The body undergoes numerous changes during pregnancy, leading to discomfort and abnormal movement patterns and postures postpartum. Common challenges after delivery include diastasis recti (separation of the abdominal muscles), urine or stool leakage, pelvic organ prolapse, low back or SI joint pain, and neck or shoulder pain. A physical therapist with additional training specific to women who are pregnant or postpartum can effectively address these challenges and help women maintain relative strength and control of the core and pelvic floor muscles during pregnancy and assist women through their body’s recovery post-pregnancy. This specific care will help limit difficulty returning to pre-pregnancy activities.
Restoring Abdominal Pressure. One of the essential goals following delivery is to restore the abdominal pressure system. During pregnancy, your baby pushes up on the diaphragm, out on the abdominal wall, and down on the pelvic floor. This creates an abnormal and ineffective pressure system postpartum that can lead to pelvic floor issues (ex: leaking, pelvic organ prolapse) and diastasis recti, limiting your return to pre-pregnancy activities. It is important to regain coordinated breathing with normal diaphragm and pelvic floor movement FIRST. By doing this, you will build a solid foundation as you progress to more involved exercises and eventually higher impact movements as you desire. In the absence of medical complications, these important breathing and coordination activities can start right away postpartum. A physical therapist can create a program tailored to the needs specific to your body and guide you as you progress toward your specific activity goals. It IS possible to cough, laugh, jump, and run again without leaking and do push-ups without feeling like your organs are going to fall through your stomach! (If you know, you know)
Correcting Postural Changes. Another important area to address is posture. Unaddressed postural changes can lead to low back and SI joint pain and shoulder and neck pain. Physical therapy is effective in helping women regain mobility in areas that develop tightness and strengthen muscles that become overstretched and weak during pregnancy (as well as postpartum from baby holding and nursing positions).
When is the right time to start physical therapy? Seeing a physical therapist before delivery is a great place to start. This will allow the PT to go over safe breathing and coordination activities you can start now and right away postpartum (assuming an uncomplicated delivery). Having good control and coordination of your pelvic floor, abdominal muscles, and diaphragm will build that foundation for exercise progression when your OB releases you to exercise (typically six weeks postpartum). As early as six weeks, a physical therapist can lay out a plan for you to slowly (aka safely) work toward your specific activity goals, whether that be coughing/sneezing more comfortably or returning to high impact exercise. However, no matter how many months/years ago you were pregnant, physical therapy can help address residual pelvic floor and abdominal challenges.
Author: Stef Davis, PT, DPT | Clinical Director of Physical Therapy – Seneca, SC