Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport

Abstract

Increased participation and duration in sport has become commonplace for women with their involvement often including the transition to motherhood in the peak of their athletic careers. No rehabilitation models that assess the full spectrum of pregnancy to postpartum have been developed for women to assist in safe exercise progressions that reduce postpartum symptoms and optimize performance during the return to full activity. Referral to physical therapy both in the prenatal and postnatal period is currently not considered standard of care to reduce prevalence of symptoms such as musculoskeletal pain, diastasis recti, and pelvic floor dysfunction which may ultimately interfere with physical activity and performance. This commentary presents a timeline and suggested progression for exercise participation to improve awareness of the musculoskeletal changes that occur after labor and delivery. The concepts covered may increase the understanding of how to manage pregnant and postpartum athletes from a musculoskeletal perspective and serve as a starting point for establishing appropriate and guided rehabilitation for safe return to sport after childbirth.

Current Research Trends, Hotspots, and Frontiers of Physical Activity during Pregnancy: A Bibliometric Analysis

“…Generally, PA during pregnancy with moderate intensity is agreed to be basically safe and beneficial for both mother and fetus [ 47 , 48 , 49 ]. However, exercise with contraindications is outside the purview of what an exercise expert is allowed to do.…”

Guidelines for Prenatal and Postpartum Resistance Training

“…Prenatal exercise has a plethora of benefits for both pregnant women and the fetus(es) they carry. Exercise during pregnancy has been shown to increase the incidence of vaginal delivery as well as lower the incidence of cesarean delivery, excessive gestational weight gain, gestational diabetes, gestational hypertensive disorders, preterm birth, and lower birth weight [1][2][3][4][5][6]. Additionally, prenatal exercise has a positive impact on healthy growth and improved cognition and intelligence of the baby after birth [3].…”

“…An estimated 37% of women experience urinary incontinence during pregnancy and it is most common in the third trimester [24]. Running and jumping will increase the incidence of urinary incontinence during pregnancy as it significantly increases the stress on the pelvic floor [2] which is already undergoing increased stress from the weight of the uterus and growing fetus. Other lower-impact modes of cardiovascular training should be considered to replace running such as walking, swimming, stairmaster, elliptical, upper body ergometer, etc.…”

“…Equipment selection will also be an important consideration as pregnancy progresses. As the pregnant belly continues to grow, lifting a barbell may not be comfortable or safe-ensuring that there is adequate clearance from the belly while lifting and lowering the barbell will need to be a top priority to prevent dropping the bar on the pregnant belly [2]. Balance will also be altered as the pelvis tilts anteriorly and the pregnant belly expands 18].…”

“…Historically, pregnant and postpartum women have been discouraged and even advised against partaking in physical activity for fear of harming or terminating their pregnancy [1]. With an explosion of research in prenatal and postpartum exercise in the last decade, not only has the myth that physical activity causes miscarriage been disproven, evidence to support prenatal and postpartum exercise as a contributing factor to improved maternal and fetal health has emerged [1][2][3][4][5][6]. Adherence to guidelines for prenatal and postpartum exercise, including resistance training, can ensure safe and active pregnancies and restorative postpartum recoveries.…”