When Is It Safe To Return To High Intensity Interval Training After Having a Baby?
We frequently get questions in our clinic and on social media about when it is safe to return to HIIT like Crossfit after having a baby. That is often a hard question to answer, or rather there are many factors that go into that answer. Let us help shed some light on when and how to return to intense exercise after having a baby.
Taking a Look At The Scientific Research
To start, there is the length of time required for proper healing. A study done by the NIH in 2012 found that postpartum health problems can occur for up to 18 months after delivery and can potentially negatively affect the woman’s overall health long term. The same study also found that there was no statistical difference in the prevalence of health problems in women who had cesarean births versus vaginal births. Another study done by the British Journal of Medicine in 2018 found that women who return to activities that increase abdominal pressure (like running and Crossfit) prior to 12 weeks postpartum are at increased risk for pelvic floor injury and/or worsening of any pre-existing injury from delivery.
What Does The Research Mean for Me?
So, what does that mean exactly? Does that mean we have to wait 12 weeks before we even step foot in the gym? 18 months until we really start pushing ourselves again?
To begin, several things will need modification in the beginning, and it will be many weeks before you should be participating in a class and/or many of the movements specific to Crossfit. This means that you may not fully feel like yourself again in the gym for 18 months postpartum. This timeframe will also look different depending on your prior fitness level, level of injury sustained during delivery (if any), and several other contributing factors.
Risk Factors To Consider
Some factors that may slow your return to exercise postpartum or put you at increased risk of injury include:
- A return prior to 3 months postpartum.
- Pre-existing connective tissue hypermobility issues such as Ehlers Danlos.
- Breastfeeding – due to the hormones keeping our connective tissues loose and soft.
- Psychological issues such as postpartum anxiety or depression that may affect a woman’s ability to determine appropriate intensity and duration of activity.
- A cesarean birth or perineal tearing with a vaginal delivery.
- Relative energy deficiency in sport.
Dying to Get Back Into Exercise Postpartum?
So, where does that leave those of us dying to get back into the gym? After all, for most of us Crossfit junkies the gym is our community. This is where we go to decompress, engage in fellowship with like minded people, and just to feel good (mentally and physically).
My best recommendation is to stay home for a minimum of at least 4 weeks. During this time you can spend the first 2 weeks resting and doing minimal activity. At 2 weeks you can begin walking and working on very light mobility and core work. This can include kegels, gentle TA (deep ab) activation and breath work. At 4 weeks, you can return to the gym, but before you get too excited… this does not mean you can participate in a class, strength training or a metcon.
Do Your Pelvic Floor Exercises
For your sanity, you can do your core, mobility and pelvic floor exercises in the gym. This is especially ideal if your box has set “open gym”class times. Many of our patients who are planning to return to Crossfit start going to their local box and doing their “homework” from therapy. This often includes breathwork in various positions to get your pelvic floor and deep abs used to activating and relaxing again, as well as some mobility work. This is a great time to befriend that foam roller and lacrosse ball you have been avoiding since you were a Crossfit newbie (wink wink). These first few weeks can also be a great time to start working on strict strength that will carry over into your movements once you return to full activity. However, know that I DO NOT mean gymnastics or barbell movements.
The strict work that I am referring to is banded shoulder work and potentially banded hip work provided that your pelvic floor and core strength are adequate at this time. Ultimately we are using this time to get back into the gym for our mental and emotional well being, but are not returning to classes.
Another great thing to work on during this time period is retraining your breathing mechanics. You see, postpartum breath work with HIIT looks a lot different than prepartum. Postpartum we need to be extremely mindful about the pressures in our abdominal cavity. We need to ensure that we are breathing in a way that will limit an excess of pressure in our abdomen during the movements we are performing so that we limit the risk of diastasis recti (abdominal separation) and pelvic organ prolapse (insides falling out) as our tissues continue to heal.
What to Do When Your Pelvic Floor & Core Strength Is Adequate
Ditch The Lifting Belt to Strengthen Your Pelvic Floor
One way we can do this is by ditching the weight lifting belt. That’s right, I said ditch the belt. Although the belt is theoretically used to improve trunk rigidity and stability with heavy lifts, it does so by increasing the pressure in the abdominal cavity. The belt is also used to cue us to puff out our abdomen – which is the opposite of what we should be doing postpartum. This is because both of these things (increased abdominal pressure and a puffing out of our abdomen) put negative stress on the connective tissues of our abdomen and pelvic floor and can ultimately lead to diastasis recti, pelvic organ prolapse, and stress urinary leakage.
Breathe Properly To Reduce Risk of Injury to Your Pelvic Floor
The other way we can reduce our risk of diastasis recti and pelvic organ prolapse is by learning how to breathe properly during our lifts and our metcons. Oftentimes, when the weight gets heavy we get into a habit of breath holding. We may have even been coached to breathe this way to improve our trunk rigidity. Take a squat, for example. We typically breath hold on the way down into the squat, and then use an explosive exhale on the way back up to standing. While this breathing technique might seem beneficial, it can actually be detrimental to a postpartum woman. The reason is, as with the weightlifting belt, this breath hold significantly increases intra-abdominal pressure.
Focus On Proper Pressure Management to Protect Your Pelvic Floor
To ensure proper pressure management and activation of the pelvic floor with our lifting, we always want to exhale with exertion. Therefore, anytime we are lifting a load or going into a movement, we want to exhale. This will not only decrease the pressure in our abdomen, but it will also cue our pelvic floor and transversus abdominis (deep core) to activate. This will help stabilize our trunk and pelvis, and limit any unwanted strain on our pelvic floor or abdomen. Ultimately, it will reduce the risk of pelvic organ prolapse and/or diastasis recti.
So, the next time you go to your local box, be sure to modify your breathing: scale the movement, weight or speed if you experience pelvic heaviness or pressure, urine leakage, doming or coning in your abdomen, or pain.
Avoid Kipping Postpartum
You’ll also want to avoid kipping for at least 6 months. Kipping is a high velocity activity that requires a significant demand on the muscles of our core and pelvic floor. What that means is that we are very rapidly and maximally loading these tissues. When muscles are recovering from injury or surgery, they cannot meet all of these demands at once. Therefore, they need to be retrained by beginning with the least intensive type of activation and only moving on once efficient. In terms of the difficulty of types of muscle recruitment, the order is typically as follows (easiest to hardest): isometric (like a glute squeeze), concentric (like a bicep curl), eccentric (slowly lowering out of a bicep curl), then plyometrics (jumping squats or kipping movements). While we might think kipping is easier because it is using momentum, it is in fact placing a higher demand on our muscles. So you’ll need to do strict movements with a band until you are proficient without one. The wonderful thing about bands is that you can gradually reduce the amount of assistance you are getting. This allows for a gradual return to strict movements. You should only move onto kipping once you can perform the movement strictly.
Scale Back Barbell Movements Postpartum
The same will apply to barbell movements. You will want to scale back to a weight that is considerably less than your previous max. You will want to choose a weight that allows you to perform the movement for several reps without breakdown in form, pelvic pain or heaviness, stress urinary incontinence, or coning or doming along the middle of your abdomen. For the strength portion of your programming you will likely be able to go slightly heavier as you will be going at a slower speed. During the metcons, you will likely need to lower the weight even more, break the reps more frequently, and slow your speed considerably with barbell cycling. The same concepts or breaking up reps and slowing the speed will apply for movements like box jumps, wall balls and burpees.
See a Pelvic Floor Physical Therapist for Guidance
We encourage you to work with a professional pelvic floor physical therapist who can help you develop a plan so that you can meet your return to exercise goals. Knowing how you are healing postpartum, and knowing what to do for your specific needs, is powerful. Being able to balance risk and reward towards your goals wisely is powerful.
Are you currently pregnant or planning to conceive? If so, make sure to download my FREE resource — 5 Myths We’ve Been Told About Pregnant Bodies! I correct common pregnancy myths and give you tons of tips to help you feel strong and healthy for 40 weeks and beyond.