Your guide to postpartum return to sport

The journey of being a pregnant athlete and giving birth is exciting. Over the past nine months, as your body changed and created a tiny human, you probably learned a lot about yourself and found a new appreciation for your body’s capabilities. If you haven’t seen Part One of my Pregnancy and Postpartum series, check it out! I’m a professional cyclist; I trained through my pregnancy, and have been documenting life both during my pregnancy and postpartum. Here, I’ll share some of the key points I’ve learned from medical practitioners about postpartum rehab and return to sport.

If you’re active, the burning question in your mind is likely, “When can I get back to my sport after I give birth?” You might also be wondering what to expect of your body in the weeks and months after you have a baby. It was a source of stress for me. Every woman has a different birth experience and level of physical fitness. Some women are able to get back to their sport quickly postpartum while others might have a prolonged rehabilitation route. While your body incurs some injuries during pregnancy and birth, most of these injuries are not permanent. Just as it took nine months for you to get to that point, it takes some time to recover.

Perinatal chiropractors and pelvic floor physical therapists help women get back on their feet faster after having a baby. Dr. Amanda Stevens, a chiropractor who works exclusively with pregnant and postpartum women, says, “By the end of pregnancy, you have pretty much maxed out your body’s capacity to adapt. You’ve gained weight, your center of gravity has shifted forward, and your posture is compensating for these changes. During the perinatal period, low back, pelvis, and hip pain are all very common and certainly can impact your daily life and performance. Diastasis recti is another condition that is very common. If you do too much too fast, before your body is ready to load in the way you are challenging it, then you are certainly at higher risk for injury, both acute and repetitive strain.” That said, seeing a professional while pregnant and postpartum will be key to getting a personal assessment to a rehab plan designed for your body.

The general recommendation for women returning to sport postpartum is to wait 6 to 8 weeks, regardless of mode of delivery. There is varied and individual experience with women returning to sport. Dr. Amanda Stevens notes that when you are working directly with a perinatal professional, you can usually safely return to sport sooner than 6 to 8 weeks because they will assess your actual physical capacity and be able to provide more specific guidance. Corinne Wade, a Doctor of Physical Therapy (DPT) specializing in pelvic health, has specific advice for cyclists. She recommends that athletes do not sit on a bike seat until any vaginal tenderness, swelling or sensitivity, or healing of episiotomy stitches has passed. That starting point varies for everyone and depends on the damage from the birth: for me, it was 1.5 weeks postpartum with a cautious and easy 20-minute ride to start. Getting back on the bike happened much sooner than I anticipated. For others, it might be months. It’s important to start where you are and look for symptoms to be sure that your exercise is not making things worse. Dr. Wade suggests that “starting with short-duration, flat rides are ideal at first looking for any symptoms of hip, pelvic, pubic bone, tailbone, or groin pain.” Other symptoms to watch out for postpartum are urine or fecal incontinence, bleeding/lochia, or abdominal pain. Dr. Wade also suggests that your personal protocol for returning to specific sports will vary depending on sport. She noted that “returning to high-impact sports such as running or CrossFit would require pelvic floor muscles and a core system that can handle even higher repetitive high loads. For high impact sports, it’s even more important for the athlete to keep checking in with themselves for any sign of pelvic organ prolapse and keep checking for signs of incontinence.”

The most common focal point for postpartum recovery are the pelvic floor muscles. Both men and women have a pelvic floor—a group of muscles in your pelvis, much like a trampoline, that supports your organs, regulates opening and closing of bladder and rectum, stabilizes the core, and moves blood and lymph through the pelvis. The pelvic floor also plays a role in sexual function for both men and women. “During pregnancy the pelvic floor muscles are under physical strain as the baby grows, so this can cause weakening and lengthening of the pelvic floor muscles. Changes in posture and the alignment of the pelvis during pregnancy can also impact how the pelvic floor muscles function in coordination with the other core muscles such as the diaphragm and deep abdominals,” says Corinne Wade, DPT.

Re-teaching the body how to coordinate breathing and stabilization after having a baby requires professional help and home care. In fact, in France, pelvic floor physical therapy sessions are paid for by the French government. Understanding how the pelvic floor functions and how to train it is the main role of a pelvic floor physical therapist. Breathing, holding and releasing tension, and functional movement are key focuses at an appointment, as are internal exams. Personally, Dr. Wade has had me doing work on a Pilates ball and many stabilization exercises on a foam roller. She told me, “the diaphragm and the pelvic floor work in a coordinated synchronized fashion much like a hydraulic shock absorber on a mountain bike. Upon inhalation, both the diaphragm and pelvic floor descend; upon exhalation, the pelvic floor and diaphragm recoil and elevate. If the rib cage or thoracic spine are tight (which is common in cyclists due to posture on the bike) then this can inhibit optimal breath/cardiovascular function. Additionally, if the diaphragm is restricted and has a poor range of motion, then the pelvic floor can’t respond and work fluidly with the diaphragm to absorb shock and generate core power.”

It’s interesting to note that all athletes, regardless of sex or whether you’ve had a baby, can experience performance benefits from a strong, well-coordinated pelvic floor. Taking the time to train your inner core (pelvic floor, transversus abdominis, diaphragm, and deep spinal muscles) and pelvis is necessary for all sports. I learned from Dr. Wade that not only is it necessary for optimal performance but also for preventing injuries in many other areas of the body.

The end goal of pelvic floor treatment is to return the function of the muscles to work together and automatically. Dr. Wade says, “No athlete should have to consciously ‘kegel’ with every step as they run down the road or bike up a mountain trail!” If you haven’t heard of kegels, they are the tightening and releasing of pelvic floor muscles coordinated with breath and movement.

Another mode of treatment, in addition to pelvic floor physical therapy, is Dynamic Neuro-muscular Stabilization (DNS). DNS is a rehab system developed by Dr. Pavel Kolar, MD, PhD, from the esteemed Prague School of Rehabilitation and Manual Medicine. DNS is a way of progressing through physical rehab from a developmental kinesiology perspective. Chiropractor Dr. Amanda Stevens uses DNS in her practice. She says, “We look at the way a baby would develop movement and posture ‘from scratch’ and use this framework to create ideal core and joint loading patterns.” She notes that women have faster recovery times when implementing DNS as part of their postpartum recovery plan. I’ve been working on DNS as part of my postpartum recovery, and each month has a new functional movement exercise that also matches how the baby is developing.

A benefit of being an athlete is that many of us have had injuries and understand rehab, carving out time to take care of ourselves, and are used to hands-on care. During the first few days of healing from birth, I was surprised and even a little frightened by how my body felt. My pelvic area felt unstable and it was unnerving, but it rapidly improved. Also, knowing I had practitioners to advise me gave me confidence in my recovery. Interestingly enough, I discovered that many of the weaknesses and recurring injuries I’ve had in the past are linked to my core, diaphragm, and thoracic spine. Because of what I’ve learned from seeking out postpartum care, I’m coming back even stronger and am better because of it!

Pregnancy and childbirth are not career-ending life changes. If you’re a professional athlete, they do not have to be a retirement slip. You can get back to the same fitness level and even improve after having a baby with focused work. Finding yourself a perinatal and postpartum practitioner is key to coming back sooner and safer. Good luck and ride safe!