Breastfeeding and Exercise Q&A: Can I make a diastasis or damage my joints if I exercise while b

Q: Hi Jen, I'm looking for some advice... My post natal yoga teacher said that whilst breast feeding the pregnancy hormones remain in your system and as a result if you push yourself too hard you can still end up with diastasis recti and joint problems even if you didn't have them after the birth. Because of this I've only been doing gentle-ish exercise but I really want to get stronger, I have noticed my knees ache if I run for over 12km but don't know if that's the hormones or lack of strength! I don't have a gym membership so I'm thinking just quick workouts I can do at home like HIIT training or something. My little boy is nearly 1 so my body is very much recovered from childbirth/pregnancy but it's the breastfeeding thing that I just can't find any advice on... Do you reckon I can just go for it? (building up according to my ability)

Hi Anna - great question, I get asked this a lot, and you're right, the advice about exercise while breastfeeding is pretty lacking... and a lot of it is total garbage.

Your yoga teacher isn't totally wrong, but she's definitely gone a bit OTT with her message.

Remember, we have to hit a good balance when we advice women about exercise postpartum (or anyone really)... we don't want to throw the baby out with the bathwater and just do anything we want to do, or go straight back into what we were doing before, but on the other hand, there is such a thing as being TOO cautious. This can be just as bad as throwing caution to the wind and going bonkers because we can make women so fearful of doing any exercise that they just don't. Exercise is good for us - it's good for joint health, cardiovascular health, longevity, it prevents osteoporosis, diabetes, heart disease, obesity and depression. If our message is too restrictive or too cautious, we stop women from getting all these health benefits.

In addition, while there is a ton of information out there on the effects of exercise on breastfeeding; not many people are talking about the inverse relationship: the effects of breastfeeding on exercise.

What we do know is that breastfeeding affects your hormones. Estrogen and progesterone levels are high during pregnancy, and they plummet after giving birth and will only start to rise again when the ovaries start producing them once more.

In breastfeeding women, levels of estrogen and progesterone will remain low until they stop.

There's not an awful lot written about how breastfeeding affects exercise, but it is thought that breastfeeding affects our connective tissues and joints, making us a bit weaker and more prone to injury.

(On a side note, it often makes fat loss really hard, but that's a separate blog post).

HOWEVER, there is little proof to back this up. Anecdotally, I often work with breastfeeding women who have DR or pelvic floor complaints who find that it's really very stubborn. As soon as they stop breastfeeding, things start to get better very quickly. The same is true of fat loss. But this is not true for every breastfeeding woman, nor is it the same as research.

If we presume this to be true, what that would mean is that we might be a little more prone to "the big 3" of pre- and postnatal complaints:

1. Pelvic floor dysfunction

2. Diastasis Recti

3. Muscluloskeletal complaints i.e. back pain, hip or knee pain etc.

HOWEVER, let's talk specifically about your situation

You are a year postpartum, don't have and haven't had any pelvic floor dysfunction or diastasis recti. You've been exercising for a while now doing yoga and running. You are experiencing some knee pain after running longer distances. You feel ready to up the intensity of your exercise, but are concerned about causing damage.

So let's break this down.

In terms of pelvic floor dysfunction, women always have some degree of risk of pelvic floor dysfunction, especially after having a baby. Higher impact exercise (running, jumping and lifting heavy weights) may put us slightly more at risk than lower intensity exercises. However, if you love running, it's important that you do the exercise you love, so you might want to take the following measures to keep your pelvic floor healthy:

• Go and see a pelvic floor physiotherapist and get treated for any symptoms

• Ensure you have good breathing mechanics and you understand how to regulate intra-abdominal pressure. Ensure that your "core system" (pelvic floor, diaphragm, abdominal muscles) are balanced

• Understand the importance of good alignment and try to spend more of your day in those positions, especially when exercising

In terms of diastasis, if you don't already have one, it's very unlikely that you will cause one at this stage, unless you are doing some seriously aggressive core exercises with seriously bad form.

When it comes to knee pain, you mention that it starts to hurt around 12K - this isn't a reason to stop running altogether. Maybe you can end your run at 10 or 11 K... how does it feel then? Or if you notice it hurts after an hour, maybe you could stop at 50 minutes, a bit before it starts hurting.

This is a simple case of not throwing the baby out with the bathwater - or as my grandfather used to say "there's a difference between scratching your arse and tearing it to pieces". 12km is a bloody long run if you ask me - there's nothing wrong with that, but if it is causing knee pain, you might need to just reel it in a bit.

Furthermore, knee pain is really common in women, and it's often to do with a bit of hip instability - so basically some weakness around the hip (and not the knee itself). It often looks like the knee falling in towards the centre each time the foot strikes the floor. This can often get worse in women who have had babies, and running can accentuate the tendency for the knee to cave in, rather than strengthen it.

Again, this isn't a reason to stop running. Instead, you might want to just try some simple exercises to strengthen that hip up.

You'll want to focus on:

• Balance work, like single leg squats and deadlifts

• Abduction (taking the foot right out to the side, opening the legs)

• and External rotation (turning the toes out)

Try the following exercises:

Clam shells (external rotation)

These are mega easy and you'll want to progress onto something more functional and challenging rather quickly (see the banded squats below)

Single leg deadlifts (balance)

Walk walks (abduction)

Squats with a mini-band (also external rotation, a bit of abduction, and some other stuff too that will strengthen you for running)

Make sure you push your knees outwards against the band

In conclusion...

As I said earlier in the post, there are very few studies done on the effects of breastfeeding on exercise, joint health and conditions like pelvic floor dysfunction and diastasis recti. Most of the information we have is from observation and/or is highly speculative.

Ultimately, while breastfeeding might be a reason to take a few more precautions, a lot of what we think we know is highly speculative. It shouldn't be a reason for you to not exercise (if you are keen to) and advice like what was given above by your yoga teacher is pretty unhelpful and makes women scared to do anything. We have to find a balance and keep women doing whatever type of exercise they enjoy while keeping them mindful of postpartum considerations so they can remain injury-free.

It's likely that you can start to increase the intensity of your workouts, like you said, by increasing a bit here and there. It might not be wise to add more running right now (and you might even start by decreasing your running just a little as I discussed above) and start introducing strengthening exercises for that hip at home and some HIT if you want to (and enjoy that kind of thing). You can start with just 5 minutes a couple of times a week and increase by a few minutes each time.