It Is Nice to be Told That I Can Exercise in the Post Natal Period

I recently put together some grabs from the feedback we received for our exercise education courses for trainers. You can watch them here: Modern Pregnancy Feedback & Modern Post Natal Feedback.

I was struck watching the Modern Post Natal feedback, by the mums and personal trainers who repeatedly commented that it was nice to train with a “can do” attitude. That we CAN exercise, that we CAN perform the sport we love again, that we need not be FEARFUL when we prescribe exercise… and it begs the question, if these fit, young, invincible personal training mums feel liberated by that message, what is the common message being sold to regular mums?

It is no secret that my view is that the common myths go both ways – either one is super conservative, focused on breathing and posture and kegals, or ignores the process all together and recommends that they return straight to exercise. Unfortunately the health industry seems to be unwittingly contributing to this at a mothers 6-week check. If they check the mother’s pelvic floor at all, they “clear” the mum for exercise with very little information. A mum can be forgiven for assuming that they are good to return to the activities they enjoyed pre-pregnancy, despite the radial changes her body has been through since then.

Conversely, the culture of “fearful programming” that pervades many trainers is having the opposite, but no less damaging, effect. Fearful programming is when a trainer prescribes conservative exercise because the client might be one of 10 or 20% of women that has a particular ailment. When all the ailments are added up, the result is such limited options that the trainer has no choice but to prescribe unpractical and useless exercises!

Activities of daily life: this 15wk pregnant woman is carrying a daypack, her 20kg son, and pushing her other 15kg son…

I’ve used this fitball program from fittamumma.com as an example, but there are literally hundreds of programs like it online. Whilst some women may be so restricted that this program is appropriate during the pregnant or post natal period, the vast majority will be able to perform more practical exercises such as what’s available on the Burrell Education blog.

1. Seated on fitball, dumbell rows: now, if you have a healthy mumma, this exercise is pointless. She won’t be able to lift enough in this movement to get a strength increase, and will be lifting more at home moving her baby from place to place.

   If this mumma has neck problems, she may not even be able to move her arms in this way for long enough to get the right training effect, and exacerbate her neck problems.

   Furthermore, when does a mumma ever move her arms straight in front of her? Everything a mum does is against gravity; think about loading a baby capsule, picking the baby up off the floor (and putting them down), changing nappies, and pushing prams… there is literally zero everyday movements that look like this exercise – so why is it in the program??

   If a mum wants to work her shoulders in the manner that she’ll be using them, think about hanging out the washing, lifting the baby for a cuddle, breastfeeding, and capsule-carrying. Doesn’t it make more sense to train her to perform these movements well?

2. Seated on fitball, opposite arm and leg raise. Again, if the mum has pelvic instability, and cannot work against gravity, then i might put her on a fitball for this exercise. I like that it is contra-lateral (opposite arm and leg) and they have to stabilise. However, this movement is completely impractical for our healthy mum! The skills that she will learn performing this exercise will not necessarily translate into pelvic stability in her activities of daily life – because she’s NOT working against gravity in this position!

   A better exercise choice would be Robin Kerr’s “swagger”. This is a walking technique (ie. working against gravity – like we live!) that teaches posture, contra-lateral co-ordination, and thoracic mobility. For me, this exercise trains the client in the environment in which she needs to function, and therefor makes more sense.

   

   Opposite hand to toe

3. Fitball squats… I do like a squat in anyone’s program, and the fitball is a good solution if you want to take the person’s ability to control their trunk out of the equasion.

   Exactly where in a mother’s activities of daily life does she lean against something and slide down the wall? Or is she more likely to be squatting forwards to pick up an object or toddler? And if the latter is true, would it not be more sensible to prescribe a goblet squat or bent leg deadlift? If we coach her with good technique then i can see these exercises actually improving her quality of life!

   The facts are that mums deadlift, squat, and lunge over and over again on a daily basis. They bend at the waist, they round their backs, and they twist. We have to train these movements so that we are setting our mums up for success.

   Incidentally, can you read how heavy those weights are in the squat? I can’t, but they look SMALL. A baby comes out at 3-4kg (average), so shouldn’t we be training with that as a minimum?

4. Fitball reverse lunge. This is in the same program as the seated opposite arm and leg raise. I would give the opposite arm and leg raise to someone who had an unstable pelvis, however, I would definitely NOT give this exercise to a women with an unstable pelvis! The large step and elevated, unstable, back leg is a recipe for pelvic injury in these populations, and I would be more inclined to train a basic lunge, then a lunge and reach, then elevate the front leg and destabilise with a power plate or wobble board. The reasons for destabilising the front leg is that it is the weight bearing leg. Elevating it takes pressure off the back hip and knee, and destabilising it gets the balance training in a strong position.
   

   Plain old lunges, with straps for Luigina because she gets vertigo

5. Seated on fitball, pelvic tilt. Perhaps this would be a good mobiliser, but not an exercise in a strength training program.

The next program i want to analyse is this “modified cross fit program” for pregnant women. This is the opposite of conservative, but they’ve tried to be! Having said that, whilst they’ve ignored some of the major physiological changes to a pregnant woman’s body, some of their suggestions are quite good, and because they’re not fearful they are prescribing stuff that may actually help that mum function post-birth.

1. Elevated push ups – Elevating the arms is a great way to take pressure off the trunk, which is important during pregnancy because most women’s abs will end up around the sides of their body. When the abs contract in this position, they squish everything in between out through the gap – essentially training a hernia or diastasis. Anytime the trunk is under load, case must be taken to ensure that the abdominals are not “doming” both during pregnancy and post natally. Watch this to see what doming is.
2. Shoulder press – except for the few women with low blood sugar, or low or high blood pressure, this is a practical exercise for a pregnant or post natal woman, providing she’s not doming down her mid-line. Again, just because some women couldn’t or shouldn’t perform this exercise, doesn’t mean all women can’t do it.
   
3. Plank – not thrilled about the inclusion of this exercise (see “push ups”), and it doesn’t make sense that they’ve elevated the hands in the push up but not in the plank. If a “core” exercise is necessary, i would be more likely to prescribe some kind of woodchop or deep core synchronising with the breath.
   

   Woodchop

4. Step ups – these are a GREAT modification for a box jump, and perfectly practical too. Many mums will climb stairs in the pre and post natal period so it is logical to train them. A pregnant woman also gets heavier as her pregnancy progresses, providing her own progression. On a side note, make sure they have a good working pelvic floor and stable pelvis first.
5. Reduced weight clean and press – reducing weight is definately an option, but the article is not clear on why. For me, a pregnant woman is gaining weight rapidly, but a post natal woman is usually losing it, while her baby gains weight rapidly. I think weight selection should depend on the integrity of the woman’s core and pelvic floor, and shouldn’t be a blanket “rule” that applies to all women.
6. Bodyweight exercises – great! Bodyweight exercises work against gravity and require a lot of synchronisation between the various muscle groups. However, care must be taken to ensure the abdominal integrity, pelvic, and pelvic floor are working optimally.
   
7. Pregnant burpees – see points 1 and 3. I agree that a pregnant and post natal woman has to get up and down off the ground, however my preference would be using this technique. I think you’ll find it just as challenging from a cardio perspective without compromising the vulnerable core.

The industry sorely needs some logic, accountability, and thought put in to it’s pre and post natal training, and i am pleased to be part of Burrell Education’s mission to achieve it!