Exercising Again After a C-Section

On March 11, 2016, my wife, Sam, brought our first born, Bryson, into the world. Due to my wife’s acute high blood pressure and Bryson stubbornly breeching, she underwent a Cesarean section delivery. After a few weeks, my wife asked what exercises she could do after the procedure. The PT and blogger in me immediately thought she would make a great case study.

I enjoy research and using evidence to recommend any treatment plans, so I started there. I didn’t find too many people writing about exercises after Cesarean section, other than a few recommendations to do very little. After talking with her doctor, my wife was told to not push exercise but if something didn’t increase pain/discomfort she would be safe to pursue some activities. (Note: Talk with your doctor before beginning any exercise program.) Once my wife had the “all clear”, my PT side really kicked into gear.

This is her post Cesarean section exercise routine and a little about her journey along the way.


Post delivery, Weeks 1-3:

Exercise:
  • Kegels
  • Gentle scar tissue massage
  • Breastfeeding (We learned this does burn significant calories)
Sam’s journal:

I maintained a minimal activity level to allow myself to heal. By week three, it started to become easier to get in and out of bed without pain and became more comfortable with doing housework. At the advice of many others, I got plenty of rest and slept when the baby slept the first three weeks.

Breastfeeding helps to get the baby weight off, but it’s a slow process. I continue to remind myself that it took nine months to gain the weight, so it can’t be expected to go away in a day, or week or even months.

I was very emotional the first three weeks, but don’t be too hard on yourself. It’s OK to let yourself have those “overwhelmed” feelings, but don’t internalize them. Share your feelings with your spouse/significant other/family/friends and know you aren’t alone!

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Postpartum, Weeks 3-4

Exercise:

Gentle core exercises such bridges, posterior pelvic tilt, cat/cow yoga exercises, and core exercises on hands and knees (quadruped). Quadruped exercises included arm raises, leg raises and alternating arm and leg raises while on your hands and knees.


Postpartum, Weeks 5-6

Exercise:

At week 6, she started gentle elliptical workouts. Also at this time, I noticed Sam had diastasis recti (2 finger), a separation in her abdominal muscles. She had to really start to focus on exercise technique to not increase the condition. She stopped doing any exercises that increased this separation or made her abdominal muscles appear to push out, and modified general activity as well.

Sam’s journal:

I now have no pain with everyday movement, but my core feels very weak. I have been comfortable with returning to exercise slowly and my emotions are more stable. I am starting to have more body image concerns knowing that the diastasis recti will make core exercises more difficult. I have also purchased scar tissue silicone based patches to help reduce my scar.


Postpartum, Weeks 7-8

Exercise:

Beginning week 7 or 8, we started to progress the exercises more to include the following:

  • Daily elliptical/walking
  • Bridges
  • Pelvic Tilt
  • Tilt with March
  • Tilt with clamshells (3 way – on back, and laying on each side)
  • Tilt with heel slide (will need a slippery surface – slide heel away from body as far as comfortable and return)
  • Side lying leg raise
  • Side planks on knees

When the above got easier, Sam progressed to exercises on an exercise ball. Including:

  • Tilts
  • Circles
  • Marches
  • Leg kicks
  • Arm raise
  • Alternate arm/leg
  • Same arm/leg

She also added some leg exercises, as she felt comfortable:

  • Wall sits
  • Squats
  • Lunges
  • Step ups (forward and lateral)
  • Step downs
  • 4 way hip kicks

Her guidelines for preventing worsening diastasis recti were: nothing should cause your abs to “push out” and should not cause incision or back/abdominal pain. You should not feel like you are pushing through any type of pain.


Postpartum, Weeks 8-9

Sam’s journal:

I’ve started to do more elliptical as tolerated. Mostly compliant with exercises daily. I am still wearing silicone patches and performing daily scar tissue massage and the incision is looking better. I have some pain if my incision is stretched laterally. My core is starting to feel more stable, and the gap between my abs is noticeably more narrow. Everyday activities and household chores do not cause any pain. I am able to carry Bryson in his car seat longer distances with no difficulty.


Postpartum, Weeks 9-12

Exercise:

By week 12, she had not been as compliant with exercises (which is typical), and went back to work. She had no pain with standing 10+ hours. By week 14, she returned to play slow pitch softball with our coed team. We are now approaching six months from our baby being here and she is not limited with any activity.

The above exercises were safe for her to pursue and seemed to work well with getting her back to work and recreational activity. Everybody is different and if you don’t feel comfortable with these activities don’t pursue them on your own! Speak to a heath care provider first and remember these should not hurt to perform!

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I encourage you to ask questions, share your experience and leave suggestions for future topics in the comments below. I will do my best to respond to each as timely as possible.

imageBryon Renwand, PT, DPT, CSCS, has been working with ProMedica Total Rehab since 2012, and is currently seeing patients at Total Rehab of Bedford, Mich. 

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