Welcome to the long overdue part 3 of the series focusing on your C-section recovery. Here, we will discuss the considerations in returning to exercise post C-section.
Click here to read blog 1- C-section and scar tissue healing
Click here to read blog 2- C-section and pelvic floor muscle recovery
Please do remember that these are general guidelines and it is recommended that you speak to your Women’s Health Physiotherapist for individual advice.
So, you’ve seen the gyne for your 6-week check-up and you’ve been cleared to exercise- Yippy!
But wait, what does that even mean???
Let’s set expectations here…What does exercise look like or mean to you? Is it going back to HIIT or running, or is it walking around the block or going to that postnatal class or is it doing those abdominal exercises that promise to rid you of your postpartum tummy?
Recovering from a C-section isn’t like recovering from any other surgery. You need to care for your newborn (and possibly other children), you are battling sleep deprivation, stress, hormonal fluctuations and the emotional and psychological roller coaster (let me add COVID here too).
And all you can think of is the person that you were…
From a rehab perspective, returning to exercising post C-section is often likened to returning to exercise post ACL repair – we’re thinking graded loading over a 9-12 month period, depending on where you are at and what your goals are.
Exercise guidelines recommend that the return to running or high level exercise should not occur earlier than 3 months (Goon et al 2019).
RESPECT THE 4TH TRIMESTER
Note: That does not mean you can’t do anything for the first 3 months. The first 3 months is about setting the foundation for that gradual return to your chosen goals, from 3 months onwards. And let’s be honest, everyone is different. So whilst some mummies can be running/exercising much sooner, for others, this may not be appropriate even at 3 months. Working with your Women’s Health Physiotherapist can give you a plan to work towards your exercise goals based on your assessment.
When chatting with mummies about exercise, I often talk about exercise that promotes your healing. This is what a postnatal return to exercise journey may look like for some.
WEEKS 1-3: WOUND SUPPORT
- Think about movement and breathing that supports your wound healing
- Diaphragmatic breathing with a soft belly to help ease pain and inflammation
- Start pelvic floor contractions once the catheter is out and it is comfortable to do so
- Perform some gentle pelvic tilts to restore the loss of lumbopelvic motion due to pregnancy
- Supporting your wound during these activities helps to promote confidence and healing, especially when opening bowels, coughing or sneezing or moving in/out of bed
- Do some cardio, like walking, adding 5 minutes per week
WEEKS 3-6: WOUND MOBILISATION
- Scars can get sticky, much like how your spine might feel after all that time spent trying to contort yourself around your baby to feed or co-sleep
- Focus on a range of motion movements and you can start as early as comfortable. Consider movements such as cat-cow, thread the needle, overhead arm stretch or modified cobra poses. (Note: none of these should be painful)
- Start to activate the deep abdominal wall muscles- the transverse abdominis. Think about zipping up your tummy muscles (NOT sucking in), from the pelvic floor up to the breast bone. (TRY: exhaling as if you are blowing candles- do you feel the tension in the tummy?)
- Can consider bodyweight exercise such as bridging, lunges and/or squats, within your comfort
- Continue to walk, building endurance
WEEKS 6-12: CORE CONNECTION
- Definitely check in with your Women’s Health Physiotherapist, if you haven’t already, for your 6-week postnatal assessment
- Focus on activation of the inner core. This is important due to muscle inhibition as a result of the incision and associated swelling. The nerves supplying these muscles take time to fire up optimally again and targeted exercises (that are pelvic floor friendly, of course) can help this along.
- Note at this point abdominal muscles have only regained ~ 50% of original tensile strength by 6 weeks (Ceydeli et al 2005), so sit-ups and crunches may or may not be relevant for some mums (best to have this assessed)
- Consider specific postnatal exercise classes with instructors trained to support postpartum women
- Walking up to 45-60mins. If comfortable, consider reclined or seated cycling or elliptical trainer
WEEK >12: GRADED RETURN TO EXERCISE/RUNNING
- Now might be the right time for some to increase the intensity and add variety to your exercise repertoire
- Give consideration to exercise-specific strengthening/proprioception i.e. if returning to running, build strength in glutes and quads and focus on thoracic rotation and abdominal strength. The Couch to 5k app is a great place to start getting back to running.
- Increase the abdominal challenge. Remember, by 6-7 months, only 73-93% of original tensile strength is regained (Ceydeli et al 2005).
WHEN RESUMING EXERCISE, HERE ARE A FEW THINGS TO KEEP AN EYE ON:
- Signs of pelvic floor dysfunction- changes to your bladder or bowel function (such as leaking, urgency or pain), vaginal pressure or heaviness
- Pain anywhere especially over your scar
- Breathing control- are you able to comfortably breathe through your exercise or are you holding your breath?
- Posture- have you got a posture that supports your muscle function and feels right?
- Doming/tenting of the abdominal wall- is your abdomen forced out during exercise?
These are all signs that perhaps the technique is off, so stop, reset and try again. If that doesn’t help, then perhaps it’s not the right exercise for you at the moment, and reach out to your Women’s Health Physiotherapist for guidance.
A word on diastasis recti
60% of women will have an abnormally widened separation (more than 3 fingers/cm wide and soft end feel) at 6-8 week postnatal. The connective tissue may continue to remodel for up to a year post-birth. If this is you, you may benefit from targeted management from your Women’s Health Physiotherapist. To learn more about diastasis recti you can read my blog here.
A word on strength training
Start with low weights, more reps and gradually shift the balance depending on what you want to achieve (i.e. strength vs muscle bulk).
A side note- when to seek help after a C-section:
If you experience the following, it’s recommended that you reach out to your health care provider.
- Pain on passing urine
- Pain relief is not working
- Abdomen feels sore or tender or you have an upset stomach
- Wound is red, swollen or painful
- Wound has a discharge or you are worried that it’s not healing properly
- High fever
- Vaginal bleeding is still heavy or foul-smelling
- Feel faint or heart is racing
- You have chest pain or are short of breath
- Have a headache with nausea or vomiting
- You have pain, redness or swelling in the calf muscles of one leg
You only get to do postnatal once, so let’s give you the best chance we can under the guidance of a Women’s Health Physiotherapist.
And don’t forget to focus on what you can do, not on what you can’t…
If you feel like you could benefit from specialised guidance and treatment for your C-section recovery or return to exercise, reach out by calling/WhatsApp on 9780 7274 or email.
You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.
Goom, Tom & Donnelly, Grainne & Brockwell, Emma. (2019). Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population.
Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg. 2005 Mar-Apr;62(2):220-5.