How can I get fit again? It’s one of the most common questions we hear as physiotherapists, from women following the birth of their child. And whilst it’s a critical question (as all the evidence shows that the right type of exercise is very important before, during and after pregnancy, it is not an easy question to answer in a generalised fashion.
Obviously every pregnancy and every birth is different, and every woman is different, so there are many variables that must be taken into account when determining safe exercise in the post-natal period. What we do know is that there are many common physical and hormonal changes during pregnancy that change the structure and stability of the body, therefore care must be taken when returning to exercise to ensure that you are not placing more strain on your body, and therefore leaving yourself vulnerable to unnecessary injury and pain.
There are three particular areas that your physiotherapist will be interested in assessing, before advising on appropriate post-natal fitness and exercise:
- The abdominal region: the abdominal muscles undergo a significant lengthening and weakening during pregnancy. The Rectus Abdominus (R.A) muscles (more commonly known as the “six pack muscles”) runs from the breast bone down to the pubic bone. Being vertical in alignment, this muscle is really effected with the expanding size of the abdominal region. Transversus Abdominus (or T.A), one of the critical stabilising muscles, is also stretched and weakened, resulting in difficulty “connecting” to, or “activating” this muscle. Without it, the lumbar spine and pelvis is vulnerable to force and movement strains. A caesarean section requires even more care and retraining of the T.A muscle. When you think about all the bending, lifting, bathing, feeding, carrying, transporting from cots and cars etc, it is little wonder that this time of high force and lower muscle activation can result in pain and injury.
- The pelvic floor muscles (PFM) – like the abdominal muscles above, the poor old PFM undergoes quite a bit of trauma, both during pregnancy and the birth process itself. A similar stretching, weakening and deactivation occurs, with one of the more common outcomes being reduced urinary/bladder control, and the potential for some urinary leakage when lifting or exercising. The PFM and the abdominals require specific retraining techniques in many cases before activities such as quicker/longer distance walking, or running, are commenced.
- Pelvic Stability: Relaxin is a hormone released during pregnancy to help the cervix widen and dilate, however it also has a generalised effect on the ligaments of the pelvis (and other body areas), allowing those ligaments to soften and stretch. Ligaments provide support and stability, connecting bone to bone, holding joints together. Ligaments softening during pregnancy allows the pelvic girdle to expand for the growing baby. Unfortunately this can also cause instability around the pelvis, and returning too soon to activities like running, can cause pelvic girdle pain. This ligament laxity effect also contributes to the Diastasis Rectus (separation of the abdominal muscles) that can be seen post birth.
The best time to start exercising your pelvic floor and deep abdominal muscles is immediately after the birth (unless instructed by your obstetrician not too). Hopefully you will have learnt some basic T.A and PFM techniques during the pre-natal classes, and it is strongly advised to continue these simple exercises after giving birth. However prior to considering a return to any vigorous exercise or resistance type exercise, it is highly recommended to see your physiotherapist, who can perform some simple tests to assess your pelvic stability, posture, and muscle control of the abdominal and pelvic floor muscle groups. Real time ultrasound (where a probe is gently placed on your abdominal area) is a brilliant way to assess the abdominal and pelvic floor muscles in a simple, accurate, and non invasive way.
As a reminder on how to activate your pelvic muscles, try these simple exercises:
PFM – Lie on your back, knees bent, and focus on breathing in a slow and controlled manner. Very gently squeeze your pelvic floor muscles (as though you are trying to slow the flow of urine when on the toilet). Imagine the sling of pelvic floor muscle gently lifting upwards. Maintain your breathing pattern whilst holding the contraction. The key to this exercise is not strength or effort of contraction, but more a gentle and sustained contraction that doesn’t alter your breathing pattern.
Transversus Abdominus – After pregnancy, activation of the transverse abdominis helps to increase the lower back and pelvic stability along with assisting to close any abdominal separation that is present. Lie on your back and draw your lower abdominals in slightly towards your spine, ensuring that there is minimal activity in the muscles above your belly button. As with the PFM exercises above, it is essential that you don’t hold your breath whilst you are contracting your T.A muscle.
As a general rule, walking is a very gentle and safe form of exercise that that has many benefits in the immediate post-natal period, and your baby can come with you in the pram. However we strongly recommend you seek a physiotherapist’s assessment and opinion before embarking on any higher level exercises such as running, high impact exercise classes, jumping activities, sit ups or abdominal curls, higher weights or resistance work, and weighted or deep squats.
Tanya Szylkrot – Physiotherapist
We are happy to announce that Tanya Szylkrot has returned to SSPC East Bentleigh following her own maternity leave, and pre/post natal physiotherapy and Pilates during pregnancy is her special interest area. We also have Leonie and Millie at SSPC Parkdale with a similar interest field, so please ask for one of these practitioners if you would like further advice and management.
