Tuesday, September 13, 2016

Returning to Exercise after Childbirth

Returning to exercise after childbirth

Part 1: Your Changing Body

Just two years after having her son, Jessica Ennis Hill won a silver medal in the Rio Olympics in the heptathlon.

Those of us who have had children can relate to just how hard her comeback must have been and what an amazing achievement it is in such a short space of time.

For many women, making a post-natal comeback to exercise is a daunting prospect, however it can be extremely rewarding, both physically and mentally. It allows quality time to yourself, improving mood and energy levels as well as helping to get rid of pregnancy weight gain.

It also regains muscle strength, mobility, posture and cardiovascular fitness. It’s important to remember however that you cannot just jump straight back into your pre-pregnancy exercise regime and there are a few important things to consider:

It is NORMAL to have a ‘saggy’ looking stretched tummy for the first few months after giving birth, do not expect it to suddenly snap back into shape and do not put extra pressure on yourself by setting unrealistic goals – enjoy being a mum too!

Effects of relaxin on the body

During pregnancy your body produces a hormone called relaxin which causes ligaments to become more elastic, allowing the pelvis to accommodate the growing baby and to help the pelvic floor and abdominal muscles stretch during birth. Although relaxin is no longer produced after birth, the effects of relaxin on the ligaments and joints may persist into the post-natal period.

The exact length of time the effects persist is unknown and appears to vary but is thought to be around four to six months. This may cause joint pain during high impact exercise, especially in the knees, hips and back. Be sure to not over-stretch during this period, especially.

Your oestrogen levels also decrease after childbirth and when breastfeeding. Oestrogen has a protective effect on joints and bones so during times of decreased oestrogen, such as when breastfeeding or during the menopause, women may experience joint pain, especially in the hips and knees when exercising, particularly during high impact sports like running.

These hormonal changes appear to affect some women more than others and do not necessarily mean high impact activities like running should be avoided in the first six months after birth. Make sure you’ve done the appropriate strength work to build up your muscles so they can help support the joints. If you experience any knee or hip pain, consider other lower impact activities.

Abdominal muscles during pregnancy

The rectus abdominis muscles (six-pack) which run in two parallel lines up your, tummy stretch and lengthen during pregnancy. Rectus abdominis separation (or diastase recti) occurs as the two bands of muscle which used to lie parallel stretch away from the midline to make more space for the growing uterus.

This separation is normal in pregnancy, however, in the post-natal period, we want to encourage the ‘gap’ to reduce and the muscles to shorten and strengthen again in order to regain full function of the abdominal muscles and a flat tummy.

Crunches and planks can make the separation worse so AVOID them at least in the initial post-natal period, crunches are definitely NOT required for a flat stomach or good abdominal muscle strength.

Three to four days after birth, your muscles will begin to realign and the wide separation will reduce. In most cases, by eight weeks, the gap has reduced to 2cm or less. Gentle exercises like pelvic tilts and leg slides can begin immediately after birth and will help to reduce the abdominal separation.

The rectus abdominis muscles (‘6 pack’) which run in two parallel lines up your, tummy stretch and lengthen during pregnancy. Rectus abdominis separation (or diastase recti) occurs as the two bands of muscle which used to lie parallel stretch away form the midline to make more space for the growing uterus.

Breastfeeding & Exercise

If you are breastfeeding then ensure you have an adequately supportive and well-fitting sports bra. For comfort, feed from both sides before exercise, especially if you are doing vigorous or high impact exercise.

Moderate exercise does NOT affect milk production, nutrient composition or baby weight gain. Ensure you are adequately hydrated by drinking plenty of water and ensure your diet is balanced and contains adequate protein.

Oats have anecdotally been thought to increase milk supply although there is no scientific evidence to support this.

A woman who is breastfeeding exclusively requires about 200-300 extra calories per day. Although there are no known harmful effects of lactic acid in milk, it may be present in breast milk when mums are exercising to the point of exhaustion.

If your baby seems reluctant to feed after a particularly high-intensity session then this may be something to consider, although showering to remove salty tasting sweat may also help.

Rest & Sleep

Rest is important too. Try and sleep or rest when the baby does. Although exercise can help improve mood and boost energy levels, don’t over do it. Make sure you have a minimum of two rest days a week to let your body recover.

If you feel exhausted or have been up all night then do not feel guilty about allowing yourself a rest or limiting your exercise to stretches or yoga.

I do hope you find these guidelines helpful. I’ll be writing a follow-up article in a few weeks, describing the step-by-step process for safely returning to full exercise after childbirth :)

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Scottsdale Sports Medicine

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