By Allison Oswald (DPT, WCS, CPT) Physical Therapy, Board Certified Women’s Clinical Specialist, Certified Pilates Instructor, and mother (http://www.allisonoswald.com )
Recovery Tips Postpartum
During pregnancy there is so much attention paid to how to take care of yourself, as well as how to prepare for labor and delivery….but then what? You have this beautiful bundle of joy and then is your body supposed to magically come back together again? I wish!
In practice, I help to navigate this time with women individually, specifically in and around their physical recovery. And though each woman’s body is unique, there are a few general and simple tips I can share with you to improve your healing and prevent pain right for after your delivery (no matter vaginal or cesarean).
PELVIC FLOOR CONTRACTIONS | Within the first 24 hours you can begin to do pelvic floor contractions (only if not painful and cleared with your OB or midwife). This means that you can practice pulling your pelvic floor up and in while you EXHALE (through your mouth). This will stimulate circulation, which can help with healing of the pelvic floor muscles and connective tissue.
ABDOMINAL WALL ACTIVATION | Simultaneously while you EXHALE (with the first exercise mentioned) your abdominal wall should tighten slightly, providing your back and pelvis with support.
EXHALE WITH EXERTIONS | Blow out when you move or lift anything. After learning in the first two tips that when you EXHALE your pelvic floor and abdominal wall contract, then we know that EXHALING while your change positions or lift your new baby, you will be providing your body with the extra support it needs.
AVOID “DOMING” | With any activity or action you do, make sure that your abdominal wall is not bulging out. This is a sign of diastasis recti (separation of the abdominal wall) which is very common during and after pregnancy, but in order for it to heal properly you do not want to exaggerate the separation. (note: if you think you might have this, it is best to consult a physical therapist for proper diagnosis and an individualized treatment program)
PELVIC/BACK SUPPORT | If you’re feeling like you need even more support, then a gentle back brace is great to use for the first couple days to weeks. However it does not replace the breathing and contractions, it should be used with tips 1-3. Wearing anything too tight or too long can put too much pressure on your abdominal wall and pelvic floor, causing an imbalance in your core that can lead to other issues. It is best to consult your doctor or physical therapist to ensure it will benefit you and that you are fitted properly. Be sure to use it only as needed and always with the goal of replacing it with your own core strength and stability.
LOG ROLLING | After 10 months of pregnancy, your abdominal muscles were stretched to the max. Therefore they are not going to work like they used to right away. Hopefully you were used to this tip during pregnancy, but if not then it’s not to late to start. When you get in and out of bed, be sure you roll to your side and then come up to sitting (and vice versa) to prevent straining your abdominal wall. And as you may have thought….EXHALE through your mouth as you transition.
POSTURE | Do your best to keep your posture aligned, this will put your body in the best position for your core (abdominal wall, pelvic floor and diaphragm) to function. The best rule of thumb is to keep your rib cage over the top of your pelvis (picture in the center) and avoid slouching or overly arching your back. And while sitting use pillows or other supports as needed, especially during feedings.
Both Stephanie and I experienced diastastis and we asked Allison to explain it to us and most importantly, give us tips on what we can DO about it!
A diastasis is an abnormal separation of the abdominal wall often due to the demands of pregnancy. The separation creates a weakness and imbalance in the core which often times can create symptoms such as incontinence, back pain, hip pain, and pelvic pain – just to name a few. Your pelvic core is composed of four main components: your diaphragm, pelvic floor, abdominal wall (transverses abdominis) and back (multifidus). You can think of your pelvic floor as a hammock of muscles that is not only used for sexual function, but a group of muscles that also help to house and support your organs.
In order to promote healing/ function of this system, alignment is key. Every person is different, but in general your alignment should be having your diaphragm parallel to your pelvis in order to optimize function of your core system. Once alignment is achieved, then the breath needs to be incorporated and connected with the pelvic floor. As most of us who are chest breathers, you instead want to imagine that your breath is moving more laterally, or to the sides of your ribcage. Think of placing your hands on your ribs and while you breathe on an inhale, notice your hands expand to the sides. When you exhale notice them come back together. Essentially, on the inhale the diaphragm and pelvic floor move down, and on the exhale they move up. When this breath is coordinated, intra-abdominal pressure (IAP) is equalized and the pelvic core functions at it’s best.
So if you are doing something more challenging (ie. lifting, exercising, or coming up from the floor), exhaling will engage your core properly and support your diastasis during that said movement.
You never want to do anything that creates a dome in your abdominal wall, causes pelvic floor symptoms or does not allow you to breath. There are always movement strategies that can be used to prevent the diastasis from worsening.
Seeking a women’s health physical therapist will educate you on these strategies, tweak your alignment specific to your needs, test your core system to ensure it’s working properly and may even incorporate manual techniques to improve the function and healing of your core.
Everyone is different and it is so important for all women to understand that it’s never too late to work or address your diastasis recti. No matter what stage you are in life, whether you are currently pregnant or whose kids are off to high school – by seeking a Women’s Health PT to ensure that your pelvic floor and core is functioning optimally can become so beneficial for your for your overall health
Allison Oswald (DPT, WCS, CPT) Physical Therapy, Board Certified Women’s Clinical Specialist, Certified Pilates Instructor, and mother. Allison’s work relies heavily on strengthening and healing the pelvis. The maintenance of core strength and mobility impacts mind and body, including anorgasmia, loss of bladder control, prenatal and postpartum preparation, and elements of emotional stability which all needs to be looked at holistically. She has owned and operated her own private clinic, Plumb Line: Pilates and Physical Therapy Studio in Santa Monica, CA.