20 Apr The Ultimate Guide to Returning to CrossFit Postpartum
I’m excited to have postpartum fitness specialist Christina Prevett MScPT, Ph.D. (c ) discuss the important topics you need to know prior to returning to CrossFit postpartum! Christina recently joined the Performance Plus team writing an 8-week program for athletes wanting to return to gymnastics movements postpartum! Get started building those skills back by joining Performance Plus Programming!
Here’s a preview of that latest program:
You are a Crossfitter. It’s what you love to do. You live and breathe the sport. When you get pregnant, you hate that you’re holding back and can’t WAIT to get back at it postpartum.
You wait the six weeks, get the “all clear” from the doctor … and then what?!
That is the “ultimate” question.
How do we know when we’re ready to return to certain movements? How do we know that we aren’t going to harm our pelvic floor in any way?
This article will deep dive into ALL of it so that you will feel better prepared for what to expect as you come back to CrossFit after baby.
Unfortunately, before we get into the meat and potatoes of return, we need to lay a bit of a foundation first.
How Pregnancy and Labor affected your Body
A woman’s body goes through a complete transformation during her pregnancy. There are gradual changes that happen that place a lot of stress and strain on our system.
Some of these changes include:
- Increased blood volume
- Increased resting heart rate
- Low back curvature increased
- Stress on our core
- Stress on our pelvic floor
- Widening of our pelvis
All of these (I know sometimes they don’t feel like it) are GOOD changes. They’re necessary changes. They allow babies to live and grow to bring babies into the world eventually.
That leads us to labor and delivery. We are going to need to make a couple of considerations that have to do with how your birth story went. Two main methods of delivery are C section and vaginal delivery.
As the baby passes through the birth canal, our pelvic floor muscles need to stretch and allow baby passage. Sometimes instruments like forceps or vacuums are needed if the baby is stuck in an awkward position or is going into distress and needs a switch exit. That means that our pelvic floor suffered a trauma, which can be variable in how it impacts us. We can have a tear in our perineum. This is the tissue or space between our vaginal opening and our anus. The degree of tear ranges from Grade 1 (minor) to Grade 4 (complete tear to anal sphincter, also known as an OASIS injury).
**The higher the degree of tear you have, the more time it will take to heal your pelvic floor to handle high impacts and pressure postpartum. Be gentle with yourself **
You need to gradually increase what you’re asking of your pelvic floor with proper progressions of weight, movement, and pressure. More on this later.
A C-section is a major abdominal surgery through a common method of delivery. We need to make sure we are considering that when we think about return to sport. How fast would you return if you had your ACL repaired? Would you rush? The same mindset needs to go into return to gymnastics movement post-C section. After a C section, proper rehab involves work on the scar, including desensitization and movement of the scar so it doesn’t feel stiff and stuck.
We must understand these changes to set you up for success as you get back into the Box.
Where to Start with Getting Back into CrossFit
Returning to CrossFit postpartum can be broken down into three main categories, and each has some overlapping but unique considerations. These three categories are returning to barbell movements, gymnastics, and cardio/metabolic conditioning. Though the way we progress each exercise is unique, the considerations we’re looking out for to see if we are pushing it a bit too much are the same. Let’s go through a couple of examples of things to watch for.
What am I Looking Out For?
It is important that you feel empowered and informed about what to be on the lookout for that might mean you are going back to movements a bit too quickly. There is some nuance to this, and having a pelvic floor physical therapist working with you will help you immensely to navigate this process.
It is so hard for many female athletes to navigate that their body just FEELS different. Some of this change is going to be permanent and a new normal. This isn’t a bad thing. It’s the changing feels of a woman who has given birth. For example, if you gave birth vaginally, you will feel more movement of your pelvic floor/vaginal area than you did before birth with activities like jumping. This is not necessarily a sign that something is wrong but a change in your anatomy that occurred with pregnancy and birth. If you’re unsure of if the changes you’re feeling are normal or not, again, go consult with a pelvic floor PT.
Now, what is potentially outside the normal, or flags that are signs you might need to slow down a little bit. These flags to look out for include increased bleeding (early postpartum), leaking of urine or stool, deep abdominal ache, heaviness in the vaginal area, a feeling of a bulge in your vagina, doming or coning of the linea alba or six-pack line.
Let’s go into each of these in more detail.
Increased Bleeding Early Postpartum:
It is normal for women to bleed in the 4-8 weeks postpartum. (This can happen too if you’ve had a C-section!). The passing of clots or a large increase in blood can be a flag of something more serious. You may need to consult with a doctor if you experience a large change in bleeding after exercise.
Leaking of urine or stool:
This is commonly referred to a stress urinary incontinence and/or fecal incontinence. This means that muscles in the pelvic floor are either too tight or too weak and rehab needs to be done. Leaking occurs with increases in intra-abdominal pressure. This pressure increases with impact movements such as jumping, fatigue, increased weight with a strength movement or holding your breath while lifting. You need to gradually train your body to handle these things again postpartum. CrossFit athletes can NOT assume that they need to do more kegels!! Because of our sport, we can have too much tightness, and then we can do all the kegels we want, but it won’t make the issue go away.
Deep abdominal aching, bulging in the vaginal opening, feeling heaviness in the vagina
These symptoms all relate to an issue called pelvic organ prolapse or POP. POP is a descent of one or more of the pelvic organs closer to the vaginal opening. It can happen for a variety of reasons that include the type of delivery, number of pregnancies, genetic history, conditions that affect ligament support, and several more. In the early postpartum phases, you can feel these symptoms as a component of your overall healing. Many women diagnosed with POP can be very concerned about returning to exercise postpartum. However, rest assured that there are many ways to return, and you can absolutely do the exercises you love with a diagnosis of prolapse. If you are concerned, I would consult a pelvic PT
Doming or Coning of the Linea Alba
Let’s move away from the pelvic floor and towards the abdominal wall. Coning or doming of the six-pack line (aka linea alba) is speaking about diastasis rectus abdominus or diastasis for short. This happens naturally in 100% of pregnancies. The linea alba stretches and thins in order to give the baby room to grow. Postpartum, it takes TIME for that tissue to get stronger again. Some women will experience a persistent gap between their two rectus muscles. The size of that gap is often measured by finger widths when we are on our back and lift our head up into a mini crunch. Not only are we looking for the gap but the strength of that line of tissue. Does it feel like a spring or does it feel softer? When we are doing gymnastics movements or conditioning circuits, this doming can be a signal that you are pushing past what your body is ready for right this second. Not to worry! You can get stronger and train your core to improve this strength. If you’re concerned about this gap, you can reach out to a physical therapist who can get you on the right rehab program.
When will I be back to everything 100%?
This is a question we get asked a lot. Unfortunately, the answer is it depends… but I have some guideposts for you.
Many athletes describe it as taking 9 months to grow the baby and 9-12 months to feel like they’ve recovered athletically from birth. This does not mean you won’t make progress, but it means that until then, you probably have to hold back at least a minimum degree to allow your body enough time to heal.
The number of pregnancies you’ve had matters. It’ll take a bit longer to come back from baby 2 than baby 1 in general. Again, this is okay. Just setting expectations!
Pelvic floor issues and diastasis recti might lengthen your timelines. It is important that you allow these conditions time to improve. You’ll thank me in the long run. Small gradual improvements are better than a big hiccup (I’m sure you understand this if you’ve ever had a sports injury as well!).
So… what do we do once you’re cleared to exercise?
Who is Ready to Get Started Returning to CrossFit Postpartum?!
Now that we have the things to look out for when returning to CrossFit postpartum, there are a couple of variables that we modify and generally progress in order for us to get back to all of skills we see in the sport. The six-week checkup is NOT the all-clear to go back into CrossFit movements 100%. It’s okay to START getting back into CrossFit movements. Here are some general principles to use while returning.
Disclaimer: each female’s body is going to heal at a different rate. Some will get through these steps faster than others. Both are okay. You do you.
Make sure you lay the foundation first. It is important to get to your rehab exercises after having a baby. Reconnect to your deep core muscles. Work on your pelvic floor muscle strength, relaxation, and coordination. Do the work. It’s boring, but it’s necessary. Once you are there, your return to CrossFit will be that much smoother.
Here are the variables you want to apply gradual volume and overload to allow your body to gradually return to CrossFit.
If you are coming off a six-week break of any kind, you aren’t going to jump right back into the volume you are doing before. Add in this case the fact that you just gave birth to a tiny human and aren’t sleeping with a newborn at home. … give yourself a break. Even if you are further postpartum, it is important to GRADUALLY increase the amount of work you do in a week of exercise. That can mean starting 2x/week. It can mean just doing strength work and returning to cardio later. There are many permutations to this. It means holding yourself back a bit most likely. Many women feel okay DURING the workout and then after can feel tiredness in their vaginal area because they aren’t used to the activity since giving birth.
Box jumps and double unders are the two exercises in CrossFit where repeatedly we are seeing women have the most leaking. This is independent of it you’ve had a baby or not. It is not a coincidence that these are also two high-impact exercises. Impact increases intra-abdominal pressure and therefore stress on a healing pelvic floor. Running and jumping activities are usually better to introduce once you are over three months postpartum. Then be gradual. If you have 15 box jumps in a metcon, start with 5 low box jumps and the rest as step ups. Don’t rebound. See how your body does, and then next time do 7 or 8.
This is also relevant in Olympic weightlifting, where there is a lot of impact as you turn over the bar at the end of the second pull and move your feet.
Breath Manipulation and Return to Valsalva:
Valsalva is when you hold your breath and tighten your core to allow you to lift more weights. Previously, it was thought that women should never hold their breath while lifting. Thankfully this is starting to be outdated and more and more people are challenging this narrative (myself included… loudly). However, your body needs to be ready for this pressure. Start getting back to barbell movements with breathing out on exertion. This is out of the hole of a squat or off the floor of a deadlift or clean. Then gradually stop breathing out and just hold your breath but brace gently. Then layer in the intensity of your brace. After that, you can consider getting back to using your weightlifting belt. For this, you NEED to make sure you have done the foundational work of healing your pelvic floor to be able to handle increasing pressure. If you have not, you might experience leaking as you add Valsalva and weightlifting belts back in.
Also, being dialed in with breathwork makes it easier not to redline during conditioning circuits from a performance perspective. Make sure you are focusing on a good breathing pattern. Focus on it early and often in conditioning. You’ll recover faster, and your performance will improve.
Load on the Barbell:
Even if you kept lifting heavy through your pregnancy, it is not advised to go back right away to super heavy loads. Your pelvic floor and core need to heal and establish their strength again without a baby in utero. That takes time. You need to start slow and progress steadily. Consider every new load on the bar a postpartum PR. Try to let go (at least for now) your previous numbers. It will come back. You’ll get there. But it’ll take time.
Monitor Intensity and Fatigue on the Pelvic Floor:
Fatigue is another variable to monitor when it comes to returning to CrossFit postpartum. If you’re in a 15-minute AMRAP, you might feel great down there in the first 3 minutes, but the last 3 minutes… yikes. That endurance and performance will increase with time but know that you might need to slow it down. Your body is sending you signals of what it is ready for, and it means we need to try to turn our athlete brain off and listen in this phase of our life. I know… it’s easier said than done.
Considerations for Return to Kipping Pull-Ups
The gymnastics work can feel so foreign postpartum. Your balance has changed, and your core strength hasn’t gotten back to where it was.
There are a couple of very notable factors that occur to your body that you will need to consider when returning to kipping pull-ups.
- Core Control: Your abs were stretched out during pregnancy and will take time to come back to the strength they had in the past. Kipping is largely core control and force transfer through the abs. Remember you need to lay that foundation down to re-establish deep core control before you can show it off in the kip.
- C-Section Scar Mobility and Pain: If you delivered via C- section, the front part of the kipping pull-up (well, all kipping movements for that matter) would create a BIG stretch over that scar. If you have stiffness and sensitivity there, it will feel uncomfortable. There are many scar desensitization and mobilization techniques you can use to get it moving more smoothly. This will make the kip much more comfortable.
- Body Weight: In gymnastics, bodyweight matters. It is not a rush to lose the baby weight or lose it at all, for that matter. It is about making sure you have the relative strength to pull and transfer force at the bodyweight you are currently at.
- Upper Body Strength: Many women don’t do as much core and upper body pulling work later in their pregnancy because of changes to their program late in pregnancy. This will mean that your pulling strength is not the same as it was prior to pregnancy. You will get it back, but it will take time. Take that into consideration if you thought you would get back to kipping earlier then you are.
Considerations for Toes to Bar When Returning to CrossFit Postpartum
- Core Control: As with kipping pull-ups, core control is hugely important with toes to bar. Getting the deep core muscles strong again to transfer force will be important before being able to string toes to bar together.
- Core Demand: Hip flexor and core strength in the toes to bar is high! Our pelvis widens during pregnancy, and our lower abdomen in general takes on more of the stretch. This area of our core strength can take the longest to get back. Working on hip flexor strengthening in conjunction with core rehab will be important.
- C-Section Scar Mobility and Pain: The toes to bar is another kipping movement meaning that scar mobility will be important. The scar will also be moved in a different way with the closing of the hip angle on the active part of the movement. Both movements will need to have less sensitivity for scar movement, so you don’t have any pain as you get back to this movement.
- Body Weight. Again, mirroring the kipping pull-up, bodyweight impacts gymnastics movements. For this, extra weight in the thighs and legs can be more challenging. There will also be an increased demand on grip strength that you may not be used to. Working on increasing hanging tolerance will be helpful.
Considerations for Returning to Olympic Weightlifting
Olympic weightlifting is the clean and jerk and the snatch. These movements require strength, balance, coordination, and control. We need to pay particular attention to some of these variables as we return postpartum.
- Core Control: Many people don’t think about this, but Olympic lifting requires a massive amount of core control. You need to be able to create good tension in your brace and gradually build your tolerance to Valsalva as you progress in your rehab.
- Upper Body Stability: The snatch and the jerk require upper body stability that you may have not trained in awhile. The endurance to hold a barbell overhead in a split, push or snatch position will take time. I get many of my athletes to do tempo overhead squat and overhead holds to re-establish this control and strength postpartum.
- Possible changes in mobility: Many women can feel like they have a BETTER squat position postpartum. It is the one time the hormones feel like they work to our advantage! If you have gained 3 inches of depth in the bottom position of the snatch and clean, know that you might not feel very strong yet in those positions. Give it time, and expect to feel a bit weaker in that range. This is particularly true if you finished your pregnancy box squatting.
- Balance: Your pregnancy changed your body drastically but gradually. Your postpartum body happened in one last big push! It will take time to re-establish your balance points, especially when moving a barbell around. Incorporating pause work and tempo pulls can help to re-establish your positions.
- Impact: Returning to the clean in particular can cause some women to feel minor to severe amount of leaking. This is often due to both weight on the barbell and the impact of Olympic lifting. It takes time, but your body will again get used to the impact. Start with a smaller range of motion and no feet variations. Progress as your body feels stronger in those patterns.
Mama, you got this! You can get back.
The recovery might feel long at times. You might get frustrated. There might be some hiccups and roadblocks along the way. I have faith though. You can do it. Healthcare providers well versed in the sport of CrossFit and pelvic health can help.
You are strong and resilient. Sometimes we just need a bit of patience. Your body went through a lot (for the first time or again), and you need to give it the time it needs to heal.
Use these steps. Take progression slow, and you’ll look back in a couple of months and realize just how far you’ve come!
Ready for more guided assistance getting back into CrossFit postpartum? We’re excited to announce our 8-week programming through Performance Plus!