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Tips & Techniques to Get You Back to Full Strength

The Pelvic Floor and Returning to Sport Postpartum

Ashley Dougvillo 
January 26, 2023

Let’s first start by defining what the pelvic floor actually is.  The pelvic floor is a sling of muscles that run from the pubic bone in front to the tailbone in the back and between the sits bones.  These muscles must work together to support the organs and body systems that lie above the sling.  A trained physical therapist can assess an individual both internally and externally to see if these muscles are tight, whether they are weak, and if they are coordinating well with other muscle groups.  It is incredibly important for all women to have a check in with a pelvic floor therapist 6-8 weeks postpartum.  It is crazy to me that for 6-8 weeks women are told to limit their exercise and like magic at their 6 week check they can return to running.  In some cases that may be appropriate, but a quick check in with a pelvic floor therapist to assess as mentioned above, allows for a safe and gradual return to activity.  Especially because as a Physical Therapist we can cater your sessions toward whatever your specific area of interest is (whether that be tennis, crossfit, running, etc).  For example with running, we would utilize video analysis.  We video from multiple planes to see how the runner is landing and whether that is contributing to symptoms or could lead to symptoms.  When we video from the side, we want to see the runner landing under their body weight  (not with their foot out in front) to avoid over striding.  If they are landing with their foot out in front, there is more impact that their joints (and pelvic floor) have to absorb which is problematic.  If you couple that with weak gluts and core, and a pelvic floor that has recently undergone some major changes, you have a recipe for a possible injury.

A question we get then, is what expectations can an individual have about maintaining fitness during pregnancy and then in the early postpartum stages.  Unless stated otherwise by your OB/midwife, the continuation of physical activities throughout pregnancy is typically safe, if not encouraged. A great rule of thumb to follow while pregnant is just to listen to your body.  What do you feel after a run (bike, swim)?  Are you having any low back pain, pelvic pain, heaviness, incontinence, etc?  This isn’t the time in your life to be pushing your RPE or trying to surpass a PR.  However, if you have been consistently swimming, biking and running, those all can be safe activities while you are also carefully monitoring how you are feeling.  The same can be said about coming back in the postpartum period.  Having realistic expectations of your timeline is helpful, and recognizing that each individual will be following their own timeline based on their prior level of activity, nature of their delivery, how they heal postpartum, whether they are breastfeeding, etc.  Typically women can begin some strengthening and low level weight bearing activities prior to that 6 week check up appointment (again, as long as they are not noticing any symptoms with these activities).  Then after that 6 week appointment, they should seek out a pelvic floor physical therapist to be properly assessed, and they will help guide you the rest of the way.  Every person is different so what worked for your friend postpartum, may not be the same for you.  Embrace the journey!

Meet the Author
Ashley Dougvillo joined Smith Physical Therapy and Running Academy in 2019. She graduated from Marquette University in Milwaukee, WI in 2008, receiving her Bachelor of Science degree with a concentration in Biomedical Sciences. She then went on to attend Northwestern University in Chicago, IL to complete her Doctorate of Physical Therapy in 2010. She is a Certified Manual Therapist and has additionally obtained specialty certifications in the Pose Method of running, kinesiotaping, FMS/SFMA, ASTYM, and Women's Health.