January 7, 2020

By Carolyn Yates, PT, DPT

All right, you’ve made it to the 6-week check-up and your OB/GYN has cleared you for sex, exercise, jumping on trampolines...whatever your heart desires. Great! That means from the OB/GYN perspective you are healthy and ready to move on to the next thing. The OB/GYN “sign-off” is very important but should be viewed as a “yellow light” as opposed to a “green light” for all things exercise. Let’s pump the brakes on the clearance to do any form of exercise as soon as you get that 6-week sign-off and think critically about what your body went through and what has been happening for the past 6 weeks.

The current state of your body at 6 weeks

At 6 weeks postpartum your uterus and other pelvic organs will finish returning to their pre-pregnancy states, bleeding will typically resolve within 6 to 8 weeks, and urinary incontinence that is going to resolve on its own will typically subside by 6 weeks to 3 months.

At 6 weeks postpartum your body is now ready to start preparing to return to all the beloved exercises you used to do. Think of it this way, you wouldn’t jump into a marathon the day after you decided you wanted to run one right? Well, the 6-week “sign-off” is like the day you decide to sign up for a marathon and not the day of the marathon. So, treat the 6-week “sign-off” as the day you start making your training plan. You need to prepare your body for the road ahead by ensuring that your core is strong and that all of your muscles that were stretched out and pushed through by that little bundle of joy of yours, are back to working properly before you start pounding the pavement!

Related: How to get the most out of your 6-week postpartum check-up

It is well known that exercise has many more benefits than just weight loss. It combats health conditions and diseases such as depression, anxiety and metabolic syndromes. It improves mood, and sleep, and increases energy. It also can have a positive impact on your social life by going to group exercise classes and getting you out of the house.

Related: 7 ways to fight postpartum depression

Exercise is fabulous and should be in every postpartum mama’s routine. However, the type of exercise you are doing at 6 weeks postpartum is crucial. Ideally for the past 6 weeks you have been doing some simple and gentle rehabilitative exercises (If not, no worries! Check out this article, How to start rehabilitating and strengthening immediately postpartum for some tips on a couple of easy exercises to do for mobility and initial reactivation of your core and pelvic floor). These exercises will have reestablished your core’s foundation to start building upon. Remember, it is the day you DECIDED to sign up for the marathon. So, what’s the next step? Upping your exercise game but not too aggressively. Yoga, pilates, biking, swimming, hiking. Anything that is low-impact is fair game now as long as you are not experiencing symptoms such as pelvic heaviness or have diastasis recti that has not been evaluated. In addition to low-impact exercise, add to your routine these 4 simple exercises described below to ensure that your core, pelvic floor, and hips are reestablishing strength appropriately.

Side-Stepping w/ Pelvic Floor Contraction: [10 steps to the right, 10 steps to the left] x3 sets

• Place a loop band around your ankles (if you don’t have a loop band, try using a sports bra that you no longer use and don’t mind stretching out). Bend your knees so you are in a slight squat. Engage your core and pull your pelvic floor up and in and hold this position.
• Slowly take 10 steps to your right with control and not letting the following leg “snap” back together. Make sure you are staying down in the squat position. Do not bounce up and down. Then take 10 steps to the left.
• Rest and repeat.

Monster Walks w/ Pelvic Floor Contractions: [20 steps forward, 20 steps backwards] x3 sets

• Place a loop band (or that handy old sports bra) around your ankles and start with your feet together. Bend your knees so you are in a slight squat. Engage your core and pull your pelvic floor up and in and hold this position.
• Slowly take 20 steps forward (10 total on each leg). Make sure you are striking with your heel as you step forward and that you are staying down in the squat position the whole time. Then take 20 steps backwards striking with toes.
• Rest and repeat.

Down-Dog to Plank flow: [5 repetitions] x4 sets

• Start in down-dog position (see the first picture; your hips are up, arms straight and you are pushing your heels down towards the ground). In this position, engage your core and pull your pelvic floor up and in like you are “zippering” up from your pelvic floor.
• From here, pull your hips higher and push up onto your toes by and then roll forward slowly until you end up in plank position. The key to this movement is to roll up and forward.
• Pause for 1 second and then push back into down-dog.
• Repeat 5 times, rest and then repeat the entire sequence 3 more times.

Crab Walk Position Holds: [20 second holds] x4 sets

Start sitting on the ground with your feet in front of you and your hands flat on the ground behind you.
Engage your lower abdominals by pulling your pubic bone towards your belly button and contract your pelvic floor muscles.
Lift your hips up off the ground by pushing through your hands and feet so that you are in a table-top position. Hold her for 20 seconds.
Make sure to but pushing up through your hips and engaging your pelvic floor the entire time you are holding.

When can I run and do high-impact exercise?

If you can confidently pass all 6 of the criteria below then you are cleared to return to running and other high-impact, high-load exercise.
When you are:
1) 12-weeks postpartum,
2) have implemented the rehabilitative exercises outlined in this article as well as the How to start rehabilitating and strengthening immediately postpartum article,
3) you are not experiencing any heaviness or pressure at your pelvic floor,
4) you are no longer experiencing incontinence,
5) bleeding has resolved, and
6) you are not having any pelvic, low back, hip or any other unusual pains.

What should I do if I am experiencing heaviness or pressure?

• Heaviness and pressure are signs and symptoms of prolapse. Make an appointment with your local pelvic floor physical therapist to ensure that you are appropriately rehabilitating and not increasing the prolapse.

What should I do if I am experiencing incontinence?

• Incontinence can be a sign from the body that you have reached your fatigue point and it is time to rest. If you start experiencing incontinence at set number 3 or after 30 minutes of walking (for example) then take that as your body telling you that it is time to stop for the day.
• Incontinence that happens daily no matter what you have done prior can be a sign that you need to focus more on strengthening the muscles of the pelvic floor specifically.
• If you are experiencing incontinence, make an appointment with your local pelvic floor physical therapist to make sure your muscles are strengthening appropriately.

What should I do if I am still bleeding after 12 weeks postpartum?

• Postpartum bleeding, also known as lochia, typically resolves after about 6 weeks postpartum. If you have stopped bleeding and then start bleeding again after initiating exercises, stop and consult your doctor.

What should I do if I have pelvic or other pain?

• If you have pelvic pain or other pain during any exercises stop that exercise for the time being. As long as the pain resolves after stopping the exercise that day, then try that specific exercise again the next day.
• If the pain continues, make an appointment with your local pelvic floor physical therapist.

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.