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Postpartum recovery or "The Fourth Trimester", I believe is not a finite period of time. It is an ongoing process. When you finally decide that you are mentally and physically ready to put in the work then please do! If that means that you decide that you are ready to begin 6 weeks after giving birth or 15 years, the time frame does not necessarily matter. The care you need will just match what stage your body is at!



Most importantly after birth is the need for rest, especially in the first two weeks. You and your family need to accommodate to the fact that you have a newborn to take care of! This transition is easy for some and more difficulty for others. Having a great support system can be very helpful! This can include family, friends, and/or doula services. Having support in place can be best for assisting with looking for the signs of postpartum depression. It can affect 20% of Mamas.


In those coming weeks just after birth, make sure you get up and move! Even if this is just doing a few things around the house. If you are breast feeding, you may feel like you spend most of your day sitting. This can decreases those already decreased estrogen levels! Make sure to get up and move as much as you physically and mentally feel able. Walking outside and getting some fresh air can be restorative.


Other ways you can begin moving your body is through light exercise. This can include but isn’t limited to breathing, rib cage mobility exercises, and light resistance training. Now that we don’t have this extra load on the front of us, we may feel stiff through our spine, rib cage, and hips. It is time to get things moving again! It is typically recommended to wait until week 4-8 weeks to being resistance training. Also wait until after 12 weeks to push weight to anything above 80% of your one rep maximum.




A common question I always get is when can I run? I highly recommend not running for at least 12 weeks. Your body is still healing! If you have any of the following symptoms please DO NOT run!

  • Urinary or fecal incontinence

  • Pressure/bulging/dragging in Vaginal wall

  • Ongoing or onset of Vaginal bleeding with onset of initiation of low impact exercise

  • Pelvic

Here are my requirements to clear someone to get back to running postpartum.


SL Balance 10s

  • SL Squat 10-20 reps ea side

  • SL Sit to stand x 15-20 ea

  • SL Calf Raises x20 ea

  • Jog in spot for 1 min

  • Forward Bounds x10 ea

  • SL Hops x10 ea

  • Abdominal Control w/ SLR 30 deg

It is so important to begin addressing plyometric activities in your recovery in order to get back to running which is a plyometric activity! This is why checking for the ability to jog in place, perform bounding, and single leg hops are so important!


Now let’s circle back around to the different consideration


s for c-section versus vaginal deliveries! I always recommend a Women’s Health Assessment for both situations. First scar tissue should always be addressed whether this is from vaginal tearing or cesarian! Check out my posts below on cesarian considerations!



Vaginal deliveries can put a lot of stretch to those pelvic floor muscles. Whether there was tearing or not, we want to make sure these tissues are working appropriately! The other big issue that should be assessed and addressed is diastasis recti! I will refer you back to my previous social media series and blog post on addressing and discussing this topic!


Hopefully this gives you an overview of what to consider in your own postpartum journey! I hope that you get all of the services and support that you need to help you along the way.


If you are looking for additional information, here is an Instagram live that I did @fitnessxaspen on Postpartum recovery!


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Updated: Jun 2, 2023





Pregnancy is a time when our bodies are going through many changes. We have to listen to our bodies during this time. Most people don’t realize how physical therapy can assist with keeping your body feel well through these changes. Physical Therapy can assist with sacroiliac joint pain (SI joint pain), pubic symphysis dysfunction, low back pain, round ligament pain, diastasis recti, and decreased rib cage mobility. Learning how to take care and manage these issues can be very helpful.

Exercise can be a great way to support your babies growth and support your own body in process. Despite misconceptions, it is completely safe to exercise during pregnancy as well. It can help prevent gestational diabetes and manage weight gain. Exercise produces greater red cell volume which leads to increase in oxygen to the mom and fetus. My advice as a Physical Therapist would be not to embark on a new and very unfamiliar form of exercise, but that it is favorable to begin a new exercise routine such as walking, weight lifting, barre, or yoga. Just to suggest a few. Beginning more extreme forms of exercising during pregnancy may not be advisable such as wake boarding or contact sports etc. How do you know if your exercise is too intense? Well, wearable heart rate monitor can be helpful but also simply “The Talk Test”. Yep! You heard me right! Can you speak or talk to someone while performing the exercise? If you can hold a conversation or sing a short song like happy birthday, then you are probably exercising right on track at a moderate level! Some mothers may not be able to lay on their back for exercise or lay on their back in general towards the end of pregnancy. The baby weight can compress inferior vena cava and lead to decrease fetal blood supply. If you are able to tolerate doing exercises laying down, I would consider laying on your side in between sets to minimize the decrease in blood flow. If you can’t tolerate fully laying down on your back that a reclined position is also a great option. Physical Therapist can also help adjust exercises as necessary to accommodate changing bodies with new aches, pains, or restrictions.

Keep in mind that some cannot tolerate exercise which is okay too. Extreme exercise is not recommended especially is hot temperatures since it can increase the fetus temperature too greatly. In some, it can also lead to early contractions and in this case may not be recommended by your doctor. In the very least, keep moving, performing breathing exercises, and stretching as much as tolerated during this time.

Informing soon to be mothers of the birthing process can be be empowering. It can be especially helpful when trying to understand what needs to happen in order to assist with a smoother delivery. Being able to practice keeping your pelvic floor relaxed during birth may decrease the likelihood of tearing your pelvic floor. Although, truthfully the evidenced based research on this topic is limited. What I can tell you is that it is not harmful to begin tuning into this area of your body in order to prepare! Check out my posts below on some positions to practice relaxing your pelvic floor! Finding a comfortable position for your body where you don’t feel any aches and pains and are able to connect with pelvic floor is optimal for labor and delivery. Sometimes laying on one side may be more comfortable than the other. Try the different positions and see for yourself. Perinatal care can be just as important as the aftercare in order to support Moms to be! Physical Therapy while pregnant can also manage painful conditions such round ligament pain, pubic symphysis pain, sacroiliac joint pain, low back pain, sciatica etc. Incontinence, constipation, pelvic floor heaviness, diastasis recti may also begin to be a problem while pregnant as well. Some of these issues can also be addressed in Physical Therapy while pregnant! Why not work on things prior to the postpartum period! It may make you more comfortable during your pregnancy and make you recovery postpartum quicker.


Investing in services such as chiropractic care, prenatal massage, support groups, and physical therapy can give guidance, comfort, confidence during this unpredictable time!

Here are the links to some of the tips on Pregnancy and Delivery I have discussed through social media.

















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Pelvic Organ Prolapse is condition in which the pelvic organ are descending or have descended down into the vaginal wall or the rectum. It is typically abbreviated as POPS. This condition is typically diagnosed and graded for severity by your Obstetrician or Midwife. Pelvic floor therapists can screen for these issues as well. Let’s go into more detail about some of the different types of vaginal prolapse.


Prolapse is typically graded from 1-4. One being the least severe and grade four being the worst. Cystocele is when the bladder drops down into the vaginal wall. Rectocele is when the rectum descends down and forward in to the posterior vaginal canal. Uterine prolapse is when the uterus and cervix descends. Less commonly seen is enterocele, when the small intestine descends into the vaginal wall. Additionally there is vaginal vault prolapse is when the vaginal canal folds in on itself.


Some forms of prolapse are manageable with pelvic floor physical therapy using pressure management strategies. An additional strategy that can be helpful in some cases includes the use a pessary fitted by your obstetrician. Grade three or four prolapse is in some cases are a surgical procedure. Strengthening and mobility of the legs, hips, trunk, and coordination of these structures can assist with mitigation of some symptoms as well.


Prolapse can happen with or without previous birthing history. Commonly prolapse symptoms can begin during pregnancy which is why it is so important to begin addressing symptoms as early as possible. Symptoms can included but are not limited to urinary incontinence, decreased ability to hold in gas or stool, in complete emptying of stool or urine, and pelvic floor heaviness. In severe cases, you may feel sometimes coming out of vaginal wall.







Managing how you are pressurizing the system can assist with symptom modification. Re-training these things does take work and commitment re-learn how you are going about some of your daily tasks and exercises. If you are having any of the symptoms or struggling with anything discussed in the videos, please don't hesitate to reach out to your local pelvic floor therapist to get assessed and get some help!


References:


Carvalhais, A., Natal, J.R. , & Bo, K. (2017) Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls. Br J Sports Med, bjsports-2017


de Mattos Lourenco, T.R., Matsuoka, P.K., Baracat, E. C., & Hadad, J.M. (2018). Urinary Incontience in female atheltes: a systematic review. International urogynecology journal, 1-7


Matthews, et al (1991) “Prevalence, Incidence and Correlates of urianry Incontinence in Healthy, Middle-aged Women” Journal of Urology 146: 1255-1259


McKenzi, S., Watson, T., Thompson, J., & Briffa, K. (2016). Stress urinary incontience is highly prevalent in recreationally active women attending gyms or exercises classes. International urogynecology journal, 27 (8), 1175-1184


Whitehead, W.E. (2017, 07). Symptoms & Causes of Fecal Incontinence. National Institute of DIabetes, Digestive, and Kidney Health. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/symptoms-causes


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