Postpartum Fitness

Why I am proud to be a ‘Fit Mama’ – The Benefits of Fitness Postpartum

fit mom with baby

Childbirth is a beautiful thing. Everyday I am in amazement that my body was able to make a human being, a HUMAN BEING, do you know how crazy that is?! My body was stretched out and pushed to its limits during the 9 months of pregnancy and now it provides all the food and nutrients my baby needs to survive.

My body has taken a beating. My bellybutton will never be the same, my butt will never be as firm and my boobs never as perky (there is a lot to say for good angles and flattering lighting). Sure, I don’t have stretch marks but I have dealt with terrible hip pain, knee pain, back pain, stress incontinence and separated abs all due to carrying around my beautiful 9lb12oz baby! If any of you knew me before you know I have always been slender, so it’s not really a surprise that I bounced back after the baby. Before pregnancy I was a 32A and a size 4, and now at 6 months postpartum I finally fit into my pre-pregnancy clothes again. I won’t say that I didn’t have to try, of course I did, but I have always lived a healthy active lifestyle and I wouldn’t have it any other way.

My motivation for getting fit postpartum is simple, I want to be healthy so that I can feel my best and be able to do the things that I want to do with my daughter and husband. Losing weight just happens to be one of the many benefits of exercise. I work in the health and fitness industry…I always have, and I always will. It is my job to motivate others to succeed and reach their goals. As an Occupational Therapist we encourage people to set goals that are important to them. I feel this is important not just from a health and fitness perspective but also to provide some organization to life. How do you work towards something if you don’t know what you are working towards?

danielle honea family photography

So what are my goals? I want to be the best mother I can be, I want to be physically and mentally strong so that I may provide for my daughter in any way that I can. I also want to be happy and healthy, which for me go hand in hand. My definition of health does not include weight or measurements but rather how I feel. I FEEL best at my normal size. In all honestly, I felt AWFUL while I was pregnant. I vividly remember walking up the stairs at the beach one day (and I was only about 20 weeks pregnant at the time) thinking that I was glad this was just temporary because I never wanted to feel like this again. I didn’t see pregnancy as a reason to ‘throw in the towel and kiss my former body goodbye’ but rather a reason to strive to be fitter, healthier and stronger postpartum than ever before. To me health is not defined by the number that you see on the scale but rather by functional measures. These include how well you are able to do your day-to-day activities, how you are able to engage in leisure time, and how you keep up with your family and manage responsibilities at work.

Baby swim lessons

Lately there is a new social media trend, particularly in the postpartum community. Women are encouraged to love their postpartum body and show appreciation for who they are and what they have accomplished (like making a baby!). I truly think this is fantastic. It is wonderful and empowering to see other women who are proud of being a mom, stretch marks and all. Check out the hashtags #takebackpostpartum and #takebackfitspo for a beautiful array of women showing love for themselves and their babies. Unfortunately this has spurred another movement that I don’t agree with. Women now feel it is okay to put others down for their lifestyle choices, particularly those who choose to workout and ‘get their bodies back’ postpartum. With social media it is easy to judge others, but it’s important to remember that there is a real person behind those pictures, and you can never judge a book by its cover.

#takebackpostpartum

Obviously I am an advocate for working out after pregnancy. Rebuilding your core and gaining back your strength is key for preventing injury and health conditions later in life. By exercising effectively now you decrease your chance of developing pelvic floor dysfunction, pelvic organ prolapse, back pain and incontinence later in life. Have I been doing all this for a flat stomach? No. Sure It’s nice, but rebuilding my core strength after pregnancy has improved my low back pain and healed my diastasis recti so I can avoid complications in the future. Most people become deconditioned during pregnancy, which can also cause injuries and pain that interfere with your ability to care for your child(ren). Did you know that people gain on average a pound a year after the age of 20? Add 5-10 pounds retained after each pregnancy and that would put an average woman at 30-40 pounds overweight at age 50 after 2 kids. This additional weight puts you at risk for heart disease, diabetes, cancer, injuries, chronic pain, mental health issues, and shorter life expectancy. Having a baby is tough, it is exhausting caring for another little human all day! But by finding 30 minutes a day to engage in physical activity now you can help prevent so many health conditions later.

The words thin and healthy are not always one in the same. People can be very unhealthy but still be thin (take a look at some drug addicts or heavy smokers), and people can also have a large build and still be healthy! It is important to see people as individuals rather than quantifying others based on their weight or appearance. It is extremely frustrating to see derogatory comments to others online implying that if someone looks good on the ‘outside’ they must be rotten ‘inside’ or vice versa.

skinny is not sexy, health is

I workout 5 days a week, I eat healthy, I work hard, and I take care of my family. In return I feel happy, I have increased energy, I have more patience, I suffer from less injuries and pain, I have decreased stress and anxiety, I have no major health issues, and hey, I fit into my skinny jeans again. For me, the link between physical health and mental health is strong, and one cannot exist without the other.

Does this make me obsessive? Possibly… exercise is addictive. When I do something, I strive for 100%, that is my personality and that will never change. I crave exercise, I crave the fresh air, I crave the sweat on my face, I crave the adrenaline rush and I crave the feeling of accomplishment when I get through a tough run or crazy Crossfit workout. I crave the feeling of being alive.

Does this make me vain? Maybe…but people who look better often feel better, so if this is counteracting depression then I’ll take it.

Does this make me a bad mother? Absolutely not. I spend quality time with my daughter and husband everyday. I workout with her or I workout at home or sneak to the gym while she’s having a nap. My husband and I share delicious home-cooked meals every night and he appreciates all that I do in order to take care of my family and myself. Everyone has their own priorities and it’s important to respect that. By doing the things that make you feel alive, whether it be working, playing with your kids, cooking, eating, or spending time with family and friends, you are living your life to its full potential and fulfilling your own personal goals and aspirations.

So call me vain, call me selfish, call me obsessive, what’s important is that this little girl can call me Mom.

happy baby

In fitness and good health,

Natasha

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Pelvic Girdle Pain During Pregnancy

Lumbo-pelvic pain, which can be defined as, pregnancy related low back pain or pregnancy related pelvic girdle pain, occurs in 24%-90% of women while they are pregnant (Van Benten et al., 2014). Although this usually goes away after birth over 1/3rd of women still have pain 1-year post pregnancy (JOSPT, 2014).

What is Pelvic Girdle Pain?

Your pelvis is made up of your hip bones (ilium, ischium, pubis bones), your tailbone (sacrum/coccyx) and various muscles, tendons and nerves which all work together to support your pelvis and internal organs. When these bones, tendons and muscles do not work together as they should this is when you feel pain. Pain can be in the posterior pelvic girdle (below your lower back) most often caused by an unstable sacral iliac (SI joint), or in the anterior pelvic girdle (in your groin) due to instability in the symphysis pubis. These ‘joints’ are not meant to move, but due to the lovely relaxin hormone floating through your pregnant body they can easily become unstable and extremely painful!    pelvic girdle pain

Pelvic girdle pain (PGP) increases with everyday activities such as walking, standing, sitting and lying down. It can increase drastically after only 30 minutes of activity (Fagevik Olsen, Elden & Gutke, 2014). Sounds pretty annoying right?

Why is it important to identify and treat pelvic girdle pain?

This persistent and awful pain not only effects women physically but also puts them at an increased risk of depression and decreased quality of life. Lumbo-pelvic pain is responsible for a large percentage of sick leave costs for pregnant women as well (Fagevik Olsen, Elden & Gutke, 2014). I laugh because my doctor wrote me a note to have modified work due to pelvic pain and my restrictions were “no standing, no walking, no sitting, or lying down for more than 25% of the day”…Uh, so what exactly could I do? Obviously this resulted in me going off on maternity leave a little earlier than planned.

Identification of women with severe PGP is also important since they are at the “highest risk of persistent pain both during and after pregnancy…and have the greatest consequences in terms of pain, intensity, disability and health related quality of life” (Olsen, Elden & Gutke, 2014). As a sufferer of PGP I can attest that it absolutely affected my quality of life and overall mood since some days even walking around the house was intolerable.

How can I tell if I have PGP?

A recent study by Fagevik Olsen, Elden & Gutke (2014) looked at the effectiveness of self-tests for pregnant women to screen for pelvic girdle pain so that they can be referred to a doctor or physical therapist for evaluation. Here are some of the tests I pulled from this study and this study !  Now, just a warning, if you do have Sacroiliac (SI) joint pain or Symphysis Pubis Dysfunction (SPD) you will know within SECONDS of attempting any of these tests.

SI joint pain is felt beside your tailbone and is often a sharp, deep pain that occurs with certain movements. It can even feel like your hip or tailbone is ‘out of place’. Symphysis Pubis pain is a sharp, lightning bolt type pain that feels like it is often deep in your pelvis. These pains can range from a dull ache or nothing at rest to constant excruciating pain all the time.

Please note all the images and descriptions for these tests were taken directly from the two articles cited above. (Fagevik Olsen M et al, 2009) and (Fagevik Olsen, Elden & Gutke, 2014)

1) P4 Test

Lying in the supine position with 90-degree flexion at the hip the patient presses on the flexed knee, along the longitudinal axis of the femur.

Positive test = reproducing the pain in the SI area
POSH test self adminstered

http://www.thestudentphysicaltherapist.com/posh-test.html <– see more info on this test here

Patrick Faber Test

Lying in the supine position with one hip flexed, abducted and rotated so that the heel rests on the opposite kneecap. Positive test = reproducing the pain in the SI area

faber test self administered

http://www.thestudentphysicaltherapist.com/faber-test1.html <– see more info on this test here

Trendelenberg Test

Standing on one leg, flexing the other with the hip and knee at 90. Positive test = reproducing the pain in the SI area

trelenberg test

http://www.thestudentphysicaltherapist.com/trendelenburg-test.html

Bridging Test

The patient lifts the buttock and extended one leg. Positive test = reproducing the pain in the SI area

bridging test pelvic pain

Mat Test

The patient performed a movement of hip abduction and adduction simulating the movement to pull a mat across the floor. Positive test = pain in the symphysis
mat sliding test

Straight Leg Raise Test

Tests for disc involvement, see more info here.

straight leg raise test

Per (Fagevik Olsen, Elden & Gutke, 2014) , in order to be classified as PGP the following criteria had to be fulfilled…

  • Pain experienced between the hip bones and the gluteal fold particularly in the area of the SI joint in the symphysis.
  • Reports by the women of weight-bearing related pain and its duration in the pelvic girdle.
  • Diminished capacity to stand, walk and sit.
  • Positive clinical diagnostic tests, which reproduced pain in the pelvic girdle.
  • No nerve root syndrome (Negative SLR test).

Be sure to quantify your pain on a scale if you are bringing it to the attention of a doctor or therapist! It really helps them establish a baseline and help rule out other problems.

pain scale

What can I do about it?

Physical and Occupational Therapy during and after pregnancy can help decrease low back and pelvic pain and increase mobility and quality of life.

Van Benten et. al (2014) concluded “according to the literature there is moderate evidence for the positive effect of exercise therapy on pain, disability, and/or sick leave for the treatment of lumbo-pelvic pain during pregnancy. Moreover, data shows that patient education seems to be a helpful intervention”.

Talk to you doctor about a referral to therapy or seek out a therapist near you. A physical therapist who specializes in orthopedic rehabilitation or women’s health will be able to do a proper assessment and prescribe exercises for you to continue at home which can provide some relief! They can also recommend appropriate braces or taping techniques that may help decrease the pain and provide increased stability to those poor overstretched joints. If you are able to see an Occupational Therapist (usually covered by insurance with a doctors order) be sure to take advantage, a home visit will help identify the daily activities that are most difficult and how you can modify the activity or the environment to be able to complete them with as little pain as possible! Also, chiropractic care is fantastic for helping to realign your pelvic bones and spine. This can decrease pain due to nerve irritation and  inflammation. This is what helped me the MOST during my pregnancy and I always recommend chiropractic care to other pregnant mamas out there. As always please comment below or send me an email if you have any questions!

Hope this helps!

In fitness & good health,

Natasha

 

References

JOSPT (2014). “Pregnancy and Low Back Pain: Physical Therapy can Reduce Back and Pelvic Pain During and After Pregnancy”. J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505

Fagevik Olsen et al. (2009). “Self Adminstered Tests as a Screening Procedure for Pregnancy Related Pelvic Girdle Pain”. Eur Spine J (2009) 18:1121–1129 DOI 10.1007/s00586-009-0948-2

Fagevik Olsen, Elden, & Gutke. (2014) “Evaluation of Self-adminstered Tests for Pelvic Girdle Pain in Pregnancy”. BMC Musculoskelet Disord. 15(138)

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Lactation Smoothie

I posted another recipe on yummy lactation cookies that turned out great, so I decided to just take the ingredients and throw them all into a smoothie. It turned out great too! Here’s the recipe…

imageYou need, a blender of sorts – We have the Nutribullet and it’s awesome.

Ingredients
1/4 cup rolled oats (old fashioned works best)
1 tablespoon brewers yeast
1 frozen banana
1 tablespoon almond butter
1/2 tsp coconut oil or flax seed oil
Almond/Coconut/Cows Milk
Cinnamon for taste
Handful of Spinach (optional – you can’t taste it but it’s a good addition!)

Put all the dry ingredients in the blender, fill with milk, blend until smooth.

Enjoy!
Natasha

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Effect of Exercise on Breast milk

So with all this running I’ve been doing it got me wondering if I am negatively affecting my milk supply and if my baby was still receiving adequate nourishment (I think I was just looking for reasons NOT to train for this half marathon). This led me to do some research! Yes, I know… of course I’m a nerd like that but I didn’t become an evidence-based practitioner for nothing…this is how we roll! So let me share with you bits and pieces of what I learned.

women after long run

In summary, breastfeeding is not negatively affected by exercise whether it be prolonged cardiovascular exercise or moderate to high intensity training. There is some evidence that lactic acid levels increase if you feed your baby immediately after a high intensity workout (Carey & Quinn, 2001), which could cause a change in the taste of the milk but has no negative effects on the baby and most of the time they don’t notice. Even then, you would have to REALLY exert yourself to see this kind of change in milk composition.

In terms of milk supply, as long as adequate fluid and calorie intake is achieved exercise has no negative effect on milk supply (Dewy et al., 1994). This is what I was most worried about because after my long run last week I tried to pump afterwards and got very little! Which was stressful obviously! Of course I panicked, and then my husband reminded me that I just fed her before I left so it had only been a little over an hour and a half. Duh, that makes sense. Also, my own personal hypothesis is this… your body probably puts milk production on hold while exercising because it is using the energy for your muscles, BUT most likely makes up for it later in the day.

When the composition of breast milk was studied it was also found that there was no change in immune factors (such as SigA, lactoferrin, and lysozyme), major minerals (calcium, phosphorus, etc) and major nutrients (fat, protein, lactose) (Fly, Uhlin, Wallace, 1998).

I also found this to be super interesting ….

“ recreational athletes who performed an average of 88 minutes per day of aerobic exercise during the 6 months of breastfeeding had less body fat and produced a slightly greater quality and quantity of milk than postpartum non-exercising women” (Lovelady et al., 1990)

So pretty much because I am exercising I am producing higher quality and quantity of milk as well as reaping all the other benefits of postpartum exercise such as; decreased incidence of depression, decreased stress, improved mood and behaviour and increased weight loss. Guess this half- marathon training is paying off for everyone, including my baby & husband!

Now I have to add, after my quick literature review I did find there is definitely  room for further research on the subject, a lot of the studies were from the 90’s and came from the same few researchers, but it’s just not a very highly studied topic so have to take what I could get!

So there is it, you can put your mind at rest…. breastfeeding and exercise are actually a good combo! Few things to remember…be sure to keep your fluid intake up, especially if it is a hot day out! It’s crucial to replace everything that you sweat out to avoid dehydration. I aim for 16 cups of water a day, and I usually have a coconut water or electrolyte beverage if it’s a day where I particularly sweat a lot. Also, losing 0.5-1lb a week while breastfeeding is perfectly healthy but you don’t want to lose too much weight too fast so be sure to replace some of the calories burned by exercise by having an extra snack afterwards.

In fitness & good health,

Natasha

Sources

Carey GB, Quinn TJ 2001, Exercise and lactation: are they compatible? Can J Appl Phys 26(1): 55–74.

Dewy K, Lovelady C, Nommsen–Rivers L, McCrory M, Lonnerdal B 1994, A randomised study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. New Engl J Med 330: 449–453.

Fly AD, Uhlin KL, Wallace JP 1998, Major mineral concentrations in human milk do not change after maximal exercise testing. Am J Clin Nutr 68(2):345–9.

Lovelady C, Lonnerdal B, Dewey K. Lactation performance of exercising women. Am J Clin Nutr. 1990;52:103–9.

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Protect Your Back – Vol 3. Posture and Positioning

Okay, for my last blog post in the protect your back series, I wanted to focus on preventative care, and the importance changing habits to prevent pain and future problems!

‘Posture’

is a big word we hear a lot but never think much about. How do you stand? sit? walk? What is your posture like? Staying in the same position for long periods of time (such as sitting all day at work) can put added strain and stress on your spine and cause big problems down the line!

bad posture (click image for source)
Some common postures that are problematic to new mothers include
– Breastfeeding (hunched over, looking down)
– Cradling the baby (standing, forward head, rounded shoulders)
– Holding the baby (swayed back, hip bones forward, forward head)

Some Tips To Try
– Use a nursing pillow, this personally never worked for me, but it does for some people!
– Recline back while feeding to relax your shoulders.
– Prop your elbow up on a pillow or armrest for support while holding the baby.
– Be aware of your posture, set visual cues around the house, for example everytime you walk by a mirror you pull your shoulders back.
– While standing with the baby keep moving, static standing is worse than walking around.
– Get in your stretches daily!

How can this be fixed?!

Seek our a professional to assist with correcting your posture and teaching you ways to work on this at home. Bad posture is a bad habit and can take a lot of work, concentration, and time to correct.

I highly recommend Chiropractic care, check out these great resources from Santa Barbara Family Chiropractic. If you are in the Santa Barbara area Dr. Nick is excellent and I highly recommend him! He helped me greatly throughout my pregnancy and is consistently working to expand his knowledge to help others. He offers wellness chiropractic, pain relief, chiropractic for kids, nutritional counselling, and prenatal chiropractic. Contact them today to set up a consultation!

The following was used with permission from SBFC!

HOW TO PROTECT YOUR SPINE BY REPLACING BAD HABITS WITH GOOD!

Replacing bad habits is an important step in holding your healthier chiropractic adjustment patterns longer = better results faster.

Action Step #1: Have a co-worker/friend/family member take 2-4 pics of you at your work/hobby station in any position you are in for more than 2 hours /day (one picture from side and one from behind – per position)

Action Step #2: Email pictures to support@sb-fc.com so that Dr. Nick will make notes and review with you!

Action Step #3: Watch the following videos.

HOW TO SIT/DRIVE:

https://yourhealthbuddy.wordpress.com/2011/02/14/you-can-drive-4000-miles-without-back-pain/

HOW TO SLEEP

https://sbfamilychiro.wordpress.com/2012/05/24/restful-sleep-isnt-a-myth-just-do-it-right/

HOW TO LIFT SAFELY

https://sbfamilychiro.wordpress.com/tag/good-posture/

Action Step #4: Practice! Begin replacing unsafe movement/postures with good movement/postures. Remember this takes time and awareness is the first step!

Health = Freedom
Nicholas Araza DC CCWP CFL1; Santa Barbara Family Chiropractic; 805-682-4620 / www.santabarbarafamilychiropractic.com

 

In fitness & good health,

Natasha

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