My twelve kilo injury – about coming back to training after pregnancy
Hanneke Boon, 18-12-2016
Pregnancy sometimes seems some sort of open invitation for others to tell you what you should and shouldn’t do. One of the topics under discussion during my pregnancy was training during and after pregnancy: neighbours and in-laws alike made sure they voiced their opinion: ‘Do you want to go back to training ALREADY? Don’t forget to enjoy this special time!’ (pressing that ‘guilt button’ at the same time!). This foregoes the current scientific opinion that training after pregnancy is a good thing. It helps bring you back in shape and lose your pregnancy kilos, you also sleep better, get some stress relief and it helps you re-tone those important core muscles. That is, if you do it wisely. Be patient and don’t force it, choose the right exercises and listen to your body. For a suggestion (not advice…) on what to do and which warning signs to look out for, especially in the first 6 months or so, read on.
If you’d have to believe what you see in social media, all hope is lost if you are not back on pre-pregnancy weight after 6 weeks, you still haven’t run a meter and your stretch marks are still there despite litres of tummy-oil. The (hard) reality is that you’re still at least 5 kg away from race weight, your belly looks more like a deflated balloon than a six-pack and you’re seriously considering giving up breastfeeding and switching to formula (the horror!). You’d do anything for a full night of sleep.
A sure-fire way to get injured and delay your return is to do too much, too soon. You’ve lost your muscle, shape and form over the course of 40 weeks of pregnancy and so it will also take time to rebuild. Tough luck.
Weakened pelvic floor and other core muscles
Even if you’ve had a normal pregnancy and vaginal delivery without major complications, your pelvic floor muscles will be severely strained. The added weight of a baby plus enlarged uterus, as well as the pushing during delivery, are the cause of this. You can picture your pelvic floor muscles as the bottom of your core. These muscles support organs such as the bladder, uterus and the last part of your bowels. If these muscles are weakened or stretched, these organs can lose their support, which can result in a so-called prolapse of these organs. The result is a number of symptoms ranging from loss of urine or even faeces, constipation and a ‘heavy’ feeling in and around the vagina. In a bad case, parts of these organs even protrude out of their openings. Not fun – not fun at all! The good news is that most cases are, though highly uncomfortable the first months, relatively mild and you can train these muscles just like any other muscle. The bad news is that you need to avoid high-impact activities such as running, jumping and heavy weight lifting until the pelvic floor has been re-strengthened.
Not only your pelvic floor muscles, but also your other cores muscles haven’t exactly had the time of their life during the pregnancy. The left and right side of your straight abdominal muscles separate to make space for a growing baby. This can cause a ‘gap’ of several centimetres. Anything wider than 2 cm is called ‘diastasis recti’. It affects your posture and can cause back pain. Heavy core exercises such as sit-ups and planking can worsen the separation and should be avoided until the separation is gone.
So which exercises are okay to do? Well, lots of kegel exercises. It takes some practise to do these correctly, so make sure you do the right from the beginning. Below this blog are some links to a good video on kegel exercises and an app for post-partum exercises that are not too easy and not too hard.
Your baby moves through your pelvis during delivery. This is made possible because the two halves of your pelvis separate a bit. Obviously the joints and ligaments need to recover from this, which can result in back pain or a remnant of pelvic instability pain in the weeks following the delivery. Your joints are also affected by the hormones involved in breastfeeding (more on breastfeeding later). The joints become much more flexible which could make you more prone to injuries. Think injuries of the hip/SI-joint, twisting your ankles, foot injuries and shoulder problems. Something to consider when you go back to repetitive movements such as swimming, cycling and even running. Make sure technique comes first and speed comes later.
You should also realise that you have (probably) trained less often and less intense during pregnancy. If you didn’t run for the last months during pregnancy, your joints, ligaments and muscles need to get used to that load again. So the best thing you can do is to increase the workload very slowly. Keep a training diary where you not only note down distance and/or training duration, but also all pains (small and big) you feel so you can act before they turn into a long-term injury.
You could call it the breastfeeding mafia, but these experts are right: breastfeeding is (theoretically) the best option for your baby. But it comes at a cost. Especially if you want to combine it with training. The fact that you produce the food that your baby grows on, implies the energy is taken from you. Not only your energy stores, but also your calcium stores are affected. Though you’re probably okay with sacrificing some baby weight, it’s not as great to have to (at least temporarily) give up bone mass, as this increases your risk of stress fractures in, for example, shins, hips and vertebrae.
In the old days, some used to think that training makes your milk ‘sour’, leading your little one to reject the breast. This is an old wives’ tale and as many others, not true. However it could be that very intense training can lead to slightly decreased milk production. Though your baby will compensate by just asking for more feeds, it is something to bear in mind. Though having read the above, you probably want to avoid superintense trainings anyway.
A practical problem with training, at least something that I have noticed, is that your baby wants food every 2-3 hours. Thus it requires planning to fit in a training and a shower. Also, don’t be surprised if your little one decides to ignore his current schedule, and demand food after 1.5 hours already. So that shower might be a very short one… This can lead to some stress and frustration if all you want is some peace and quiet time. It will get better when the baby and his tummy grow. In the meantime, leave a bottle of pumped milk, tell your partner to enjoy this ‘bonding time’ (with a screaming baby…) and just head out of the door. By the way, feeding just before the training has the other advantage that your breasts don’t feel as full.
Just a tiny bit exhausted
Breastfeeding or not, the first months with a baby are not your best nights of sleep. Not that the last months of pregnancy were like sleeping in heaven, with that enormous, moving belly, those pregnancy aches, and having to go to the toilet 3 times per night. The result? You’re just a tiny bit exhausted. Maybe frustrated about feeling so different from before your pregnancy. Again, it’s important to adjust intensity (and duration) of your training so keeping the right technique comes first and you minimise the risk for injuries.
From a training perspective, I thought of my pregnancy as a 12 kilogram injury. A very welcome injury, but still, an injury. It helped looking at it that way because it made me realise that the extra weight and all the physiological and psychological changes, were like an injury that had changed me, made me weaker and that I needed some serious rehabilitation from. Too much, too soon increases the risk of an actual injury. Training requires planning, too. Even if you are desperate to strap on your running shoes and go for a run in the woods, you should wait and be patient until your pelvic floor, other muscles, joints and ligaments are up for it. A couple of extra weeks of patience will give you a solid base to come back to your old level safe and sound.
All this doesn’t mean you should lock yourself up inside, glued to your little miracle. Go outside, on your own or with the stroller, go for a walk and do some exercises in the outdoor gym. Give your baby to your partner for some quality bonding time and head to the pool for a swim, or to the gym for some light strength training as these sports are good alternatives for high-impact sports like running.
The first 8 weeks, focus should be on recovery of your pelvic floor. You can walk as much as you feel comfortable with, as long as you don’t get a ‘heavy’ feeling in your pelvic floor or lose urine. After 6-8 weeks you can start cycling and swimming, and pick up the pace in your walks. After 10-12 weeks, if all goes well and you have none of the above issues, you could train on a cross-trainer. Most physiotherapists recommend not to run for 6 months. If you don’t want to wait that long, you could follow a ‘start-to-run’ program between the 4th and 6th month, where you alternate running and walking.
I realise the above information is probably not what you were hoping to hear when you are eager to go back to training after pregnancy, so to end on a positive note: most athletes come back stronger than ever after a pregnancy. It requires planning, patience and determination, but after a pregnancy and delivery you surely have an elevated pain threshold. I think most women learn to take things as they come, with a bit of humour and more self-confidence. I hope you also learn to ignore other people’s opinions, and to listen to your body and do what fits you best. These are very strong assets to have as an athlete and will definitely help improve your performance.
A useful link and app:
www.pelvicexercises.com.au (also videos on youtube, search ‘Michelle Kenway pelvic floor exercises’
An app called Mamatummy (or the Swedish version Mammamage) for Android and iPhone