Pelvic Health 2.0 : Postpartum Physical Therapy Care is Getting a Fitness Forward Revamp

“Take it easy for six weeks and then return to activity as tolerated” might get our vote as the worst commonly issued medical advice, especially for women after giving birth.  Before we talk about evidence, let’s acknowledge that this advice doesn’t even pass the common sense test.  Imagine having trauma to a muscle group, resting for six weeks with zero rehabilitation, and then returning to full activity without any guidance.  We can all agree this can’t be best practice for any region, let alone an area as complex and important as the pelvic floor. Let us discuss how this relates to the practice of postpartum physical therapy for women.

What does evidence say about postpartum physical therapy?

Fortunately the evidence supports a different and better approach to postpartum life.  In 2021 The American Journal of Obstetrics and Gynecology published a paper titled “Early Postpartum Physical Activity and Pelvic Floor Support and Symptoms 1 Year Postpartum”.  In short, this paper found that moderate exercise 2-3 weeks OR 5-6 weeks following vaginal delivery did NOT increase incidence of pelvic floor dysfunction.  Additional evidence for ditching the infamous “6 weeks of rest” advice comes from The Physical Therapy Journal with a paper published in 2020 titled “The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum”.  The authors found that early postpartum exercise had either a protective effect or no effect on pelvic floor health and concluded with this quote: “Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6 weeks after giving birth”.  We could go on, but believe these two recently published articles from highly respected journals effectively supports our point that the time for a paradigm shift is here for postpartum physical therapy.

Mothers deserve to know this information.  They deserve to be granted permission to move, to build confidence in their postpartum bodies, and to use exercise to support their mental health during a phase of life that is unpredictable and challenging.  Please consider sharing this information with a mom or mom to be in your life.

The Institute of Clinical Excellence is steadfast in our commitment to teaching the good news of fitness forward postpartum physical therapy and care through our online and live CMFA PPP course offerings.  We are training hundreds of clinicians (physical therapists, occupational therapists, physicians, chiropractors, and more)  across the country every year to use an evidence based approach that supports and guides mothers through an active and empowered pregnancy and postpartum journey. Our online postpartum physical therapy course takes a deep dive into the research guiding all stages of pregnancy and postpartum care while our weekend live course teaches internal examination/treatment day 1 and spends all day 2 in the gym teaching return to fitness!  Both courses are pre-approved for CEUs and available to a wide range of rehabilitation and medical practitioners, find them at www.ptonice.com!

References

Nygaard, Ingrid E., Ali Wolpern, Tyler Bardsley, Marlene J. Egger, and Janet M. Shaw. 2021. “Early Postpartum Physical Activity and Pelvic Floor Support and Symptoms 1 Year Postpartum.” American Journal of Obstetrics and Gynecology 224 (2): 193.e1–193.e19.

Tennfjord, Merete Kolberg, Marie Ellström Engh, and Kari Bø. 2020. “The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum.” Physical Therapy 100 (9): 1681–89.