Specialist pelvic health physios should be supporting female athletes in postpartum phase

Why change is needed

While clinicians such as physios, surgeons and physiologists have traditionally joined coaches in such teams, change is needed because more women who are pregnant or on maternity leave are now engaging in professional sporting activities, Ms Donnelly and her colleagues state. ‘However, provisions to assist these athletes returning to their sport are lacking and there is a need for greater recognition of perinatal health considerations, for example, pelvic health.'

Return-to-sport frameworks tend to focus on issues such as managing musculoskeletal (MSK) injuries, ‘psychological readiness’ and re-injury risks, the editorial suggests. But crucial issues relating to women’s return-to-sport at the postpartum stage have been overlooked, perhaps because the focus has been on male rather than female athletes.

Breastfeeding and other issues

Ms Donnelly and her colleagues continue: ‘Furthermore, female athletes entering motherhood during their athletic career is a relatively new occurrence. For these athletes and their multidisciplinary teams, the perinatal period provides challenges due to the complex changes to bodily systems.'

The factors to consider, they suggest, include childbirth-related trauma (such as abdominal wall dysfunction, pelvic floor dysfunction or post-traumatic stress), menstrual health, breast health, energy balance, psychological well-being, fear of movement and sleep.

‘Additionally, athletes should be supported in their choice to breastfeed, with consideration given to the physiological impact and practicalities surrounding breastfeeding with training and competition.'

'Unique opportunity'

Multidisciplinary teams have a ‘unique opportunity’ to plan ahead for the physical and psychological changes that can be expected in women who are pregnant, the editorial adds. ‘This opportunity for forward planning calls for the development of athlete driven services to formulate proactive rather than reactive approaches to athlete care.

'Enhancing perinatal athlete care via a proactive approach could optimise athletic performance and enable women to continue sporting careers beyond the transition into motherhood, safeguarding their sporting longevity.’

The editorial features an infographic titled Reframing Return-to-Sport Postpartum: the 6 Rs framework (summarised below)

1 Ready

Focus on preparing athletes for changes such as weight-gain, pelvic floor function and perinatal mental health. Aim to maintain exercise throughout pregnancy (where it is safe to do so for the mother and baby), limit deconditioning and optimise postpartum recovery with forward planning

2 Review

Review and evaluate the postpartum athlete and address acute MSK and pelvic health rehabilitation needs. Screen for whole-systems and biopsychosocial considerations

3 Restore

Restore physical and psychological wellbeing and prepare perinatal athletes to return to structured training environments (include pelvic floor rehabilitation, for example)

4 Recondition

Recondition perinatal athletes for the physical and psychological sporting demands they will face. Begin graded exposure to training load requirements. Revisit whole-systems, biopsychosocial considerations and monitor symptoms as training increases

5 Return

Return to sport through an individualised, evidence-informed and guided exposure to the competitive environment and re-evaluate regularly

6 Refine

Refine whole-systems, biopsychosocial strategies (optimise sleep quality and monitor for signs of relative energy deficiency syndrome, for example) to enhance athlete training and competition availability, retaining the athlete in their sport and optimising performance

Emma Brockwell, one of the authors, was profiled in PhysioUpdate in 2021. To find out more, visit: https://www.physioupdate.co.uk/news/pelvic-health-physiotherapist-emma-brockwells-new-book-aims-to-empower-and-educate-women/

To see the full version of the BJSM article, titled Reframing return-to-sport postpartum: the 6 Rs framework, visit: http://dx.doi.org/10.1136/bjsports-2021-104877