Caoimhe McNamara is a Women’s Health Physio who plays oodles of Sport, so her advice is priceless! 3 June ’19
‘When can I get back to tennis?
Can i get back to touch rugby this month?
Am I OK to run this week?’
These are very common questions that we get asked by new mums. With the benefits of sport and activity being so well documented – positive for physical health, mental health and an important social contact point for many people – it is always a great goal for us, as Physios, to help our patients to achieve. After having a baby, these goals are still within reach, however it is important to be aware that your body has been on a challenging journey and extra steps may be needed to return back to sport safely.
Everybody has a different goal, everybody has a different pregnancy and everybody has a different birth experience.
1/ Consider a pelvic floor muscle assessment by a specialist Women’s Health Physiotherapist.
Our pelvic floor muscles are a layer of muscles that support the pelvic organs and span the bottom of the pelvis. They act as a type of muscular trampoline from the tailbone (coccyx) at the back to the pubic bone(at the front), and from one sit bone to the other (side to side). After having a baby the pelvic floor is weak and injured in most women.
When performing high impact activities (ie running, jumping, skipping) the physical force of landing passes through the lower limb and pelvic floor as the foot strikes the ground. This ground reaction force is felt as the abdominal contents bear down on the pelvic floor, making it difficult for a weak pelvic floor and bladder not to let go. This added strain on the abdominal muscles and pelvic floor can be too much for the weak muscles to control and you can become symptomatic (ie leaking of urine, pelvic organ prolapse, back pain).
It is important to be able to perform a correct pelvic floor muscle contraction – regardless of how you have delivered your baby, and especially if you did not train these muscles before giving birth. A Women’s Health Physiotherapist will assess the pelvic floor strength and control, teach you how to perform a correct pelvic floor muscle contraction, and set a personalised strengthening programme for you.
2/ Core strength assessment.
During pregnancy, the abdominal muscles are stretched as the baby grows. This can sometimes lead to a stretching of the outer abdominal muscles – called Diastasis Rectus Abdominis. While this is common ( ⅔ of pregnant women will experience this), our core strength depends on good control and strength of these muscles around our abdomen and also our lower back and hips.
It is recommended that an assessment of these muscles – including the abdominal muscles – is completed by a Women’s Health Physio, prior to returning to higher impact activities. This is quite often done together with a Pelvic Floor Assessment at a 6 week post natal assessment.
3/ Functional assessment.
Returning to sport after a period of time off should always be preceded by a return to sport assessment. If you had taken six months off playing soccer due to a knee injury, you would get your strength, movement and control assessed by a Physiotherapist before returning to the pitch to reduce risk of further injury. The very same is valid for returning to sport in the postnatal period.
Quite often it may be close to a year between the pregnancy and postnatal period, before you are feeling able to returning to your sport – and so identifying areas that may put you at a risk of injury is key! Functional assessments look at your control and strength in various movements to ensure that your key muscle groups are prepared and strong enough to return to your particular sport/activity.
4/ Gradual load progression.
Return to running ( and so high impact activities/sports) is not advisable in the first 3 month post natal period, and beyond this if there are any symptoms of pelvic floor dysfunction ( as mentioned above).
- We recommend that a low impact exercise routine is followed in the post natal period, with a return to impact exercises from 3- 6 months postnatally at the earliest. An example of a gradual load progression would involve starting initially with walking for cardiovascular exercise, then introduction of functional activities (ie squats, lunges).
- The next progression would involve low impact exercises such as static cycling bike, swimming ( if wound healing is complete), power walking, and building on your functional strength programme. Remember, you need to be strong to run – and so consider building up your lower limb, core strength and general cardiovascular strength in alternative ways, until your body is ready to return to high impact activities.
- Once you have gotten the green flag to get back to higher impact activities, consider the ‘couch to 5km’ app for a planned guided return to running and building up your running tolerance.
5/ Treat yourself to some new activewear!
Having addressed all the above steps, consider a well deserved mini shopping spree. Comfort is everything when exercising, so with that in mind, start with looking after your feet.
- Often during pregnancy your feet can change shape – widening a little – or you may still be holding a little extra water. Check that your trainers/runners still fit comfortably and that they aren’t pinching anywhere.
- Does your sports bra still fit, and is it supportive enough? If you are still breastfeeding, or have recently stopped, a supportive sports bra that fits correctly is important for any impact sports. It helps with reducing upper back and neck pain, and also supporting your breasts to be comfortable with higher impact activities.
Having some help to get you back to doing what you enjoy safely is important, and having some guidance tailored to you and your sport is essential.
Physiotherapists with specialist training in Women’s Health are well placed to give you that individual guidance.
