In the past I was never one to take stretching, rolling or pelvic floor and core health that seriously. It was always something I knew I should make time for but never really did consistently.
After 3 births, a 4th degree tear and a c-section, I know that if I want to continue running for a long time my pelvic floor and core health is something I can’t ignore.
I spoke with longtime friend and accredited Exercise Physiologist Kiera Underwood who owns Active Health Solutions Mudgee, to share some information about pelvic floor and core health during pregnancy and postpartum.
Tell us a little about yourself
My name is Kiera Underwood, I’m an accredited exercise physiologist. I live in Mudgee with my partner Brett and our beautiful baby boy, William.
I studied a Bachelor of Exercise Science (Rehabilitation). I worked the first 5 years in private practice and then went out on my own to open my own studio in 2016. My scope of practice has been in injury management, chronic health rehabilitation, sports performance and perinatal exercise. I’ve particular enjoyed working as apart of the local health district on an initiative to improve the health of women during pregnancy through safe exercise and healthy eating. The program was designed to cater women throughout pregnancy and postpartum, to reduce the risk of health complications and improve recovery postnatal.
You recently had your beautiful bubba boy, William. How is new mum life treating you?
It has been a huge blur of happy, fuzzy, overwhelming moments! As I write this, Will is now 14 weeks old. We had a pretty rough start after I ended up having an emergency c-section to deliver Will. From there we had about 6 weeks colic, which was super challenging being a new mum, recovering from surgery and lack of sleep. We really got through this tough time by getting out of the house and going for walks when we could. Fresh air and gentle exercise! Soon after the 6 weeks had past, Will’s colic had settled and he has been such a happy bub, which makes me a very happy mum!
As an exercise physiologist what are your key tips for maintaining pelvic floor and core health throughout pregnancy and rehabilitation during the postpartum period?
This is such an important topic. Staying on top of your pelvic floor and core strength during pregnancy will assist in your postpartum recovery. Ignoring this will result in incontinence issue and increase risk of injury.
A few tips to keep in mind are:
- Maintain good posture during exercise to ensure you can engage your core and pelvic floor correctly, poor posture makes it harder for these muscles to be engaged.
- Pelvic floor muscles work harder than normal during pregnancy. They are required to support the weight of your growing baby. They are also softened by the effects of pregnancy hormones. So scaling back the training you have been doing is important. Reduce your weights, decrease your run distance, if you’ve been given the all clear by your health provider to continue these.
- Finally, there is a difference between ‘core’ and ‘abs’. Core strength refers to the group of deeper muscles that assist in stabilising your spine and pelvis. Abs/‘6 pack’ – abdominal muscles, refer to the superficial muscles of your stomach. While they are a part of the core group of muscles. Their purpose is to sit you up. During pregnancy the abdominals actually separate to allow the uterus to grow and expand as your baby grows. Training this muscles is therefore pointless and can actually do more damage long term, called Diastasis Recti. Diastasis Recti can be repaired through rehabilitation exercises, but in more extreme cases require surgery to bring the muscles back together. So the key point here is to learn how to engage core muscles and cut out the ab exercises ie. crunches, during pregnancy and early stages of postpartum.
Should postpartum runners take anything else into consideration when returning to running?
This is all dependent on a few questions. Did you have a natural birth or caesarean section? Perineal lacerations or pelvic floor damage? Are you breastfeeding?
The general rule for a women who had a healthy pregnancy, no complications during birth I would suggest 12 weeks. The first 6 weeks to recovery, 6-12 weeks to start rehab exercises and running drills and after that start back with a light running regime and adjust according to how you feel/recover. A c-section would extend this time out to 12 weeks and then rehab exercises to build up to running by 16-20 weeks. Once again, everyone is different. The most important thing is to ensure your pelvic floor is recovering/strong enough to endure the impact of running. These can all be assessed by a physiotherapist or exercise physiologist.
The reason why I also bring up breastfeeding is that hormones that slow the muscles and ligaments to soften and relax during pregnancy in preparation for labour, are still present in the body whilst breastfeeding. This can increase your risk of injury due to the lack of stability of the pelvis. Using the initial recovery period to focus on pelvic floor, core and pelvic stability exercises will greatly improve your ability to return to running sooner.
How’s your own return to exercise postpartum going?
I wasn’t really anticipating a c-section. So when we had an emergency c-section, my rehab plans became a little more extensive. However, I stayed active throughout my pregnancy and pulled up at about 37 weeks and had Will at 38! So I have actually found my recovery to be quite good because I did keep active throughout my pregnancy.
After having Will, I spent the first 6 weeks resting, recovering and adjusting to our new life! We would go on short walks and I started gentle pelvic floor activation whilst laying down in bed.
After 6 weeks we started taking longer walks, I started functional body weighted exercises to improve my strength, pelvic stability and core strength. Around 10 weeks I added in resistance training with weights, resistance bands and TRX (suspension training ropes). All still at 60-70% of the weight I used to be able to do and I focus on technique and controlling the movements with core and pelvic floor activation, it can be a lot to focus on, so simple is best.
Stretching has also been an important part of my recovery. Between sleeping in uncomfortable positions, breastfeeding and creating a permanent butt print on my lounge whilst feeding and nursing the first 6 weeks, played havoc on my body. Stretching has been vital to relieving sore, tired muscles; reducing my risk of injury as I’m now carrying around a growing boy, I want to me sure my strength and flexibility match that.
My next step is to return to some of the classes I was participating in pre and during pregnancy but modified to my level.
Biggest mistake you see women make when returning to fitness postpartum?
CRUNCHES! And poor technique.
As I touched on above, crunches can do more damage than good in the early postpartum period. As your abdominal is slowly repairing and coming back together after beginning separated during pregnancy. Adding a movement that essentially places pressure behind the abdominal wall, pushing it back apart. This can create a doming effect and doesn’t slim the waist like women think. Instead, focus on strengthening your body back into correct posture. The posture your body changes to during pregnancy is called ‘Lordosis’. This is the increased arching of your lower back and tilt of your pelvis forward as your belly grows during pregnancy. This places more load on your lower back which can result in back pain or sciatica. It also lengthens your abdominal muscles and weakens them. This gives you the ‘mum tum’ appearance. By correcting your posture, by working on strengthening your pelvis back into the correct position with core, pelvic stability and glute (bum) strengthening exercises, you can return to running sooner and also gain the slimmer waist you were aiming for that you were trying for with crunches.
Any other comments/tips/info you’d like to share?
If you’re a new mum and planning on starting to run with bub, please wait until 6-8 months before running with a pram. Babies need to be able to stabilise their head and neck before you run with them in the pram. You can start running sooner on your own but a good rule generally, is that you’ll be ready for road running when bub can sit up in the pram.
Another important tip for running with a pram is to practice running and holding the the handle with one hand and move slightly to the side to ensure you have a normal running stride. I know this sounds scary, so start with a steady speed and build up your speed when you can comfortably control the pram with one hand. It’ll take good core strength! This is important because rotation of the spine is an important part of running. Rotation allows for hip extension and glute activation (bum muscles). The overall movement is more efficient and you’ll find you have less back pain than running right behind the pram when you first start out postpartum.
Holding the pram with both hands will shorten your stride if you are right behind the pram. This will in turn strengthen your body into this shortened movement pattern and reduce the effectiveness of your running. Be sure to alternate which side you run on. But please use both hands if you don’t have good control over the pram when you’re running and then go back to alternative side to side when you’re back in control.
Beer or wine?
If you could have said beverage of choice with anyone, who would it be?
Turia Pitt, the epitome of a strong, empowered woman!
Favourite series to binge on Netflix?
Currently Brooklyn 99.
For more wonderful information, Kiera shares exercise videos such as the one below and extensive exercise knowledge on her Instagram page @Kizfitnessandhealth