Returning to Exercise After Birth: A Physiotherapist's Guide

Anna Trewhella, Physiotherapist - Move Sports Physio Geelong

If you're reading this with a baby in one arm and your running shoes eyeing you from the hallway, you're in the right place. Returning to exercise after having a baby is one of the most common questions I get asked as a woman's health physio. And rightly so, there is a lot of noise out there to navigate. Such as; arbitrary timelines, guilt-inducing "bounce back" language, and conflicting advice from every direction. So let's cut through it.

First of all, you do not need to rush back, or be overly cautious either. Returning to exercise is about understanding what's actually happening in your body, so you can make informed, confident decisions about when and how to move again.

Every Body's Timeline Is Different

There is no single "correct" week to start exercising again. Recovery depends on your birth (vaginal or caesarean), any complications, how you're feeding your baby, your sleep, your pre-pregnancy fitness, and simply how you feel. What we do know from the evidence is that gentle movement; walking, breath work, and pelvic floor activation — can usually begin within days of birth, while higher-impact activity needs a more structured, individualised approach.

One of the clearest, most consistent recommendations across the research is this: every postpartum woman, regardless of how she gave birth, should have access to a pelvic health assessment from around six weeks postpartum with a physiotherapist trained in this area.

This is the recommendation with the strongest level of evidence in current postnatal guidelines, while the remaining recommendations are based on expert opinion because research in this area is still limited. A pelvic floor assessment isn't a hurdle, it's your traffic light letting you know when it's safe to get going.

Return To Exercise

Exercise after birth isn't just permitted, it's actively encouraged, and the evidence for its benefits is strong. Major bodies such as the American College of Obstetricians and Gynecologists note that aerobic and strength-conditioning exercise should be encouraged before, during, and after pregnancy, and that regular activity in the postpartum period can also help protect against depressive disorders. This isn't about "getting your body back" it's about rebuilding function, energy, and strength for the demands of caring for a new baby, whilst supporting your own physical and mental wellbeing.

Re-building The Foundations

The first days and weeks -  For most women with an uncomplicated vaginal birth, gentle movement can start almost immediately: Light activities such as walking, breath work or pelvic floor exercises are generally considered permissible soon after birth if medically appropriate, with gradual return to physical activity typically supported from around six weeks postpartum for uncomplicated vaginal deliveries. If you've had a caesarean or a more complicated birth, this generally takes longer, and it's worth being guided by your care team and how your incision and abdominal muscles are healing rather than a fixed date on a calendar.

Building back the foundations - Before jumping into a class or a run, the priority is rebuilding the "inner system" — pelvic floor, deep abdominals, breathing mechanics, and postural control.

Targeted abdominal and core exercises, including controlled drawing-in movements, have been shown to help reduce the extent of abdominal separation (diastasis recti) postpartum.

This groundwork pays off later when you return to higher-impact activity.

Levelling Up

Strength and cardiovascular fitness - Once the foundations are in place, a well-rounded return to exercise generally includes:

• Walking - gradually increasing in duration and pace, genuinely one of the most underrated tools in postpartum recovery.

• Strength training - Research suggests combining core-strengthening work with resistance training has shown greater improvements in muscle strength and body composition than aerobic exercise alone. Think squats, hip hinges, rows, and carries, progressed gradually.

• Low-impact cardio - Such as swimming, cycling, or the cross-trainer, which are kind on the joints and pelvic floor while you rebuild capacity.

• Mobility and stretching - especially through the hips, thoracic spine, and shoulders; areas that often get stiff and tight from feeding positions and carrying a baby.

A general (and genuinely achievable) target once you're cleared from your pelvic floor physiotherapist is around 150 minutes of moderate activity a week, spread across most days. Building gradually if you weren't very active beforehand.

However, this isn't a pass/fail number in the early months. Ten minutes of walking with the pram to the coffee shop, or a short strength session in the lounge while baby naps all count.

Listen for feedback, not failure - Your body is very good at giving you signals to slow down or check in with a physiotherapist.

• A dragging or heavy sensation, or bulging, in the vagina

• Leaking urine, wind, or stool during or after activity

• Pain that lingers in the pelvis, back, or abdomen after a session

• A general sense of "wobbliness" or loss of control

None of these mean exercise is off the table, they simply mean it's worth building a little more strength and control before progressing load or impact.

Return to Running

Returning to running is one piece of the bigger picture, but does require some additional considerations. Higher-impact activity like running places significantly more load through the pelvic floor, abdominal wall, and joints than walking or strength work, so it's generally best introduced once those foundations are solid. This timeframe may be anywhere between 3-12 months guided by how your body is functioning rather than a specific number of weeks alone. Current postnatal guidelines recommend low-impact exercise within the first three months postpartum, with return to running generally considered appropriate from around three to six months.

Starting out

• Consider how long you haven't been running for?

• Start slow, and low volume's

• Take at least 2-3 days rest between runs to assess your recovery from running.

• Listen for feedback (see above)

The number one risk factor for injuries during this period is simply increasing running volume too quickly. This is entirely within your control, so it gives you the power to make informed decisions on when to proceed, progress, or pull back.

How We Support Your Return to Exercise at MOVE

At MOVE, our prime objective is to support and empower you in your journey back-to or beginning-to exercise. If you're working with a pelvic floor physiotherapist, we can work alongside them, to ensure congruent treatment and progress.

We'll get a deep understanding of your exercise history, injury history, pregnancy, birth, and exercise/movement goals. Your treatment plan is completely dictated by you as an individual.

• Hands on treatment if needed - to help release any areas of stiffness and tension.

• Movement analysis

• Strength testing if appropriate

• Clinical Pilates - to help build the foundations

• Resistance training - to strengthen the foundations

• Progressive overload education / program design if required.

Key Takeaway

Your postpartum body isn't fragile, it's adapting, recovering, and rebuilding.

With a sensible and gradual approach to returning to exercise by building your foundations before your intensity, the vast majority of women return not only to the activities they love, but to a body that feels strong, capable, and genuinely theirs again.

If you're unsure where to start, let us help take the guess work out work together to build a path forward that gives you confidence, not just hope.

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References:

• ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period.

• Goom, T., Donnelly, G., & Brockwell, E. Returning to running postnatal: guidelines for medical, health and fitness professionals managing this population.

• Schauberger, C.W., et al. (1996). Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol.

• International Delphi study on common musculoskeletal impairments in postpartum runners.