Eliana Cardozo, DO, Medical Director of the Women’s Health Program at the Mount Sinai Rehabilitation Center
One of the biggest stories in tennis these days is not about the ongoing rivalries among top players, but about Serena Williams’s struggle to return to top form after delivering her first child last year.
It may be one of the toughest assignments for any female player, whether an elite athlete like Serena or a club player, according to Eliana Cardozo, DO, Medical Director of the Women’s Health Program at the Mount Sinai Rehabilitation Center. The center specializes in treating athletes and active individuals with a wide range of musculoskeletal conditions affecting muscles, bones, and joints. Mount Sinai Health System is the official medical services provider of the United States Tennis Association (USTA) Eastern Section and the US Open.
Rule number one: Be sure to take your time and consult with your obstetrician-gynecologist and other medical specialists before returning to tennis or any strenuous exercise, Dr. Cardozo says. Beyond that, there are a number of steps you can take to ease your way back, and there are specialists available to help who understand that properly returning to a sporting life can boost your overall health and well-being.
Dr. Cardozo, an Assistant Professor of Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, has a wealth of experience to drawn upon, including having just had her own first child.
“I have always been a very active person. Being able to feel first-hand how your body changes in the prenatal and postpartum period gave me more insight and an even greater appreciation for what my patients are going through,” she says.
Dr. Cardozo offers some other insights in this Q&A.
How soon can a woman return to playing tennis after childbirth?
For an uncomplicated delivery, a woman can usually start light physical activity, such as walking, a few days after birth, beginning gradually with short walks and progressing to longer, more brisk walks. After that, we recommend starting a general core and pelvic strengthening program. Then, before getting back on the court, you will need specific clearance from your Ob-Gyn. The average time for patients I see returning to rigorous sports is about six to eight weeks after delivery, but it can take ten weeks or more, it really depends on each individual situation. Some women may even be able to return to playing in as little as four weeks after childbirth, it really depends. If you were very active and playing tennis before and during your pregnancy, you will probably have an easier time getting back on the court.
How do you know if you’re ready?
It is important to be patient and have respect for the recovery process. I tell everyone the same thing: Start slowly with physical activity and gradually increase. If there is any pain, or if something feels like too much, scale it down. You need to listen to your body.
What if I’ve had a caesarean birth?
A C-section is major abdominal surgery, therefore the recovery process is longer. We recommend starting with a light exercise program about six to eight weeks after delivery, although you can generally start a walking program prior to that. Depending on the individual, there may be other things to take into account, such as any issues with the incision healing or infections. Our general guidance is to start slowly and gradually, and build up your level of activity.
Why are strengthening exercises so important?
Both pregnancy and childbirth are huge events that produce many different changes to the body, including hormonal fluctuations and changes to your muscles and joints. This can increase “joint laxity,” which translates into looser joints, making us more susceptible to certain injuries. We recommend a series of progressive exercises, particularly for the core and pelvis. Depending on the situation, it may be ideal to start a program under the guidance of a rehabilitation physician and physical therapist. The exercises can be pretty basic. I normally give my patients simple, printed handouts to start. You can also get a number of helpful tips from the American College of Obstetricians and Gynecologists.
Why see a rehabilitation specialist?
There are many options available to women, including personal trainers and others with special certifications. We suggest you work with a rehabilitation doctor with experience in this area. They are able to provide you with a detailed plan for your condition and a tailored physical therapy prescription addressing your specific needs, after they conduct a thorough history and physical examination. Your physician can also direct you to a physical therapist with experience in treating postpartum patients. Typically a physical therapist will report back to your doctor regularly, and the patient will return to the physician after four to six weeks of therapy. One important point is that the physical therapist will be creating and teaching you a home exercise program, so that when you are done with your therapy you can continue the exercises on your own. We’ve had great results with our program. It’s no wonder that in many European countries, it’s much more common for new mothers to start a core and pelvic strengthening program after childbirth.
What are some of the biggest problems you see among your patients?
Many of my patients complain about pain in their upper back from carrying the baby, but most of what I see is low back pain. We can prescribe medication—usually anti-inflammatories—if the pain is intense. Or we may instead use topical medications, especially if the mother is breast-feeding. Some women have the misconception that it’s normal to experience pain for a long time postpartum and that they should “just deal with it”. But that’s not the case. There are many things we can do to help healing and expedite recovery.
What do you say to those who are pushing to get back out there as soon as possible?
Some women are eager to get back to vigorous exercise. We work with them because exercise can be a very important outlet, and studies show it can help boost your mood, which is very important during the postpartum period. But we need to be careful and avoid injuries, such as avoiding an overly aggressive abdominal exercise program that can put excessive pressure on the muscles in the abdomen and cause injury.
When will I be back to normal?
I get that question a lot. Your body is undergoing tremendous changes during the postpartum period, and some of that relates to whether you are breast-feeding. Around six weeks after delivery, there is normally a big shift when tissues have significantly healed. But you won’t be back to a “new” normal until eight to twelve weeks postpartum, assuming there were no complications during birth.
Eliana Cardozo, DO, is Medical Director of the Women’s Health Program at the Mount Sinai Rehabilitation Center. The center specializes in treating athletes and active individuals with a wide range of musculoskeletal conditions affecting muscles, bones, and joints.