A structured resistance training programme can commence following a positive postnatal check-up.

Activities that increase the load placed on the pelvic floor muscles are typically considered inappropriate for women with a dysfunctional pelvic floor. Since 50% of women sustain some degree of prolapse as a result of childbirth, the suitability of resistance training for women at this time should be considered carefully and assessed individually on a case-by-case basis.

An initial programme for lumbo-pelvic stabilisation training should be implemented and only once stability has been achieved can additional load or resistance be added. Like other modes of training, the workload should be increased gradually and the response to any increase in load should
be monitored closely. This concept may feel a little alien to many experienced exercisers, who may be keen to return to lifting challenging loads; it is imperative, however, that
the recovery process is not rushed.

All resistance work should initially be endurance-based and include a range of functional movement patterns that better prepare the participant for motherhood, and which restore optimal posture. Only when a solid foundation of both stability and endurance has been built should strength training be performed; this may take as long as 5-6 months in some cases.

Range of muscles that should be made a priority within resistance training:

• Lower trapezius (located on the middle back)
• Vastus medialis (one of the four quadriceps muscles, located on the front of our thighs, above kneecap)
• Lifting muscles – latissimus
  dorsi ( the largest muscle in the upper body, located on the side of the middle back) biceps (front part of the upper arm), triceps (back of the upper arm) and quadriceps (a group of muscles located in the front of the thigh)
• Glutes maximus, medius and minimus (buttock muscles)

Exercises to Avoid:

• Any exercise or transition
  that causes the abdominal
  to dome
• Any exercises that cannot be performed with correct technique
• Adductor and abductor group should be treated with caution due to the vulnerability of the symphysis pubis.

Kettlebell Training

Women in the postnatal period should generally avoid kettlebell exercise until joint and lumbo – pelvic stability has been restored, breastfeeding has ceased and general strength has been improved by less dynamic and explosive methods of training. Clearly, if kettlebells are used as a substitute for barbells, dumbbells or other forms of resistance then this does not apply; exercise like kettlebell swings, snatches and cleans, however, or other explosive kettlebell movements, should be avoided.

GENERAL RESISTANCE TRAINING GUIDELINES

The following guidelines summarise a range of general resistance training guidelines for women during the post-natal period

• If resistance training was performed during pregnancy, training can be resume at approximately the same intensity post-birth
• Emphasis should be placed on muscular endurance and core stability before performing strength training; only when the solid foundation has been achieved should the load be increased
• Only low-moderate resistance should be used until the muscles and joints regain their strength and stability; for the first 5-6 months post birth higher repetition ranges should be used (12-20)
• All exercises should be performed in a slow and controlled manner and with good technique
• Women should not work to failure, only mid fatigue at the most should be achieved on the final repetition
• It is important to avoid straining or performing exercises that cause a rapid spike in intra-abdominal pressure
• Regain from holding the breath during exercise or performing a valsalva maneuver (forced expiration against a closed glottis)
• Exercise body parts in rotation e.g. alternate between upper and lower body exercises
• Focus on exercises that will help with activities of daily living like lifting, carrying, stepping and those which help the redress any postural imbalances that may be present
• Be aware that exercise for the adductors and abductors may cause pubic or sacroiliac joint pain; avoid these if this occurs

Source: Ante and Postnatal Fitness Instructor Level 3 Student Manual