MonthAugust 2014

Baby Steps to Exercise

(Pictured: Chelsea Ciano, founder of Family Fit Exercise Physiology, sharing exercise with her daughter!)

Bouncing on a trampoline or simply laughing at a joke can be a tricky experience for new mums and their pelvic floor muscles. Childbirth places tremendous strain on the body, even if the labour and delivery were relatively straightforward.

Regular exercise offers a range of health benefits for the new mother, including faster recovery from the birth process, faster reestablishment of the abdominal and pelvic floor muscles, increased energy to cope with the demands of a newborn baby, increased ability to deal with stress and depression and, of course, faster return to pre-pregnancy shape and fitness.

Nevertheless, don’t feel any pressure to exercise before you are ready – listen to your body.

It’s important to be well informed before starting postnatal exercise. The focus for a new mother should be primarily on recovery and rehabilitation. This is achieved through strength development, postural alignment, functional stability, core strength, balancing opposing muscle groups and flexibility. Exercise post pregnancy should also be about the well-being of the mother and rewarding the body with the energy it requires to be a great mum.

All too often the focus for new mothers is about ‘losing baby weight’ and ‘getting your body back’, and while these goals are achievable, it’s important to understand that if recovery exercises are rushed or bypassed, future injuries are likely. For example, new mums performing crunches, planks or full push-ups before the abdominal muscles have repaired themselves will cause further abdominal separation and damage.

So my message for new mums is: think rehabilitation. Weight loss and aerobic fitness can wait. And remember that weight loss is largely tackled from a dietary perspective.

 

Post baby exercise

It is very important to exercise safely and correctly after the baby is born. Your body has undergone nine months of physical and physiological changes and these do not reverse overnight. Many ‘how to get your body back’ programs ignore the maternal adaptations of pregnancy (which can continue for up to six months post-birth) by prescribing exercises that can aggravate and exasperate postpartum symptoms and discomforts, potentially leaving new mothers with unnecessary injury, dysfunction and pain.

It’s best to omit or modify exercises that require fast movements, jumps, lateral movements, fast changes of direction and extremes of joint flexion and extension (e.g. deep squats). New mothers should avoid exercises that cause a bearing down on their pelvic floor, certain abdominal exercises and high impact exercises until core control, pelvic floor strength, bladder and bowel control has been regained. It is best to listen to your own body and if you are unsure seek advice from an accredited exercise physiologist.

Many new mums love the idea of ‘exercising with baby’, however you must be very careful when using your baby as a weight. Often technique is compromised, thus reducing the benefit of the exercise and increasing the risk to mum and baby. I personally love to workout with my baby girl and she enjoys it too. We often use a mirror to observe technique and avoid unstable objects like fitballs, discs and BOSUs.

Mothers constantly push their bodies to their limits – whether it is carrying your baby throughout pregnancy, feeding your baby with heavy breasts or lugging your toddler until they are too heavy to lift. They often put up with upper and lower back pain, unaware of the safe, effective exercises available to minimise their discomfort.

I’m a mum of two and I have experienced firsthand the benefits of a well-organised postpartum exercise program. My second pregnancy was more physically demanding than my first, probably because I had a toddler to look after and I used more of my ‘me’ time to rest rather than exercise. The progression of the pregnancy triggered several debilitating physical conditions and after giving birth I felt weak, soft and tired. A month postpartum I realised I needed to rehabilitate myself if I were to be dynamic mum. Slowly and gradually my post-baby discomforts were alleviated and corrected through prescribed exercise. Eight months on and I am fit, energetic and strong helping me to be a vibrant, active mum.

Specific exercises are required to heal stabilising muscles, correct any post-pregnancy abdominal separation and strengthen pelvic floor muscles. Concentrate on repairing the body first, which can take weeks or months depending on the individual, and then you will be able to fully enjoy being active with your family, and living your best life without any aches, pains or weaknesses.

Always consult with your doctor or midwife prior to commencing any postnatal exercise regime. Whether you are ready or not is dependent on many individual factors. It is recommended that your return to exercise be gradual and that you progress slowly.

My postnatal approach is to primarily:

  1. Activate your core and pelvic floor muscles.
  2. Heal abdominal separation (diastasis recti).
  3. Correct posture.
  4. Strengthen core and butt muscles.

Vigorous cardio exercise should be avoided until the above has been achieved. Cardiovascular exercise has many benefits, but being exhausted and sore has none, so mum has to be well rested and getting regular restorative sleep.

My recommended modes of exercise are personalised exercise prescription, walking, pram exercises, swimming, Pilates, yoga, cycling and light controlled gym work (preferably with a well-organised program).

New mothers can resume exercise without negatively affecting breastfeeding, provided the mum consumes enough calories to support both breastfeeding and exercise.

An appropriate and supportive bra is essential to any new mum looking to enjoy her exercise. It is best to exercise after breastfeeding, rather than before when the breasts are heavy and full. Don’t perform any exercises that hurt the breasts.

Be careful not to overexert yourself because a tired, sore mum is no fun for anyone. Stop exercise and see your doctor if there are any changes in your lochia.

Don’t expect too much too soon. Many women experience difficulties in losing weight and gaining fitness in the post-partum period. Allow yourself a reasonable length of time, such as a year, to get back into pre-pregnancy shape.

Patience, rehabilitation and sleep are essential when returning to exercise post pregnancy. Listen to your body. Have an exercise plan before you start and remember it is always best to seek professional advice.

Chelsea Ciano
Exercise Physiologist AEP MESSA

M: 0412 198 519
E: chelsea@familyfit.net.au
FN: Family Fit Exercise Physiology on Facebook
In: Family Fit Exercise Physiology on Instagram

Wee-wee woes?

Do you have wee-wee woes?

Do you leak (urine, that is) a little when you laugh, cough or jump? Do you have a sudden, strong urge to urinate? Do you wake more than 2 times to go to the toilet at night? Sound familiar? Well, firstly you’re not alone! Secondly, leaking is not an inevitable part of parenthood or ageing. In the majority of cases, it can be reduced, if not reversed. So, where do we start?

What and where is your pelvic floor?

Your pelvic floor is a sling of muscle and connective tissue that runs from your pubic bone at the front of your pelvis, to your tail bone at the back. Its purpose is to support the organs of the pelvis, i.e. the bladder, uterus and bowel. It also works to close off the opening at your bladder and bowel that helps maintain continence.

What happens during pregnancy?

During pregnancy your body releases hormones that soften the tissues in your body, allowing it to expand to accommodate your growing baby. The softening effect on tissues and the increasing weight of your baby place pressure on your pelvic floor. The pelvic floor muscles and connective tissue are also stretched at birth. This makes it harder for the muscles to do their job.

What to do?

The first thing to do is to start exercising your pelvic floor and keep exercising it for the rest of your life. It is like any other muscle; use it, or lose it!

How to contract your pelvic floor: Imagine that you are trying to stop the flow of urine or stop passing wind. Feel the squeeze in your muscles down below. This is a pelvic floor contraction. Now try and add a little lift to that squeeze. So squeeze in, lift, hold for 5-10 seconds, drop and relax. It is just as important to relax your pelvic floor after a contraction so it is ready for the next one. Three times a day, aim to do 10 quick squeezes and 10 squeeze, lift and holds for 10 seconds. Keep breathing! Holding your breath increases the pressure inside your abdominal cavity and puts more stress on your pelvic floor (that’s not what we’re after!).

NB: It is really important that you do not bear down (i.e. try to push, like the way you would if you were constipated, or having a baby!). The correct technique is vital, so if you are at all unsure about whether you are doing your pelvic floor contractions correctly, it is best to consult a women’s health physio or continence nurse. They can check it out and give you feedback to get you going in the right direction!

Once you have your pelvic floor muscles going, try to switch them on before you laugh, cough or sneeze and before you lift anything. If you have already had your baby, be aware of all the lifting that is involved with prams, capsules, and even just your baby – and make sure you switch on your pelvic floor before you lift.

What else to think about?

It is important to maintain good bowel habits and avoid constipation because straining to open bowels can put pressure on your pelvic floor and cause weakening. So be sure to eat a healthy diet including a lot of fruit and vegetables, maintain adequate fluid intake and take the time to open your bowels. It is easy for busy new mums to ignore that urge to go or not take the time to empty bowels completely and this may lead to constipation.

A final note…

There is still a lot of taboo around discussing bladder and bowel issues and the fact that one may occasionally wet oneself! And it is not normal despite that nearly all the mums in your new mothers’ group can relate! The only way we can break this taboo is to discuss these issues openly and not to be embarrassed. Remember, you are not alone. If you have any issues with your bladder or bowel, the best thing to do is have a chat to your GP, women’s health physio or continence nurse. In 90% of cases something can be done to improve, if not fix the problem. It is not something that you have to live with. By seeking help early you will not only be helping your condition now but preventing further decline in the future.

For more information and some great apps check out The Continence Foundation of Australia or phone the National Continence Helpline on 1800 330 066.

Sharyn Wappett
B.App.Sc (Physiotherapy)
Member of the Australian Physiotherapy Association (MAPA)
W: Restore Physiotherapy
FB: Restore Physiotherapy on Facebook

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