Congratulations, you had a baby. You’ve rested for the past several weeks. Focused on healing, bonding and figuring out how to care for another human. Then at your 6 weeks postpartum visit you are told, “you are ready to return to all forms of exercise.”

Full stop.

But is your pelvic floor ready for fitness exercise?

No!

Let’s check your muscles to see if they are ready for exercise. Do you feel ready for exercise? What forms of exercise do you like to do? What did you do pre-pregnancy or during pregnancy?

To be fair, your OB or Midwife aren’t the experts on exercise. They aren’t even the experts on muscle function. So they shouldn’t be the ones to clear you for exercise, other than from a cardiovascular and pathological perspective.

The real experts in muscle function and exercise are pelvic floor Physical/Occupational Therapists. Which is why every person after giving birth should see a pelvic floor PT or OT for clearance to exercise.

Unfortunately, that isn’t the case [yet]. So what can you do?

Test yourself!

Is this easy? No and it helps you become more acquainted with your own body.

There are 5 areas to test to see if you’re ready for fitness exercise at 6 weeks postpartum. These do not test your pelvic floor directly, but look at how well your whole system is working together.

I’ll go over how to test and what to look for. But if you are visual learner, I recommend you go to my Youtube Channel to watch and hear me talk you through these tests.

1.360 breathing

First up is your breathing. We want to make sure you are getting your respiratory diaphragm on board to sync up with your pelvic floor. This requires a 360˚ inhale and exhale. What that looks like is your ribs expand out and up like an umbrella opening on your inhale and down and in like an umbrella closing on exhale.

How to test yourself:

In sitting place your hands on your bottom ribs so your fingers are resting on your back and your thumb is on the front portions of the ribs. Inhale through your nose and see if your ribs move.

What you should feel:

Your ribs, especially in the back lift into your hands with a soft belly and pelvic floor.

What you may find/feel instead and what is means:

• Your chest or shoulders rise - you’re accessory breathing muscles are working on over drive, which can make taking a deep breath more challenging and harder to access your abdominal muscles since your ribs can stay in a lifted position.

• Your back extends or arch- you’re back muscles are working on over drive which flares your front ribs with every inhale. This puts more pressure into your abs and pelvis and keeps your abdominal muscles in a lengthen position which makes it harder for them to work.

• Your belly inflates or sucks in - while inflating your belly can helpful for some reasons, it can also keep your ribs from moving as your body is finding the path of least resistance to inhale. On the other hand if you find yourself sucking your belly in on your inhale, this is creating a vacuum effect on your pelvic floor which then causes a bear down every time you exhale.

As you can see how you breath is an important component, not only to living, but to how your body and core muscles function. If you have difficulty with 360˚ breathing, you’re not alone. It’s very typical to have a different pattern from all the changes that happen in pregnancy. When this is the case though, correct exercises that improve your 360˚ should be top priority!

2. Pelvic pressure or leakage

Next up is pelvic pressure, meaning do you feel pressure in your pelvic floor/perineum/vagina/rectum or do you leak urine when you exercise. This area looks at your ability to manage intraabdominal pressure. There are several aspects to this test, including: position, movement, reps and load. This test is more of an on going test, but you can begin with more basic and functional moves and progress from there.

How to Test Yourself:

During a squat or lunge you’re going to pay attention to the sensation in your pelvic floor. Do 2 sets of 10 without any additional weight. If you have no signs of pressure or leakage add the weight of your baby (10-20 pounds) and do another 10 reps.

What you should feel:

When moving through the squat or lunge you should feel in control of the move through your trunk while your legs move you.

What you may find/feel instead and what is means:

• Pressure or bulging in your perineum or vulva - your pelvic-core is unable to manage the intraabdominal pressure change through the move.

• Urine leakage - your pelvic floor is unable to manage the intraabdominal pressure change through the move.

• Back extension or rib flare - your may be relying on your default pattern from pregnancy of using your spine (including your psoas) muscles to stabilize

• An pelvic movement - this could be a drop to one side or tilting forward or back, revealing a weakness in your pelvic stabilizers or over utilizing glutes/hip rotators

If you are unable to perform a body weight squat or lunge without pressure or leakage, you may need to modify the move or switch to different leg exercises like a bridge as you build strength in your pelvic floor and core.

If you can do body weight but not baby/gear weight, reduce the pounds to what you can do then gradually increase as your strength improves.

If you don’t have pressure or leakage in the move but notice later in the day you have issues during a squat or lunge functionally (think picking something up). It may be from the positioning you were using (the last two bullet points from above) or your core endurance.

As I mentioned above, this area should be tested with multiple exercises. Just because you can manage with one exercise doesn’t mean you can with all. And just because you can’t manage with one exercises doesn’t mean you can’t with others. My biggest advice for this one is find your threshold of control with pressure management and progress from there to meet the demands on your life and the form of exercise you like to do.

3. Doming with load

Next is doming with load. This is also a pressure management test. Just like with pelvic pressure, this really isn’t a one time test, but one that you’ll want to reassess as you go because it can be dependent on position, movement, load/resistance/force, speed and reps.

How to Test Yourself:

Lie on your back with your knees bent and lift your head off the floor. Repeat 3 times.

What you should feel:

A flattening and scooting in of the abdominal wall as your spine lengthens and flexes.

What you may find/feel instead and what is means:

• Midline doming of the abdominal wall - you may have a diastasis recti and the abdominal tissue is unable to manage the pressure created from the head lift

• Lower belly bulging - your lower abdominals are unable to manage the downward pressure from the head lift

• Whole belly bulging - your abdominals are contracting and pushing out at the same time

Even though you are looking at doming, it’s a good idea to also pay attention to how your abdominal muscles are contracting. This helps you know if your deep core is turning on enough, in the right way or at all. Again, doming can happen in various positions so the “crunch” isn’t the only exercise you’ll want to pay attention to, but it’s a good place to start. If you have doming or an of the other signs you’ll want to work on connecting to your deep core through exercises you can manage the intraabdominal pressure in, gradually progressing to more challenging exercises.

4. Glute awareness

Next is glute awareness. Glute strength is important for pelvic stability and pelvic floor function. Weakness and tension can impede the pelvic floor from doing it’s job or cause pelvic symptoms like urgency/frequency and pelvic joint pain.

How to Test Yourself:

Lie on your stomach with your legs straight. Lift one leg off the floor at a time. Notice how you lift each leg. Is it easy, hard, different from side to side.

What you should feel:

When you lift your leg should come straight off the floor with your glutes starting the movement and your hamstrings (back of thigh) contracting secondarily.

What you may find/feel instead and what is means:

• You can’t lift your leg - weak glutes

• Can’t lift your leg without your hip pushing into the floor - possible imbalance of your glutes and hip flexors

• Your back arches when you lift - possible weak glutes or default pattern of back extensors contracting first

• You feel your hamstring turn on first - weak or uncoordinated glute control

• You feel your hips turn out to lift - likely using more hip external rotators to move the hip rather than your glutes

If you find yourself clenching your glutes or tucking your butt throughout the day it may be a compensation for lack of stability. Even though it may work in the short term this is not a long term solution.

5. Core control with hip hinge

Part of your cores job is to stabilize your spine through movement. A lack of spine stability can lead to back pain and other issues. To be clear, when I say spine stability, that does not mean no movement in your spine, on the contrary you want to be able to move your spine through multidirections in a controlled way. It’s when you limit your movement or go outside a controlled range you may find yourself in trouble.

How to Test Yourself:

A hip hinge is a great place to start for testing your core control for spine and pelvis stability. Essentially you are testing how well you can keep your spine and pelvis in a neutral alignment as you bend forward at the hips. So as you bend forward your spine should remain stacked over your pelvis even though you are hinging forward.

What you should feel:

Your abdominal wall engaging just enough, meaning you use the least amount of contraction needed to maintain a neutral spine and pelvis through the movement. Objectively your ribs and pelvis should not change distance from each other, when you start in a neutral spine/pelvis position.

What you may find/feel instead and what it means:

• Abdominal wall bulges - this is a sign your core is either not responding or is contracting while pushing out.

• Spine rounds - this isn’t necessary a bad thing, but you want to make sure you can also remain in neutral as needed

• Spine arches/ribs flare - this is a sign your back extensors are either tight or working more than your abdominal muscles, or it’s a default pattern your body goes to because of pregnancy posture

• Pelvis tucks - this is a sign of your body trying to find stability through using your glutes, unforutnately it actually shuts the glutes off for the return from hinge position relying more on your back muscles

As I mentioned before spine and pelvis stability doesn’t mean no movement, but controlled movement in all directions. Starting with neutral and working outward helps you find your threshold to bulid from.

These tests are for basic exercise, not high impact, like running or cross fit. These require additional tests. However, these are a great place to start because buliding a foundation of strength and mobilty prior to returning to running and cross fit will reduce your risk of injury and pelvic floor dysfunction.

Returning to exercise doesn’t have to be confusing in postpartum, but it should be methodical and planned. The good news is exercise can begin within days of giving birth depending on your definition of exercise. Which means when you reach that 6 weeks your more ready to return to regular exercise to restore and rebuild your strength to meet the demands of motherhood.

Watch me do these tests by heading to my YouTube channel!