There is a shortage of research regarding exercise and rehab protocols for pregnant and postpartum women.  In the past, pregnant women were told exercise was not safe and were often put on bed rest. This has since been debunked but more new research is still needed. A new research article published by R. Selman and colleagues has recently been published regarding this topic. This article titled, Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport, is a great reference for all health care professionals who treat pregnant and postpartum women as well as a resource for pregnant and postpartum women themselves. The authors did a great job of putting together a concise but thorough timeline for each trimester of pregnancy as well as each stage postpartum. 

The article discusses the symptoms that pregnant and postpartum women can experience in each stage. This includes musculoskeletal symptoms such as incontinence and diastasis recti as well as visceral symptoms such as nausea and fatigue. The authors also discuss what to look out for and how to modify exercise. The goal of exercise during this time is to maintain health and fitness of the mother and child while not causing detriment to the changing body. This is a transformational and wonderful time in any woman's life but can also be confusing and overwhelming. Therefore, it is so important for these women to have the tools and knowledge to continue to exercise safely. 

During the first trimester of pregnancy, the timeline includes goals such as informing the patient on musculoskeletal changes and physiological changes that may be happening to their body. This is when the patient should be receiving medical clearance for exercise as well as guidelines for exercise and any red flags they should be aware of. The important thing to look out for during pregnancy is control of the abdominal muscles and the pelvic floor during exercise. This needs to be a priority in order to prevent symptoms such as pelvic floor dysfunction and diastasis recti. Throughout pregnancy, the patient should be continually checking in with their medical providers. In the second trimester, the pregnant woman should continue to get exercise and work on mobility safely. This is a good time to check in on posture and breathing patterns as the growing belly may affect this. The third trimester is when the pregnant woman should start to think about birthing postures and make sure she can contract and relax the pelvic floor for labor. 

For the postpartum stage of this timeline, it is broken up into weeks. The first two weeks of the postpartum period are focusing on posture and body mechanics while breast feeding and handling the newborn. The new mother can also start to add in some light open kinetic chain movements such as walking and pelvic tilts to encourage healing and posture reconditioning. In the following weeks, it is important to add movement back in slowly. The next two weeks can focus on walking for a short duration such as 10 to 15 minutes and some light exercises to work on core and pelvic floor rehabilitation. The intensity and duration of exercise can increase at two week intervals. High impact exercises such as running and HIIT training should not be considered until 8 weeks postpartum. High impact exercises often require automatic relaxation and contraction of the pelvic floor and core stability. Without the strength of the core and pelvic floor muscles, the woman is putting herself at risk for diastasis recti and pelvic floor dysfunction. It is encouraged for the new mother to work with a pelvic floor physical therapist and a health care team to confirm they are ready to get back to intense exercises. 

Selman R, Early K, Battles B, Seidenburg M, Wendel E, Westerlund S. Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport. IJSPT. 2022;17(6):1170-1183. doi:10.26603/001c.37863