 100% of women develop it, but as Physical Therapist Julie Wiebe explains here, there are flaws in this study. Another one found that 66% of women had diastasis in the third trimester, and 53% continued to have it immedietely postpartum (read more here).

It should heal on its own by 8 weeks post partum, (Coldron et al 2008) but if it doesn’t don’t worry, this is far from uncommon! It just means you need to work out why it isn’t healing, and do a few restorative exercises to help.

If you don’t and your DRA remains, your body will be forced to rely on other muscles to stabilize the pelvis, which can lead to:

– Back pain

– Pelvic pain

– Incontinence

– Pelvic organ prolapse

– A tummy pooch that never goes away

It’s not just about closing the gap

In fact you can have a diastasis and still be functional. I have about a finger’s gap there still! You also need to consider the tension of the midline: there is a big difference between having a firm and functional gap, and a gap that is soft with lots of give.

You need to consider WHY the gap is there. Yes, you grew a baby (again well done for that! I never fail to be amazed by how awesome it is that we can do that!)

But it should heal in the first few months after giving birth. If it doesn’t, this is down to too much pressure in the abdomen which then pushes out on your tummy or down on your pelvic floor. This happens when your core isn’t functioning as it should, so it isn’t managing to control the pressure.

What to avoid

Any exercise that puts repeated forward pressure on your abdomen could very well be making your diastasis worse.

This means avoiding many common exercises such as crunches, sit-ups, and conventional planks. I discuss this in more detail in this blog.

Diastasis can also be worsened by poor posture and an imbalance in the muscles of the core.

So what do you need to do?

It’s about connecting with your core to recruit the right muscles, and this starts with how you breath. Which sounds too simple but it’s SOOO important, and where I start with all my clients. You can read more about this here.

And you can’t look at your core in isolation. Your alignment, nutrition and stress all affect your diastasis recti. And you have to do the exercises RIGHT (we look at all of this in my Restore My Core programme).

It sounds odd, but one of the hardest things for me is getting clients to back off: the exercises are subtle, and no way as hard as what you are probably used to doing. I struggled to get my head round it. I spent years working in gyms taking abs classes and pushing through that burn. But contracting the deep transversus abdominis muscle is subtle, and until you have connected and it is happening naturally you risk just engaging the abs and obliques and having them take over. Then they pull on the midline and stop your diastasis from healing. This blog has some diastasis safe exercises to get you started.

To learn how to test for diastasis recti sign up to my free Restore My Core mini course.

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Phenomenal Woman: In Celebration of the Post Natal Body

 Earlier in the year the fitness and lifestyle coach Jessie Mundell shared this meme:
e56a76_5900625ffe5c44ddb88869045d1a7432

And as the anniversary of the passing of Maya Angelou approaches, I find my mind wondering back to it as I read one of my favourite of her poems.

We are so quick to celebrate the pregnant body in all its glory, but what about the post natal body? If anything our society is quick to remind us that we should feel shame at this new and unfamiliar shape, hiding behind a blanket, shrinking into ourselves as we perform the natural and beautiful act of breastfeeding our baby.

And all the diet and exercise tips are to banish that unsightly ‘mummy tummy’, or creams to get rid of those stretch marks.

If you want to change, that’s fine. In fact it’s normal: obviously we all want to get back in shape. But that doesn’t mean you need to look (or even not look) down at yourself with horror at the stretched skin and the extra lumps and bumps. Because every contour, every line, is a mark that shows you’ve created life.

This body is the one that has just endured hours of pain, even complications, and withstood more than the old you ever did. It has pushed through every challenge thrown at it. Celebrate that power, because for many who convince themselves ‘when I reach this weight/ size I’ll be happy’, the goalposts then shift to a new target.

Sure, you want to lose the extra weight and tone the belly. But enjoy the journey and celebrate every inch of your body and what it can do. Because if you hate yourself now losing weight alone is unlikely to be enough to make you love yourself. Start from a place of self-love and gratitude for what your body can do.

And stop worrying about what other women look like. Surround yourself with positive images: is your newsfeed filled with unrealistic pictures of fitness models with bodies that most of us will never achieve? Unfollow that page. I don’t find it motivational, and I doubt you do either. I don’t want to be thinking about my appearance all day, and all these pictures do is reinforce the idea that women are for public consumption, broken down into mere physical attributes to be analysed, rather than complex multifaceted personalities.

Besides, most  women look don’t look like that- head over to look at the Real Girl Belly Project for some more realisic photos.

It isn’t all about appearance.

Easy to say, harder to believe, and even harder to carry yourself with confidence in that belief. But Maya Angelou did: “Pretty women wonder where my secret lies. I’m not cute or built to suit a fashion model’s size.”

Be the person you want your baby to see, confident, embracing life, not holding back, waiting until you look right, one day. Let your baby see the joy in your feet and the sun of your smile; make sure your “head’s not bowed”.

I’ll leave you with the poem in all its glory.

Phenomenal Woman

Pretty women wonder where my secret lies.

I’m not cute or built to suit a fashion model’s size

But when I start to tell them,

They think I’m telling lies.

I say,

It’s in the reach of my arms,

The span of my hips,

The stride of my step,

The curl of my lips.

I’m a woman

Phenomenally.

Phenomenal woman,

That’s me.

 

I walk into a room

Just as cool as you please,

And to a man,

The fellows stand or

Fall down on their knees.

Then they swarm around me,

A hive of honey bees.

I say,

It’s the fire in my eyes,

And the flash of my teeth,

The swing in my waist,

And the joy in my feet.

I’m a woman

Phenomenally.

 

Phenomenal woman,

That’s me.

 

Men themselves have wondered

What they see in me.

They try so much

But they can’t touch

My inner mystery.

When I try to show them,

They say they still can’t see.

I say,

It’s in the arch of my back,

The sun of my smile,

The ride of my breasts,

The grace of my style.

I’m a woman

Phenomenally.

Phenomenal woman,

That’s me.

 

Now you understand

Just why my head’s not bowed.

I don’t shout or jump about

Or have to talk real loud.

When you see me passing,

It ought to make you proud.

I say,

It’s in the click of my heels,

The bend of my hair,

the palm of my hand,

The need for my care.

’Cause I’m a woman

Phenomenally.

Phenomenal woman,

That’s me.

By Maya Angelou

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