According to several studies, exercise has been proven as an effective method of treating and preventing depression. Some studies suggest that physical activity may be as powerful as anti-depressants for treating mild to moderate depression over time. The same is true for women experiencing mild to moderate postpartum depression. It’s important to note that there are different levels of postpartum depression and screening is available through hospitals and doctors’ offices if PPD is suspected. Both the Edinburgh Postnatal depression scale questionnaire and a PAR-Q medical history questionnaire will help give insight to healthcare practitioner and patient on treatment methods.
Many women post-pregnancy are very eager to rejoin the exercise world and at least resume the physical activities they once enjoyed prior to pregnancy. More and more women are seeking out fitness professionals or exercise programs to help them lose the baby weight and engage in safe and effective exercises. Many women understand the toll pregnancy and childbirth took on their bodies and they are ready and willing to seek out professional advice. Working with the postpartum client has benefits for both the trainer and the client. I encourage those who treat this population to get as much education in this area so you can better serve their needs.
Once you begin your journey caring for the postpartum client, there are several important factors to consider when beginning exercise program design.
First, remember she gave birth. Look at birth like any client who is rehabilitating from any type of injury or surgery. The postpartum phase is typically the first 12 months after having a baby but can be longer if a woman is nursing.
Second, consider how long it has been since exercise has been part of her regular routine. Even if she exercised regularly during pregnancy, she probably was limiting the intensity compared to her pre-pregnant self. Keeping that in mind, it may feel like for you (and her) that you are working on a beginner level as you begin.
Third, it’s really important to know the type of birth the woman had and how it affected her pelvic floor muscles. Obviously for vaginal birth pelvic floor prolapse, vaginal tearing or possible Pubic Symphosis diastasis could have occurred. For women who have gone through a cesarean (C-section), the abdominal muscles have been affected through the incision made into the abdominal wall and uterus.
Fourth, it is vital to understand the fitness level of the woman prior to pregnancy and the activities in which she participated. The fitness level or prior activities or sports in which she participated could shape the type of recommended exercises in her program.
Finally, consider any injuries or medical history that may affect her current fitness especially if she has been inactive or just returning back into exercise. Many of this information may be obtained in your initial meeting or phone consultation. You can use a PAR-Q (Physical Activity Readiness Questionnaire) to access this information. I suggest customizing the Par-Q to be very postpartum specific and asking detailed questions about pregnancy and delivery before you begin treatment.
Considering all of these factors, lets now look at how to exercise safely and effectively following delivery.
Start with basic range of motion exercises and corrective, posture-based movements that will help her body begin to feel restored. A little movement goes a long way.
Get to Know Her Limitations
As with other injuries, or surgeries, childbirth is comparable for your client as her body is still healing, hormones are still adjusting that affect range of motion, core is weak and most women are sleep deprived for months after giving birth. With this in mind, her balance and equilibrium are affected. Careful of movements that change position briskly or go from standing to lying.
Establish Realistic Expectations
Develop reasonable exercise goals for your client. Along with her physical health, mental health is also affected.
Exercise is directly linked in helping to prevent postpartum depression, however, setting fitness goals may create anxiety or worsen her mental state, so be sensitive to this. Start with manageable times to exercise during the week. As the client become stronger you can increase the number of days you exercise per week in addition to the exercise intensity.
Create a Supportive Network
Connecting clients who are going through similar life experiences may help motivate them to exercise more regularly and in a small group setting the cost is usually less per person and more efficient for the trainer for the hour. This may also help give the client additional accountability.
Teach Sustainable Lifestyle Habits
Help your client embrace this journey as a marathon rather than a sprint. Explain that the baby weight will come off but the end goal is to do this safely and cautiously. You must be ready to advise on sustainable, healthy eating habits and adapt if the woman is nursing.
Danielle Spangler has been a fitness professional for over 20 years. Danielle is the creator of “Coremom” (Corrective Obstetrical Related Exercises) for purposes of creating a pre and postnatal small group-training program in a variety of fitness facilities. Danielle’s goal is to train other qualified fitness professionals and group exercise instructors on teaching pre and postnatal small group exercise classes using her method. Visit her website, daniellespangler.com
Being pregnant and having a baby is stressful on its own. Now imagine being pregnant and delivering a baby during a global pandemic. Being a mother myself and treating pregnant women and new mothers, I recognize this population struggles with support, proper healthcare (especially postpartum), isolation and they may have limited resources at their disposal. It is important to understand that for many of these women the unexpected turn of events, has left them disappointed and it has affected the entire pregnancy and postpartum experience affecting both their mental and physical health.
Pelvic floor dysfunction, or PFD, is a broad term used to describe several physical conditions that occur mainly as a result from pregnancy and childbirth. As a pre and postnatal fitness specialist for over 20 years, almost every one of my clients has had some form of PFD. What does this mean and why is it relevant to women’s fitness? I will further define PFD in detail and explain how it changes the way we as exercise professionals program design for this clientele.
First, let’s look at the pelvic floor muscles. The pelvic floor looks like a sling or hammock that forms the floor of the bony pelvis and it serves several important functions in our bodies. The internal layer or “pelvic diaphragm” work with the external muscles of the pelvic floor to support our internal organs, stabilize our bodies, allow for sexual function, urinary and bowel movements and assist in contracting and pushing in the birthing process. These muscles are prone to trauma from the various functions they perform. The stress of the growing uterus in the body during pregnancy coupled with the changing gravity, posture and production of the hormone Relaxin all contribute to weakening the pelvic floor muscles.
Second, consider the whole Neuromuscular Core system. Pelvic floor muscles connect to the Transverse Abdominus (TVA) and they work together in harmony essentially hold the body upright. It is almost impossible to engage one without the other. Tightness in the hips combined with weak pelvic floor muscles creates PFD.
Diastasis Recti, Symphosis Pubis Dysfunction (SPD), Urinary and or fecal incontinence, pelvic pain, chronic lower back pain, Piraformis syndrome, sciatic pain, pelvic organ prolapse are all conditions under the pelvic floor dysfunction umbrella. Below these conditions are listed and defined in more detail.
Diastasis Recti: This is a separation of the right and left side of the Rectus Adbdominus in the Linea Alba connective tissue more than 2 cm in width
Pubic Symposis Disorder: A separation of the pubic bones, which often occurs during birth but sometimes during the third trimester.
Urinary incontinence: Uncontrollable leakage from bladder.
Fecal incontinence: Uncontrollable leakage of fecal matter from colon. Usually as a result from severe tearing during birth.
Pelvic pain: This type of pain can be during sex or when performing a movement that is irritating or uncomfortable, many possible underlying issues.
Chronic lower back pain: Unexplainable chronic lower back pain
Sciatica: Pain that radiates from lower back down one leg along the sciatic nerve as a result of compression of the sciatic nerve
Piraformis syndrome: Also a result of an inflamed sciatic nerve but more localized
Pelvic organ prolaps: When organs of the pelvis fall as a result of weak pelvic floor muscles.
These conditions can be limiting for many women and go untreated because they are embarrassed or told that they are normal “experiences” after giving birth. Until recently, very few fitness programs existed to help women strengthen pelvic floor muscles. It is my opinion that every pregnant woman and new mother should be automatically screened for PFD and treated right away. If women do not learn proper strengthening exercises of pelvic floor muscles they can potentially live in discomfort for years. The sooner preventative care is offered the better the quality of life for these women.
As mentioned earlier, many of these conditions are preventable and remedied through a combination of functional strength with corrective, posture-based range of motion exercises. When a woman becomes pregnant there is an immediate increase in pressure to the pelvic floor muscles. The body begins to produce relaxin which affects the joints throughout the body, especially the pelvis as it prepares to accommodate the growing uterus and eventually for birth. If treatment begins to help women continue strengthening the muscles surrounding the hips immediately, the pressure on the pelvic floor muscles will be reduced.
It was common practice until recently that women were advised to learn and perform Kegel Contractions. We understand more now as movement therapists that Kegel contractions are very hard to teach, very isolated, and in most cases, when examined internally by a women’s healthcare PT, women are not performing them correctly. A more effective approach to strengthening the pelvic floor muscles is to treat the entire hip complex as “one”– or a “global approach” — as described in applied functional science.
So, how do fitness professionals help create beneficial, safe and effective exercise programming for pregnant clients and new mothers that hone in on the core and pelvic floor? We must start by helping our clients improve their posture first and foremost, then work on proper breathing techniques and lastly incorporate larger exercises that do not isolate, but recruit many muscles from the hip complex and surrounding muscles groups. By incorporating all three planes of motion instead of working primarily in the sagittal plane (forward and backward) when performing even the most basic of exercises (i.e., the squat), you must change the movement by foot placement, arm placement, direction, tempo, range of motion etc. The variety in actions creates good stress to the pelvic floor and core muscles. Additionally, increasing the adduction and abduction action simultaneously while performing various exercises will help activate and recruit pelvic floor muscles subconsciously. Anatomically speaking, everything is connected in the body. Understanding that big global movements of the upper body and lower body together affect the position and strengthen of pelvic floor and core muscles is essential. The body is most efficient at strengthening the small muscles when big muscle groups are stimulated in combination. Throughout my years, I have seen much success with clients that incorporated these types of movements into their workout regimen and were safe and conscientious not to perform exercises that added bad stress to the external abdominal muscle group or impact exercises.
Each woman is different on how quickly it takes her to recover from PFD. The most important rule of thumb is to be reassuring and provide support and remember the time line is different for everyone depending on severity of PFD, the fitness level of the client, if the client is breast feeding and prior injuries that could prolong healing time.
Danielle Spangler, C.PT, has been a fitness professional for over 20 years. Danielle is the creator of “Coremom” (Corrective Obstetrical Related Exercises) for purposes of creating a pre and postnatal small group-training program in a variety of fitness facilities. Danielle’s goal is to train other qualified fitness professionals and group exercise instructors on teaching pre and postnatal small group exercise classes using her method. Visit her website, daniellespangler.com