Guidelines and Considerations for Optimal Postpartum Recovery 

Congratulations! You have made it to the end of your pregnancy and welcomed your precious bundle of joy into the world! As you adjust to a new life and routine including your little one, you may find yourself in the company of so many women who wish to return to exercise and sports. But how do you know when to pick back up? Here is what to look out for when returning to exercise postpartum.

What Happens To Our Body During Pregnancy?

To accommodate that growing baby (or babies), a woman’s center of gravity shifts slightly forward, so her posture and structure must adapt. Women’s bodies undergo physical and structural changes during pregnancy and postpartum, including:

  • Flaring of the lower ribs
  • Significant stretching of the abdominal muscles and fascia
  • Increased pressure on pelvic floor muscles , diaphragm and lumbar spine
  • Widening or flattening of the feet
  • Disruption of the myofascial system of the abdomen (during c-section) or pelvic floor (during vaginal delivery)

While this is natural and normal, many women are dismayed to find that their postpartum body doesn’t function quite the same as it did before. There is often little guidance from birth professionals on these issues, which can lead to returning to activity too soon or neglecting to strengthen appropriate muscles. Both of these can lead to increased risk of injury, developing  compensatory strategies or chronic pain. At the very least, it can lead to suboptimal performance and decreased power output.

What Is The Pelvic Floor?

Our pelvic floor is often referred to as the “floor of our core”, as it works together with our deepest core muscles: 1) the transversus abdominis, 2) the lumbar multifidi (the deepest spinal muscles), and 3) the diaphragm to maintain the pressures in our abdominal cavity and create the stability needed to move. Many of the common complaints that arise during the pregnancy/ postpartum period such as pelvic pain with movement, intercourse or bowel movements, changes in sexual function, or urinary leakage, aren’t traditionally caused by the pelvic floor muscles themselves, but rather are symptoms of a greater stability problem.

Now we’ve discussed how the body changes, let’s dive into an action plan for your postpartum recovery:

The First Six Weeks Postpartum:

  • Rest up, mama! First priority in those initial weeks should be letting your body heal, getting into a rhythm with your baby and sleeping when you can. 
  • BreathingRetrain your diaphragm to help you move in those initial days. As I mentioned earlier, the diaphragm is an essential part of our dynamic stability system, and is impaired during late stages in pregnancy. Since the core is overly stretched following pregnancy, it can feel physically harder or painful to move, particularly if we’re recovering from a c-section or have perineal stitching.  Begin in bed as soon as you feel comfortable by taking slow, deep breaths visualizing getting air equally into each portion of your lungs. Try to feel the movement coming from your lower ribs. Using a technique often called “huffing”, exhale and try to engage that deepest core layer before moving to decrease strain  on those healing parts of your body. You can also do this exercise sitting up as shown in the photo.
  • Begin gentle core strengthening by practicing a gradual but sustained exhale as if you are blowing out a candle. See if you can feel your deepest core activate by placing your fingers on your abdomen. If this is difficult to feel or coordinate, don’t worry! A skilled pelvic health physical therapist can help!
  • When your body feels up for it, start including some walking at a comfortable pace, beginning with shorter distances and working up gradually. Let your body be your guide. If you experience a significant increase in bleeding or soreness afterward, you may want to scale back temporarily.
  • Assess your pelvic floor. On an exhale, gently draw in your pelvic floor muscles, and slowly but completely relax them with your next inhale. Try this a few times, making note of how it feels. If there is any pain or difficulty coordinating the contraction, you should seek a consultation with a Pelvic PT. We are here to help you! You don’t need to figure this out on your own.
  • If you experience back, hip pain, or shoulder pain from breastfeeding at any time during the first 6 weeks postpartum, contact your pelvic PT to help address the issues. Again, in most states, you don’t need a referral from a doctor to see a PT.

After Six Weeks Postpartum: 

  • MD Follow-up. While you are with your physician or other qualified healthcare provider, make sure you address any concerns you may have postpartum or issues with recovery. You may want to keep a list when you see them to ensure you don’t forget to ask any pertinent questions. 
  • Consult with a Pelvic Health PT. Most states now do not require a referral for Physical Therapy, so you can see us anytime! However, if your insurance requires it, ask your doctor for a referral for a pelvic PT evaluation. 
  • Start off slowly. Once you resume exercise, it is important to not jump right back into exercise where you left off! The speed at which you can return to your previous fitness level depends on several factors.  Begin with some gentle core strengthening exercises, such as bridges incorporating your breath. Avoid sit ups and crunches, at least initially, and ideally until after having a PT evaluation. We will help guide you! 
  • Incorporate previous exercises. Gradually begin incorporating basic versions of your previous exercises. Give your body a day or two in between to fully assess for pain or symptoms before continuing. For higher impact activities such as running or CrossFit, you may want to wait until at least 8 weeks postpartum and consult for Pelvic PT for guidance. 

Who Should See a Pelvic PT?

Every post-partum woman should consult a Pelvic PT before returning to exercise.  However, if at any point post-partum you experience the following, you should book a consultation:

  • Persistent pelvic pain, or pain with movement
  • Heaviness feeling or increased vaginal pressure
  • Discomfort, injury or pain in one or both legs, abdomen or back, particularly if not present prior to pregnancy
  • Increased urgency to go to the bathroom or persistent leakage during activities

In Summary

Keep in mind, this is a very general framework. We recommend getting a PT evaluation with a pelvic health PT during the initial postpartum phase to assess for and address many common complaints and issues, as well as to reactivate crucial core muscles altered during pregnancy and postpartum. 

If you or someone you know recently had a baby or want to be evaluated, contact our clinic and schedule an evaluation today! Postpartum is a quest back to yourself. We are here to help you build back stronger! 

About The AuthorLaura Glazebrook

Dr. Laura Glazebrook joined One on One Physical Therapy after spending 6 years specializing in neurological disorders, including stroke, brain injury, spinal cord injury and multiple sclerosis at the Shepherd Center in Atlanta. She continues to remain active in neurologic rehab, but enjoys integrating her passion for pelvic health into her practice. She enjoys providing a personalized approach to restoring optimal function for both neurologically involved patients as well as patients with pelvic health concerns and postpartum women. Laura has integrated her passion for pelvic health into her practice and is actively working to improve awareness of pelvic health concerns for individuals with neurological impairments. She participates in community outreach to educate support groups and healthcare professionals on pelvic health issues, and presented pelvic health considerations for neurologic patients at the Physical Therapy Association of Georgia’s fifth annual neuro symposium. Laura grew up in a dance studio, but currently enjoys an active lifestyle including running, triathlons, Pilates and yoga. In her time outside the office, she and her husband enjoy traveling and navigating the mayhem of parenting. You can email Laura at laurag@onetherapy.com. To learn more, visit www.onetherapy.com.