Postpartum Physical Therapy– While pregnancy can be a wonderful time, any woman who has experienced childbirth knows that it is also a painful process that does not end at the moment of giving birth.
Most women find that even weeks after delivery—regardless if it was a vaginal delivery or a C-section—the body won’t quite be able to bounce back to normal.
Aches, pains, an enlarged belly, poor posture, pelvic floor issues: just a few of the problems that make life miserable for many new mothers.
Not surprisingly, since pregnancy puts a lot of strain on a woman’s body due to the hormonal and physical changes that prepare it for delivery.
Nevertheless, even if it seems difficult to return to your exact pre-pregnancy shape, with the help of postpartum physical therapy, there is a lot you can do to help your body heal and be able to enjoy the first months of motherhood while caring for your newborn baby.
Read on to find out about the common issues associated with childbirth and how postpartum physical therapy may help manage them.
When is the Right Time to Start Postpartum Physical Therapy?
The recommended recovery period after giving birth is between six to eight weeks before you can start exercising again. Six weeks is commonly advised but the exact timing depends on the individual.
Recovery after a C-section is also slower than after vaginal delivery. But every woman has her recovery span and some are capable to resume exercise even within days of delivery.
This should not be the goal, however. It is important to respect your body and your individual needs when it comes to postpartum physical activities, pushing it too hard and too soon can have unwanted and long-lasting consequences.
Some women may feel the urge to start with crunches, planks, or high-intensity workouts (while still suffering from pelvic floor issues).
But this is not the way to go, as traditional ab work tends to worsen some postpartum conditions.
You need to keep in mind that for nine months, your body has gone through significant musculoskeletal and hormonal changes that cannot be reversed overnight.
After giving birth, your abdominal muscles are separated, your pelvic floor is weakened, and—due to the hormone relaxin—your ligaments and joints are still loose.
For this reason, vigorous, high-impact workouts, and intensive stretching should also be avoided until around three months postpartum (assuming an uncomplicated delivery).
The right postpartum physical therapy exercises should instead be based on gentle methods aimed at correcting posture, reducing abdominal pressure, and strengthening the core to give a solid foundation from which you can build towards medium and high-impact exercises over time.
This also applies to women that do not feel like exercising in this period (or to those who hope that their bodies will bounce back naturally).
Understandably so, as pregnancy and giving birth are physically and mentally exhausting–and before getting any rest, you find yourself caring for your baby day and night!
Still, as hard as it seems, postpartum exercise is not only about flattening your abs, but also about getting your strength back to feel better in your post-pregnancy skin, to be able to better perform your daily activities, and to make sure that untreated postpartum problems won’t cause any complications in the future.
If you are unsure about when and how to get back into exercising, an experienced physical therapist can help assess the right time for you to resume workouts and create a postpartum physical therapy program tailored for your needs.
Reducing Abdominal Pressure After Pregnancy
During pregnancy, as the baby grows, it pushes on the pelvic floor, as well as the abdominal wall and the diaphragm. This creates an abnormal abdominal pressure that lasts well after delivery, affecting breath mechanics.
The diaphragm is an involuntary muscle that participates in breathing and helps maintain a balanced posture.
A tense diaphragm pushes the organs against the abdominal muscles and pelvic floor muscles, making them weak.
This abdominal pressure is therefore the source of the two common postpartum conditions: pelvic floor dysfunction and diastasis recti.
Most postpartum symptoms (lower back pain, enlarged belly, poor posture, incontinence, neck pain, constipation, sexual dysfunctions) can be linked back to these conditions.
For this reason, the first thing to aim for in postpartum physical therapy exercises is reducing abdominal pressure and restoring normal diaphragm and pelvic floor movement.
To achieve this, you should start with learning the correct breathing and coordination activities (assuming that there were no complications during delivery) and move on to other low-impact activities after the recovery period.
Are Abdominal Exercises Safe?
As with other activities in this period, whether abdominal exercises are safe depends on the individual. But in general, unless there is medical advice against it, mild abdominal exercises are safe if done correctly.
That said, doing the wrong exercises might do more harm than not working out at all. That is why you need to start slowly, respecting your body’s limits: with basic strengthening exercises of the deep core muscle, the transversus abdominis.
Doing crunches should be avoided at this point until you have achieved a better functioning core. This doesn’t mean that you have to give up on reducing your waistline, however.
Gentle methods, especially breathing exercises, hypopressives, and isometric abdominal workouts can help to flatten your abdomen as well as to improve your posture, correct any muscle imbalances, and strengthen your pelvic floor muscles.
Types of Exercises
Breathing Exercises:
Breathing is at the heart of postpartum recovery. Learning the correct breathing techniques will help the diaphragm work correctly and get the abdominal and pelvic floor muscles to engage.
Breathing exercises can be performed during any activity throughout the day, even while sitting and caring for your baby.
Pelvic Floor Exercises:
Pelvic floor muscles support your pelvic organs: your bladder and bowel, and your womb. Pregnancy puts a great strain on them and causes them to weaken.
You have probably performed some pelvic muscle exercises during pregnancy.
It is important to keep exercising your pelvic floor (e.g. Kegels) to help your muscles get back their strength, not only to relieve any urinary and bowel problems you might experience after giving birth but also to make sure these muscles work as they should later in life.
If your pelvic floor issues persist, you might need to consult a pelvic floor physical therapist that can create a specialized treatment plan for you.
Low-Intensity Workouts:
Once you have learned the correct breathing and pelvic floor techniques, you can move on to other low-intensity workouts that don’t put unnecessary strain on your muscles but at the same time help strengthen your core.
Gentle methods such as heel slides, leg extensions, or toe taps have been developed to help improve stability and coordination after giving birth.
Balance exercises (usually performed on a yoga ball) are another great way to strengthen your core and to improve your posture without putting too much pressure on your muscles.
As these exercises might seem technical at first, it is a good idea to consult a physical therapist about the correct way of performing them.
Hipopresivos:
A popular technique based on a sequence of postures and breathing, Hypopressives was developed in the ’80s by Dr. Marcel Caufriez as a safe alternative to traditional abdominal exercises.
Hypopressives is an isometric postural-abdominal workout which means that the abdominal and pelvic floor muscles get stronger without movement and without stressing the back or the neck.
The key to this method is learning to balance the pressure in the abdominal cavity with a specific breathing technique called expiratory apnea and in return, you can achieve a flatter abdomen, a better functioning core, correct muscle imbalances, improve posture, and stronger pelvic floor muscles.
Expiratory apnea means holding down the breath after exhalation and drawing the belly button in and up toward the spine. This produces a suction effect, releasing stress from pelvic floor organs, and activating the pelvic floor muscles.
Other Low-Impact Exercises:
Depending on the intensity, brisk walking, swimming, yoga, pilates, and cycling might all be possible three months after giving birth.
If you exercised regularly before pregnancy, you might feel frustrated for not achieving the same results or not having the same stamina as before. But you need to let your body heal and gradually increase the workload.
If you notice any signs of overexercising such as changes in your vaginal discharge (lochia), or if you feel any pain during the exercise you need to stop immediately.
In the absence of such signs, you might still feel exhausted or have muscle soreness for an extended period: that is your body telling you to slow down.
If you had an uncomplicated delivery, breathing exercises and pelvic muscle contractions are safe to start as soon as you feel like it, you don’t have to wait until the end of the recovery period.
As for other exercises, and especially in the case of a C-section or if there were complications during vaginal delivery, it is important to consult your doctor before you start.
Not only will your mind be at ease afterward but an expert opinion will also help you respect your body’s limits when you return to your physical activities.
At the end of the day, this time is about letting your body heal. Intensive workouts will also be more fun to engage in after you have got your strength back.
Correcting Postural Changes
Poor posture is caused by the same physiological and hormonal changes that we have seen with other postpartum problems: during pregnancy, as your abdomen stretches out, your back muscles shorten and your pelvis tilts to make room for the growing baby.
This typical “mom posture” is likely not going to correct itself on its own—your body is too used to it by now— so you need to train your muscles to support your correct posture.
Some women get through pregnancy without major issues and recover from childbirth relatively quickly, but later on experience back pain, often because they don’t correct poor form and posture in time.
It is therefore important to be mindful of your posture during your daily activities, even if nothing feels wrong at the moment.
Remember, during pregnancy, your muscles have got used to changes in your posture, so what feels comfortable right now might not be the best for your body.
Maintaining the correct posture will also be crucial as you resume physical activities in postpartum, as improperly done exercises might hinder your recovery.
What Does a Pelvic Floor Physical Therapist Do?
A pelvic floor physical therapist is trained to help with issues related to pelvic floor dysfunction such as incontinence, pelvis pain, pelvic organ prolapse, pain during intercourse, and bowel issues.
These issues are not exclusively pregnancy-related but a lot of women experience them postpartum.
Physical therapists specialized in this field perform a physical examination to understand your symptoms, and by taking into consideration your medical history and complaints, they develop a treatment plan tailored for your needs.
Even if you don’t experience any major discomfort postpartum, a pelvic floor physical therapist can help with exercises that are easy to do in your home.
Kegel exercises, for instance—as easy as they seem—are actually difficult to perform correctly. By knowing the proper technique, you will be able to work on your pelvic muscles on your own, which might help eliminate pelvic floor issues (such as those associated with menopause) later in life.
Is Pelvic Floor Physical Therapy Effective?
Pelvic floor physical therapy is aimed at relieving the symptoms of pelvic floor dysfunction.
It is a specialized form of physical therapy that combines techniques such as education, manual therapy, pelvic floor physical therapy— depending on the patient’s symptoms and complaints.
Other related exercises include relaxation exercises, re-educating the muscles, pelvic floor biofeedback, or electrical stimulation.
While some of these methods might seem unusual, they are proven to be effective in helping your pelvic muscles get stronger and eliminating your symptoms associated with a weakened pelvic floor after childbirth. (There are exceptions, however: in the case of severe pelvic floor disorders, such as pelvic organ prolapse, pelvic floor therapy is not always sufficient and surgery is recommended.)
What is Diastasis Recti?
During the second and third trimester, the midline of your stomach muscles starts to widen and separate your abdominal muscles (rectus abdominis). This condition is referred to as diastasis recti.
Every woman has diastasis recti during pregnancy, and it is estimated to be present in more than half of women immediately after giving birth.
But the issues start in postpartum when the muscles have a hard time coming back together, resulting in a protruded abdomen and instability because of the weakened abdominal muscles.
Some women are lucky enough to naturally return to their pre-pregnancy shape on their own and their ab muscles would also heal within six months after giving birth.
But if your muscles are not coming back together (and this applies to one-third of women in postpartum) and you notice the below symptoms, you might still have diastasis recti:
- A gap in the middle of your belly, feeling like your abs are separated
- A “mom pooch”: a protruding abdomen below the navel
- Feeling like you have no support in your core
- Weak pelvic floor muscles, urinary or bowel problems
- Lower back pain
- Certain tasks (bending, lifting, stair climbing, etc.) remain difficult to perform
If this wasn’t your first pregnancy, carried twins, or have given birth later in life, you might be at risk for developing diastasis recti.
This is also the case if you have a poor muscle tone or performed improper abdominal exercises previously.
But regardless of the risk factors, your doctor or physical therapist can determine best whether you have a larger than normal abdominal separation.
You can also perform a quick check on your own by doing the following:
- Lie down on your back with your knees up, place your fingers vertically below your navel.
- Lift up your head and check with your fingers if your abs are separated.
- If your abs are separated more than two fingers wide, diastasis is present. If they are separated more than four fingers wide, severe diastasis is present that might require specialized physical therapy.
Even if you only notice a small abdominal separation (i.e below two fingers wide), it is important to be aware of this when you get back to exercising, as some exercises, such as sit-ups tend to make the separation worse.
Are Abdominal Exercises Effective in Treating Diastasis Recti?
As in the case of other postpartum conditions, traditional ab work should be avoided if you experience diastasis recti.
This includes crunches, planks, curls, roll-ups—any movement that makes the belly bulge outwards and places stress on the abdominal tissues, since such exercises may make the separation of the abdominal muscles worsen.
This does not mean that you have to say goodbye to working out altogether.
Functional abdominal work including squats as well as compressions, pelvic tilts, toe taps, heel slides, single-leg stretches is key to strengthening your deep core muscle and might be performed even if you experience diastasis recti.
It is important to consult your physical therapist before you start.
Not only can they determine the severity of your abdominal separation, but will also advise you on the right exercises and help you correct any mistakes that may result from poor form and discomfort.
Finding the Right Postpartum Physical Therapist
The right postpartum physical therapist is a skilled professional that can create a treatment plan for you based on your medical history, symptoms, and complaints.
They use techniques of manual therapy and physical exercises to help manage physical and functional impairments (incontinence, diastasis recti, organ prolapse, and lower back pain) related to postpartum.
Ideally, they would also educate new mothers on how to carry the baby, perform daily activities with proper form and posture, and explain the movements or activities of daily living that are best to avoid or modify.
The right postpartum physical therapist is patient, empathetic, and understands the various challenges new mothers face.
They will encourage you to open up about your postpartum issues (that are often not easy to talk about and you might find embarrassing), and with a personalized treatment plan, they will help you get your pre-pregnancy body back.
The relationship between physical therapist and client is one based on trust and respect.
Booking an appointment and asking about how they would approach your issues is the best way to find out if you can work together.
First impressions matter: you only have to share as much as you are comfortable with and a good physical therapist will respect this.
Summary
While pregnancy and childbirth is a magical time, it is not without their challenges. New mothers come to realize that their bodies go through major changes that persist weeks or even months after giving birth.
Every woman is different, and experiences these changes differently: some can bounce back to their pre-pregnancy bodies relatively easily, while others suffer from pains and discomfort which makes it difficult for them to carry out basic tasks in their new roles as mothers.
Fortunately, with the help of postpartum physical therapy, you will be able to manage the most common issues related to childbirth (such as diastasis recti and pelvic floor issues).
Starting from breathing exercises, hypopressives, pelvic floor contractions, and moving on to exercises that strengthen the deep core muscle, and other low-impact activities, the goal of postpartum physical therapy is to improve your posture, correct muscle imbalances, and strengthen your pelvic floor muscles.
A successful treatment plan takes into consideration your individual needs, your medical history, your symptoms, as well as your individual recovery span, to help your body heal after the challenging time of pregnancy and childbirth.
If you are dealing with pain and discomfort after giving birth, or you want to start postpartum exercises and you don’t know how to start, call Doctor Alexandra Chaux at Chaux Physical Therapy at 805-203-9940 to find out how postpartum physical therapy can help your body heal faster, get stronger and fitter so that you can fully enjoy the first months with your newborn baby.
