6 Exercises for Recovery After Birth



It is easy to fall into the trap of jumping back into the exercise you used to do prior to pregnancy, but when we consider the stretching of the abdominal wall, the pressure of pregnancy on our pelvic floor, any birth related injury or surgery along with hormonal changes, it is obvious that our bodies have been through a significant transformation and a restorative approach to exercise after pregnancy is needed.


We have consulted one of Brisbane’s leading pregnancy and postnatal exercise physiotherapists, Briony from Be In Blossom at Chermside, to bring you a selection of key exercises that should form the foundation of your postnatal recovery exercise program.


If you are currently pregnant, you might want to read Briony's earlier blog on Pregnancy Exercise.


It is important to keep in mind that these exercises have not taken into consideration your individual circumstances and an assessment by a women’s health physiotherapist and the guidance of a qualified pregnancy and postnatal trainer will determine any “red flags” that require modification of exercises, so you get tailored options for you. Some of the factors that a physio or trainer should take into consideration during an assessment include:

- A large baby (over 4kg) - A short or very long second stage of labour - Extensive perineal tearing - Use of instruments (particularly forceps) - Client’s perception of their birth as traumatic - Multiple births - Babies close in age - History of pelvic floor symptoms - PND or history of anxiety/depression - Abdominal muscle separation (rectus diastasis) with either a larger than 3cm gap and/or significant weakness and laxity of the connective tissue joining the two sides of the abdomen.


They will also consider your exercise history and goals.

Key Exercises and Tips for the Early Postnatal Period

1. Posture Correction and Breathing


Posture (aka alignment) has a direct impact on our pelvic floor function and can be important in managing back pain.



Benefits:

  • Better shape to the abdominal wall

  • Takes the load off the abdominal wall while the connective tissues and muscles are recovering

  • More optimal position to start working on your breathing pattern

  • Reduces back ache

  • Facilitates better pelvic floor and abdominal wall function


Method:

  • Start to check in with yourself when you are waiting at the checkouts, doing the dishes or holding your baby

  • Aim to stack your body along the spine

  • Think of hips over heels, ribs over hips, ears over shoulders

  • Relax your shoulders down and your rib cage down at the front

  • As you take a breath let your abdomen stretch a little to accept the breath


2. Pelvic Floor Exercises (Variety of positions)



They might not be the most exciting exercise to do, but they can make the difference between peeing your pants or not, so let’s give them the credit they deserve. The short video below gives a great explanation of the anatomy and function of the pelvic floor plus some guide on how to do your pelvic floor exercises.


As the muscles are internal it can be very difficult to understand if you are doing them correctly. It is highly recommended that all pregnancy and postnatal women see a pelvic floor physiotherapist for an assessment on their pelvic floor and whether they are doing their exercises correctly. They will also be able to diagnose overactive pelvic floor muscles which require a different approach to pelvic floor training.


Benefits:

  • Prevent bladder leakage

  • Support the pelvic organs to limit descent

  • Contribute to stability of your pelvis

  • Respond to abdominal pressure changes

  • Reduce pain with intercourse and increased sensation


Considerations:

  • Women need to learn both how to release and how to engage their pelvic floor.

  • There should be adequate rest phase (approx. same length of time as the contraction)

  • May be helpful to use visualisations (eg drawing a tampon up inside or slowing down a wee), or use hand over perineum to cue the muscles.

  • Try some sets earlier in the day before the PF is fatigued.

  • Lying positions may initially be easier than upright if the muscles are weak.

For guidance on whether you are doing your pelvic floor exercises effectively, visit the Pelvic Floor First website or have an assessment with a pelvic floor physiotherapist.

3. Thoracic Spine Mobiliser

Breastfeeding and holding young babies can see women developing rounded shoulders and losing mobility through their thoracic spine. This exercise is beautiful for opening the chest up and getting the rib cage moving.

Version 1 - Arms opening to the sides

Version 2 - Arms opening on the diagonal


Benefits:

  • Improve thoracic mobility (open chest)

  • Reduce upper back pain from feeding and carrying

  • Keep the rib cage mobile for good breathing mechanics

  • Assist the abdominals to function correctly (attachment point)

Considerations:

  • Use of a folded towel under head for Mums with tight thoracic spines to support the head.

  • Watch that the lower back doesn’t arch upwards with the arm openings.

Method:

  • Lay on your back with your knees bent and feet flat on the floor

  • Place a rolled up towel lengthways underneath your upper back

  • Start with your arms raised above your chest

  • Inhale to open and exhale as you bring the arms back to the starting position. Think about gently tightening your pelvic floor and drawing in across your lower abdomen on the exhale and releasing them as you breathe in to open the arms.

  • You can also hold the open position while you do a few deep breaths for a deeper stretch

4. Wide Knee Rocks - hip mobiliser​

Benefits:

  • Alleviate low back ache

  • Alleviate ache through the pelvis

  • Lengthen tight muscles within the pelvis and around the hips

  • Assist with better squat technique


Considerations:

  • If you are experiencing pelvic pain while doing this exercise please see a pelvic physiotherapist


Method:

  • Lay on your back with your knees bent, Feet placed wide apart and flat on the floor

  • Extend your arms out to the sides

  • Gently let your knees and ankles drop to one side while keeping your feet in contact with the floor

  • Rest in this position while taking a few breaths before exhaling, engaging your lower abdominal muscles (think of trying to draw your hip bones together) to bring your knees back to the centre

  • Repeat on other side


5. Bent Knee Leg Lowers​



Benefits:

  • Build abdominal wall support (and rest of core)

  • Assist with correcting abdominal muscle separation

  • Improve body awareness and trunk control


Considerations:

  • Use of hand support to stationary leg until Mums can control their intra-abdominal pressure and avoid bulging/coning.

  • Use of the exhale to engage core more effectively and avoid breath holding

  • Watch for the ability to maintain back alignment

  • Question about ability to engage the pelvic floor during leg movement


Method:

  • Lay on your back with your knees bent and feet flat on the floor

  • Slowly bring one leg up to a 90 degree position. Before you raise the second leg place your hands behind the knee of the leg that is in the air to support some of the weight.

  • As you lift the second leg from the floor breathe out, gently contracting your deep abdominal muscles and pelvic floor.

  • Take a breath in when both legs are at 90 degrees and then lower them one at a time being sure to exhale and switch on your core as you lower the first leg.

  • Alternate the leg you start with.


6. Squat Adding Single Side Loading



Benefits:

  • Strengthen legs for lifting babies, prams etc (stronger legs = less likely to strain back)

  • Practice integrating pelvic floor and deep abdominals

  • Incorporating free weights to build support through upper back for baby carrying and feeding and support of added weight of breast tissue

  • Single side loads create a functional aspect to cope with requirements of the new Mum eg lifting the pram.


Considerations:

  • Pelvic floor symptoms

  • Pain in the pelvis or back

  • Pre-existing lower limb conditions


Method:

  • Have your feet slightly wider than hip width (if you have pelvic pain or pelvic floor dysfunction keep you knees closer together)

  • Inhale as you bend your knees and come down until there is a 45 degree angle at your knees (you can stop higher if you have pelvic pain or pelvic floor dysfunction or go deeper to a maximum of 90 degrees if it feels OK)

  • Before starting to straighten your legs, contract your pelvic floor as you exhale and press your whole foot into the floor (ensuring your weight isn’t all in your toes)

  • Add some weights to one side to further train your core. Keep your shoulders level so you don’t drop towards the weighted side. This simulates carrying groceries or a baby capsule.



Useful Information


Below are some resources for understanding what constitutes suitable pregnancy and postnatal exercise. For a comprehensive approach to your postnatal exercise program ensure you keep your health care provider aware of your participation in exercise activities, see a women’s health physio and use a qualified postnatal trainer.


Fitness Australia Pre and Postnatal Exercise Guidelines


The Royal Australian and New Zealand College of Obstetricians and Gynaecologists - Pregnancy Exercise Guidelines


Sports Medicine Australia - Pregnancy Exercise Guidelines




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