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Red Flags During Exercise in the Post Natal Period… obvious or not, these are the things you need to be vigilant for in any woman who has had a child.

No matter how many weeks, months, or years post natally that your client resumes exercise, chances are her body will be different to what it was before. Pregnancy and childbirth are massive physical events, and they leave their mark on the body – not necessarily a negative one, but different all the same. If she has not seen a women’s health physio since having her babies, then now is the time.

Furthermore, you’re going to keep an eye on the following red flags as she progresses through your programs. If you notice one, you can be sure there is another one that you can’t see – pelvic dysfunctions always come in pairs – so send her to a women’s health physio, and begin your deep core restore protocol (a 6 step process for trainers is available here).

Red Flag #1 – Doming

Doming is not necessarily a cause for alarm, but it is a red flag that is cause for consideration and investigation. If you see doming, chances are you’ll see back pain or stress incontinence as well – so a referral to a pelvic physio is important!

Next, check her posture – do you see upper or lower cross syndrome? If yes, then posture training becomes a higher priority than your regular program because both of these things impact pelvic function:

  1. upper cross syndrome pushes down and out on the PF and abdominal wall
  2. lower cross syndrome further stretches the abdominal wall and disables the PF

Next, check her breath – does she breath in to her lungs? Or is she chest or belly breathing? If you see anything except an intercostal breath, then teach her how to breath in to her ribs – demonstrate.

Finally experiment – if you saw doming during chin ups, is there a level of chin ups she can do without further doming? If you saw it in a plank, can you do a version of the plank that doesn’t cause doming? Or is there another exercise that hits your target muscles without pushing out through the abdominal wall? Give it a crack and see what happens!

An example of post natal doming (and the experimenting I did) here, and another one here and how the breath can help here! Video on belly shapes, movements, and what each might mean here.

Red Flag #2 – Leaking Urine or Fecal matter

Yep. We’re starting today with Feces.

Now, it may seem obvious that a woman who is leaking anything she should be holding in while training is a red flag, many trainers are continuing to train women completely oblivious to this possibility. Furthermore, they assume that because the client doesn’t say anything, that nothing is occurring.

Here’s the thing, though.

Women are masters of fitting in, in a world shaped for men’s comfort. Before you bite my head off, look at public toilets: urinals, toilet paper, sit down toilets, soap and water are necessary for men. For women, toilets, toilet paper, menstrual products, water and soap are vital. Who has their needs met? So, women learn to fit in.

The same issue is threaded throughout the fitness industry, particularly in our screening processes. If we aren’t asking about leaking or incontinence, then the majority of women will go ahead and fit in anyway, despite their symptoms or pelvic health. An even larger group of women won’t participate in exercise at all, with pelvic floor dysfunction being the number 1 barrier to exercise for women more broadly.

So. You have to get comfortable ASKING about whether or not they’re leaking, then you have to have a referral process with your local pelvic health physio. If you don’t ask, they won’t tell, and you miss a fantastic opportunity to promote and value her body, her health, and her future health.

Look up your local women’s health physio here:

Red Flag #3 – Back Pain

I know what you’re thinking… ALL women have back pain, and you’d pretty much be right! Women have back pain for a variety of reasons, their back might be tight, unstable, unaligned, etc. So you can’t assume stretching is going to “fix” It.

What you may also not realise is that back pain is a gigantic red flag for pelvic dysfunctions. In the post natal period, which i’d say is anytime after a woman gives birth – to infinity, a woman with chronic back pain needs to see a pelvic health physio.

Not a muscular-skeletal physio.

Not a sports physio.

A pelvic health physio (link to find one in comments).

In addition, pelvic floor exercise has an analgesic effect on back pain. So even if you back pain is NOT pelvic dysfunction, you can ease it by teaching her the kegal (get properly qualified first – it’s more than just vagina squeezing!).

Red Flag #4 – Mental Health Changes

I think we have good awareness about what post natal depression looks like, and perhaps you’ve even heard about post natal depletion. If not, post natal depression is a clinically diagnosed form of depression in the post natal period, with symptoms like insomnia and a profound loss of joy. Depletion on the other hand is closer to a form of anxiety, with symptoms such as hyper vigilance, frustration, overwhelm, and loss of libido.

Your job as a PT isn’t to diagnose or even say “hey, I think you have depression”… it’s to NOTICE CHANGES. We have this unique opportunity where we see the same women, at the same time, in the same environment every single week, sometimes multiple times a week. So we are also uniquely placed to notice changes.

For example, have you noticed any changes in:

  • How she talks about herself? Is she bubbling with self deprecating talk, self-put-downs, or vocalising depressing ideas and attitudes? And is this new for her?
  • Her behaviour? Is she cancelling her sessions a lot? Turning up late? Is that new? Why is she doing it? What’s happening at home?
  • Her habits? Has she quit wearing deodorant? Or is she in clothes from two days ago? Is she always relaxed about her personal hygiene or is this something new? Or is she training an extra 1.5hrs either side of her session? Why? Why the change?
  • Her appearance? Does she have an unusual skin tone, or are her eyes half lidded? Is she rapidly gaining or losing weight?
  • Her mood? Was she previously joyful and adventurous but not she’s flat and irritated? Or is she jerky and high energy and rushing about like a chicken?

There will be some version of the changes above for every post natal woman; as they adjust to their new role, and the lack of sleep (not that we ever adjust to that). What is key is noticing these changes, and making sure she’s ok (not judging her because she doesn’t wear make up or deodorant anymore)!! If you’re not sure, Beyond Blue has a wonderful resource in the mental health checklist for mums. You can ask her to fill it out or fill it out together and go from there:

The next step is referring her to her GP, who will take her trough the process of getting a Mental Health Plan, where her couselling will be subsidised.

Again, do not diagnose or refer her yourself – send her to her GP and let them take it from there.