Pelvic Health PT

Post Partum

The Return of the Active Mom: 4 safe and easy exercises you do after childbirth

By Dr. Theresa Lugatiman, PT, DPT Pelvic Health Specialist @CentralCarePT

So, you have just given birth -- when is it safe to return to doing the exercises you love? Often,  new mothers are left with the question of when to start exercising and what exercises to initiate with.  Common sense will tell us to take it easy and slowly work your way up to your previous routines. But where do you start?

Changes happen to the female body as the uterus increases in size, accommodating the baby’s growth.  At around 22 weeks of pregnancy, relaxin hormone is released. As its name implies, it allows for relaxation of body structures, especially around the pelvis where the baby is nestled. Towards the third trimester, the pregnant woman’s center of gravity is shifted forward. The anterior shift will cause posterior structures to work slightly harder to prevent the body from leaning forward some more. Pressure is increased towards the pelvic floor muscles and like a net of the pelvic bowl it keeps abdominal contents in place. Back pain and pelvic pain may happen. If pain does not go away with positioning or supportive belts, a pelvic health physical therapist can guide you through your pregnancy with movement strategies and exercises.

After childbirth, structures are left lengthened and loose, often weaker than they were prior to the pregnancy. Fortunately, these structures begin to ease back to their pre-lengthened state at about 6 weeks. Your OB visit at about this time will mark your return to your usual activities.  Ask your OB provider if it is safe for you to begin exercises. If you have pain back pain,  pelvic pain or are leaking, a referral to pelvic health physical therapist may be necessary. Your Pelvic PT can guide you to start with pain-free Kegel exercises. Since your pelvic floor muscles have been lengthened during pregnancy, you might have a difficult time feeling the movement. These are the muscles you use to pause urine flow to catch it in a specimen cup. BUT IT IS NOT A GOOD PRACTICE TO STOP URINE FLOW! Think about pulling these muscles up and this may be easier done when you breathe out through pursed lips.

Do graduated exercises that improve your core strength. Sit ups, however, are not encouraged. In lieu of a full sit-up, curl-ups done with knees bent and laying on your back may be better. To avoid exerting too much pressure towards the abdominal area and pelvic floor, exhale or count loud as you lift just your head and shoulders off the mat.  If you notice a bulging or opening of your belly muscles as you come up, use a sheet around your abdominal area to draw the belly muscles closer together. Should you have pain or increased bulging while doing the activity, stop and consult your pelvic health physical therapist.

Another easy exercise that you can start with is a modified plank,  placing your hands on the kitchen counter and keeping your arms straight. If your wrists hurt, lean on your elbows. Try to maintain a straight line from you head to your feet. Flatten your low back and aim to hold  the position for 30 seconds. If you can only hold for a few seconds, that is perfectly fine. Repeating the activity will facilitate core muscle co-contraction and allow you to tolerate the hold for just a bit longer the next time.

While jumping and hopping exercises are to be avoided in the beginning of your recovery, you may initiate leg strengthening with a partial wall squat. With your back against the wall, move your feet forward about 12 inches. Remember to keep your knees over your heels as you slightly lower your hips, then use your leg muscles to push up into standing.  If you cannot keep your back flat against the wall, a rolled towel between the arch of your back and the wall will do the trick. Press your low back into the towel and feel your abdominal muscles activate. Your core, hip and thigh muscles will thank you later for initiating a great workout.

Lastly, remember to line up your joints in good body mechanics as you transition from one position to another. Carrying your newborn in your arms is only slightly different from carrying the child in your womb. While it is common to feel upper back aches and pains after delivery, it is also alright to seek help if the pain does not go away with just a heating pad or massage. It is a good idea to seek help if your muscles feel weak. Find pelvic / women’s health physical therapist in your area to give you a competent  assessment and guided progression to return to your athletic activities. Keep in mind, you carried a miracle in your womb for 9 months. Your body will begin to mend in 6 weeks and soon, you will be up and running with your new exercise buddy.

ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists.Committee on Obstetric Practice - Int J Gynaecol Obstet - April 1, 2002; 77 (1); 79-81

MEDLINE is the source for the citation and abstract for this record

Metz, M., Junginger, B., Henrich, W., & Baeßler, K. (2017). Development and Validation of a Questionnaire for the Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Post-Partum. Geburtshilfe und Frauenheilkunde, 77(4), 358-365

Murphy, K., & Fosnight, A. (2018). The Role of Pelvic Floor Physical Therapy for the Female Patient. Physician Assistant Clinics, 3(3), 445–455. doi: 10.1016/j.cpha.2018.02.01