Postpartum

Pregnancy and delivery bring extraordinary changes to the body. Mothers become immersed in baby care and often do not take the time to care for themselves and recover their strength and muscle tone.

Post partum muscle weakness, if not addressed, may become symptomatic later in life as incontinence, prolapse, back pain etc.

With the help of our physical therapists’, new moms are encouraged to focus on three primary areas: BACKS, BELLIES AND BOTTOMS

Back Pain and other Post partum aches and pains:

  • Sacroiliac joint, tail bone, coccyx or pubic pain may persist after delivery (see PREGNANCY RELATED PROBLEMS).
    Try using heat, ask family/spouse to give you a massage and try the tips suggested in the pregnancy section. If pain persists, ask your physician for a referral to physical therapy.
  • Mid back pain or neck pain may start because new moms are lifting, feeding, bathing and carrying baby - activities to which they are unaccustomed. Strengthening specific muscles in the back and learning to do these child care activities correctly, will help ease discomfort
  • Wrist and/or thumb pain: from over use of tendons and muscles in the hand/wrist with child care and lifting. Try changing the way you lift baby – scoop with your hand under babies bottom, carry baby this way sometimes, try to change the way you handle baby to minimize using the “same” movements all the time. Physical therapy will include modifications of child care activities, massage, exercises and braces if appropriate

Bellies

Most moms want to minimize the “jelly belly” postpartum and get back into their prenatal jeans! While this is a great vanity motivation – there are other reasons why getting tone back in your lower belly is vitally important.

The belly muscles consists of 3 layers

First Layer:

Rectus abdominus: this muscle lies closest to the surface and runs from beneath the breast bone to the pubic bone. This is the muscle we use do to sit ups and crunches. This is also the muscle that separates during pregnancy

  • Diastasis Recti: This is the separation of the abdominal muscles during pregnancy – commonly occurs after the second trimester when the uterus grows out of the pelvic basin and the belly muscle separates (like a zipper that comes undone) to make room for the growing uterus. The belly muscles come together 4-6 weeks after delivery
  • To Test for the separation:
    • Lie on your back with your knees bent and feet flat on the floor
    • Place your fingers horizontally below your belly button
    • Raise your head and shoulders up off the bed
    • Feel your fingers sink into a soft spot between two firm muscle walls
    • How many fingers can you put into the soft spot?
    • Up to 2-finger widths is common and should not cause you concern
  • To allow healing – try to not jack knife into sitting position
  • Don’t do sit ups or crunches TILL THIS SEPARATION HEALS
  • Some patients may benefit from a corset but the goal is always to tone up the muscles so that the corset is only needed for a few weeks.
  • Physical therapists will teach you the correct exercises to do

Second Layer: Obliques

These muscle fibers run in a diagonal direction as if you put your hands in a jacket pocket located below your breast. This muscle is use with diagonal crunches and provides a “corset” to the trunk

Third Layer: Transversus Abdominus:

This the deepest layer of abdominal muscles. If you were a mama kangaroo this is where baby joey would be sitting! This muscle forms a pouch in the very low abdomen and gives us the “Jelly Belly”! The muscle inserts into the fascia of the low back and therefore strengthening this muscle will help support the back and minimize back pain. Sit ups and crunches will not help to lessen the jelly belly because these movements use another muscle!

This muscle along with the muscles of the pelvic floor (that surround the vagina and other openings) form the “CORE” – the inner core provides the much needed stability to the trunk and creates the internal girdle or NATURE’S CORSET and provides support to your pelvic and abdominal organs and minimizes urinary leakage and organ prolapsed.

To Activate this muscle:

Try pulling in your lower belly as if you are trying to zip up a pair of pants that does not fit, maintain a normal breathing pattern. Hold this for 10 seconds and do this several times a day.
This is the most basic exercise for this muscle and there is a series of exercises that will help strengthen this muscle.
Physical therapists will teach you how to correctly strengthen and use these muscles and appropriate exercises to strengthen your INNER CORE.

Bottoms:

The pelvic floor is the area between the pubic bone in the front and the tail bone at the back. It is richly meshed with several small muscles, nerves, and other soft tissues. These structures form a sling that supports the abdominal and pelvic organs primarily the bladder, uterus and bowel. These muscles also encircle the openings of the bladder (urethra), bowel (rectum) and uterus (vagina) – they provide closure as appropriate for these openings and enhance sexual activity. These muscles are weakened in pregnancy and delivery and NEED TO BE STRENGTHENED POSTPARTUM. Muscle weakness of these INNER CORE MUSCLES contribute to organ prolapse (falling out feeling) and incontinence.

Studies have shown that 40% of women who are doing “kegels” exercises to strengthen the pelvic floor muscles are doing them incorrectly. Your physical therapist will show you how to do these exercise correctly.

Secondly tension in these muscles from delivery may cause “tension myalgias” including pain in the pelvic floor, sexual pain, incomplete voiding or constipation. Physical therapy is then directed towards relaxing and stretching these muscles to minimize discomfort.

Recovering from C-Section:

Patients are taught scar massage, abdominal stabilization, modification of transitional movements (getting in and out of bed for example) to minimize pulling on the stitches.

Sexual Pain: due to tense vaginal muscles and/or scars

Episiotomy or fascial tearing during delivery may lead to painful scars. If you have a painful scar, or sexual pain related to a painful scar, physical therapy might help. Ultrasound is used to soften scars, therapist massages the scar and gently stretches tense tissues. Patient is taught how to massage the scars at home and a partner is instructed if appropriate. We may recommend and teach you how to use dilators and/or vibrators to help yourself at home.

You will need a prescription from your physician and physical therapy services are reimbursed by most insurance companies.

Physical therapists are health care professionals who assess and manage patients who have medical problems or other health related conditions that limit their ability to move and perform their daily activities comfortably. Your Physical therapist will take a detailed health history, examine you and develop a personal plan of care.

Treatment techniques are used to promote movement, reduce pain, restore function, and prevent disability. Your Physical therapists will work with you to enhance health by developing fitness- and wellness-oriented programs for healthier and more active lifestyles tailored your ability.

For more information or to schedule an appointment call 713-799-6193