PT on the Net Research

Guidelines for Training Your Postpartum Clients


The postpartum phase of pregnancy should be given great care. Think of it as her “fourth trimester.” Her body has a lot that is going on in those months following birth and her workouts should reflect on that. While she may want to lose the extra baby weight right away you must encourage her to be kind to her body and give her body time to heal all while slowly working back into her workouts. In this article you will learn what questions to ask your postpartum clients, what to focus on during the postpartum phase, and recommended exercises.

Learning Objectives:

  1. Understand what questions you should be asking your postpartum clients.
  2. Learn what important focus points you need to be working on with your postpartum clients.
  3. Discover recommended exercises and modifications to include in those first postpartum sessions.

Questions to Ask Your Postpartum Clients

Just like your prenatal clients, be sure she has talked with her physician and received approval to exercise prior to beginning an exercise program, even if you trained her while she was pregnant.

If she is a first time client you must ask her about previous exercise experience along with any health or potential health issues. It’s important to know the answers to these following questions: 

The more you know about your postpartum client’s history the better you can create a specific program for her. Rather than just providing her with a workout, create a program that is also creating balance throughout her body. Give her extra “take-home” tips that she can do throughout her day, such as “stand or sit tall” - simple tips like that can help her carry the techniques you are working hard to teach her and apply them to her everyday life.

Postpartum Focus Points

Gradually increase her workouts

Typically your postpartum clients will return or want to begin their workouts after 6 weeks postpartum (and once their doctor has cleared them). This general 6-week guideline is given because those “physiologic and morphologic changes of pregnancy persist 4-6 weeks postpartum” (via ACOG.org), along with the risk of hemorrhaging. Start her where she left off working out in her third trimester and gradually increase her workouts.

Begin each session by asking her how she is feeling and then adjust her workout accordingly. Life as a mom with a newborn can be extremely exhausting and even more so if she has older children at home, which does not allow her any down time to rest. Just like when she was pregnant it’s important to work on increasing her strength but you want to do so by also helping her feel her best, leaving her workout sessions feeling better than when she walked in.

Re-teach her deep core activation

Teaching (or re-teaching) her how to connect her deep core muscles is an absolute must for your postpartum moms. Whether she has diastasis recti (abdominal separation) or her abdominals/core are stretched and weak, she needs to be given time to slowly strengthen and return to normal. It’s even possible for your postpartum clients to have a stronger core after baby then before, but it’ll take time. Here’s how you can teach her:

Exhale to gently lift and activate the entire pelvic floor muscles, while lifting up and zipping through her abdominals and continue by lengthening through the top of her head.

It will take practice but encourage her to practice this while holding her baby, walking, standing, and before she begins any exercise. This is the “core” to every movement in her workouts and in life.

Encourage her to be patient with her body

While she may be in a hurry to lose the extra baby weight, encourage her that in time it will happen but she must be patient. Keeping the focus turned towards strengthening and re-balancing her body and posture will in the long run give her great results. Plus, it takes time for her ribcage and hips to return to normal and her extra skin to rejuvenate. Typically with each pregnancy it may take longer, so keep her thinking positively but realistically, too.

Strengthen and stretch her back

Pregnancy itself can cause poor posture and now that your postpartum client is home holding her newborn all day and most likely nursing, her posture needs a lot of TLC.

There is much that contributes to posture but as a general rule for moms I recommend doing 3 to 5 times the amount of exercises to strengthen her back (including rear delts and triceps) vs. strengthening her chest. Some exercises to focus on for her back include:

For stretching her back, try the Forward Roll Pulses and Hips rolls featured in this article. Teach her to connect her deep core to help release stress going to her low back.

Get her rear back

Many new moms notice their rear disappeared, so now it’s time to get it back! Her glute and hamstring strength can relate to her having less back pain, better deep core connection and an overall better feeling about her body.

The recommended exercises in this article such as Hip Rolls into Bridging, Single Leg Curtsy Lunges, Squats with Frontal Raises, and Lunges with Twists all are great exercises for her hips, glutes, and hamstrings.

Full body exercises are a must

Teaching your postpartum clients some full body exercises she can do at home is a great way for her to see results faster and for her to do more in less time, such as the Squats with Frontal Raises and Lunges with Twists featured in this article (or any featured in this pregnancy article series). Encourage her that even just 10 minutes on her own at home can add up and make a difference.

What about diastasis recti?

This is very important when training your postpartum client. It’s also important to know how far along postpartum she is. Here are my expert guidelines for approaching diastasis recti (the separation of the rectus abdominals):

Exercise can greatly decrease her fatigue

In a new study on the effects of Pilates exercises on postpartum maternal fatigue by F. Ashrafinina and colleagues found that at week eight postpartum of follow-up those women who did 30 minutes of Pilates exercises, five times per week starting at 72 hours after birth, reported much lower levels of general fatigue, physical fatigue, and mental fatigue.

I’m not recommending you start your clients this early doing formal exercise but it is a good idea to encourage her to move, such as walking, doing some light exercises that do NOT put great stress on her uterus and abdominal area. Be sure she has discussed with her doctor that it is okay for her to do some light exercise. While many doctors may encourage her to move, some may not. As trainers we understand how much muscle mass she stands to lose if she waits those six weeks following birth before getting back into exercise, but this is also a very crucial time for her body to recover and to bond with baby.

Recommended Exercises

Immediately below is a video demonstration of the recommended exercises from this article, and even further below are written instructions with photo aids of the recommended exercises.

Hip Rolls into Single Leg Bridging

This is a perfect exercise for that first session postpartum and a good exercise for her to do daily at home to help reconnect her deep core, while stretching her low back.

Hip Rolls into Single Let Bridging 1

Hip Rolls into Single Let Bridging 2

Hip Rolls into Single Let Bridging 3

  1. Lay supine with spine in a neutral position, knees bent and feet shoulder-width apart. (Neutral spine is when the pelvis is balanced between the exaggerated posterior and anterior positions, the PSIS and ASIS points).
  2. Exhale to activate pelvic floor and begin to tuck her pelvis, then engage glutes and hamstrings to slowly roll her spine up one vertebrae at a time.
  3. Inhale to hold and exhale drawing ribcage down. Slowly articulate spine rolling back down one vertebrae at a time. Complete 5 to 10 reps then move into Single Leg Bridging. 
  4. Single Leg Bridging: Move legs together and lift hips off the ground.
  5. Then reach one leg up towards the sky. Do 10 to 20 hip pulses then switch legs.
  6. Place both feet together and exhale to slowly articulate rolling the spine back down one vertebrae at a time.

Forward Roll Pulses

Forward Rolls are a fantastic exercise during pregnancy and again postpartum. Teaching her pulses is a safe and effective way to stimulate deep core connection, while being gentle on her abdominals. Do 10 slow pulses in sets of 3 to 5.

Forward Roll Pulses 1

Forward Roll Pulses 2

  1. Kneeling with the ball positioned close, inhale to initiate movement by tucking her chin to slowly articulate her spine and roll the ball out.
  2. Exhale to initiate movement by rounding her spine at her pelvis and gently pressing hands into the ball; focus on articulating her spine back about half way so her spine is rounded and she can feel her abdominals lightly contract.
  3. Inhale to lengthen part way out then exhale to rounded, continue for about 10 pulses then on the last one exhale back to starting.

Single Leg Curtsy Lunges

A good exercise to target her hips, glutes, and deep core. Do 10 on one side then switch sides. Have her hang onto a solid surface such a pole if she needs extra support.

Single Leg Curtsy Lunges 1

Single Leg Curtsy Lunges 2

  1. Start in a curtsy lunge with the right leg back and across the left leg.
  2. Exhale to stand reaching the right leg out and away from her body, reaching through her heal and lifting up through her torso to activate core muscles.
  3. Inhale to lower. 

Squats with Frontal Raise

This combo exercise is wonderful to strengthen her deep core, improve posture, strengthen mid-back and shoulder muscles, and keep glutes and hamstrings strong. Do in sets of 10 to 20 reps, with lighter dumbbells to start. Be sure she only takes her stance as wide as it feels comfortable for her pelvic area (especially if she had a vaginal delivery).

Squats with Frontal Raises 1

Squats with Frontal Raises 2

  1. Standing in a slightly wide squat, feet slightly rotated out, hold the dumbbells between legs.
  2. Exhale to stand pulling the dumbbells to her chest while drawing shoulders gently back doing a frontal raise.

Lunge with Core Twist

This exercise is a good core focus exercise while strengthening her glutes, hamstrings, and posture. Do 10 reps then switch sides, using a light dumbbell or medicine ball.

Lunge with Core Twist 1

Lunge with Core Twist 2

  1. Starting in a forward lunge position, keeping the weight in the heel of her left leg while rotating her torso and reaching her arms past her left.
  2. Exhale to bring her back leg through to standing, instruct her to use her deep core to bring her back leg through and lift, or modify and just bring back leg to tap by her standing leg, and continue rotating her torso reaching to her right side.
  3. Inhale as to move back into her forward lunge and rotate back to the left side.

Conclusion

Now you understand what questions you need to be asking your postpartum clients when they first return or are new clients postpartum, and why those first 6-weeks are important for her body to recover. Keep her moving by focusing on deep core connection along with the other key focuses that can help her feel stronger, confident, and more energized. Include the recommended exercises (and modifications) in those first sessions as they all are a safe and effective way to target her core and full body exercises that she can do at home when she is short on time. Remember to remind her to be patient with her body, to give her body time and that those first weeks to months postpartum are an important time for her body to heal.

References

American Congress of Obstetricians and Gynecology (ACOG). (2002, January). Exercise During Pregnancy and the Postpartum Period. Retrieved June 30, 2015, from http://www.acog.org

Ashrafinia, F., Mirmohammadali, M., Rajabi, H., Kazemnejad, A., Sadeghniiat Haghighi, K., & Amelvalizadeh, M. (2015). Effect of Pilates Exercises on Postpartum Maternal Fatigue. Singapore. Med J., 56(3), 169-73.

Kirkegaard, H., Stovring, H., Rasmussen, KM., Abrams, B., Sorensen, TI., & Nohr, EA. (2015). Maternal Weight Change From Pre-pregnancy to 7 Years Postpartum—The Influence of Behavioral Factors. Obesity (Silver Spring), 23(4), 870-8.

Kahyaoglu Sut, H., Balkanli Kaplan, P. (2015). Effect of Pelvic Floor Muscle Exercise on Pelvic Floor Muscle Activity and Voiding Functions During Pregnancy and the Postpartum Period. Neurourol Urodyn., Feb 3. doi: 10.1002/nau.22728.