A recent article in the Journal of Orthopaedic and Sports Physical Therapy (Deering et al, June 2020) discusses the research currently available to guide a return to exercise (including competitive sport) after pregnancy and childbirth. The short answer is, there’s not much. The article proposes a 3 phase approach to postpartum recovery in athletes.
Phases of the proposed return to sport plan:
1. Recovery: prioritize physiological recovery, relative rest to return to homeostasis, wound healing monitored.
In addition: monitor HR, BP, establish feeding, mother-infant bonding, assess mental health, assess musculoskeletal function, scar management, body mechanics.
This is when a pelvic health physical therapist should screen and assess for low back pain, pelvic girdle pain, incontinence, and abdominal wall integrity.
If no major healing concerns are present the athlete can progress to rehabilitation and training in < 12 weeks. If there are healing or cardiovascular concerns present from pregnancy/delivery related complications the time frame for the recovery phase may be extended.
2. Rehabilitation/Training: progressive aerobic exercise, strength training, sport specific exercises, biomechanical assessment, pelvic floor assessment/treatment, and monitor and adjust training goals.
In Addition: continue feeding support, reassess mental health at regular intervals, Nutrition counseling for support of successful breastfeeding, bone health, safe weight loss, and optimal exercise performance.
A physical therapist with expertise in both women’s health and sports physical therapy is the proposed primary health care contact along with lactation consultant, mental health therapist, coach, dietitian.
3. Competition: return to competition level of performance
In addition: educate the athlete and coach on when and how to involve the care team in the event of an injury or performance concerns.
Key takeaways: Each plan should be individualized and comprehensive, looking at the level of fitness prior to pregnancy, complications in pregnancy and delivery, sports specific demands, and performance goals of each individual. We should no longer be using arbitrary time frames and instead provide individualized care. A collaboration between multiple health care providers and allied health professionals should be implemented to provide the necessary support and education at each phase of the program. The proposed plan did not comment on hormonal changes in the postpartum period and did not specifically discuss time frame for c-section healing. Overall, more research is needed to develop best-practice guidelines returning athletes to sport and competition following pregnancy and delivery.
Contact the women’s health and sports medicine experts at MEND for help with your return to sport or competition after baby.