Strength Training After Having a Baby: An Evidence-Based Approach For Return To Fitness

Written by: Dr. Olivia Jones, PT, DPT. Pelvic Floor and Orthopedic Physical Therapist

Returning to exercise after childbirth can feel confusing. Many women are told to “just do Kegels” or to avoid lifting altogether. Others resume high-intensity workouts without clear guidance.

The reality is more nuanced.

Strength training after having a baby is both safe and beneficial when progressed appropriately. As a physical therapist who specializes in orthopedic and pelvic health rehabilitation, I approach postpartum return to lifting with a focus on tissue healing, pressure management, and progressive load tolerance.

Changes That Occur During Pregnancy That Affect Strength Training

The Core as a Pressure System

The core canister functions to coordinate pressure systems without your body which includes:

- The diaphragm

- The pelvic floor

- The transverse abdominis

- The deep spinal stabilizers

Following pregnancy, coordination within this system may be altered. This does not necessarily mean the muscles are “weak,” but rather that timing and load transfer may need retraining.

Strength training is appropriate postpartum, but breathing strategy and load progression matter.

Pelvic Floor Recovery and Load

The pelvic floor undergoes substantial load and pressure during pregnancy and delivery which can lead to concerns such as:

- Urinary/bowel leakage

- Pelvic heaviness and pressure

- Pelvic pain

- Decreased coordination

These symptoms may limit return to lifting initially, however resistance training is not inherently harmful for the pelvic floor. The combination of general strength training, pelvic floor focused exercises, stress management and pressure management improve overall outcomes and life-long function (Bø et al., 2017).

When Is It Safe To Return To Lifting?

Rather than stating a period of time (such as 6 weeks), symptoms should be monitored to determine readiness to return to activity. A symptom checklist such as”

- No worsening pelvic pressure or heaviness

- No increase in urinary leakage with exercise

- Ability to properly manage pressure such as coordinating breath with effort

- Tolerance to daily activities without flare in symptoms

- Stable or improving pain levels

When Is It Safe To Return To Running?

A high-impact, structured strength progression and impact readiness are recommended. This will include:

Strength Assessments:

- Single Leg Squats

- Single Leg Bridge

- Single Leg Sit To Stand

- Side Lying Abduction

Load and Impact Management:

- Walking 30 minutes

- Single Leg Balance

- Jogging in place

- Hopping and Jumping

Pelvic Floor Strengthening and Endurance Assessment

Before returning to running, patients should be able to perform all activity without reproduction of pelvic floor symptoms or low back pain (Goom, Donnelly & Brockwell, 2019).

Common Postpartum Challenges Seen In Pelvic PT With Return To Activity

I will often see patients who are eager to return to exercises but are not sure where to start. This may lead to patients:

- Rapidly returning to high-intensity exercises without rebuilding foundational strength

- Performing only kegal exercises without functional integration and experiencing symptoms once returning to exercise

- Lifting with excessive abdominal bracing or breath holding

- Avoiding exercises due to fear of symptoms or of making them worse

A Progressive Framework For Postpartum Strength

Phase 1: Coordination and Reconditioning

Goal: Restore pressure management and baseline control.

This may include:

- Diaphragmatic breathing

- Pelvic floor contraction and relaxation (*very symptom dependent*)

- Hip strengthening

- Abdominal coordination and strengthening

Phase 2: Foundational Strength

Goal: Build tissue capacity and increase tolerance

Many exercises can be included in this phase. The emphasis should be on increasing tolerance to activities such as squats, deadlifts, lunges, rows, etc while maintaining proper pressure management and symptom control.

Phase 3: Advanced Strength Training and Plyometrics

Goal: Restore dynamic control and impact resilience

This is where progression of heavy compound movements, jumping, and running find their place.

When To Seek Pelvic Floor Physical Therapy

- Persistent urinary or bowel leakage

- Pelvic heaviness or pressure with exercise

- Pain with intercourse

- Bathroom disturbances such as incomplete emptying, pain with urination or with bowel movements, or excessive straining

- Abdominal doming that worsens with load

These symptoms are common but treatable and can improve greatly with the help from a pelvic floor physical therapist all while keeping your goals in mind!

Our Approach At The Green Room Physical Therapy

We emphasize the importance of a one-on-one individualistic approach for every patient. Pelvic physical therapy includes postpartum rehabilitation and integrates orthopedic strength principles with pelvic health expertise. Our goal is not simply symptom reduction, but restoration of strength, confidence, and long-term resilience.

If you would like individualized guidance for returning to lifting, contact our office to schedule an evaluation.

References:

Bø K, Artal R, Barakat R IOC Medical Commission, et alExercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3—exercise in the postpartum periodBritish Journal of Sports Medicine 2017;51:1516-1525.

Goom. T, Donnelly, G. & Brockwell. E (2019). Returning to running postnatal - guideline for medical, health, and fitness professionals managing this population. Open access via Researchgate.