I clenched my teeth as my physical therapist lifted my right leg, slowly moving it to assess my mobility and pain level. It’s February, but the paper that lines the table is clinging to my sweat-soaked lower back. The pain in my pelvis was excruciating. Through tears, I asked her how this could have happened. I ran until I was 35 weeks pregnant and I never could have imagined that at seven months postpartum, I would still be out of commission.
Your body is still producing a lot of hormones that are making your ligaments loose which may be causing this issue.
“You’re still breastfeeding, right?” she asked as I wiped my eyes and nodded. “OK,” she said, her eyes kind. “Your body is still producing a lot of hormones that are making your ligaments loose, which may be causing this issue. Has anyone told you that?”
After I began having intense pelvic pain after my first postpartum run, I spent months searching for answers. No one mentioned that pregnancy hormones meant to ready my body for birth would cause me pain in the postpartum phase—until that moment. I was floored.
“What most women do not realize is that their body is still under the influence of the pregnancy hormones for a good while after childbirth,” says Marianne Ryan, a physical therapist and orthopedic clinical specialist, as well as the author of “Baby Bod: A Groundbreaking Program for Pregnant and Postpartum Women.” “It takes a while for the pregnancy hormones to dissipate, and that is one of the reasons why your body doesn’t "snap back" to “normal” right after birth.
What exactly are those “pregnancy hormones”? While there seems to be some disagreement about which hormones are to blame, most experts point to relaxin, the hormone that is most commonly pegged as the one responsible for readying a woman’s body for pregnancy and birth.
“Relaxin is one of the main hormones during pregnancy that allow for the body's ability to deliver a baby vaginally,” says Karen Joubert, a physical therapist based in Southern California. “It eases the tension on the ligaments, increasing their elastic property in order for the pelvis to relax.” Ryan explains that this helps the pelvic bones spread to widen the diameter of the pelvis so a baby can make its way down the birthing canal. And like Ryan, Joubert emphasizes that most women don’t realize that these hormones don’t just go away once their bundles of joy arrive.
While researchers aren’t exactly sure how long relaxin and related hormones stick around after birth, Ryan outlines some general guidelines in her book. On average, she says pregnancy hormones will hang around and continue to affect connective tissue for up to three months after birth, if a woman is bottle feeding. If a woman is breastfeeding, then hormones will linger for three months after she weans her child.
“It’s important to keep this in mind because a lot of moms wrongly assume that once they have their six-week postpartum checkup and hear the healthcare practitioner tell them that everything ‘looks fine,’ they can go back to ‘business as usual,’” Ryan writes in "Baby Bod," adding pelvic organ prolapse and diastasis recti are other injuries that might occur as a result of doing too much too soon. “Not true.”
If a woman is breastfeeding, then hormones will linger for three months after she weans her child.
Even though I didn’t pick up where I left off, I did assume that waiting the required six weeks would have been enough recovery time, especially given my active history. I chalked up my initial discomfort as simply getting back into it but when my physical therapist diagnosed me with a combination of a psoas injury and high tone pelvis months later—leading to pelvic, hip and lower back pain—I realized I had been wrong.
In order to avoid injury during this period, Dr. Nicole Scott, an OB-GYN at Indiana University Health says women should ease into a workout routine.
“I recommend starting with walking or other low impact exercise, and working up to running or other higher impact exercise,” she says. “Swimming, yoga and Pilates are great choices to avoid injury.”
Scott also emphasizes that if breastfeeding, a mother should be sure to compensate by eating more calories, drinking more water and “cutting yourself some slack when trying to get your pre-baby fitness back.”
Because of my injury, I was forced to take it easier and slower than I had initially imagined my postpartum recovery to be. I’m looking forward to finally running my first 5K this fall, two years after my daughter was born. It was a long road but perhaps this piece will serve as a warning to those who want to jump back into their pre-baby exercise routine. Take it slow, take it easy and as Joubert says, “Keep it simple and listen to your body.”