Postpartum Exercise to Restore The Core
The postpartum period is known at the 4th Trimester. Although it is important to note that the body requires more than three months to recover fullly from the changes of pregnancy and childbirth. The focus of exercise in the postpartum period should be on pelvic girdle stabilization. The ligaments that hold the joints in place, known as form closure, have been stretched and become deformed as a result of extra hormones in pregnancy. This requires extra help from the muscles, or force closure, to hold the pelvic girdle together. Once you have had a baby, your body will be different.
The deep core is a group of muscles that works as a system to stabilize the lumbopelvic girdle. These muscle include the diaphragm, pelvic floor, transverse abdominus and multifidus (see image below). Pregnancy alters the core and needs to be retrained or other muscles can remain perpetually tight, leading to dysfunction. Symptoms of abnormal tension include back pain, hip pain, pelvic pain, urinary urgency or incontinence, painful penetration and more. In addition to the deep core, the muscles that need to be retrained during and after pregnancy to properly stabilize the pelvis are the glutes/buttocks, quads and inner thighs.
REDUCE THE JELLY BELLY
Ideally, the abdominal wall should be assessed before beginning an exercise program in the postpartum period. Click here to read more about DIASTASIS RECTI, a vertical abdominal split between the rectus abdominus muscles. Risk factors of an abdominal split include low back pain, urinary incontinence (involuntary loss of urine) and pelvic organ prolapse.
Exercise should be aimed at retraining the tranverse abdominus, or deepest abdominal muscle. The function of this muscle is so vital to core health; it is the timing and sequencing of this muscle that is so important. Doing sit-ups or crunches can increase back and neck pain and increase pressure on the pelvic floor and abdomen while it is healing. Click here to read our blog on why sit-ups and crunches are not the best core exercise.
EXERCISE TO INCLUDE IN THE POSTPARTUM PERIOD
The six-week check-up is often when you will be given the green light to return to all activity, including exercise and sexual activity. If there is a delay in healing or an infection, the time frame will be longer. A good rule of thumb to follow for returning to full activity is generally after the lochia, or postpartum blood flow, subsides. The postpartum period is a great time to return to exercise. This is a time when motivation is high to regain your waistline and maintain the physiological training effects of pregnancy (your body thinks you ran a marathon). If you begin retraining the core during pregnancy and initially right after birth, it will be easier to return to exercise. If you haven't gained sufficient core strength, I recommend postponing running or impact activities until after three months and the core is able to transfer the load from your feet to your pelvis effectively. Read our blog on returning to running here.
The following symptoms are a result of the core not working properly and need to be addressed, or they can worsen and lead to chronic problems. The deep core muscles can be further activated by adding the glutes and quads to maximize time and engage synergistic muscles.
EXERCISE TO AVOID IN THE POSTPARTUM PERIOD
Pelvic girdle instability can persist in the postpartum period due to hormones that contribute to joint laxity. Some of these hormones remain in high concentrations, especially if you are breastfeeding or during the luteal phase (second half) of your cycle. The most important aspect of returning to exercise is to manage pressure properly, which means mastering the timing of your breath with lifting, carrying or anything strenuous. It is also recommended to postpone running until you are at least three months postpartum to give your body time to repair.
WHEN TO SEEK HELP
Severe back, pelvic or hip pain in the first few weeks following pregnancy
Back, pelvic or hip pain during or after activity that persists beyond 6 weeks
Pain during or after intercourse, or lack of sensation
Fear of pain with intercourse
Pain with urination or bowel movements
Urinary leaking, urgency or frequency (>8 voids in a 24-hour period)
Urinary retention or inability to empty the bladder completely
Diastasis recti or doming of the abdominal wall with exercise or activities
Inability to perform a Kegel
If you have any of the above symptoms or attempt to return to exercise and continue to have problems, it is time to seek the help of a pelvic health physical therapist who specializes in treating the pelvis and postpartum dysfunctions. With proper training and hands-on treatment, the muscles can function optimally, even after many years of dysfunction. To find a qualified physical therapist in your area, click here or schedule with one of our expert physical therapists. You not only deserve to live optimally; your family is depending on you to be the best version of yourself!
Lee L-J, Lee D. 2011. Chaper 7: Clinical Practice - The Reality For Clinicians. The Pelvic Girdle, 4th edition. Elsevier, Edinburgh.
Janda V, Va'Vrova'. 1996. Sensory motor stimulation. In Liebenson C (ed). Rehabilitation of the Spine. Wilkins & Wilkins: Baltimore. 319-328.
written by Janine Laughlin, PT - January 2017; revised October 2023