Pain while exercising postpartum - what is normal?
In short, pain during exercise is never normal. Now, of course exercise can be uncomfortable. If it weren’t you probably aren’t working hard enough to get any benefits out of what you are doing. If you are weight lifting, there should be discomfort in the muscle you are working in order to build strength and endurance. If you are running, your heart and lungs probably get tired (oh, and your legs too). If you are doing yoga, you are probably experiencing new ranges of motion that may feel uncomfortable when you first try them. However, there should never be pain during exercise. Pain is our body telling us that something isn’t right and that we should change something.
If you are having pain during exercise postpartum, there are a few things to consider. How many weeks postpartum are you? What was your level of fitness before you got pregnant and during your pregnancy? Did you have a vaginal delivery or a cesarean section? If you had a vaginal delivery, was there any tearing? Did you have any excessive bleeding after delivery? Do you have any other conditions that may impact your recovery time? Have you been getting enough sleep for your body to heal?
The general recommendation for exercise is to wait about 6 weeks or until you are done bleeding. However, this doesn’t mean you should lay on the couch all day for the first 6 weeks. Getting rest is important, but moving your body during early postpartum in safe ways is important as well. You can do body weight exercises, especially focusing on breathing coordination, core connection, and stability exercises. You can walk as well, but don’t try to walk quickly and don’t go too far. If you are doing these activities in the first few weeks postpartum, make sure to monitor your bleeding, as increased bleeding is your body telling you that you are overdoing it and that you need to rest.
At your 6 week follow up appointment, you will likely get cleared for exercise, unless you are dealing with other complications. After you have been “cleared” for exercise, this is when you can increase the intensity of your workouts. There are several caveats, though. If you did not do any specific exercising during the first 6 weeks, your body might not be ready for a full on HIIT workout. Take things slow and gradual. You can find many workouts online these days, but they often move at a faster pace than your body may be ready for. Try to find a routine that is specific for postpartum, especially early postpartum. If you have been working on your breathing, core connection, and stability exercises, you are probably ready to increase to more reps, add weights, or even increase speed.
Your level of fitness before you got pregnant and during your pregnancy are also important to consider. If you didn’t do any strength workouts during pregnancy but now you are asking your body to adapt to that type of exercise, your body may revolt. Similarly, if you go out and try to run when you were not running previously, you will probably experience pain.
C-sections usually require a bit more recovery time, so you may want to wait until closer to 8 weeks postpartum to start a formal exercise routine. Perineal tearing can also impact what types of activities you may be ready for. Especially with a grade 3-4 tear, we want to be careful that we don’t increase intensity too quickly or we can compromise the tissue integrity.
If you had any excessive bleeding postpartum (hemorrhage) or any other conditions that may impact recovery time, you may want to ask a few additional questions at your 6 week visit. You may want to ask if there are any restrictions or recommendations for you to follow when increasing activity levels.
And finally, sleep matters way more than we think. Sleep is when our body repairs itself. So not only the healing that must happen postpartum, but healing any tissue “injury” from exercise. Especially if you are weightlifting, you are creating little microtears in the muscle, which when repaired, builds strength. This is a good thing and we want these little micro injuries, but if we aren’t getting enough sleep to rebuild these tissues, we can have breakdowns and injuries occur. If you are feeling completely depleted and exhausted, a nap is going to do you more good than a workout, so prioritize sleep over workouts in this phase of life.
If you are hoping to return to workouts that require impact, such as running, CrossFit, most HIIT workouts, jumping, or heavy lifting, the recommendation is to wait until 12 weeks postpartum and to gradually ramp up impact training. If you are specifically looking to run, download our free checklist to see if you are ready to run.
If you experience pain during any of these phases, you should listen to that pain. Pain is not normal and as aforementioned, it is your body telling you something isn’t right. It might be that you are trying something too soon that your body isn’t ready for. It could be that your insides are still healing, even though you feel fine on the outside. Or, it could even be that you are using improper form. Your body and center of gravity change during pregnancy and then change again postpartum. So you have to get used to a new balance system. Try the move again but try to do it differently. Sometimes small changes can make a big difference.
If you are exercising postpartum, have tried a few of these strategies, and are still having pain, contact a pelvic floor physical therapist. Seeing a pelvic PT trained in various movement screens and internal work can help see if there are any glaring issues with the activities you are trying to accomplish and can help you get back to pain free exercise!