No matter how many weeks, months, or years postnatally you return to exercise, chances are your body will be different to what it was before. Pregnancy and childbirth are massive physical events, and they leave their mark on the body – not necessarily a negative one, but different all the same. If you have not seen a women’s health physio since having your babies, then now is the time.
Furthermore, you’re going to keep an eye on the following red flags as you progress through your program. If you notice one, you can be sure there is another one that you can’t see – pelvic dysfunctions always come in pairs – so send yourself to a women’s health physio, and begin your deep core restore protocol (a 6 Step process for mums is available here). You can look up your closest WHP here: https://whta.com.au
Red Flag #1 – Doming
Doming is not necessarily a cause for alarm, but it is a red flag that is cause for consideration and investigation. If you see doming, chances are you’ll also have back pain or stress incontinence as well – so seeing a pelvic physio is important!
Next, check your posture – do you see upper or lower cross syndrome? If yes, then posture training becomes a higher priority than your regular program because both of these things impact pelvic function:
- upper cross syndrome pushes down and out on the PF and abdominal wall
- lower cross syndrome further stretches the abdominal wall and disables the PF
Next, check your breath – do you breathe into her lungs? Or are you chest or belly breathing? If you see anything except an intercostal breath, then you need to re-learn how to breathe! Your ribs should expand and contract with every breath, but if they’re stiff your body finds a way.
Finally, experiment – if you saw doming during chin-ups, is there a level of chin-ups you can do without further doming? If you saw it in a plank, can you do a version of the plank that doesn’t cause doming? Or is there another exercise that hits your target muscles without pushing out through the abdominal wall? Give it a crack and see what happens!
Red Flag #2 – Leaking Urine or Faecal matter
Yep. We’re starting today with Faeces.
Now, it may seem obvious that a woman who is leaking anything she should be holding in while training is a red flag, but many trainers are continuing to train women completely oblivious to this possibility. Furthermore, they assume that because you don’t say anything, that nothing is occurring.
Here’s the thing, though.
Women are masters of fitting in, in a world shaped for men’s comfort. Before you bite my head off, look at public toilets: urinals, toilet paper, sit-down toilets, soap and water are necessary for men. For women, toilets, toilet paper, menstrual products, water and soap are vital. Who has their needs met? So, women learn to fit in.
The same issue is threaded throughout the fitness industry, particularly in our screening processes. If we aren’t asking about leaking or incontinence, then the majority of women will go ahead and fit in anyway, despite their symptoms or pelvic health. An even larger group of women won’t participate in exercise at all, with pelvic floor dysfunction being the number 1 barrier to exercise for women more broadly.
So. You have to get comfortable TALKING about whether or not you’re leaking, and then you have to have a referral process with your local pelvic health physio. If they don’t ask, you won’t tell, and you miss a fantastic opportunity to promote and value your body, your health, and your future health.
Look up your local women’s health physio here: http://whta.com.au/
Red Flag #3 – Back Pain
I know what you’re thinking… ALL women have back pain, and you’d pretty much be right! Women have back pain for a variety of reasons, their back might be tight, unstable, unaligned, etc. So you can’t assume stretching is going to “fix” it.
What you may also not realise is that back pain is a gigantic red flag for pelvic dysfunctions. In the post natal period, which I’d say is anytime after a woman gives birth – to infinity, a woman with chronic back pain needs to see a pelvic health physio.
Not a muscular-skeletal physio.
Not a sports physio.
A pelvic health physio.
In addition, pelvic floor exercise has an analgesic effect on back pain. So even if your back pain is NOT pelvic dysfunction, you can ease it by learning the kegal ( learn from a professional – it’s more than just vagina squeezing!).
Red Flag #4 – Mental Health Changes
I think we have a good awareness of what post natal depression looks like, and perhaps you’ve even heard about post natal depletion. If not, post natal depression is a clinically diagnosed form of depression in the post natal period, with symptoms like insomnia and a profound loss of joy. Depletion on the other hand is closer to a form of anxiety, with symptoms such as hypervigilance, frustration, overwhelm, and loss of libido.
For example, have you noticed any changes in:
- How do you talk about yourself? Are you bubbling with self-deprecating talk, self-put-downs, or vocalising depressing ideas and attitudes? And is this new for you?
- Your behaviour? Are you cancelling appointments and catching up a lot? Turning up late? Is that new? Why are you doing it? What’s happening at home?
- Your habits? Have you quit wearing deodorant? Or are you in clothes from two days ago? Were you always relaxed about your personal hygiene or is this something new? Or are you training an extra 1.5hrs either side of your session? Why? Why the change?
- Your appearance? Do you have an unusual skin tone, or are your eyes half-lidded? Are you rapidly gaining or losing weight?
- Your mood? Were you previously joyful and adventurous but now you’re flat and irritated? Or are you jerky and high-energy and rushing about like a chicken?
There will be some version of the changes above for every post natal woman; as they adjust to their new role, and the lack of sleep (not that we ever adjust to that). What is key is noticing these changes, and making sure you’re ok (not judging each other because one of us doesn’t wear make-up or deodorant anymore)!! If you’re not sure, Beyond Blue has a wonderful resource in the mental health checklist for mums. You can fill it out and go from there: https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/mental-health-checklist-for-mums
The next step is heading to your GP, who will take you through the process of getting a Mental Health Plan, where counselling will be subsidised.
Again, do not diagnose or refer yourself – go to your GP and let them take it from there.
Clare Hozack is an ex-athlete and owner and founder of IntoYou. Clare is currently a strength and conditioning coach, using her skills to return women to functionality after having kids, and providing education for personal trainers in how to train women better for life.