By Liana McMorrow
Timelines … a blessing and a curse. The reason behind why your physiotherapist might encourage you to be more conservative in your rehabilitation and return to exercise. Understanding the tissue healing timeline, helps to set expectations, open discussions around care and plan towards goals.
During pregnancy, the body and pelvic floor undergo reshaping and changes to prepare for birth. The abdominal muscles stretch to 115% of their resting length by 38 weeks gestation! During labor and vaginal delivery, the pelvic floor muscles stretch 250% of their resting length!
The recovery time of a birth surpasses the time of 6 week check-up. As a general guide muscle takes 2-4 weeks to health, ligaments take 10-12 weeks and nerves can take up to 12 weeks. At minimum, following up with your physiotherapist at 6 weeks, allows for an assessment to look at your birth story, identify healing factors, muscle strength/endurance and any tissue laxity. This then helps to guide your specific recovery timeline.
In the early weeks postpartum, horizontal rest in your best friend. Removing gravity, and body weight from healing abdominal and pelvic muscles, and prioritizing rest can help to optimise healing. During the first few weeks, walking around the block is what we consider as exercise.
The pelvis has different layers of support which need to be considered with recovery. For the muscle layer of support, tissue recovery time is thought to be around 4 - 6 months post natal. Whereas laxity in the bladder neck, or anterior vaginal wall are at higher levels postpartum, compared to pregnancy, increasing the risk of developing incontinence. For abdominal muscles, research suggests that strength and control remained reduced at 6 months postpartum, regardless of type of birth! For cesarean specific deliveries, the research suggests that the uterine scar thickness is still increased at 6 weeks post delivery, that abdominal connective tissue has only gained just over 50% of its original strength!
Return to impact exercises (running, jumping, weight lifting etc), is suggested to be at a minimum of 12 weeks. Impact exercises are found to increase the risk of pelvic floor dysfunction 5 x compared to low impact, requiring additional rehabilitation and healing time before recommencement.
Recovery from pregnancy and delivery is influenced by many variables including sleep, hormone levels, breast feeding, psychology, nutrition and tissue health. RED-S or Relative Energy Deficiency is an imbalance in the relationship of energy intake to energy expenditure RED-S is common in the athletic female population, but also in the post-natal population. Symptoms to watch out for are fatigue, irregular menstrual cycles and weight loss.
If you are wanting guidance about pregnancy and delivery timeframes and expectations, reach out and book an appointment with your local pelvic physiotherapist!
Selman R, Early K, Battles B, Seidenburg M, Wendel E, Westerlund S. Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport. IJSPT. 2022;17(6):1170-1183. doi:10.26603/001c.37863
Ready, steady…GO! Ensuring postnatal women are run-ready! BJSM. Gráinne Donnelly . 2019.