Exercising after C-sections: How to safely return to your exercise routine…

Although c-sections are becoming fairly common in the United States, approximately 30%, that does not mean they should be considered a “small surgery”.  Cesarean births are incredibly involved; both during and following the procedure. There is cutting that occurs of skin, fat, and organ tissue, a manual separation of the abdominal wall, and the shifting of pelvic floor organs to remove the baby from the womb.  This is no small procedure! So when you are ready to return to your prior level of activity, and exercise routine, it should be a major consideration to consult not only the surgeon who performed the procedure, but a physical therapist who is comfortable treating, and trained to assist you.

Prior to beginning any exercise routine always consult your physician/surgeon.

The first 6 weeks following the cesarean should be used to rest and recover from the procedure.  It may be okay for you to begin gentle pelvic floor and breathing exercises, and be trained how to perform scar tissue mobilization by a physical therapist; but always get the “okay” from the surgeon first.

Your first appointment with the physical therapist would likely include an evaluation of the scar; ensuring proper healing and introducing you to techniques to begin to “mobilize” the tissue in that area.  It is important to assist the body in its healing so there is not an “overgrowth” of scar tissue which can lead to restriction of movement and pain in later stages of recovery.  

At this first appointment we would also likely introduce some gentle breathing and pelvic floor exercises.  It is likely, following the cesarean, we would focus on the activation and re-training of the pelvic floor through the use of kegal exercises.  

We would also assist you in safe rolling and transfers to ensure protection of the abdominal wall, and breathing techniques to assist in bracing during these functional tasks.

All of this would be tailored to your individual needs considering your muscle weaknesses/imbalances, and restrictions.

Once we get the “all clear” from your physician/surgeon we can begin gentle core exercises to re-train the abdominals and pelvic region.  We need to begin here because the abdominals are the foundation for your body; your arm and leg strength, and stability all depend on this foundational support.  So before you can begin more strenuous or vigorous exercise, we need to ensure your core has adequate strength and stability for the task.

Exercises to avoid without proper training or core stability would include the following:

  • Running/Jumping/Plyometric training
  • Traditional planks, crunches, or sit-ups
  • Leg raises
  • Heavy weighted exercises
    • Overhead press & squats with bar across the back (these can cause increased pressure on the pelvic floor)

Exercises to initiate core retraining would include the following, but should always be cleared by the physician and instructed by a trained physical therapist:

  • Bridges
  • Clams
  • Reverse clams
  • Pelvic tilting
    • With introduction of hip movements/strengthening
  • Abdominal bracing
  • Side planks

When returning to a more strenuous exercise program, you will want to consider the following:

  • It’s going to take time:  It took 9 months for your body to change and adapt to the growing life within you – it’s going to take time for your body to recover from that change and the added stress of the birthing process.
  • Start small:  We all hate set-backs, so it is so important to start small and build up to what you were previously doing.  We need to begin with training the core/abdominal region to give you the “foundational strength” and then increase exercise time/duration, and frequency as appropriate.
  • Start light:  By introducing too much, too soon, you can easily overstress your body which could lead to increased pain and healing times.
  • Avoid pain:  Re-introducing exercises should not be painful, this is not a situation in which you “push through” – you need to listen to your body and modify accordingly.  That is why it can be so beneficial to work with a physical therapist who understands the procedure you’ve just had, your specific musculoskeletal needs, and your ultimate exercise goals.

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