There is no standard of care for post-partum women.
Birth is trauma to the body. Whether you feel birth is a positive or a negative experience, it is still an injury. Recently, I was listening to an activeRX podcast with BIRTHFIT founder Lindsey Matthews and she said "if an NFL player sustained a birth injury, they would be out for the season!"
Chiros, PTs, midwives & OBgyns have undergone a ton of education pertaining to embryology, prenatal care, and identifying red flags but when it comes to the post partum period -- there is simply no standard rehabilitative program.
There is a significant gap in the training of health professionals in the post-partum period for women. A few weeks ago, I found a 4-finger diastasis recti in a patient 3 years post partum. The patient has returned to full exercise (CrossFit) 6 weeks after giving birth, but had persistent low back pain ever since. Upon discovery of the diastasis, she said to me "why didn't my doctor check for this before clearing me?" to which I responded "well, it's not your drs fault.... they didn't learn this stuff in school."
But while we can blame a lack of education, as health professionals we are taught to think critically — and does it make sense to give better rehabilitation to a sprained ankle than it does to a women after she has given birth?
Of course not.
When I see a patient with an ankle sprain, I typically give an 8-12 week prognosis for healing. We look at this healing process in phases.
When the injury occurs -- there is an initial rupture of the ligament, as well as torn blood vessels which release inflammatory cells and hormones that cause pain. The injured party typically limps their way into my clinic and reveals a swollen ankle with localized bruising and tenderness everywhere.
In the acute phase - the body is working to protect from further damage -- this is typically 2-4 days post injury, but the time varies dependent on how you treat your injury.
As an acute injury transitions from protecting the injured site to repairing the injury tissues, you enter the sub-acute phase of healing. This phase commonly lasts up to six weeks post-injury and features the body doing what it does best - healing itself! At the cellular level, fibroblasts are synthesizing proteins to restore the injured fascial connective tissue framework, and new capillaries grow to re-vascularize the injured area. The new tissue is weak, but responds to stress + load from the body in order to increase tensile strength.
After the sub-acute phase, we move into the chronic remodelling phase - tissue healing does not stop at that magic 6 week post injury mark - it can last for over a year! Healing is a continuum, and the new tissue laid down by the body continues to mature and respond to you as you strengthen and stress it. The body is amazing at healing itself, but when it first lays down the new tissue post-injury, it lays it down in haphazard fashion and it does not have a lot of strength. The injured ligament gains strength as it is loaded and stressed in a proper, controlled way (through a proper rehabilitation program!). Again, this remodelling phase can last up to a year, and if you're following a proper program you are given timeline goals, and are regularly reassessed to ensure your proper progression.
So, if this is the timeline to heal an ankle -- don't you think a woman deserves more time to rehabilitate after she gives birth?
Let's shift our mindset away from the magic 6 weeks of healing, and change our expectation that a women should snap back to mental + physical normalcy by this mark.
The post-partum period deserves more respect.
- Dr. Alli Cain
Dr. Alli Cain is a doctor of chiropractic, and owns a clinic + fitness + yoga studio in Keswick, ON. She is currently expecting her first child due Feb 2018, and is aiming to lead a shift in how women approach their body & fitness post partum. Her first post partum fitness series will launch in spring 2018 at ANCHOR / crossfit. yoga. lifestyle.
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