Carrying and delivering a baby is a huge event for a woman’s body. Hormones allow for tissues to soften preparing for a smoother delivery. Muscles may become weak due to the pressure of pregnancy and due to reduced ability to activate the core as pregnancy progresses.
Fortunately, women can work to gently strengthen these muscles postpartum. Some patients may also struggle with the abdominal separation or pelvic bones shifting due to pregnancy and delivery, which can also be addressed with a physical therapist.
Within the first six to 12 weeks after baby has arrived, you can talk with your provider about reintroducing movement to regain strength, stability, tension, coordination and balance in your mid- to lower body. It is important to know that it is normal for full muscle and tissue recovery to occur slowly over six to 12 months.
“If there are two words we could emphasize regarding any physical activity in postpartum, that word would be ‘gentle and gradual,’” said Staci Wietfeld, PT, DPT, of Avera Therapy. Going back into physical activity too hard and too fast can cause further injury and trauma to your tissues.
Read more: How to Fix Abdominal Separation
Importance of Postpartum Physical Therapy
It’s important to inform your provider how you are moving, stretching and exercising during postpartum. If you notice any negative side effects, your provider may recommend a physical therapy consultation.
Signs a woman might need physical therapy during postpartum:
- Musculoskeletal pain such as neck, back, hip or pelvic/sacroiliac (SI) pain
- Leakage of urine or stool
- A separation, bulging or doming of your abdominal muscles with exercise
- Vaginal pressure or heaviness
- Vaginal or perineal pain with intercourse
Low-Risk Postpartum Physical Therapy Exercises
It could take up to a year, sometimes even two years, for your body to fully heal from a pregnancy. So, in addition to the gentle exercises below, Wietfeld encourages you to utilize all other aspects and resources to help you through this journey:
- Adequate sleep
- Proper nutrition and hydration
- Postpartum mental health support from your partner, family, friends or medical providers
- Stress management
- Physical activity
1. Supine Diaphragmatic Breathing
Diaphragmatic breathing helps you relax and gently engages your muscles.
How to do it:
- Begin lying on your back.
- Lift and bend your knees with your feet on the floor.
- Exhale, drawing in your abdominals as if you are pulling your belly button toward the floor.
- Inhale, focusing on expanding your belly instead of your chest.
- Repeat three to five times.
What you need: exercise mat or a bed surface
2. Supine Pelvic Floor Contraction
Delivering a baby is a big event for your pelvic floor muscles. Pelvic floor contractions, often called kegels, help strengthen and improve coordination in these muscles.
How to do it:
- Begin lying on your back or sitting upright in a chair with your legs bent and supported.
- Exhale, and contract your pelvic floor muscles. This contraction should feel like a “tightening and lifting” of the pelvic floor muscles. Similar to if you were attempting to pick up a blueberry with your vaginal muscles.
- Hold the contraction for 10 seconds while you maintain relaxed breathing.
- Relax and repeat 10 times.
What you need: exercise mat, bed or chair
3. Dead Bug
This pose improves balance and engages the core, which is essential for stabilizing the spine during daily activities.
How to do it:
- Lie on your back.
- Bend your hips and knees while keeping your arms at your sides and your feet resting flat on the floor.
- Lightly tighten your lower abdominals and pelvic floor muscles.
- Slowly lift one arm and your opposite leg while your knee is bent at 90 degrees. Make sure to keep your back on the mat.
- Return to starting position and repeat with your other arm and leg. Alternate right and left for 10 reps. Avoid holding your breath.
What you need: exercise mat or bed
4. Supine Bridge
Gluteal and thigh muscles help support hip and core stability along with lower body strength.
How to do it:
- Lie on your back. Lightly engage your abdominal and pelvic floor muscles.
- Squeeze your buttock muscles and lift your bottom up off of the floor and into a bridge position.
- Return to the ground.
- Relax and repeat.
What you need: exercise mat or blanket
5. Side-Lying Hip Abduction Along Wall
This simple exercise helps strengthens your muscles on the outer thigh — as well as your core.
How to do it:
- Lie on your side. Lightly engage your abdominal and pelvic floor muscles.
- Slowly raise your leg up, sliding your heel along the wall.
- Lower it back down.
- Relax and repeat. Avoid holding your breath.
What you need: exercise mat or bed, clear area near wall
6. Bird Dog
Bird dog targets your glutes and core, while gently builds stability, coordination and balance.
How to do it:
- Start on your hands and knees.
- Breathe out and tighten your pelvic floor and lower abdominal muscles.
- Lift one arm and your opposite leg. Hold for one to three seconds.
- Bring them back to the ground.
- Repeat with your other arm and leg. Avoid holding your breath.
What you need: exercise mat or blanket
7. Chair Squat
Squats help strengthen lower body muscles and improve coordination between leg muscles and your core and pelvic floor muscles.
How to do it:
- Lightly engage your pelvic floor, breathe out and squat until you touch the chair.
- Return to standing.
- Relax and repeat.
What you need: chair (or edge of bed), a cushion/pillow for the chair if you can’t bend very low
8. Forward Mini Lunge
As you get stronger, a mini lunge can engage your core, pelvic floor and lower body muscles.
How to do it:
- Keep your torso upright. Abdominals and pelvic floor muscles are lightly engaged.
- Step forward and lower your body into a small lunge position.
- Return to the starting position.
- Repeat with the other leg. Avoid holding your breath.
What you need: if needed, a sturdy ledge or handle for balance
Final Exercise Tips
Maintain relaxed breathing while during exercises. As you perform more difficult exercises, the tendency to hold your breath should be something we work to avoid. We want to be able to talk or breathe throughout a movement.
Starting with these stretches and exercises will provide a strong foundation as you gradually add more strenuous exercise back into your daily routine.
Exercise for Busy Moms
These exercises will help you make the most of your time as you increase your activity.
If you have pain or muscle tightness during or after your pregnancy, schedule an appointment with a pelvic floor physical therapist at an Avera Therapy location near you.
