The Healthy Post Natal Body Podcast
The Healthy Post Natal Body Podcast
Don't focus TOO MUCH on the rehab part of postpartum exercise
This week I am waffling through another episode all by myself as I try to get the point across that a very narrow approach to postpartum recovery training will actually hurt you more than it will help.
Basically I am saying that, by only focussing on things like diastasis recti, pelvic floor issues etc and ignoring "normal" upperbody training and movements, you're going to run into problems later on and you really don't need to.
As I explain, unlike some other programs, in the HPNB program we start incorporating upperbody strength training from week 4 onwards as it's a vital part of getting you fit as a fiddle and ready to deal with whatever life throws at you.
Anyways, if you don't mind me taking ages to get to the point, this is a valuable episode for anyone to listen to..I promise :)
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So this means that you not only get 3 months FREE access, no obligation!
BUT, if you decide you want to do the rest of the program, after only 5 months of paying $10/£8 a month you now get FREE LIFE TIME ACCESS! That's $50 max spend, in case you were wondering.
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Playing us out this week; Moses Kidd is back! "Leaving this town" is the name of the track
Hey, welcome to the Healthy Postnatal Body Podcast with your postnatal expert, peter Lapp. That, as always, would be me. Today, I am talking about the mistake of focusing too much on the rehab element of postpartum exercise. So postpartum exercise programs that focus only on recovery of diastasis, recti and pelvic uh, girdle pain and and and all that type of stuff, I'm not saying it's not important. I'm just saying there's more to it than that and it's important to keep it up, and I'll explain why it's important to be a little bit broader than just focusing on the narrow issues. So, without further ado, here we go. Hey, welcome to the Healthy Postnatal Body Podcast. For what are we today? The 16th of Feb 2025. And it's just little old me again this week.
Peter:I hope you enjoyed last week's interview with Nigel Brayer. What was that last week? I think that was last week. No, last week we did the other one. What was that with Jessica, which was phenomenal, with Jessica Setnick, which I really enjoyed Paediatric eating disorders and all that type of stuff. I really enjoyed the conversation.
Peter:So I'm all over the place right now. I've got three episodes to edit. I'm a busy, busy bee and I'm all over the place. I know that next week, for instance because I just sent that off we're talking traditional Chinese medicine and how it can help your postpartum recovery, the things to do, what not to do. The problem with the American style and traditional Chinese medicine and all that sort of stuff, how the monetization of it kind of goes against what you're really supposed to do, which is with Brian Crawford from Crawford Wellness, which is a phenomenal guy. I love that dude. I love that dude. But this week, this week, I am talking about the problem of only focusing on the rehab element of any sort of postpartum program. Now, I've mentioned before that a lot of the programs that say focus on diastasis, recti, for instance, they all just talk about core engagement and work, the transverse abdominis, the TVA and all that type of stuff, and that is where their narrow focus is and how that is a mistake, how I think we should work more on other things as well, as you know, glutes and obliques and blah, blah, blah, blah, blah, all that type of stuff. But I think there's much more. There's a much broader problem and to indicate what I'm talking about, I'll mention the following I have a client who's been with me for I don't know a year and a half or so now, who's been with me for, I don't know, a year and a half or so now, not postpartum, but she had quite a crappy accident a skiing accident and then a car accident very unlucky like 15 or so years ago and then she started training for me for health and fitness.
Peter:One or two issues from her accidents Her grip strength on the left side was really poor and her shoulder. There were a lot of shoulder problems Again from the accident from more than a decade earlier and it never resolved itself. She'd been very active her entire life, swimming and lifting weights and all that type of stuff, but no one, barring the physio, getting range of motion back. No one had ever really spent any time strengthening up the shoulders. So there were one or two issues. All she could lift overhead was a two-kilogram weight with her left arm and that's not a lot. Almost everybody should be able to. I've worked with one of my client's kids who's six and he can do two and a half. So it's important for people to be able to lift a little bit more than 2 kg overhead without the weight falling on your head.
Peter:Anyway, she was working with me for about seven, eight months, making great progress and she went to one of the luxury resorts in Scotland, up north in Scotland. You know the one. I mean there's two, there's Archerfield and there's the other one, and it's the other one. I'm not going to name the names of the place, but it's in, it's near St Andrews, right, it's one of those nice and expensive £300 a night sort of deals. She went to the gym there and she was running on the treadmill and someone one of the cleaning crew, stuck a vacuum cleaner I shouldn't laugh, but it's so dumb um under the treadmill and she went from I don't know 10 mile an hour to zero instantly and that caused, as you can imagine that that caused quite a bit of, uh, quite a bit of of an issue like a whiplash sort of situation. She went from from 10 mile an hour to zero on the treadmill and and thank god she was very strong and well balanced and all that type of stuff, otherwise she would have done a lot of damage but her entire left hand chain, so, uh, all the joints messed up because of the impact, because that was the, the front foot as she, as she landed on that, that's where the body took most of the impact. So we're talking knees, we're talking hips and again, the shoulder is back right. Everything along that chain was messed up some neck trouble and all that sort of thing right now.
Peter:She went to see various you know people to help out with stuff specialists and get scans, and and we uh, we kept working together on on one or two things and the shoulder problem went away quite quickly and the hip problem took a bit longer. But the knee was messed up. There there was a lot of soft tissue damage, a lot of soft tissue damage, and that was causing some long-term problems. And I'm not the knee guy, right, it is just not what I do. I know it as a joint, but I'm not a physio and I don't focus on that element. So she finds someone to work with. There's a point to this story, I promise.
Peter:So she finds someone to work with who is a knee specialist and they do a lot of exercises, work with him for a couple of months now. They do a lot of exercises, work with him for a couple of months now, and it's all the focus. All the focus is on the knee. Now that's great, of course, because the knee needs to be healed, right, that is important. You do bits and pieces around the knee and you do range of motion stuff and activation stuff and just general strengthening up of the area around the knee and all that type of stuff.
Peter:The problem is, of course, that the loss of muscle mass that she's now experienced from focusing too much on the rehab elements, especially in her legs and all that sort of stuff a lot of strength is gone, a lot of muscle mass is gone means that her knee is actually weaker now than it was. Knee pain is a bit less but the knee is still weaker, if that makes any sense. And because they focus that much on and I'm still working with her for upper body and core and all that type of stuff, so that's getting stronger and we're doing bits and pieces. But now she's unhappy because a lot of the progress that was made in the past is now kind of undone. And the issue is not so much that I spend too much time focusing on the left knee. The issue is much more about how none of this stuff has translated into doing any movements that can be transferred into life.
Peter:And you find this a lot with postpartum programs as well. So if my client had stopped working with me, for instance, and only had only done rehab stuff. And she's got a wonderful team of people around her right. We're working with with four or five different people are involved in in her health, um, and all of them are really, really. But if she had stopped working with someone who knows about strength and other things, so upper body stuff then that would have gone, and we're now seeing that with the legs a little bit.
Peter:So I had to have a chat with the knee person and say, listen, we need to make sure that the focus is not just on rehab. And the knee person came back and said, yeah, oh no, you can definitely do all that stuff if she wants, but he only cares about the knee and the knee pain, right? The narrow focus therefore doesn't help, right, she'll struggle to run, for instance, because the impact is too much and her quads are now nowhere near as strong as they used to be and they could be. Right, it's a and the issue is right and I'm not showing anyone under the bus here. I've not named any names, anyways, but it's. The deal was that I was going to do the upper body stuff and all that sort of thing and I would stay away from the legs because I can't clash with someone else someone's rehab, because we need to know what causes what and all that sort of thing.
Peter:The issue is that the focus has been so much on knee rehab that the strength element is completely gone to the point that she can't really comfortably do stiff leg deadlift of any reasonable way Because she's lost that that strength element. Like I said before, there was a problem with her grip when we first started working together a year and a half ago on the left side, so we strengthened that up. That has now dropped again by 25% just because she's ignored it for now. Because you know the focus was so much on the rehab of the knee that every element around the strengthening of the leg and all the other leg exercises were ignored in favor of just doing exercises for rehabbing the knee. And you see this a lot with postpartum programs. That is the point that I'm getting to. Again, I'm not crapping on anyone, I'm just saying that this is a common problem with postpartum programs.
Peter:When you have things like a program that only does pelvic floor and core stuff, you're ignoring upper body strength, and a lot of them do this right, a lot of them. You see a ton of squats in the program and there should be, but there are no shoulder presses in there. There is no movement up there picking a weight up and holding it overhead in the program and there should be, but there are no shoulder presses in there. There is no movement up there picking a weight up and holding it overhead like you would with a baby. Right, these things translate into life, and if you do such a thing for too long where you're only focusing on the core stuff and maybe some good stuff, if you focus too much on that, then you're going to lose an element of strength that is actually really quite important in the grand scheme of things, right, if that makes any sense. So, for a mother, for instance, it's really important to be able to and I've talked about this a lot to pick a weight up off the ground and shift it from A to B, whether that's a buggy, a travel seat or a baby or a toddler. Indeed, it's important to be able to pick something up, move it from, say, the left hand side to the body and then up to the other side, or hold it up or whatever. Be able to throw a kid up in the air is, I think, an important life skill right. It's without hurting yourself and having the right core activation and all that sort of stuff.
Peter:But, as everybody who has ever done a military press or a shoulder press will tell you, that if your shoulders are not strong enough to perform the exercise with the weight that you're doing it with, your body won't use the right muscles at the right time. And I talk about muscle functionality, a lot right Core functionality. If you cannot hold a reasonable posture, as in for an overhead press that would be, if you cannot prevent yourself leaning back very far because your shoulders are too weak and you need to recruit more muscles and a bit of chest muscles and all that type of stuff, then your core is no longer active during that motion. Then your core is no longer active during that motion and all the work you're then doing with regards to pelvic floor and core recovery stuff kind of goes out the window because you've lost upper body strength to perform that movement effectively.
Peter:And if you're going to wait the three to six to nine months that it takes for normal diastasis to really be 100% and I know a lot of these programs are selling you the diastasis is a lifelong condition sort of thing, and don't lift heavy things at all anymore, right? I heard that in a medical practice the other day. Someone said you've given birth, don't lift anything heavy for the next six months. Dumb advice, stupid. And by anything heavy they meant 10 kilos. So if you're only focusing on that element and you get weaker in the other bits that you need to be strong at in your day-to-day life, then even the bit that you focused on won't recover fully.
Peter:Does that make sense? As in if you cannot do a shoulder press with a reasonable weight, as in, say, your child is eight, nine, ten kilos, right, something, something along those lines. You should be able, right, to pick that child up off the ground, place him or her on your, on your hips and maybe even hold him or her up right above your head and go Gucci, gaga and we and all that type of fun stuff, right? If you cannot do that with reasonable form, so if that means that you need to lean back a lot and you have no core activation and you feel it in your lower back and all that type of stuff back a lot and you have no core activation and you feel it in your lower back and all that type of stuff, then because you are too weak in your shoulders to to do it with proper form, so to speak. Um, then then, what are we even doing this for? Right, you don't want to be at the stage.
Peter:And I train a lot, of, a lot of women, right, they come to me, uh, a lot of women, I mean, and they, they come to me, say, six to eight weeks after giving birth, right, we do shoulder presses and all that type of stuff, pretty much week two and three in our strength training training sessions. Right, it's, it's, it is pretty early on that that we start that, um, that we start that stuff. And I, I'll just look this lunges, good, bridge, strength b for advanced and all that type of stuff. Um, let me open up one of the hp and b programs and, like I said, they generally have upper body strength weeks two, three, a, b, so, yeah, month two. So pretty much there's already stuff in bts and rows. So, after four weeks of um, because on split, yeah, so the first four weeks are all pretty much uh, because the program is, of course, slightly different. Um, the program moves a bit slower than than pt does. First four weeks, pretty much all uh, all core related and glute related stuff and all that sort of thing, pelvic floor stuff, and then weeks five to eight, the strength sessions associated with that already incorporates upper body stuff, because we need to do more than just core stuff and leg stuff and all that sort of thing for like three, four, five months.
Peter:We need to make sure that as part of the rehab the biggest part of rehab isn't a narrow focus. For me it's the most important bit of that is that you are able to do the normal things that you have to do in daily life. That you're able to do that Rehab isn't complete. Until you can do that, rehab isn't complete. When, for instance, for a shoulder injury, when you can move your shoulder properly again, that is not complete rehab. It just means that you can move your shoulder again. You still need that is not complete rehab. It just means that you can move your shoulder again. You still need to be able to lift heavy things or do shoulder presses, and with a reasonable weight. That, as in a weight that you need in life and a weight that that allows you to to to come across life situations, I don't know moving house, going on holiday, for instance, going on holiday, getting on a plane and sticking your luggage in the overhead compartment, hurting your shoulder or without um, without requiring assistance because other parts hurt that that should not be hurting right, then then your rehab isn't really complete.
Peter:Do you know what I mean? As in the the, the rehab is supposed to be able to get you from. The rehab is supposed to be able to get you from not being able to do normal life things to being able to do all the normal life things that you need to do. And of course, there's tons of people out there that are not quite strong enough to do all these things at the moment, even though they're physically they don't have any injuries they're just for want of a better phrase too weak to do it. That's a different beast altogether. I think all those people need a significant amount of strength training in their life, but fundamentally that needs to be part of rehab, especially postpartum.
Peter:If you have pelvic girdle pain and all the focus is on recovering from that, but you're then too weak to get basically get in and up and down from your comfy chair or something like that without a lot of momentum, then your rehab isn't complete. It needs to be part of that all the normal life stuff. If you have pelvic girdle pain and it goes away, but you can't pick stuff up off the floor anymore. If you have a weak pelvic floor, that's one of those. Pelvic floor is the rehab element is now done, but you still can't pick stuff up off the floor without hurting your back because your back muscles at that stage are fundamentally quite weak. Because you never spend any time focusing on, on, on, on doing those things as part of your of your recovery program or your continuation of training program, then the rehab element has actually set you back more than it has helped. Well, maybe that's an exaggeration, but it is then part hindered in a way that it didn't really need to, right. So and I know I'm waffling a lot here I hope it makes sense because I'm trying to be very careful that I don't come across that I don't upset particular people that have different rehab programs.
Peter:Right of postpartum exercise, the postpartum rehab element of a postpartum exercise program let me put it that way should not be the sole focus for three, four, five, six months. That's all I'm trying to say. You should, as part of your postpartum exercise program, you should be things like training your shoulder, training your back. You should be training your biceps, training your triceps and all that type of stuff. There should be a normal strength training element to that. That's fundamentally I'm trying to say. It just took what? Is it 15, 20 minutes to get to the point. Yeah, 25 minutes. So you want to make sure that you get your bicep curls in, you get your back flies in, you get your shoulder presses in, you get your seated rows in and in the program with resistance band rows and Ts and Ys and all that type of stuff.
Peter:If you have access to a gym, then you need to get some heavy lifting stuff in as part of your postpartum program as soon as possible Sooner rather than later. The advice of don't lift anything too heavy is terrible advice. Once you are able to get your core going the way it kind of should be going, that is when you I mean so, and that is I've always said it's four to six weeks, right, that is. That is how long that takes for for that, what I still call it activation stage and we're going to change it because that's what people understand For that first, that four to six week activation stage Get through that, get stuff working when it's supposed to be working. Then you immediately start doing things on top of of the element. You start working body parts on top of the things that you're trying to rehab, because otherwise you're going to be working against you way too much. You're working against yourself and that will sooner or later inevitably bite you in the bum Right, because it'll start, it'll genuinely start working against you after a while.
Peter:And I've seen way too many people do a postpartum recovery program, postpartum exercise program, and they only focus on the TVA, the diastasis, and the diastasis and the pelvic floor stuff. They ignore upper body stuff. And by the time they then get to the gym and the diastasis is healed and the pelvic floor is fine and all that sort of stuff, they're either going months back or they can't do normal stuff without again their back hurting. And then it's not because so, for instance, for a shoulder pressor, just lifting weights in general, it's not that the diastasis is still a problem or the core isn't doing what it's supposed to do. It's that every other thing is nowhere near as strong as it should be and therefore you're doing things with bad forming, you start leaning back and all that type of stuff and therefore your lower back then starts hurting because you're leaning back way too far. Do you know what I mean? So please, please, please, please, make sure that there's always an element of doing other things. Working the arms is part of your postpartum recovery.
Peter:Like I said, 26 minutes it took me to say that to finally get to the point. Apologies for that, it's a waffly episode, I'm all over the place, but I hope it makes sense. I'm not happy. The next three weeks we just have interviews. So, like I said, next week, traditional Chinese medicine, which is awesome. Brian Crawford is phenomenal. Then Beth Mittelman, who is a therapist a mind-blowing interview, absolutely mind-blowing, about attachment theory oh boy, you're gonna love that one. And I did one with IO Hayes about open adoption and all that sort of thing. Now, I know all adoptions in the UK are open anyways, but it's open adoption versus closed adoption and all that type of stuff. You're gonna love that. I've got a ton more interviews coming up, five or six. So you know, the next few weeks you'll hear a bit less of me waffling and a bit more structured conversation. Anyways, peter at healthypostnatalbodycom If you made it this far, peter at healthypostnatalbodycom, thank you very much.
Peter:By the way, everybody who's listening, who has very kindly left ratings on Spotify and Apple and all that sort of stuff I've seen and you know if you're watching on YouTube. We've started up the podcast on YouTube again, just with stills and all that sort of stuff that is predominantly to. We had to do that. We had to do that because YouTube sent me an email saying we're going to demonetize the channel, and what I currently do for YouTube is I've monetized it with subscribers and watch hours and all that type of stuff. You need to hit certain levels with subscribers and watch hours and all that type of stuff. You need to hit certain levels. And then I make sure there are no ads in front of any of the videos and all that sort of thing. So I switch all the monetization off.
Peter:I don't have that option. If YouTube says you're no longer in charge of your own monetization, they'll start putting ads in front of absolutely everything, because that's what they do, and then they'll take all that money for themselves, right, and I, like I said, I don't monetize anything, so I don't get any money because I don't put ads anywhere. But it's kind of a someone called it a reverse Uno Right, make sure you have enough subscribers and watch hours and all. So if you can Make sure you have enough subscribers and watch hours and all.
Peter:So, if you can, if you have nothing better to do and you want to open up a tab and run it in the background to watch a couple of these things, or have a couple of these things open on the YouTube channel, that'll help us out a little bit, because it allows me to keep everything free of ads and all that sort of thing, because I really don't want YouTube to stick stuff in front of our exercise videos sort of thing, because I really don't want YouTube to stick stuff in front of our exercise videos. We're almost there, I think, but that's why we're up on YouTube again and all that sort of thing. It's a pain in the neck, to be honest, to throw one up on YouTube all the time. But you know, hopefully we'll keep it up and then we won't have any issues with that. Anyways, peterhealthynatalbodycom, if you have any questions or comments or all that sort of stuff, here's a new me to music. You take care of yourself, all right.
Speaker 2:Bye now. I didn't sleep a wink last night. The storm was in my head. I was contemplating, tossing and turning in my bed. This is how it feels when all the welcomes have worn out. I guess the jig is up. It's time I head out. I'm leaving this town. I'm taking the same horse as before, not coming back around. If you feel like showing me the door, not gonna say see you later, cause you know I'm superstitious, I'll take one last kiss and all of your well wishes, cause I'm leaving this town. I don't need much. I'll leave my baggage all behind. I don't need much. I'll leave my baggage all behind. Don't know where I'm going, who I'll be or what I'll find. Gonna head out west until the money all runs out, looks like the sun is up, it's time I head out.
Speaker 2:I'm leaving this town. I'm taking the same horse as before, not coming back around. If you feel like showing me the door, not gonna say see you later, cause you know I'm superstitious, I'll take one last kiss and all of your well wishes, cause I'm leaving this town. Yeah, I'm leaving this town.