Postpartum Rehabilitation and Return to Exercise

Recovery doesn't end at six weeks

The postnatal check with your doctor is a medical review: the uterus, any wound, blood pressure, contraception, mood. It's important, but it isn't a fitness test. The pelvic floor and abdominal wall take four to six months, sometimes longer, to regain their strength after pregnancy, and ligament laxity can hang around while you're breastfeeding.

Meanwhile the physical demands go up, not down. A newborn gets heavier every week, and you'll lift, bend and carry thousands of times before your baby's first birthday. It's no surprise that the problems we see most in the first year are overload problems.

What we see most in the first year

Back pain from feeding postures and lifting from low surfaces is the big one; our clinical team has written a separate piece on postnatal back pain. After that come thumb and wrist pain from lifting the baby under the arms (often De Quervain's tenosynovitis), neck and upper back ache, hip and knee pain when women go back to exercise, and pelvic girdle pain that never fully settled. Leaking with a cough, a sense of heaviness, or a tummy that still bulges are just as common, and those are covered by our pages on pelvic floor physiotherapy and diastasis recti.

The first forty days

Many families in India follow a forty-day rest after birth, and we work with that rather than against it. Rest doesn't have to mean lying still. Breathing exercises, gentle pelvic floor contractions, getting in and out of bed without straining, and short walks around the house all fit comfortably into a confinement period, and they make the months after much easier. If going out isn't practical, a female physiotherapist can visit you at home.

How the program is built

• Weeks 0 to 6

  Breathing, gentle pelvic floor and deep core activation, posture for feeding, and gradually longer walks.

• Weeks 6 to 12

  Strength for legs, hips and back, progressive core loading and low-impact cardio such as cycling or brisk walking.

• From 12 weeks

  Impact work and a return-to-running check. Most guidelines advise against running before around twelve weeks, even if you feel fine.

• Months 4 to 12

  Return to gym, sport or classes with full load, and a routine you can keep up around the baby.

Getting back to running and the gym

Before running, we check the basics your body needs to absorb impact: walking for thirty minutes without symptoms, balancing on one leg, controlled single-leg squats, jogging on the spot, hopping and bounding. If any of these cause leaking, heaviness or pain, we work on them first. It's much quicker than pushing through and ending up with a setback.

For the gym, we start with the lifts you'll need in daily life anyway: squats, hinges, carries and presses, with a sensible breathing strategy. Heavier loads come back as the core and pelvic floor show they can cope.

Posture, lifting and baby care

• Bring the baby up to you when feeding, using pillows, rather than curling down over the baby.
• Change nappies on a surface at waist height where you can.
• Lift the car seat or baby carrier close to your body, bending your knees, and switch sides often.
• When lifting from the floor, squat down and bring the baby to your chest before standing.
• Carry on alternate hips, and use a well-fitted carrier for longer spells.

Getting everyday movement back

Functional rehabilitation is about the movements your day actually contains: getting down to and up from the floor, squatting on an Indian-style toilet, carrying a bucket or shopping, climbing stairs with the baby. We practise these directly in sessions so the strength you build carries over into real life.

When to call your doctor

• Heavy bleeding, large clots or a foul-smelling discharge
• Fever, or a wound that's red, hot, weeping or opening
• Calf pain or swelling, chest pain or sudden breathlessness
• A severe headache or changes in vision
• Low mood, anxiety or thoughts that frighten you, lasting more than two weeks

Frequently asked questions