The Pregnant Athlete!


Donnelly et al. 2021 (BMJ)

There is a lack of female specific research and frameworks to guide organisations in supporting and optimising female athletes, especially with the transition into motherhood.

There are many considerations necessary to support an athlete before, during and after pregnancy. The following “6 Rs” framework has been developed using a proactive rather than reactive approach to perinatal athlete management. By understanding individualised, perinatal considerations, we can educate and support female athletes in preparation for the expected whole-systems and biopsychosocial changes during and after pregnancy. This will in turn optimise a successful return to sport/exercise postpartum.


The 6 Rs Framework //

READY (pre-natal) – Ready (prepare) athlete with education about potential whole body system changes and biopsychosocial changes that can occur with the transition into pregnancy and motherhood (weight gain, pelvic floor function, perinatal mental health). The Goal of this stage is to maintain exercise throughout pregnancy, limit deconditioning, optimise post-partum recovery.

REVIEW (6-8wks post-natal) - Review (with Women’s Health Physiotherapist) and evaluate post-partum athlete to screen and address acute musculoskeletal and pelvic health rehabilitation.

RESTORE (8-16wks post-natal) - Restore physical and psychological wellbeing, prepare for structured training environments, include pelvic floor rehabilitation and other whole systems considerations.

RECONDITION (16+wks post-natal) - Recondition required physical and psychological demands- commence graded exposure to sport specific training and loading. Monitor potential symptoms as training load increases

RETURN - Return to sport following individualised, evidence based and guided exposure to competitive environments

REFINE - Refine whole systems- biopsychosocial strategies (optimise sleep quality and signs of relative energy deficiency syndrome) to enhance athlete training and competition availability. To keep athlete in sport and optimise their performance


Perinatal considerations to be aware of include:

Pelvic floor: performance and exercise participation may be affected by pelvic floor dysfunction such as urinary incontinence and pelvic organ prolapse. Women have a larger pelvic outlet which requires greater support from the pelvic floor, this also leads to increased risk of structural support deficits which has risk increases from pregnancy and childbirth.

Even with the acknowledged impact of pelvic floor dysfunction on sporting performance and quality of life it is often overlooked in return to sport frameworks as the focus is to manage musculoskeletal injuries, psychological readiness, and risk of re-injury.

Having an assessment with a physiotherapist trained in women’s health can address these considerations and implement safe return to sport recommendations to ensure a successful return to sport/exercise.



Laura Boucher

Physiotherapist