There is one question that we get asked by neary EVERY postpartum mom…
Which exercises are best for me to strengthen my core and abdominal muscles after I had a baby?
The simple answer is it depends. I know that this is not the answer you want to hear, but it really does depend. There is no one size fits all exercise that is going to get your abdominals back after having a baby. It depends on many factors:
- what you were doing pre-pregnancy
- What you were doing during your pregnancy
- how your abdominal muscles are working currently
- how everything coordinates together
I’m not going be giving you specific exercises, but instead I’m want to give you some things that you should be watching out for when you are exercising to make sure that things are working correctly. I, as a physical therapist, hate hearing people say that they should never do something. Our human body is amazing and there are definitely things and ways that we can modify so that people can be doing the things that they want be doing.
Here are my tips for the things that you should be watching out for so that you know that you’re potentially protecting and properly engaging through the abdominal muscles.
- If you are trying to decide if an exercise is appropriate for strengthening your postpartum core is you want to make sure first that you can breathe while you doing it. You should not have to hold your breath to complete and exercise. There are certain exercises when we doing very high level lifting, heavy lifting when breath holding can be a good strategy that needs to happen. However, for the vast majority of us especially when we’re just getting back to exercise, if you cannot properly engage your core muscles and breathe while performing the exercise then it’s probably not appropriate. And that goes for whether the exercise is specific to strengthening your core muscles or not.
- The other thing to think about if you are trying to make sure if a core exercise is appropriate is can you maintain a deep abdominal activation. At the start of a core strengthening exercise you should be able to gently draw in your abdominal muscles on an exhale and maintain this muscle activation throughout the exercise. If during the exercise, your feel your abdominal muscles push forward/bulge out or maybe if your laying down, you feel your back arch off the ground then that’s the sign that your not using the abdominal muscles the right way anymore.
So, if you can’t keep breathing or maintain a deep abdominal muscle activation while doing the core exercise, then it’s not probably not an appropriate exercise for you yet. That doesn’t mean never, it just mean right now.
What can you do if you are in a situation where there is an exercise that you want to be doing but you’ve notice now that you’re doing it holding your breath and you’re belly pushes out every time you do it? This is the time to partner with a pelvic health physical therapist to evaluate what is going on in your abdominal wall that you may be not recruiting correctly. They can show you how to perform the activities correctly so that you can get back to doing the exercise that you want you be doing.
It’s my goal as a physical therapist to try and get you as active as you want to be, doing what you want to be doing, and working with you to achieve the goals that you want to achieve. Sometimes, we all just need a little help along the ways.
Today, I want to talk to you about 3 simple easy exercises that you can do to for postpartum core reactivation in those early days after delivering your baby.
Many women are concerned about how their core muscles will return after they deliver their baby. There are things that you can be doing early on in the postpartum recovery time help the abdominal muscles get back to working the way they were designed. The beauty of these exercises is that they are very simple to do.
The core muscle involve the diaphragm on the top, the abdominals on the front and the pelvic floor at the bottom. We are going to be looking at how we can easily activate these muscles to work together to create some nice support for that postpartum belly as it’s healing.
None of the exercises that I am talking about should be painful. If you are experiencing any pain when doing, please stop and consult your healthcare provider. Because these exercises are gentle, you can start them in your first week postpartum. Just make sure to perform the exercises in a comfortable range that’s not causing pain.
Exercise 1: Deep Breathing
Deep breathing is a wonderful way to get all of your deep core muscles coordinating together again. Sit or lay in a relaxed position of comfort. Start by taking nice big slow breath in and out. When you inhale, big and slow, you’re letting your abdominals expand and your belly fill up with air. A visual that works well for many people is to imagine your rib cage opening up like an umbrella as you inhale. Then as you exhale the umbrella closes. Try to slowly inhale for 5 seconds then exhale for 5 seconds and do 10 repetitions.
The beauty of deep breathing is that we get movement of the diaphragm, abdominals and the pelvic floor all together. So as we inhale, the diaphragm comes down, the abdominals expand out and the pelvic floor comes down a little bit to accept the load from that increased air pressure. Then, as we exhale, the pelvic floor rebounds back up, the abdominals come back in, the diaphragm goes back up.
Exercise 2: Transverse Abdominal Activation
The transverse abdominals are the deepest layer of abdominal muscles. Think of them forming a corset around your midsection. These muscles get very stretched out with pregnancy and can use some assistance to work correctly after delivery.
Again, sit or lay in a comfortable position. Gently inhale and then as you exhale, try to gently draw your belly away from your pants. You shouldn’t be holding your breath to do this. You are also not trying to squeeze your belly in as tight as you possibly can. Try to hold the contraction for 5 seconds and then relax for a few seconds. Do 10 repetitions at a time several times a day.
Exercise 3: Pelvic Floor Muscle Activation
The third exercise is for the pelvic floor muscles. These muscles are intimately located around the urethra, vagina, and anus. There are a couple of different ways that you can think of doing a pelvic floor muscle contraction. Try to pucker the anus like holding back gas or you can think about trying to pull the vagina up and in. You can do this in any position, but you may find it easier to feel the contraction in laying down or sitting at first. Just like with the transverse abdominal muscles try to hold the contraction for 5 seconds and do 10 repetitions.
Especially if you delivered vaginally, you may have a hard time feeling the pelvic floor muscles contract. After all, they are recovering from a big stretch with the delivery. Early activation is very helpful though. Gentle contract and relax of the pelvic floor muscles will help improve blood floor to the area and help the swelling go down. Both of which will help the healing process.
So, there you have it, three exercises that you can do in the early postpartum days to help reactivate your core muscles. Reactivation of the core muscles is important for you to be able care for your baby and return to healthy active lifestyle. If you have difficulty performing any of these exercises, it may benefit you to partner with a women’s health physical therapist.
Pelvic physical therapy is something that is unfamiliar to many people. I would say for about every 10 new patients that come to see us here Legacy Physical Therapy, about 7 or 8 of them start out their evaluation by saying that they have never heard of Pelvic Physical Therapy and they are not sure how we can help them.
We are passionate about helping women & men of all ages enjoy active, healthy lifestyles, by restoring confidence and dignity in pelvic, bladder, bowel, and sexual function, without relying on medications or surgery. We provide conservative treatment options for many conditions that people may be unaware that they even can do anything about.
Conditions Pelvic Physical Therapy Can Help
- Bladder Issues:
- Leakage, Urgency, Frequency, Painful Urination, Urinary Retention
- Bowel Issues:
- Constipation, Fecal Leakage
- Pain Conditions:
- Back Pain, Pelvic Pain, Tailbone Pain, Sacroiliac Joint Pain, Vaginal Pain, Rectal Pain, Vulvar Pain, Abdominal Pain, Penile Pain, Painful Sex
- Pelvic Prolapse Issue:
- Cystocele, Rectocele, Uterine Prolapse, Vaginal Vault Prolapse
- Pregnancy/Postpartum Related Issues:
- Low Back Pain, Sciatica, Diastasis Recti, Clogged Milk Duct, Episiotomy or C-section Scar Tissue Adhesions
Many people are surprised to learn that all of the above conditions can be helped by pelvic physical therapy. One of the things that we commonly see happen is that a patient will be referred to us by their urologist for bladder issues. Then once we get talking with them, we find out that they also have some back pain or hip pain issues that despite treatment aren’t going away. We teach the patient how all everything can be related.
Aren’t You Just Going to Teach Me to Kegel?
One of the things that we get asked all the time is, “I’m already doing Kegel exercises. It doesn’t help, why would coming to pelvic physical therapy help?” For those of you who don’t know a Kegel exercise is simply a contraction of the pelvic floor muscles like you are trying to hold back gas or pee. Muscle function is not simply about contraction. We need to make sure that we have a variety of different movements with the muscles. Muscles need to be able to contract, relax, stretch, and coordinate with other muscles.
As pelvic physical therapists, our job is to figure out how your pelvic floor muscles are working and coordinating with other muscles. We really take the whole body approach to looking at how things are coordinating together. It is never simply just about Kegel exercises. Those may be a part of your treatment plan, but it may not be. For some people, the problem is that they are doing pelvic floor muscle contractions or Kegel exercises incorrectly and that is actually causing more of the problem. For other people their pelvic floor muscles may be too tense or tight and trying to squeeze them more isn’t going to improve their symptoms. Instead, we need to actually teach them to relax and let go.
Pelvic PT Can Help Before or After Surgery
Another thing we hear commonly when we talk with patients on the phone is that I’m planning them to having the surgery so why would I need to see pelvic physical therapy. Our simple answer to that is if you’re planning on having shoulder surgery, neck surgery, back surgery, or knee surgery; 9 times out of 10, you’re going see a physical therapist either before or after the surgery to help make sure that you rehabilitate the muscles and that everything is working well together. Similarly, working with the pelvic physical therapist after you’ve had surgery for a bladder sling, prolapse repair, hysterectomy, or giving birth can promote return to optimal muscle function allowing you to have better, longer lasting surgical outcomes.
Pelvic PT Helps During Pregnancy & Postpartum
Females who have given birth are at a greater risk for pelvic dysfunction. Here at Legacy Physical Therapy, we feel strongly that every women should see a pelvic physical therapist for at least for 1 visit postpartum to identify any musculoskeletal issues that may be preventing her from improving her core and pelvic function postpartum. This should happened before she starts out with any type of exercise regimen, especially a high level one, to make sure that the pelvic and abdominal muscles are functioning the way that they should be. The therapist will also review movement patterns to make so she doesn’t develop any bad habits that will potentially lead to problems down the road such as bladder leakage or pelvic prolapse.
Pelvic physical therapists also work with women during their pregnancy. We help make sure that the pregnancy progresses as comfortably as possible and that you are able to be as active as you want to be. Pregnancy is a time that can be very stressful on the abdominals and pelvic floor because of the changes in your body. Working with the pelvic physical therapist to help you maximize pelvic and abdominal support and control can really make a big difference for a comfortable pregnancy.
You May Need Need to Advocate for Yourself
So now that you have learn a little more about what pelvic physical therapy is, you may be wondering why you haven’t heard of it before or why your doctor has not told you about it despite you mentioning some of the symptoms. Unfortunately, many doctors are unaware that pelvic physical therapy is an option out there to help their patients. Even the ones who do refer to pelvic physical therapy already may not be aware of all of the different thing that we can be doing to help patients. Because of this, you may have to be an advocate for yourself if you feel like you need to see a pelvic physical therapist. Don’t be afraid to ask your doctor for a referral to pelvic physical therapy.
If you feel like you’re dealing with any of these issues that we’ve been talking about, you may have to be the one to advocate for pelvic PT. You as a consumer, have the right to go wherever you want to go for your treatment. You do not have to necessary to go only to a place that is in your doctor’s office. You can seek healthcare from a pelvic physical therapist with whom you feel comfortable.
So, that is the brief introduction to pelvic physical therapy. If anything you have read about seems like something you are dealing with, give us a call at 636-225-3649. We are happy to chat with you about what you are experiencing to see if pelvic physical therapy would be a good option for you.
Yesterday my Facebook feed was inundated with multiple shares of this NPR article titled, “Flattening The ‘Mummy Tummy’ With 1 Exercise, 10 Minutes A Day.” After all, with a title like that who wouldn’t want to click on the article and and learn what seems to be such a simple fix for diastasis recti. The trouble is that the “Fix” is never this simple.
While I appreciate the awareness this article is bringing to the topic of diastasis recti and recovery of the partpartum core, Diastasis recti is far more complex than any one single exercise for one single muscle. Diastasis recti is not just about the abs, but moreover is about full body alignment and optimal intra-abdominal pressure regulation. One of the things that I talk to my patients about all the time is that I can give them the world’s best abdominal exercise program to perform 10-20 minutes a day, but what they are doing the other 23 hours and 40-50 minutes makes a bigger difference to their diastasis recti.
Core muscle function is so much more than static recruitment of a single abdominal muscle. Your transverse abdominal muscles, pelvic floor muscles, diaphragm, and deep back muscles form your deep core canister. They all work together to provide anticipatory stability. So few women realize that their breathing pattern is connected to their abdominal wall performance and their pelvic floor muscle function. My colleague, Julie Wiebe PT has a wonderful video about how all these muscles coordinate together on her webpage. Check it out. If we do not consider breathing pattern when rehabbing a diastasis recti, we are missing a big part of the picture. Chronic drawing in of the abdominal wall is not the answer! If we squeeze in the middle all the time, what are we doing to our pelvic floor down below… setting it up for issues down the road.
The research on diastasis recti is emerging and evolving. There is no way to prevent it during pregnancy by doing an exercise. It is a normal part of many women’s pregnancies. Don’t get me wrong, there are definitely things that you can do before and during your pregnancy to reduce your risk of a large diastasis recti and improve overall core function and support. However there other factors such as one’s genetics, overall tissue laxity, number and proximity in time of pregnancies, and singleton versus multiple pregnancy to name a few.
What’s a Woman to Do?
While this article is good to raise awareness, it barely scratches the surface of what is really needed to address the postpartum core rehabilitation. My best advice is to seek the care of a women’s health physical therapist to do a full assessment of core support system. At Legacy Physical Therapy, we see women all the time who think they are doing the right thing to rehab their core, but find that despite performing the exercises their symptoms are getting worse. If you cannot get to see a women’s health physical therapist, then please do your research when searching for solutions online. Below is a list of some of my favorite go to sites.
- Julie Wiebe PT
- Mutu System
- Brianna Battles – Everyday Battles
- Jessie Mundell
- Healthy Habits Happy Moms
If you think that you are dealing with a diastasis recti or postpartum core weakness, we can help. Give us a call at 636-225-3649 to chat with one of our women’s health physical therapist to see how we can help. If you are not sure if you have a diastasis recti and want to be checked by a professional, call us to set up a free screening appointment. We are happy to help.
Did you know that there are physical therapists who focus especially on female issues? In fact, there are physical therapists here in St. Louis who are Board Certified in Women’s Health Physical Therapy (WCS).
There are multiple times in a woman’s life in which physical therapy may be appropriate. We will talk about 2 important time periods in this article: 1) during pregnancy, and 2) postpartum
Physical therapy can be a wonderful adjunct care provider during pregnancy to help with common pain complaints such as:
- Low back pain
- Sacroiliac joint dysfunction
- Carpal tunnel syndrome
- Pelvic and pubic pain
- Foot pain
- Incontinence (bladder leakage)
- Round ligament pain
Physical therapy treatment during pregnancy may include:
- Posture education to avoid injury and decrease pain
- Manual therapy to restore alignment and improve soft tissue guarding
- Therapeutic exercises for improving muscle performance and posture
- Abdominal and pelvic floor training
- Fitting for various support belts to help with stability and pain
If you are like many pregnant women, you may have concern about what exercises are appropriate during pregnancy. A physical therapist is a great resource for instruction on the do’s and don’ts of exercise during pregnancy.
The stresses of pregnancy, vaginal deliveries, and C-sections may lead to myofascial complications following the birth of the baby. Many women suffer in silence because they feel their symptoms are “Normal” after they have a baby. Fortunately, many of these symptoms can be easily treated by a physical therapist specializing in postpartum care.
Common Postpartum Complaints include:
- Low back and lower extremity pain
- Upper back and neck pain associated with breastfeeding
- Upper extremity pain or numbness associated with child care
- Diastasis recti: Separation of the abdominal muscles which commonly occurs during healthy pregnancies.
- Pain with intercourse or orgasm
- Clitoral, vaginal, rectal, pubic, or tailbone pain
- Pain and decreased mobility at scar of C-Section, episiotomy, or perineal tear
- Pelvic floor weakness
- Urinary or fecal incontinence
- Urgency and frequency
- Pelvic pain
How Physical Therapy Can Help:
- Soft tissue mobilization, myofascial release, deep tissue massage
- Therapeutic exercise for improving abdominal and pelvic floor muscle performance
- Posture, lifting techniques and biomechanics
- Home exercise program
- Abdominal binder/brace fitting
- Scar massage
- Therapeutic ultrasound to breakup clogged milk ducts
- Modalities for pain control
- Instruction in return to exercise safely
- Instruction in proper lifting/carrying of baby, stroller walking, and other activities of daily living to avoid injury
Pregnancy, childbirth and childcare are all events that result in significant physical changes and new stresses on a woman’s body. Women’s Health Physical Therapists are specifically trained to meet the special needs of women during this time of their lives and beyond.
Call us today at 636-225-3649 to set up your FREE SCREENING to see if physical therapy is right for you.
I have been wanting to get classes together for my pregnant and postpartum clients for awhile now. The childbearing years bring about so many changes in women’s bodies that can set them up for problems down the road. There are so many preventative things that women can do to avoid these problems.
I am excited to say that I will teaching 2 different classes geared towards pregnant and postpartum women in the St. Louis area. On the 3rd and 4th Wednesday of the month from 6:30 to 7:30 pm I will be teaching at the Town & Country Cottonbabies.
Mommy and Me
This class is intended for moms in their last trimester or new moms. In the class you will learn how to regain muscle strength in key areas, “back, bellies, and bottoms,” how to get tone back in the abdominal muscle, and how to minimize back pain. We will teach ways to incorporate your baby into your work-out and how to protect your body from common overuse injuries that new moms encounter.
In this class participants will learn musculoskeletal changes during pregnancy, understand reasons for back pain during pregnancy, learn techniques to minimize pain, and get self help ideas for comfort. This is great class for expecting moms and their partners.
Space is limited. Please register for this class by calling the CottonBabies Store at 636-220-7720