Reframing return-to-sport postpartum: the 6 RS framework
| 6 Rs | Description |
| 1. Ready (prenatal—early postpartum) | Ready the athlete for anticipated whole-systems, biopsychosocial changes* by proactively educating them about perinatal health considerations during the transition into pregnancy and motherhood (eg, weight gain, pelvic floor function, 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 (6–8 weeks) | Review and evaluate the postpartum athlete and address acute musculoskeletal and pelvic health rehabilitation needs. Screen for whole-systems, biopsychosocial considerations* |
| 3. Restore (8–16 weeks) | Restore physical and psychological well-being depending on individual needs and prepare the perinatal athlete for returning to structured training environments. Include pelvic floor rehabilitation and other relevant whole-systems, biopsychosocial considerations.* |
| 4. Recondition (16 weeks+) | Recondition the perinatal athlete for their required physical and psychological sporting demands. Commence graded exposure towards individual-specific 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* (eg, optimise sleep quality, monitor for signs of relative energy deficiency syndrome) to enhance athlete training and competition availability, retaining the athlete in their sport and optimising performance. |
Nb. The timescales presented are suggestions to guide multidisciplinary teams supporting perinatal athletes. They should be modified as necessary based on individual rehabilitation needs.
*Whole-systems, biopsychosocial considerations—childbirth-related trauma (eg, abdominal wall dysfunction, pelvic floor dysfunction or post-traumatic stress); menstrual health; breast health (eg, review breast support particularly in the breastfeeding athlete); energy balance (eg, relative energy deficiency in sport); psychological well-being (eg, perinatal mental health); fear of movement; and sleep (eg, sleep routine and quality).