You’ve had a c-section. You’re tired, you’re healing, and somewhere between the night feeds and the nappy changes, a question has started nagging at you: when can I actually exercise again?

It’s a question most women get a vague answer to. ‘Wait until your six-week check.’ ‘Take it easy.’ ‘Listen to your body.’ None of that tells you much when you don’t know what your body is supposed to be telling you.

The research has moved on. In March 2025, the most comprehensive postpartum physical activity guidelines ever produced were published in the British Journal of Sports Medicine. Led by Dr Margie Davenport and a team of international researchers, the 2025 Canadian Guideline for Physical Activity, Sedentary Behaviour and Sleep throughout the First Year Postpartum analysed 574 studies and reached a clear conclusion: movement after birth is not just safe. For most women, it is protective.

It is also worth saying: not every woman needs this conservative a timeline. Your starting point depends on your birth experience, your exercise history, your goals, and how your body is responding. Some women are ready to progress quickly. Others need more time. That is not failure in either direction. It is why assessment matters, and why there is no universal answer. Hydration, sleep, nutrition, and stress all influence recovery too, often more than women are told. These are not optional extras. They are part of the picture.

Here is what that means for you, week by week, after your c-section.

Does a c-section affect your pelvic floor?

A c-section is major abdominal surgery. The incision passes through seven layers of tissue: skin, fat, fascia, the rectus sheath, two layers of peritoneum, and the uterus. Each of those layers heals on its own timeline.

Abdominal muscles typically regain around 50% of their original tensile strength by six weeks, reaching 73 to 93% somewhere between six and seven months (Ceydeli et al., 2005). That matters for how you load your body in the early weeks.

At the same time, pregnancy itself changes pelvic floor function regardless of how you give birth. Hormonal changes, the weight of a growing baby, and altered movement patterns during pregnancy all affect the pelvic floor. A c-section does not bypass that. Many women are surprised to find bladder, bowel, or pelvic floor symptoms after a caesarean birth, symptoms they assumed were only possible after vaginal delivery.

Recovery from a c-section therefore involves two distinct processes: healing from surgery and recovering from pregnancy. Both need attention.

Read more about pelvic floor changes after a c-section in our blog on c-section recovery, bladder, and pelvic floor health.

What the new 2025 guidelines actually say

For years, the standard advice was to wait for six-week medical clearance before exercising. The 2025 Canadian Guideline does not abandon that framework, but it changes how we use it.

The guidelines recommend an individualised, gradual, symptom-based approach to returning to physical activity, not a fixed timeline. The guidelines specifically encourage:

• Early mobilisation with light-intensity activity from as soon as you are able to move safely after surgery
• Progression to moderate to vigorous physical activity once the surgical incision has healed and vaginal bleeding does not increase with movement
• Building towards 120 minutes of moderate to vigorous physical activity per week, spread over 4 or more days, incorporating both aerobic and resistance activity
• Daily pelvic floor muscle training throughout the first year postpartum
• Limiting sedentary time to 8 hours or less per day

The reason this matter is the evidence behind it. Physical activity in the first year postpartum was associated with a 45% reduction in the risk of postpartum depression, a 37% reduction in the risk of urinary incontinence, and a 28% reduction in the risk of type 2 diabetes, with no increase in injury risk, and no effect on breast milk quality or quantity (Davenport et al., 2025).

Movement is not something to be cautious about. It is something to be guided about.

Returning to exercise after your c-section: a week-by-week guide

Every woman heals differently. This guide covers uncomplicated c-section recovery. If you had complications, or you experience pain, prolapse symptoms, or increased bleeding at any stage, stop and speak with your physiotherapist or GP before progressing.

Weeks 0 to 2: rest, breathe, and move gently

The first two weeks are about wound healing, pain management, and preventing blood clots. Short, slow walks are encouraged from day one. Movement helps circulation and reduces your risk of deep vein thrombosis. Beyond that, keep it gentle.

Avoid lifting anything heavier than your baby (including strollers and car seats!), using stairs more than necessary, and any exercise that requires abdominal bracing or breath-holding.

On driving: emergency braking requires full abdominal contraction. Most surgeons advise waiting at least 4 to 6 weeks, and some insurance policies require medical clearance. Check with your surgeon.

Just keep an eye for follwing symptoms in the early days and seek medical attention:

• Pain when urinating
• Pain relief is not working
• Sore abdomen, upset stomach
• Red, swollen, or painful wound
• Discharge in wound
• High fever
• Vaginal bleeding is still heavy or foul-smelling
• Feeling faint or racing heart
• Chest pain or shortness of breath
• Headache with nausea or vomiting
• Pain, redness, or swelling in the calf muscles of one leg

Weeks 3 to 6: build the foundations

This phase is about laying the groundwork, not getting fit. Your scar is still forming. Your energy may be unpredictable. Focus on reconnecting with your body before you load it.

Walks can gradually lengthen to 20 to 30 minutes by the end of this phase if comfortable. Pelvic floor work becomes more structured. You can begin gentle transverse abdominis activation (the deep core muscle that wraps around your trunk like a corset).

Research by Keshwani et al. (2019) found that abdominal exercise started too early, without proper guidance, can worsen diastasis recti and pelvic floor symptoms in some women. This is not a reason to avoid movement. It is a reason to start with the right movements.

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Weeks 6 to 12: progress with purpose

Medical clearance at your 6-week check is a starting point, not a green light for everything. Most ObsGyne appointments at this stage do not include a musculoskeletal or pelvic floor assessment. Clearance to resume ‘normal activity’ is not the same as clearance to run, lift weights, or return to a group fitness class.

A 2024 international Delphi consensus published in the British Journal of Sports Medicine (Christopher et al., 2024) found that after a minimum 3-week rest period, individualised return to running can be considered, with screening for physical readiness, pelvic floor capacity, and prior training history recommended before any return to running.

Before returning to running, you should be able to:

• Walk briskly for 30 minutes without symptoms
• Perform 10 single-leg calf raises without leaking or heaviness
• Perform 10 single-leg squats with good control on each side
• Complete your pelvic floor exercises with correct technique and without difficulty

If any of these are challenging, your body is telling you it is not yet ready for impact loading. That is not failure. It is data. Work with a women’s health physiotherapist to address the gaps before progressing.

If you are looking for a supported environment to rebuild strength, our physio-led group classes at Embrace Physiotherapy may be a good fit. Classes are small, capped at 4 women, and open to clients who have completed a postnatal assessment with us. Your physiotherapist will let you know when you are ready.

Week 12 and beyond: return to sport

Full return to running, HIIT, heavy lifting, and sport is realistic from 3 to 6 months for most women, but only when the pelvic floor and abdominal wall can manage the load. There is no universal timeline, and anyone who tells you otherwise is not working from evidence.

The 2025 Canadian Guideline is explicit: progression should be individualised, gradual, and symptom-based. That principle applies whether you are returning to recreational walking or competitive sport.

Pelvic floor dysfunction after a c-section: what you need to know

Here is something that surprises many women: a planned c-section reduces some of the mechanical trauma associated with vaginal delivery, but it does not protect your pelvic floor from the effects of pregnancy.

Hormonal changes during pregnancy affect connective tissue laxity throughout the pelvis. The weight and position of your baby during pregnancy places sustained load on your pelvic floor. These changes happen regardless of how your baby is born.

Research by Tennfjord et al. (2021) followed 300 women and found that starting general exercise within the first 6 weeks postpartum did not negatively affect pelvic floor muscle function or the prevalence of pelvic floor dysfunction at 12 months. Early movement is not harmful. But the absence of harm from general exercise does not mean the pelvic floor needs no rehabilitation. You can exercise while you rehabilitate it.

Daily pelvic floor muscle training is recommended throughout the first year postpartum (Davenport et al., 2025). If you are unsure whether you are doing it correctly, or if you have any symptoms of leaking, urgency, or pelvic heaviness, a pelvic floor assessment will tell you what your body actually needs, not what a generic exercise guide assumes.

Signs to stop and seek support

These are not signs of weakness. They are your body communicating a load it is not yet ready for.

• Leaking urine or stool during or after exercise
• A feeling of heaviness, pressure, or bulging in the pelvis
• Pain at or around your c-section scar
• Abdominal doming or coning with any movement
• Increased vaginal bleeding after activity
• Dizziness, breathlessness, or chest discomfort

Any of these symptoms at any stage of recovery are worth discussing with a women’s health physiotherapist. They are common but not normal, and they are treatable.

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Do you need an abdominal binder after a c-section?

Abdominal binders and compression garments can reduce pain and support healing in the early weeks after c-section. Evidence from systematic reviews suggests they are most beneficial in the first 6 to 8 weeks (Abd-ElGawad et al., 2020).

At Embrace Physiotherapy, we stock Tubigrip, a medical-grade elasticated abdominal support available in a range of sizes, alongside other postnatal recovery options. Your physiotherapist can advise on which option suits your recovery stage.

View our range of postnatal support products here.

When should I see a women’s health physiotherapist after my c-section?

Ideally, before you need to ask this question.

A postnatal physiotherapy assessment gives you a personalised picture of where your recovery is: your scar, your pelvic floor, your core, and your readiness to progress. It means you are not guessing, and you are not relying on generic timelines that may not apply to your body.

The 2025 Canadian Guideline specifically recommends screening for pelvic floor and abdominal wall function, musculoskeletal pain, wound healing, and fear of movement as part of postpartum physical activity support. A postnatal assessment with a women’s health physiotherapist addresses all of these.

We see women from as early as 4 to 6 weeks postpartum, and at any point in the first year and beyond if symptoms arise. You do not need a referral.

For women who are ready to progress beyond their 1:1 assessment, our small group classes offer ongoing support in a physio-led setting. Because every woman has already been assessed before joining, the class is tailored to where the group actually is, not a generic postnatal programme.

Whether you are 6 weeks postpartum or 6 months, it is never too late to get the right support for your c-section recovery.

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This blog was written by Preet Singh, women’s health physiotherapist and founder of Embrace Physiotherapy. It is for informational purposes only and does not constitute personal medical advice. Please seek assessment from a qualified healthcare professional.

References

1. Davenport MH, Ruchat SM, Jaramillo Garcia A, et al. 2025 Canadian guideline for physical activity, sedentary behaviour and sleep throughout the first year post partum. British Journal of Sports Medicine. 2025;59:515–526. doi:10.1136/bjsports-2025-109785
2. Christopher SM, Donnelly G, Brockwell E, et al. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. British Journal of Sports Medicine. 2024;58(6):299–312. doi:10.1136/bjsports-2023-107489
3. Tennfjord MK, Engh ME, Bo K. The influence of early exercise postpartum on pelvic floor muscle function and prevalence of pelvic floor dysfunction 12 months postpartum. Physical Therapy. 2021;100(9):1681–1689. doi:10.1093/ptj/pzaa084
4. Nygaard IE, Wolpern A, Bardsley T, Egger MJ, Shaw JM. Early postpartum physical activity and pelvic floor support and symptoms 1 year postpartum. American Journal of Obstetrics and Gynaecology. 2021;224(2):193.e1–193.e19. doi:10.1016/j.ajog.2020.08.033
5. Keshwani N, Mathur S, McLean L. The impact of exercise therapy and abdominal binding in the management of diastasis recti abdominis in the early post-partum period: a pilot randomised controlled trial. Physiotherapy Theory and Practice. 2019 Oct 25:1–6. doi:10.1080/09593985.2019.1675207
6. Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Current Surgery. 2005;62(2):220–225. doi:10.1016/j.cursur.2004.08.014
7. Abd-ElGawad AM, Youssef AM, Ibrahim ZM. Abdominal binder usage following caesarean delivery: a systematic review and meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine. 2020;33(21):3673–3681
8. Chi C, Brealey S, Nyaga V, et al. Rising caesarean section rates in Singapore. Birth. 2018;45(2):182–189
9. Schaaf S, Schwab R, Gusgen C, et al. Recommendations on postoperative activities after abdominal operations and incisional hernia repair. Frontiers in Surgery. 2021;8:713138. doi:10.3389/fsurg.2021.713138
10. Harpham ME, Nassar N, Leung S, et al. Maternal car driving capacity after birth: a pilot prospective study. Journal of Maternal-Fetal and Neonatal Medicine. 2020;33(8):1385–1392
11. James ML, Donnelly GM, Crone DM, Stiles VH, Evans L, Moore IS. Your guide to return to running following childbirth [patient resource]. 2024. Note: this guide has not yet been formally tested.