September 22, 2017 at 2:15 pm #55509
Hi, i am 30 and 9 weeks post-partum from my first child. I have a stage 1 to 2 cystocèle and a mild rectocele as well. My symptoms (bulging, heaviness while standing and walking) started at 3 weeks post partum. I am followed by a perineal PT since then. I am a very competitive runner (5 to 21 k and cross-country) and an ex competitive swimmer. I trained 6 x/week during pregnancy (running until 33 weeks + swimming, elliptical, strength workouts). I am doing supervised core and perineal rehab since day 2 and i am already very fit but i still feel a light heaviness and bulging almost every day on/off. I started spinning and walking with progressive length and intensity at 1 week post-partum and elliptical progressively at 5 weeks post-partum and swimming at 6 weeks. My questions are:
1) Is elliptical including high intensity safe for now (while i do it i don’t really feel my symptoms and if so, i stop and go on my bike)
2) Are swimming butterfly, kick at a high intensity and flip turns safe ? I sometimes feel the bulge while doing this..(And i still have a 1 finger diastasis rectis)
3) Is walking safe if i feel the bulge (but it’s not worse during and after)
My PT says all oh these are safe but i wanted your advice..also, she says that i would be ok to start very progressive running at 3 moth post-partum since my pelvic strengh is almost normal now. What is your advice on that?
Thank you!September 24, 2017 at 9:56 am #55745
Note that since 7 weeks i’ve been doing the exercices included in the hab-it DVD (except a different kegel program) plus some more transverse strenght and i was planning on starting the advanced program before starting running.October 3, 2017 at 11:33 am #56267
I spent some time trying to answer the same questions as you. I don’t think anything at “high intensity” is particularly safe for you right now, as you’re still early postpartum and healing is a long journey. I was told butterfly is not safe (at least for now). Elliptical at a low resistance and pace should be ok (pay attention to your body though, and again, at least for now). When swimming, front crawl for example, it is still very possible to cause pressure on the pelvic floor. It’s therefore very important that you ensure you are not inadvertently bearing down during your stroke. Ensure you are blowing out while under water and not breathe holding at any point. 1 finger width diastasis is normal. I would still start slow with swimming and see how your symptoms feel after. I had to cut back a bit for now, as any swimming longer than 35 minutes was making my symptoms worse. Hoping to keep building though. I’m 4.5 months postpartum.October 18, 2017 at 6:58 am #57132
I like your mind set – you go after it! Here on my thoughts:
I don’t like ellyptical and here is why – it puts you in a position of flexion. At no point does your hip extend past neutral when you are on the ellyptical machine and when your arms are reaching forward like that, you tend to look like a turtle in a flexed position on that machine. Would much rather see you on a cross country ski machine, using kick board in the water, walking/running with focus on great toe push off, biking. All of these activties allow your body to remain in a neutral spine with tail bone lift and we get some hip extension with every stride, rep, and kick. It is this glute activation past a neutral hip with co-contraction of your TA to limit lumbar hyperextension that is key to your core strength and symptom resolution.
The butterfly stroke is tough because their tends to be a strong rectus recruitment. Unfortunately our rectus is not our friend when we are talking about trying to lift pressure up off our pelvic floor or trying to close our diastasis. Your increased symptoms demonstrate this. Listen to your body – it will usually tell you the answers!
Walking is safe, however, I encourage you to read through my Cardio topic within the Educate Yourself section so that you begin to understand the focus I want you to have on glute activation and hip extension past neutral within your workouts. Extension is your friend. Push off your big toe!!!
Finally, if your Kegel strength is where you want it, then trust your co-contraction of your pelvic floor muscles and begin to cut back on amount of time working just Kegels. They are a great starting point but it is the co-contraction of the TA, Pelvic floor, and multifidi, or the adductors, TA, and pelvic floor, or the deep hip rotators, TA, and pelvic floor that will truly have you symptom free, not the isolation of your pelvic floor muscles!!!
Read through my Rectus vs TA entries as well. You seem like you are very close, just need a deeper understanding of muscle firing. You can get this in my Educate Yourself section!