By Jenny Burrell BSc (Hons) – Founder of Burrell Education (www.burrelleducation.com) – Specialist for Modern Pregnancy and Post Natal Fitness & Therapy Education.
Part 1: Application of a GREAT PARQ, Post Natal Core Strength Assessment &
Categorization the Post Natal Client
After over a decade spent restoring and training Post Natal clients, there’s one thing that’s patently clear…..bodily events during the Post Natal period are NOT an exact science. Every woman has a unique story to tell about her pregnancy, birthing and her recovery from birth. So when creating a programme for a PN client, your best strategy – always – is to have a system built on a) great modern foundation education b) a thorough verbal and physical screening of your client.
If you’re just beginning to specialize in this area of fitness, you’re in luck, these are indeed exciting times in the world of Pregnancy and Post Natal exercise prescription. The old-guard of fear-based programming is being edged out and the light of innovation and functionality is now being shone on fitness for this client population. Over the last decade, practically, every area of the fitness education has undergone a total revolution but Pre/Post Natal education remained stale, mediocre and unyielding to many of the critical changes that could improve both it’s attractiveness and relevance to fitness professionals. Now, thanks to innovators both here in the UK and in the USA and Canada, Pre/Post Natal fitness education has finally caught up with the rest of the fitness and rightfully take its place as a ‘happening’ subject area.
So, with no further ado, let’s get started on the key components of creating modern exercise prescription for the Post Natal client.
Key Components of Modern Post Natal Exercise Prescription
- Application of PARQ, Core Strength Assessment & Categorization
- Bespoke ‘Core & Floor’ Restore
- Functional Training for Fat Loss
- Rest & Restorative Activity
- Optimum Nutrition & Supplementation
Application of a GREAT PARQ (Health Questionnaire), Core Strength Assessment & Categorization of the Client.
Quite a bit first step! But without assessing the client all exercise prescription is not only faulty but could , at the very least hinder the progress of the client back to full health and at the worst be dangerous. You can download my full Post Natal PARQ at www.burrelleducation.com so I won’t go too indepth here, but below is the first page:
Client Phone No:
Date of Delivery:
Type of Delivery (Assisted, Vaginal, C-Section):
6 Week Check-Up Date & Outcome:
Post Natal Bleeding Status:
Recently Fitted IUD?
Post Natal Pre-Activity Health Questionnaire (PARQ)
You are advised to ALWAYS have your client complete a Post Natal Specific PARQ before the commencing any physical training and as well as ENSURING THAT YOUR CLIENT HAS BEEN GIVEN PERMISSION TO COMMENCE EXERCISING BY HER HEALTH CARE PROVIDER AT HER 6-WEEK CHECK-UP.
The first 5 items on the list referring to client personal details are standard, so we’ll focus on the next 6 items on the list.
a) Date of Delivery & Outcome of 6-Week Check-Up: important because you need to know that your client is over 6 weeks Post Natal and has had her mandatory 6-week check-up via her Health Care Professional and been given the OK to commence exercise. A fitness professional should NEVER take on a client who has not had this check and been given permission to exercise.
b) Type of Birth (Vaginal, C-Section, Assisted, Complications): Important to know when considering rate of healing. A C-Section client will generally have a slower rate of recover than a Vaginal birth client due to the nature of the surgery performed. Also, there are generally differences in the trauma to the Pelvic Floor muscles when comparing the Vaginal birth with the C-Section. Assisted births can involve either Forceps or Ventous and so usually require an Episiotomy. Again, this information will have significant bearing on the healing, recovering and ability of the mother to reconnect with her whole core in the PN period.
c) Breastfeeding Status: Important information for a few reasons. Firstly, if the client attends requesting a fat loss programme, breastfeeding and her increased appetite might hinder any great plans she has! In my humble experience (unlike the celebrity scenario) most women tend to hold their baby weight until they have reduced or ceased breastfeeding. Secondly, in order to offset possible changes to both milk supply and quality that can sometimes occur when breastfeeding mothers exercise, it’s wise to advise the mother to feed the baby before an exercise session begins as opposed to afterwards and maintain good hydration both during and after the session. Finally, emptied breasts are much more comfortable during exercise than full ones!
d) Post Natal Bleeding Status: A hugely important fact to ascertain. It’s totally normal for a woman to experience PN bleeding, but just like a menstrual period. The flow of this bleeding lessens over the days and immediate weeks post birth. Lochia Rubia (red flow) eventually progressing to Lochia Alba (a pale coloured flow). There are two alarm-bell ringing scenarios that every trainer needs to be aware of: a) The client has ceased PN bleeding and after or during an exercise session, this bleeding re-commences and b) the PN client attends for exercise and is significantly post natal ie., over 6 weeks and is still bleeding. In both cases, the client should be referred back to her Health Care Provider and their advice sought before resuming with the client.
e) Recently Fitted IUD: The early PN period is when most women reconsider their contraception strategy and many choose to have an Inter Uterine Device fitted commonly known as a Coil. Opinions vary on any strict timeframe for starting exercise after having a Coil fitted but common sense dictates that performing vigorous work within a week of fitting is probably not a great idea. If in doubt ask your client to seek advice from her Health Care Provider during her fitting appointment.
Ok, so there’s a snapshot of why it’s important to take your client through a thorough PARQ, you’ll be a lot wiser as to your client’s current and previous health and also demonstrate your professionalism. Don’t forget, go to www.burrelleducation.com to download my 15 page PARQ which contains 14 pages of symptoms and conditions during the Post Natal period and considerations for exercise prescription. Enjoy!
2. Post Natal Core Strength Assessment
Basically, there are two main issues for most women:
- Rectus Distention (Diastasis) and
- A Dysfunctional Pelvic Floor
My PN Core Strength Assessment has 3 main components:
a) Questioning the client about her degree of abdominal sensation and any changes she has experienced in the post birth period. For C-Section clients returning to exercise fairly early (ie., under 3 months) this includes assessing the healing of their scar (if possible) and questioning as to whether the scar is painful during or after certain activities etc.,
b) Checking for Rectus Distension (ongoing separation of the Rectus Abdominis muscles at the midline) and Rectus Doming (a bulging of the abdominal under intra-abdominal pressure).
c) Questioning the client about her degree of connection to and function of her Pelvic Floor muscles especially whether she experiences any incontinence – urinary or feacal.
3. Categorising Post Natal Core Strength
After completing the above tests/questioning I’m then in a perfect place to categorize my client’s Core Strength with a view to creating a bespoke strength/restore programme for our sessions together and when she is exercising alone. Below are the protocols that I use.
Level 1 Client (Typically Under 3 months): Has over 2 finger wide distension (diastasis), heading towards 3 or more. Usually very early Post Natal with a palpably weak/papery/slack midline. Offer Remedial Advice that includes a full body stretch routine, massage therapy, Pelvic Floor work that includes Kegels, adduction and abduction work and TVA reconnection work, posture correction exercises, floor based/simple glute strengthening exercises – if you are confident. If you are in doubt, refer the client to a trusted Women’s Health Physio and follow their advice . Great advice would be to focus on walking, optimal nutrition to rebuild depeleted system, Pelvic Floor and as much rest as possible.
Level 2 Client (Typically Under 6 months) : Less than or equal to 2 finger wide distension with a low tension midline. Basic core and functional exercise can begin but is predominated by movement in the sagittal plane to avoid directly loading the obliques.
Level 3 Client (Typically Over 6 months): Distension has nearly or completely closed AND/OR the midline has good tension and is able to withstand intra-abdominal pressure but caution on big movements that load the obliques of build large intra-abdominal pressure is advised. Core and functoinal work can no include selected work in the frontal and transverse planes. Select and test exercises carefully. Be award that even at this stage some clients can experience urinary leakage when the core is placed under swift or enduring duress ie., a fast jump or a long jog/run.
Level 4 Client (Typically 9 months +1 Year): Client is fully restored. Her midline and Pelvic Floor muscles can withstand the pressure created by ‘heavy work’. Client can be treated as ‘normal’ core and functional exercise can now include loaded work in all 3 planes to reflect REAL LIFE!
Part 2 To Follow: Bespoke ‘Core & Pelvic Floor’ Restore for the Post Natal Client – Subscribe to be alerted instantly!
(C) Burrell Education 2012 (www.burrelleducation.com)
This information is for guidance only and created specifically for qualified fitness and aligned professionals working with the Pre/Post Client. If you’re a mom, please seek guidance from a qualified specialist professional.