Angry Rant: A case for Strength Training Post-partum
I want to have a little rant…
I hope someone will read it to the end…
I saw a blog post the other day from a pelvic floor physio in the States that I really admire, and she was talking about intra-abdominal pressure, which is the pressure that is created inside your abdomen by the forces of the muscles (diaphragm, abdominal, pelvic floor) contracting inwards. It stabilizes the spine and gives us the ability to sit up, stand up, squat, pick up heavy objects and do back-flips. When it is too great, or the core is unbalanced in some way, it can create problems in the form of pelvic floor dysfunction, incontinence, prolapse, hernias, hip or back pain and diastasis recti.
However, this physio was making a point that there is equally a lot of fear-mongering about intra-abdominal pressure in the postpartum fitness world, that we do actually need it and in fact, can’t avoid it. But that it is essential to create it in order to rehabilitate diastasis, because without it, the core muscles don’t have anything to contract against.
I really hope I’m not losing you!
I was so excited to hear this from my mentor, because I have been thinking this for a while, and I contributed that I have found that among my trainees, those who lift *relatively* heavy weights get way better results than those who do more gentle Pilates-style training, and that I discovered this somewhat by accident when one of my postpartum trainees joined my ‘regular’ class.
(Yael, pictured above, has 30kgs on her back. This is a lot of weight, right? Well, not for her, she can squat more than 50kgs for reps, so the 30kgs in the picture is just her warm-up weight. She's worked hard to get here, it didn't happen overnight, and it started with learning the technique in a body-weight squat. This sort of weight, however, would literally crush many untrained women. Weight is totally relative, there are no absolute, concrete numbers that we can say "this is the correct guideline for everyone".)
Although I got a great response from my mentor (because she really gets it), some other woman chimed in with a patronizing “That’s great Jen. But how long after giving birth are these women lifting weights?”
This response really irritated me. Why? Because it not only demonstrated a total lack of understanding about the point that any of us were trying to make, but it also demonstrated a kind of fear-mongering and misinformation that was being pointed out in the first place! And the same fear-mongering and misinformation that holds women back from achieving their health, fitness and aesthetic goals. And that confuses the shit out of people. Especially mums.
My response to her, I am sad to say, was rushed, panicky and really not of the caliber I am capable of producing when I am calm and focused and confident. So in an attempt to redeem myself from my inability to leave it, calm down, figure out why it bothered me, then write a more compelling defense of my position; I will share with you below what I SHOULD HAVE said.
Well, some of them are lifting weights the day after giving birth. They have no choice because their 20 kilo four-year-old is having a jealous temper-tantrum and wants to be picked up. Some of them are carrying strollers up 4 flights of stairs a couple of weeks after giving birth. Some of them need to carry shopping home for their growing family.
But, if you mean specifically: “when do they start lifting weights (and by weights you mean objects in the shape of dumbbells and kettlebells, some of them heavy and some of them very, very light; and not real life objects) with ME in a GYM”… the answer is “well that depends”. I don’t let anyone train with me until they have the go-ahead from their doctor at 6 weeks, which, by the way, is a totally arbitrary amount of time. Some women won’t be ready to exercise for a few months, physically, and/or mentally; and some are ready to start doing something after a couple of weeks.
In any case, I don’t really understand what criteria doctors use to determine if a woman is ready for exercise. I have had trainees with prolapse, their actual organs falling out of their vagina, and their gyno has okay-ed them to do exercise, any kind of exercise, including running and jumping. Do I give these women weights? Of course not. We don’t need to challenge their pelvic floors anymore. However, I would like to invite you to participate in a thought experiment: If said woman were to pick up aforementioned 20-kilo four-year-old on a bi-hourly basis, would that be ok? Even if she was holding her breath and bending her spine? Then if the same woman was to push a 3kg dumbell vertically for 15 reps, in a gym, while lying on the ground, squeezing a Pilates ball between her knees to get a good pelvic floor contraction first, would that be ok? What if it was a 5kg weight?
Anyway, I digress. I was saying how the sacred 6-week mark is utter horseshit. It’s so random. Everyone’s bodies are totally different. And how doctors don’t seem to have a set of criteria, like:
1. The woman is not in any pain 2. Her organs are where they should be 3. She feels good and has energy to exercise. 4. She has no other condition that would prevent her from performing certain exercises.
They seem to just check that her heart isn’t about to explode or her head fall off. But I digress again.
My point is that sometimes I wonder what makes people think it’s dangerous. Is it because we are lifting a weight that the system is too weak to handle at this present moment? Or because said weight is shaped like a kettlebell or dumbbell and not a small human? Or because we’re in a gym? Or because it says “CrossFit” on the door?
To stretch this argument a little further, many people will insist that using even the lightest of dumbells is "dangerous" after having a baby (again, often I hear the advice that you shouldn't lift more than 3lbs (about 1.5 kg) in your postpartum training) and the same people will suggest that you stick to "body-weight training". Now hold on a sec - I don't know about you, but my body weighs 65kg, that's a pretty heavy weight! Ok, I'm being facetious here, BUT the muscle group in question is extremely relevant here. My legs are much stronger than my chest and triceps, for example, so doing a body-weight squat might be fine for me (I can tell you that it is actually very difficult for many women who have just had a baby) but doing a push-up on the floor is a whole different story.
(By the way, you can find a full tutorial with progressions towards a push up here.)
But this is a common scenario. Women are thrown into a front-loaded position (think of a high plank, with the belly facing down), sometimes when they still have an abdominal separation, and asked to perform a body-weight push-up, when they do not have the strength in either their core or their pectoral muscles to perform such a demanding body-weight movement. Something like two thirds of my body weight is on my hands when I'm doing a push-up, so if I were to flip that round, put the same (post-partum) woman on her back on a bench and ask her to push a 40 kg barbell off her chest (bench press), you would think I was crazy! Yet this is akin to what we are asking many women to do when we get them to do a full push-up. And they are often doing it with poor form, breath holding, and sometimes a whole lot of bulging!
So if I got the same woman to lie on her back, gave her a 4kg dumbell to press up above her shoulder (this exercise is called a "Floor Press", and you can see it demonstrated below) isn't that a much safer, more stable, more controllable exercise EVEN THOUGH it uses a dumbell?
This might be a sensible choice of exercise postpartum, in the early stages of recovery, when the abdominal muscles are still returning to their proper position, when there is a diastasis or pelvic floor issues. We can increase the weight in 1 kg increments and the trainee even has a spare hand to feel her abdomen for bulging. We may well progress on to more challenging movements, but my point is this: This is an example of "weight-training", and it is far more gentle than most people would think. Compared with an aggressive body-weight exercise like a push-up, I think most people would agree that this is very moderate and "safe".
Sometimes people lose sight of the big picture, of the mechanics of what the body is doing which has core concepts that are at the heart of everyday movement, and they think that “lifting weights” is somehow inherently dangerous. Let me tell you that there is a huge difference between lifting 2kg and fifty, and a 5kg dumbell is still a lot lighter than a four year old, no matter which way you look at it.
MY criteria for if a woman can lift a given weight is this:
Can the WEAKEST part of her body cope with it? If she can easily push 5 kg, but it makes her tummy bulge, it is too heavy. If she can lift it, but it makes her organs pop back out of her vagina: it’s too heavy (and that includes small children and strollers). If she can press it overhead, in front of her, row it up, squat it up, pick it up from the floor 15 times with nothing bulging, protruding, hurting, aching, feeling funny or popping out: it’s too light (or it might be just right). The aim here is NOT to get to the point where something does bulge or any of the verbs listed above, but to find a weight that CHALLENGES the system without OVERWHELMING it… and this looks VERY different for each person.
“Lifting weights” has such bad associations for most people, but actually “lifting weights” is one of the most controllable activities you can do. You can use half a kilo or 100 or anything in between. It can be a hugely effective way of getting stronger in a very controlled way, and it can get amazing results. We need to get past this all-or-nothing mentality and understand the core principles that underlie all movement if we want to really learn how to train to fix diastasis, pelvic floor issues, get strong, fit, lose weight, or whatever our goals may be.