Return To Lifting Heavy: Tools You Need To Lift Post-Pregnancy

After the birth of my first child, 6 years ago, I went back to my heavy lifting lifestyle. Unfortunately, I had the same misconceptions as most women.

Being fit and strong before pregnancy is helpful when it comes to supporting a healthy pregnancy, but it isn’t your golden ticket to keep pushing yourself the same way during.

I did my due diligence. I talked to my OB who told me to keep training the same way.

So I did.

After pregnancy at my 6-week clearance, I asked the same questions.

No one mentioned the pelvic floor. There was no talk about common symptoms or rehab.

I noticed some leaking here and there. Nothing major. Didn’t really pay much attention. I remember thinking about wearing a pad during workouts at one point.

It wasn’t until my second pregnancy my pelvic floor symptoms came to light. At 18 weeks, I was in significant pain in my pubic symphysis. I now believe this to be pubic symphysis dysfunction.

I didn’t get relief until after my daughter was born.

In my research, I found stories of women sharing their experience with pelvic floor symptoms during and after pregnancy. One common treatment kept popping up. Pelvic floor physiotherapy.  

I was diagnosed with a prolapse. I remember laying on the table, blaming myself. And the way I felt about being fit and strong seemed to be a lie. And it changed how I trained. I became better educated.

I was very careful for about 18 months. The fear of lifting anything too heavy paralyzed me. My prolapse is all I could think about. That in itself is a heavy load.

Then I became pregnant with my third child. A pleasant surprise, of course, but the fear of completely ruining my body intensified.

My sons birth was traumatic. I went into preterm labour and went into the hospital. His birth resulted in an unplanned c-section. After being released from the hospital 2 days later, I was back in the hospital believing I was having a heart attack. I left 18 hours later with Percocet and antibiotics to treat pneumonia. Percocet didn’t even touch the pain I was in.

My digestive system completely shut down, I couldn’t walk I was in so much pain, and I was an emotional wreck because I couldn’t hold my baby to bond with him.

Physically, I recovered, but it took weeks to be pain-free. Emotionally, I’m still working on it.

That was the point I decided to let my fear about ruining myself go. If I could get through everything I had been through, I could deal with possible symptoms if they were to occur.

At 4-months postpartum, I signed up for CrossFit. However, my training strategies were scaled of course. Honestly, the best decision I made for my emotional and physical health.

CrossFit has been one of the key players in my recovery. I just completed my first 1RM  testing and shocked myself with my strength. I had been training for 7 months and hit several PRs including a 215-pound deadlift and 1 double under. I’m most excited about the double under!

 

Your body is resilient and in this article, I’m going to show you how to train that resilience and use your symptoms as feedback.

 

This will take some patience, but it is worth the work you put in.

 

Your Pelvic Floor

Your pelvic floor is like a woven basket of muscles spanning the bottom of the pelvis. It provides support to your pelvic organs, aids in sexual function and continence (urinary and fecal), as well as overall movement and stability.

During a big hormonal shift, like in pregnancy, the pelvic floor becomes lax in preparation for birth. As baby grows, the weight of his little body rests on the pelvic floor. During labour, the pelvic floor becomes stretched through each contraction and pushing phase.

For many women who deliver their babies vaginally and on their backs, they are coached to bear down to push. Gravity is not working in your favour.

Pelvic health symptoms aren’t isolated to pregnant, postpartum and menopausal women. Elite female athletes who have never given birth may experience stress urinary incontinence and loss of gas as a result of their high-impact training.

Again, the pelvic floor is an incredible muscle group and can be trained to withstand impact.

 

Pelvic Health Symptoms include:

  • Pelvic organ prolapse. This is where 2 or more of your pelvic organs bulge through your vagina.
  • Stress and urge incontinence (or a mix of both)
  • Urinary or fecal incontinence
  • Back/hip pain or discomfort
  • Straining when going to the bathroom
  • Vaginal flatulence
  • Pelvic pain or discomfort in the pubic symphysis or the pelvic floor
  • Uncontrollable gas and vaginal flatulence

 

Getting assessed by a pelvic health physical therapist (physiotherapist in Canada), is the best way to get a proper diagnosis and treatment.

 

What’s a Girl To Do?

This doesn’t mean your heavy lifting things days are over. You may have to change your training strategy, but you can be successful in returning to heavy lifting or even reaching a new PR.

Yes, you can lift heavier than you were before.

There is no magic formula when it comes to managing your pelvic health. Speaking to a trained pelvic health professional is the best way to maximize your training potential.

Rehab And Train Your Pelvic Floor

There are a lot of women in general who have never been educated about their pelvic floor. They believe leaking and the feeling of bulging is a normal part of being a woman, primarily after pregnancy and birth.

You’ll see celebrities marketing incontinence pads and jade eggs. You’ll even see fitness professionals on social media stating if diastasis recti don’t heal properly postpartum, they will suffer a life of embarrassing leaks–unless you buy their fitness program of course.

For the record, these methods are rarely advised for long-term treatment. 

 

Get Assessed

The first step is to get an internal assessment by a pelvic health physical therapist (PFPT).

Your PFPT will give you training guidelines based on the outcome of your assessment. However, many will only assess you laying on your back, and you’re not lifting that way. So be sure to ask for an assessment while standing as well.

Here Is What to Your PFPT Is Assessing

  • Strength and endurance.
  • Tender spots known as trigger points.
  • Movement of the pelvic floor.
  • Hypertonicity (overactive) and Hypotonicisty (weak)

They Will Also Assess You Externally Ror:

  • Alignment (Are you standing in neutral with ribs stacked over hips?)
  • Breathing patterns
  • Tone of your abdomen
  • Coordination and activation of your deep core system which is made up of the: transversus abdominis, multifidus, diaphragm, and pelvic floor.

 

 

Breathing

Breathing is one strategy used to manage intraabdominal pressure. However, when it comes to lifting your 1RM, you may use the Valsalva Maneuver to stabilize while you lift.

The Valsalva uses intraabdominal pressure which may be too much for your pelvic floor, and it may be why you have symptoms.

I want to be clear when I say this, intraabdominal pressure is not a bad breathing technique. It protects your spine in max lifts so you can increase your lifting potential and keep your lower back injury free. However, because it creates downward pressure onto the pelvic floor, it isn’t recommended when treating your pelvic health symptoms. Once you’re symptom-free, you can give it a try.

One way you can release some of this pressure is to use a modified version of the Valsalva I picked this one up from Julie Wiebe PT and have had a lot of success with it.

To perform:

  • Set yourself up for your lift as normal
  • Inhale deeply, expanding through your rib cage
  • A split second before your lift, exhale slightly to release some air, kegel, then complete your lift.

 

Keep in mind, depending on your symptoms, it may be best to avoid any breath holding if you continue to experience symptoms using this strategy. If you continue to experience symptoms upon checking you are in ribs over hips position, you may need to scale back and train up to this point.  

 

Learn To Properly Kegel And Incorporate It Into Your Lifts.

Disclaimer. Your PTPT may not advise kegels if your pelvic floor is overactive. That’s ok. Your pelvic floor will still turn on during your lifts.

However, I highly suggest scaling back on the load and not train your 1RM until your PFPT gives you the go-ahead to start doing kegels. When your PFPT does give you the go ahead, this doesn’t mean start lifting transport trucks. You may need to work on building strength and endurance under the guidance of your PFPT

A kegel is a muscle contraction in the vagina. You can hold it isometrically and let it relax. You need it to do both efficiently when training your 1RM with (and without) your pelvic health symptoms.

There is some confusion surrounding how to properly kegel. Women are taught to contract their pelvic floor muscles without knowing to relax them. This is where the pelvic floor becomes overactive and symptoms may take place.

Additionally, women will bear down (pushing down on the pelvic floor, instead of lifting it up and in), thinking they are doing a kegel. If you use a diva cup during your heavy or max lifts and it pops out, you’re probably bearing down.

 

Kegel in Preparation For Lifting.

A diaphragmatic breath with a kegel (contraction or lift of the vagina).

I like to teach this laying on your back, but you can do this seated, side lying, sitting and standing as well.

  • Lay on your back in a glute bridge position. Make sure your alignment is neutral.
  • Imagine yourself pulling your hip bones into your belly button.
  • Inhale through your nose, drawing your breath up into and expand through your rib cage.
  • Exhale like you’re blowing through a straw while gently contracting your pelvic floor (only 20%-30%).

 

How To Coordinate Your Kegel With Your Lift

Personally, I like to teach this with a deadlift or squat, starting approximately 50% load and build to 70%-80%. This is completely dependent on where you’re at currently, so these numbers may look different.

If you feel bulging or experience any urinary incontinence, make sure you’re ribs are stacked over your hips and check your breathing. If you still have symptoms, reduce the load and try again. You may need to run through this more than once.

For the purpose of this article, I’m going to run you through coordinating your kegel with a deadlift.

  • Standing in your deadlift position, make sure your ribs are stacked directly over your hips.
  • Hinge forward and maintain your neutral alignment.
  • Making sure the equipment of choice of close to your body, grip, and inhale.
  • A split second before you lift, exhale and kegel to brace your core (blow before you go as Julie Wiebe, PT cues it), then lift with full extension in the hips.

Now, let me show you how it’s done in a fun little video. Click the pretty pink words to the right to give it a watch Barbell Deadlift With Modifications

 

Tension To Task And Spread The Load And Spread The Load.

These are important strategies I learned from Antony Lo, PT in his Female Athlete: Bulletproof Your Core and Pelvic Floor course. I myself used this strategy in my own 1RM training and had a 25-pound increase in my deadlift, going from 190 1RM to 215 1RM in less than 2 months. Without a single symptom.

Tension to task is applying the right amount of tension to complete the desired outcome. This is where you can find where you’re able to work without symptoms. You may also see an improvement with your lift when you apply the appropriate tension to the task at hand.

Keep in mind your tension to task will differ from lifting at 20% of your 1RM than it will at 100%

Meaning, you don’t need the same tension picking up a hairbrush as you would lifting a car.

The same goes for your kegel. You don’t need to go full force for light to moderate load. Going from moderate to heavy or max lift, you will need a quite more recruitment from your pelvic floor. You’re looking at just as much activation as the rest of the muscle working in that particular lift.

For example, if you’re lifting at 70%, you will need to recruit 70% of your pelvic floor. Lifting at 100%, you’ll need all of your pelvic floor strength.

This is why it’s important to build on your pelvic floor strength when training your 1RM. If your pelvic floor can’t match the needs of the lift, you may find yourself with symptoms.

Spread the load is in the same ballpark as tension to task. The goal is to distribute the load or pressure throughout the body, not just one area. This is helpful in learning not to bear down on the pelvic floor or abdominal wall, keeping the brunt of the pressure off your pelvic floor.

The belt is a bit controversial when it comes. Some like it, some don’t. When it comes to managing your pelvic health symptoms, it’s best to train your core to engage effectively first.

If it’s too tight, it may increase the intraabdominal pressure, creating additional stress on the pelvic floor. It may be best to wear a bit looser to use as feedback.

If you’re dealing with symptoms while using the belt, you may want to train without it while during this time and reintroduce it when the symptoms subside.

 

Find Your Symptom Free Zone And Progressively Overload.

This is where you can work symptom-free (kudos to Kim Vopni for “work in your symptom-free zone”), confidently. If you’re symptomatic at 80% of your max, drop down to 70% and progressively overload.

The same applies if you find yourself leaking at 5 reps, decrease the load, decrease reps, or both.

You may need to play around with what works for you as there are no set rules when it comes to managing your pelvic health symptoms.

Conclusion

Being diagnosed with a pelvic floor ‘dysfunction’ doesn’t mean you have to end your lifting endeavours. You can continue to train to reach your goals while bridging the gap between training and rehab,

Scaling back and training your pelvic floor to handle your max lifts may take some time. However, in most cases, you can manage your symptoms and reach your 1RM goals. After all, it’s not what you train, but how you train.

If you are looking for a pelvic health PT in Canada, click here. In the US, click here.

If you want to return to heavy lifting or possible you 1RM and manage your pelvic health symptoms after having a baby, Barbells For Lady Parts, my signature 12-week lifting program will get you there. Click here to learn more.

Ready to maximize your postpartum lifting performance? Get my favourite barbell training strategies in my free Barbell Training For Pregnancy and Postpartum Strategy Guide. You will learn to minimize pelvic floor dysfunctions, and improve lifting power in both pregnancy and postpartum.

Resources:

[The impact assessment of pelvic floor exercises to reduce symptoms and quality of life of women with stress urinary incontinence]. Jurczak I1, Chrzęszczyk M2.https://www.ncbi.nlm.nih.gov/pubmed/27088198

Descriptive cross sectional study on prevalence, perceptions, predisposing factors and health seeking behaviour of women with stress urinary incontinence. Perera J1, Kirthinanda DS, Wijeratne S, Wickramarachchi TK. https://www.ncbi.nlm.nih.gov/pubmed/24985068

Pelvic floor muscle function and urinary incontinence in the female athlete. Casey EK1, Temme K1. https://www.ncbi.nlm.nih.gov/pubmed/28845723

Prevalence of Urinary Incontinence in Females Performing High-Impact Exercises Hagovska M1, Švihra J2, Buková A3, Horbacz A3, Dračková D3, Švihrová V4, Kraus L5. https://www.ncbi.nlm.nih.gov/pubmed/28212587