Every birthing experience is different, yet low back pain, pelvic girdle pain, and pelvic floor dysfunctions are all common problems after pregnancy. The issues that can arise following pregnancy are often not addressed or discussed.
These symptoms before pregnancy or during pregnancy are all risk factors for pain during postpartum. Still, the increased workload of caring for a newborn while trying to heal can be stressful on the musculoskeletal system.
Pelvic floor dysfunctions may lead to long-term urinary incontinence. Many people don’t know that postpartum physical therapy can help you.
How Can Postpartum Physical Therapy Help?
A physical therapist can help decrease pain with joint and soft tissue mobilization. Also, a skilled physical therapist will teach you how to engage the muscles that support the spine and pelvis and strengthen the larger muscle groups in the upper and lower body.
The goal is to relearn how to move correctly to minimize the stress and strain on ligaments and tendons. Physical therapy can dramatically improve your ability to lift your baby, pick up after them, or carry them when nursing – with less or no pain!
Diastasis Recti Abdominis
Diastasis recti abdominis (DRA) is when there is a thinning and widening or separation in the line alba of the rectus abdominis muscle. As a result, DRA can cause “tenting” in the midline of your core when increasing intra-abdominal pressure. DRA is often first noticed when performing exercises, such as abdominal crunch or curl. A pregnancy with DRA is often associated with poor abdominal strength, low back pain, and urogynecologic dysfunctions.
A physical therapist can help you learn to use your deep core and pelvic floor muscles while not holding your breath. These muscles create a natural and functional brace, so you don’t feel increased pressure on the abdominals during activities of exertion. Once you have learned how to control these muscles, functional movement training begins to teach you how to bend, lift, push, pull, and carry. When appropriate, abdominal binders provide your body enough support as it strengthens to become independent.
Pelvic Floor Muscle Training
Like any other muscle, pelvic floor muscles must be strengthened and trained postpartum. Studies have shown that pelvic floor muscle training (PFMT) is an effective treatment to help with stress urinary incontinence, which is often underdiagnosed, yet, it may not always be the answer. Still, it is an excellent place to start if you are experiencing leaking when coughing or laughing. Initiating pelvic muscle strengthening is best to have occurred during pregnancy; however, it is never too late to start!
Getting a good grasp of how to engage your pelvic floor muscles may be challenging. You don’t need to worry because a skilled physical therapist can help you find them. Using cues such as imagining you are holding your urine mid-stream or holding back gas without clenching your buttocks can be very effective. Improvements may take six weeks with a consistent targeted training program.
There are two types of pelvic floor contractions that have very different functions:
- Slow contractions are lifting and squeezing for 5-10 seconds for strengthening and endurance
- Rapid contractions lasting 1-3 seconds to respond to events such as coughing and sneezing
Appropriate recovery time between contractions is also crucial as you do not want to fatigue or create overly tight pelvic floor muscles that can lead to different problems. During uncomplicated deliveries, PFMT can begin in the immediate postpartum phase. You can progress by increasing the number or duration of contractions in varying positions.
Returning to Physical Activity
When to return to physical activity after having a child is different for everyone. Exercise should follow a gradual and guided progression to minimize injury risk and maximize the benefit. Remember to listen to your body. Factors to consider are:
- If it a natural or cesarean birth
- Duration and intensity of labor and delivery
- pre-pregnancy and pregnancy fitness levels
Research has shown that postpartum exercising has numerous benefits, including improved psychological well-being and improvement in chronic disease risk factors (cardiovascular disease, metabolic syndrome, and obesity). Returning to exercising or beginning to incorporate an exercise routine may be intimidating at first.
To decrease your stress and anxiety, you can visit a physical therapist to address your concerns. Scheduling a visit can help ensure that you are safely improving your physical health as you begin your new role as an active mother. 
Get moving and stay moving!
If you have any questions or concerns, reach out to your medical provider. If you are limited by pain, can’t do your normal activities or workouts, lack the knowledge or confidence in how to proceed safely, or just don’t feel sure how to start – give us a call!
How does Evolve Physical Therapy help?
For pregnancy physical therapy and postpartum physical therapy treatments, we perform a thorough musculoskeletal and functional movement assessment. We also consider the unique context of the physical changes and new risk factors that accompany pregnancy and birth.
For a thorough evaluation and individualized treatment, contact our Sherwood clinic or our Bethany clinic today, and be seen in less than 48 hours.
Check out what injuries we commonly treat and what to expect during an appointment.
References:
- The Academy of Pelvic Health Physical Therapy of the American Physical Therapy Association 2020.
- Benjamin, D., van de Water, A. and Peiris, C., 2014. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 100(1), pp.1-8.
- Kocaöz S, Eroğlu K, Sivaslıoğlu AA. Role of pelvic floor muscle exercises in the prevention of stress urinary incontinence during pregnancy and the postpartum period. Gynecol Obstet Invest. 2013;75(1):34-40. doi: 10.1159/000343038. Epub 2012 Oct 27. PMID: 23108378.
- Gonzales AL, Barnes KL, Qualls CR, Jeppson PC. Prevalence and Treatment of Postpartum Stress Urinary Incontinence: A Systematic Review. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e139-e145. doi: 10.1097/SPV.0000000000000866. PMID: 32282522.
- Neumann PB, Grimmer KA, Deenadayalan Y. Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review. BMC Womens Health. 2006 Jun 28;6:11. doi: 10.1186/1472-6874-6-11. PMID: 16805910; PMCID: PMC1586224.
