From my experience in physical therapy school, treatment and education regarding
pregnant and postpartum patients was essentially a one-lecture topic that covered surface level information exclusively– having patients fill out a bladder diary, tracking their incontinence symptoms, & teaching how to do diaphragmatic breathing and kegels for nearly everything. The lack of formal education I received on this topic led me to do further research during my time at Physiolete. During my time here I’ve been able to observe and assist in treating several postpartum moms who are looking to return to sport- something I definitely had never been exposed to & something I initially felt very diffident in doing. I wanted to dig a little deeper into this topic to educate myself and our patients on the most up-to-date information out there.

        Through my searching I found that the guidelines for return to sport for the postpartum
mom are generally few and far between and oftentimes vague and not sport-specific. This post
will outline the high points of what postpartum athletes should anticipate in terms of their
recovery process and their return to sport. My hope for this blog post is to shed more light on
what postpartum return to sport looks like, and to increase the awareness for further
clarification of this topic to be publicized.

        One of the first and most important topics to discuss with ALL new moms is body mechanics and ergonomics. In terms of body mechanics, this could look like teaching how to lift the baby’s car seat close to the mom’s body, teaching how to lift with legs rather than the back, or even reminding mom not to twist her spine when loading the car seat or stroller into the car. In terms of ergonomic positioning, this could look like reminding the mom to maintain good posture during breastfeeding, adjusting the height of the changing table to accommodate good posture and protecting her spine from resting or working in overly flexed positions.

        In regards to the pelvic floor specifically, there are five items of discussion for postpartum
athletes & their return to sport.

1. Education of the pelvic floor musculature is crucial and an integral part of
   pelvic floor recovery.
   1. The pelvic floor musculature works as a “sling” to hold and support our pelvic
      organs. A weak “sling” can lead to further complications, like organ prolapse
      (cystocele, rectocele, enterocele, uterine prolapse to name a few)
   2. Strengthening of the pelvic floor musculature can help prevent organ prolapse
      and decrease the occurrence of urinary incontinence, or leaking, following birth
   3. Urinary incontinence is the #1 limiting factor that postpartum moms face when
      returning to high-impact activities, so addressing & hopefully preventing it is
      crucial!
2. Recognizing Signs and Symptoms of Pelvic Floor Dysfunction
   1. Incontinence or leaking during exercise (Stress incontinence)
   2. Increased urge to urinate or defecate (Urge incontinence)
   3. Back or pelvic pain
   4. Feeling of heaviness
   5. Feeling a “bulge” in your vagina or anus
   6. Pain with sex
   7. Trouble using the restroom
   8. If you’re experiencing any of these symptoms, you may want to consider seeking out help from your primary care provider or a pelvic floor physical therapist.
3. There are complications that can arise from delivery that can impact our
   ability to exercise; these are among the most common ones
   1. Episiotomy scar/Tearing or Cesarean scar; complete tissue healing will need to
      occur prior to initiating high-impact exercises to avoid risk of increased bleeding
      or wound reopening.
   2. Postpartum depression– postpartum depression is described as long term feeling
      of sadness or anxiousness following the birth of child
   3. Changes in sleeping pattern– Rest and healing are directly linked to one another;
      without adequate sleep, which nearly no new mom gets, impacts our overall
      recovery and ability to compete
   4. Difficulty breastfeeding
   5. Diastasis Recti Abdominis – The body’s normal response to accommodate for
      a growing fetus that results in thinning and separation of the linea alba.
      1. It is suggested that 100% of women who reach 35 weeks of gestation have
         some degree of DRA
      2. Signs and symptoms of DRA include “doming,” or “coning” with
         abdominal crunches, or sinking of the linea alba at rest
4. Finding Your Pelvic Floor
   1. First thing’s first! Before you can exercise your pelvic floor, you need to “find” your pelvic floor. There are a few ways you can think of finding it for proper exercise execution:
   2. You can place your fingers on your pelvic floor, contract, and feel for a lift of the pelvic
      floor musculature
   3. You can try to stop your urine mid-stream
   4. You can think of trying to lift a marble up from a chair where you are sitting
   5. It is important to try to isolate your pelvic floor musculature – try not to activate your glutes or thigh muscles when attempting to kegel.
5. Types of Pelvic Floor Contractions
   1. The next item of discussion is the differing types of pelvic floor muscle contractions. There are quick flicks, long holds, and contract-relax contractions. Quick flick kegels are what they sound like, quick muscle contractions with quick relaxation. Long-hold kegels are muscle contractions held for an extended period of time (5-10 seconds initially), with a quick relaxation. Lastly, contract-relax kegels are muscle contractions with equal contraction time and equal return-to-rest times.

Now that we’ve exhausted the basics, let’s talk about incorporating it all into returning to sport.

References

• 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. Int J Sports Phys Ther. 2022;17(6):1170-1183. Published 2022
  Oct 1. doi:10.26603/001c.37863
• The postpartum athlete: Guidelines for returning to Sport. MedBridge. Accessed
  February 18, 2024. https://www.medbridge.com/courses/details/the-postpartum-athlete-guidelines-for-returning-to-sport-catherine-cram.