Hello everyone and welcome to the Barbell Mamas Podcast.

My name is Christina Frubbett.

I'm a public four physical therapist, a researcher in exercise and pregnancy, and a mom of the two who have competed in classic, powerlifting, or weightlifting, pregnant, post-partum, or both.

In this podcast, we want to talk about the realities of being a mom who loves to exercise.

Whether you're a recreational exerciser or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey.

We're going to talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual.

While I am a public floor physical therapist, I am not your public floor physical therapist and know that this podcast does not substitute medical advice.

All right, come along for this journey with us while we navigate motherhood together.

Hello everybody and welcome back to the Barbell Mamas podcast.

Christina Private here.

And today we're going to be talking about some common catchphrases or common pieces of blanket advice and whether or not I agree with them, yes or no, or if I think that we need to expand our definitions or think about them a little bit.

The three that I'm going to be talking about is number one, just because you can't doesn't mean you should.

The second one is just listen to your body as you're returning to exercise postpartum.

And the third one is if you were doing it before pregnancy, you can keep doing it now.

Let's start with the first one.

It's probably the one that I hear the most common about giving advice around scaling or modifying exercise during pregnancy.

So everyone says just because you can doesn't mean you should, right?

What this is referring to is using pregnancy as a protected time and potentially not a time to be going after PRs, trying to set uh fitness records or endurance records or PR your 5K or your deadlift or whatever that may be.

And the first thing that I want to say about this, and I've thought about it a ton, is that I understand where it was coming from.

I understand, right?

Where this phrase came from was this unbelievable urge to make sure individuals understand that your body goes through tremendous change during pregnancy.

And because of that, some exercises are not going to feel good.

This is the first time in a person's life for many people, not always, but for many, that they learn about their pelvic floor or they feel the changes in their core as baby grows and belly stretches.

And that may change the way that people feel within their body.

And, you know, the pendulum swings, where some people are very frightened of exercise during pregnancy.

We were kind of on that side of the pendulum for a long time, where people would stop doing anything or they would be told to just walk and swim.

And we flipped and we saw the pendulum go in the other direction where people had a lot of athletic goals postpartum, or even during their pregnancy.

We've seen people run Olympic trials and finish marathons, do alter marathons, you know, compete in the CrossFit games and like compete in the Olympics and have goals for early postpartum.

And they have this identifier with their fitness and this sometimes anxiety, this stress about losing their fitness, losing their identity of uh who they are as an athlete because they are pregnant.

So before I kind of go into why I really don't like this phrase, I want to first say that I know this is based in good intentions.

And I know that it was meant to give people permission that they don't have to push a thousand percent all the time in pregnancy if they don't want to.

And to start this education process around how their body does change from the muscles, ligaments, bones perspective as you get further along in your pregnancy.

What I don't like is the subtext of what this can imply.

Doesn't mean you should incurs a risk that if you don't scale, if you don't modify, if you don't pull back, you could be setting yourself up for X bad outcome.

And most of the time they're talking about diastasis recti or um prolapse or leaking, right?

Like something around the pelvic floor, something around the core wall.

The problem is that so many of these things that people are saying, hey, like you're running, it's like running or lifting or doing core strengthening, like really heavy, like normal core strengthening, not modified, or I'm doing air quotes here, pregnancy safe core exercises that you could put yourself at risk.

And if you've heard me talk on the podcast, you have heard me say that we are so confident in these modifications when we have absolutely no data that supports it, right?

We have no data that tells us that making X modification protects your pelvic floor or protects your core wall.

And so what that means is that we are potentially giving the wrong advice, right?

Because just because you can doesn't mean you should implies that you need to modify or that you are causing harm by failing to modify.

And that simply just isn't true.

And so I think we've almost outgrown this phase because we've had this pendulum, it's swung in both directions, and now it's time for nuanced conversations.

And that nuanced conversation is body readiness, right?

Whether you are pregnant, postpartum, or not, so much of the exercise that we do, so much of our exercise programs are around increasing body readiness and building a bridge between what you want to be able to do, what your body is currently capable of, and creating the stepping stones to get from where you are to where you want to be.

And in pregnancy, that may not be improving, that might be maintaining or trying to prevent too much deconditioning from happening, but that is a body readiness perspective, right?

That is a body readiness conversation, and what that means is just because you can means that maybe you can, right?

As long as your body is ready for it.

And where the nuance comes in is that me as your coach, me as your provider, I need to tell you what you're looking for, right?

And and so this blanket statement that everybody needs to scale and modify doesn't take into account that your fitness does matter.

Like your fitness going into pregnancy does matter.

And I've told you guys a lot about my own stories.

Like when I was first pregnant with Maya, I was a national level weightlifter.

I exclusively weightlifted.

I was 90 minutes to uh two hours in the gym five days a week, but I did zero cardio.

Like I would walk with my dogs, but that was like it, you know, that was and that probably wasn't the healthiest there, but I was like, I was competing at a high level.

That was what I wanted to do.

I've I've got put some cardio in my life.

I promise my heart is okay now, but it definitely changed my experience in pregnancy because around 16 to 18 weeks, even like a jog across the gym, I was like, ooh, that feels like really weird on my body.

My body is not used to that.

My body now just feels like it does not feel good to do even a light jog.

And so what minimal cardio I was doing became low impact cardio.

But I had done reps and reps and reps with squats and pulls and cleans and snatches.

And right up until delivery with both my kids, I was heavy lifting and it felt so good to be moving my body in that way.

And yeah, I made shifts to range of motion and things like that.

But I wasn't really, I didn't carry really big with both my pregnancies because I had a really long torso.

And so, yeah, that body readiness mattered, right?

Because my body was really used to it and pregnancy happens slowly.

And, you know, some people will say, well, what about balance and all this kind of stuff?

I'm like, if you're continually exposing yourself to something, your body shifts to changes in your body, whether you're, you know, starting to arc more as baby grows, like your belly stretching out more, your body adjusts to that, you know?

And so I actually disagree with just because you can doesn't mean you should until we have safety data that tells us doesn't mean you should is actually based in fact and not based in theory, right?

And and we, you know, when this started 10 years ago, we didn't have anything, right?

We didn't have any research.

And so we were basing a lot of our recommendations on theoretical constructs, but we have a lot of researchers, myself included, who are starting to systematically and very methodically look at some of these things, like the Valsalva maneuver and um, you know, um lifting on your back and and continuing to do core training and all those types of things.

So this one is one of these mantras that I really wish would disappear.

Become a thing of the past, and we're gonna move on to more nuanced conversations.

The second one, I'm gonna switch my order from when I said it so that we can keep doing it in pregnancy, is people really dislike if you were doing it before pregnancy, you can keep doing it.

And this kind of piggybacks on the first one because I actually do not disagree with this, right?

So many people get mad because they feel like, you know, to my last point, that it kind of removes the nuance.

But if we look at strength and conditioning, if we look at exercise principles, again, what our body has adapted to means that we are more able to handle the stress of that adaptation.

What I mean is like our runners are going to be able to handle more running volume than our non-runners.

And so as you're getting through your pregnancy, your knees and your shins and your hips are used to that high impact stress, and you can gradually build up tolerance as your body weight increases, for example.

And so I think what this statement is trying to do, and and where a lot of my research is trying to go, is that we are trying to move against having blanket contraindications to exercise that apply to everyone outside of you know the blunt force trauma to the abdomen, scuba diving, and high, high, high temperatures, like you know, saunas.

And I know that it feels very vague, but we are living in a land of gray, right?

And as a clinician, it is not my job to get every pregnant person doing the perfect program that I think is the best, right?

I've obviously biased towards heavy lifting.

I freaking love it, even though my quads are screaming at me from doing lifting yesterday.

I think strength training is super important for building reserve and building capacity as mothers.

But if my client hates it and they love yoga and Pilates, then I'm gonna figure out how to keep them doing yoga and Pilates.

And I had a client that I'm seeing for her six-week checkup, I think tomorrow or this week, who did Pilates right up until delivery.

And I wasn't teaching her heavy lifting, I was teaching her techniques to keep doing reformer stuff because that's what she loved, right?

So I think if you were doing it before pregnancy, you can keep doing it, is good advice.

It is good advice.

Where we need to take this a step further, and where we come in as exercise professionals, as we come in as colleagues, as we come in as you know, pregnant individuals ourselves who are trying to figure out, you know, what their pregnancy is going to look like, is that we need to know where the asterisk signs are.

What are the things that I need to look out for that is maybe my sign that I shouldn't be doing this anymore?

You know, like if I start bleeding or I'm starting to have incontinence, maybe there are things that I need to do, not that I shouldn't be doing anymore, but maybe I need to bring my volume down.

Maybe I need to change up my technique.

Maybe my movements are getting a bit different because I'm pregnant and I have to change them slightly to account for my pregnant belly, and that's going to help my pelvic floor feel stronger.

Like we just have to build on this statement.

So if you're doing it before pregnancy, you can keep doing it.

That's giving permission.

Love that, right?

That we don't have as many contraindications to exercise as we think.

If you have the capacity, go for it.

But the thing that we need to add on to that is what to look out for.

Another example, right?

In early pregnancy, first trimester, oh my goodness, a fatigue, right?

And if you had a hard workout, yeah, you were feeling it the rest of the day, you felt a little bit tired.

I always say it's like two to three times harder when you're pregnant because that pregnancy fatigue already feels so overwhelming.

To put a really uh high draining exercise on that may make it even more difficult.

That might mean that we may self-select to bring down our volume a little bit.

And there's nothing contraindicated, but you got to get through your day.

And you got two other kids at home and like all these things, right?

So I actually don't disagree.

Uh, there's so many people who online are really shitting on this statement, saying, how dare they just give that blanket statement.

But, you know, for some, that's coming from a place of privilege where you have access to pelvic PTs and that education, right?

Like, we don't want to create barriers to exercise.

And, you know, there's a lot of people who don't have access to pelvic PTs or specific pregnancy exercise trained individuals who can help them make really specific modifications.

And so if I had to choose between like scaring someone shitless that they can't exercise at all or giving them that empowerment and maybe they're putting their pelvic floor under a bit more strain, I'm probably gonna choose the exercise piece, you know?

Um, so I think we need to stop jumping on our medical providers about this because I actually think they're right.

The third one is just listen to your body as you return to exercise postpartum.

Or I saw some individual say start at 50% and progress as evil.

Again, this one is like 50-50.

I agree with it, which a lot of people hate that I say this, but I also think it needs a bit more of an explanation, right?

So we so story time.

Um, I was part of a group of researchers that was working on a Delphi.

So a Delphi is an expert consensus where when evidence is very low, like we don't have a lot of research to make decisions on, we start by pooling a lot of experts in the field of what they do in this clinical scenario where we don't have a lot of research.

The idea of the Delphi is then to launch into more rigorous research that allows us to basically figure out were those researchers right.

And we were talking about one around what are true contraindications to exercise in the postpartum period.

And as you know, if you've been listening to the podcast for any length of time, I'm very adamantly against the six weeks do nothing.

One, because I don't want to decondition you even further.

Two, many people who listen to this podcast are in the States.

Maternity leave is six to 12 weeks, and then you go back to full work duties, which could be you standing for eight hours a day.

And three, we don't do that when you have your heart cracked open or a black decker replaces a chunk of bone in your knee.

Why are we doing that for postpartum individuals?

So I already don't really agree with that.

But where we were asking questions was truly what are contraindications to exercise.

And so many people who are in the pelvic health space were saying if you're leaking or you're experiencing heaviness, this is a contraindication.

And respectfully, I disagree, right?

Because if I have a person who's just had surgery, I'm not gonna tell you you just had your knee replaced, you're never gonna have any pain, you're gonna have full range of motion.

And that should be if you have any pain at all, then you need to go see your doctor immediately.

Right.

And so if you're recovering your pelvic floor muscles because a baby stretched and caused a tear in those muscles, yeah, I'm gonna expect that you're gonna have some heaviness or DOMs around your pelvic floor muscles, around the opening of your vagina as you're getting stronger again.

I'm gonna expect that when you're testing your boundaries, you may leak a little bit or feel like you're gonna pee as you push a little bit farther than you have postpartum.

And where, you know, we kind of tried to come to consensus was there's a difference between a contraindication and a reason to screen and potentially get advice from a clinician if possible.

What we also know is that for some people, it truly is a weakness thing.

Where if you are experiencing incontinence, as you get stronger, your incontinence improves.

And time, postpartum, the further you get postpartum, your body starts to adjust again to getting stronger as you've recovered, you're recovering further and further from that injury.

And you know, our evidence around early, moderate intensity exercise doesn't show an increased risk for pelvic floor dysfunction or changes in range of motion of the of the pelvic floor or of the vaginal walls, rather.

And so the listen to your body, I think, is great advice because again, I've had clients who two weeks postpartum can run a 5K.

And I have individuals who are still having a really hard time getting in and out of bed after a C-section after two weeks.

Both of them are very fair, and both of them are very real, and both of them are their trajectories.

I wouldn't suggest the person who's having a lot of incisional pain around their C-section to go for a run, right?

So that is listening to their body.

Again, where we need to expand some of these definitions is trying to give people ideas of what to listen for.

And I think that's where, again, these catchy phrases can feel really good in the moment.

Um, but they get rid of a lot of the context and the nuance that is required to have these conversations.

And so when we're trying to make information into digestible five-second chunks, it misses a lot of what we need.

And so it kind of has this ish factor.

Um, and what that means is that we just have to have fuller conversations with people.

It's why I love this podcast.

It's longer form.

Um, and what that means is that I get the chance to explain.

I get the chance to elaborate and have discussions to myself.

Hopefully, you're like nodding your head along with me.

And it allows for a bit more of that in-depth discussion about individuals' unique experiences because we live in the gray, right?

We don't know.

We I always talk about when we're looking at risk factors, we're looking at recovery, we're always trying to stack the deck in our favor.

Like there are certain things that are outside of our control.

All of the things right and still have pelvic floor dysfunction.

You can, you know, keep doing court training, you can still have diastys recti.

Um, there is some things that are just outside of our control.

And so that's where these nuances come in.

And, you know, we can say, hey, you did everything right.

You know, you did the modifications, you did the scales, and stuff still happened.

We need to get a little bit more into the weeds and in general, move away from blanket statements.

So to come full circle, I feel like this was like two truths and a lie, but it was like two that I like-ish and one that I dislike.

I believe that we are really on the precipice of changing ideas around exercise in the pregnant and postpartum period.

I feel like there is research that is about to come out that is going to flip a lot of narratives, that we are finally getting into the weeds.

We have done the foundational work, we are building on this momentum, and it's freaking exciting.

It is exciting.

And where I really believe that we're gonna go is that with everything, this is everything in rehab in general, but what we're gonna see in pregnancy and postpartum is this moving away of exercise that works for everybody.

And it is gonna be meeting you where you're at as the person that is pregnant, with me, the provider who's trying to guide you along the way.

And hopefully, this comparison game goes away where some people are gonna progress at a certain rate, some people are not, some people are gonna have a whole bunch of stuff at home that's gonna give support to their healing journey, some people are not.

And what it's gonna mean is that we're gonna take an individualized approach for every person.

And we're not going to slap this label as this is right and this is wrong, because it depends.

And I know that a lot of people don't like to hear that.

But what I hope it does is gives freedom for you to know what to listen for, but to listen to your body and make those decisions for yourself.

All right.

That is all I got for today.

I hope you all have a wonderful week.

That you had a wonderful Thanksgiving filled with love and family and connection.

Uh, we will see you all next week.

It is getting so close to the holiday season.

I cannot even believe it.

But that's exciting too.

I hope you all are not too, too stressed out.

We're about to get our first snowstorm tomorrow.

I'm kind of excited about it.

And then, you know, the snow can go away as of January 2nd.

But um, yeah, we're we're uh chugging along till Christmas and looking forward to every second of it.

All right, have a great week, everybody, and we'll talk to you soon.