physical therapy – Well + Woman

Whether you had your baby yesterday or 40 years ago, you are postpartum! And it is never too late to improve your pelvic floor muscle function.

To many people’s surprise, restoring your pelvic floor postpartum does not revolve around kegals! Pelvic floor strengthening is important, but it is far from the only component, not to mention strengthening the pelvic floor involves much more than kegals anyways.

After a baby is born vaginally, it takes about 6 weeks for your vaginal tissue to heal. It is important to limit your activity to only necessary activities during your first 2-3 weeks postpartum. Around week 3-4, depending on how you are feeling, you may be able to start back to gentle, low impact exercise like walking or yoga. It is important to ease yourself back into exercise, pushing your body past its limits can cause more harm than good.

If you had a c-section, the abdominal scar will take a little longer to heal. It is best to limit activity until 6-8 weeks postpartum to allow for full scar tissue development and healing. Then, gradually increase your exercise – starting with low intensity and building from there.

There are certain symptoms you want to watch for when returning to exercise postpartum including:

Pelvic, vaginal, or abdominal pain
Urinary incontinence
Heaviness/pressure in the vaginal area

If you experience these symptoms, you may be doing too much too soon, and you would definitely benefit from seeing a pelvic floor physical therapist to address the root cause of the dysfunction and help you recover.

The progression to returning to exercise and activities of daily living will vary from person to person. The most important thing is to listen to your body and what it is ready for.

We want to restore the function of the muscles and connective tissue found in the entire trunk – because they are all affected by pregnancy and delivery! Like I mentioned earlier, we don’t want to only strengthen – muscles need to lengthen just as much as they need to contract, that’s how we have dynamic movement! Note that lengthening does not mean weak; it just means that the tissues can move through their full range of motion efficiently.

A few of my favorite muscle lengthening/mobility exercises are:

Diaphragmatic breathing: sitting or lying down → place one hand on your chest and the other on your stomach → inhale and allow only the hand on your belly to rise, keep the one on your chest still → exhale and let your abdomen relax
Happy baby pose: lie down on your back → bend your knees towards your chest → grab the bottoms of your feet with each hand → hold this position while breathing slowly and deeply (modify with 1 leg at a time if needed!)
Cat/cow: start on all fours → inhale and round out your spine from your head to your tailbone → exhale and allow your abdomen to drop and head to look up

Do these exercises 2-3x/day for 1 minute each.

Now of course, we need to strengthen our bodies too! So here are three gentle strengthening exercises that will target your core and pelvic floor:

Squats: start standing with feet just past hip width apart → push your buttock back and squat to about 60-90 degrees (not deep) → return to stand
Bird dog: start on all fours → gently draw your belly button to your spine → raise one arm and the opposite leg, keeping your hips level → return to starting position → repeat on the opposite sides
Lower trunk rotations: lying on your back → bend your knees, keeping your feet on the floor → slowly lower your legs to one side then the other (to make this more challenging, raise your legs up so your feet are off the floor and knees are bent at 90 degrees)

Start with 2 sets of 8 reps and progress up to 3 sets of 12 reps over time. Make sure to avoid breath holding, gently breathe in and out through the entire exercise.

You can start the diaphragmatic breathing right away! It is super great for the nervous system, to get blood flow to the pelvic area, and to prevent muscle spasm. Wait until about 3-4 weeks postpartum if you delivered vaginally and 5-6 weeks if you delivered via c-section to do the other lengthening exercises, unless you have clearance from your doctor. For the strengthening exercises, wait to begin until 6 weeks postpartum if you delivered vaginally and 8-10 weeks if you delivered via c-section.

These exercises are also a great place to start even if you had a baby 10 years ago but want to get back into exercise or experience any of the symptoms described above.

Need help learning how to progress through these exercises? Find a pelvic floor physical therapist! It is our job to identify dysfunctions and guide you in the progression to optimal function.

As always, make sure to message with questions. And check out my instagram @drallisonballpt to find more exercise tips!

Onward & Upward,

Allison

Whenever someone learns that I am a pelvic floor physical therapist, the question inevitably comes up, typically with some hesitation but intense curiosity – “So wait, what exactly do you do?” Or from my patients, I almost always get the question at some point – “So how exactly did you end up doing this type of physical therapy?” I love and welcome these questions!

Most people don’t even know what their pelvic floor is, never mind knowing you can get physical therapy for it! I always describe it like a knee injury. If you had pain, an injury, or surgery at your knee, you would expect to have physical therapy to recover from that. For some reason, our culture does not seem to apply the same to the pelvic floor – Europe on the other hand seems to have this figured out.

Pelvic floor physical therapists treat a variety of conditions related to the pelvis including but not limited to urinary incontinence, pregnancy related pain, vaginismus, diastasis recti, constipation, pain with intercourse, low back/SI joint pain, and fecal incontinence. We can also help prepare the body for pregnancy, labor, and delivery in addition to help with the healing process postpartum. This is done through a variety of techniques such as manual therapy, strength training, retraining the nervous system, relaxation and stress management strategies, lifestyle modifications, and functional movement training.

The pelvis is FILLED with muscles, connective tissue, nerves, and blood vessels – just like the knee (see image below). So, if there is damage to this area, say from carrying a baby for 9 months then pushing it out of your vagina or having a cesarean section (hello, tissue damage!), why would we not expect to rehab and heal the muscles, nerves, and connective tissue of that area? And this is just one example, pelvic floor rehab is not limited to pregnant and postpartum women in the slightest! I have seen patients ranging from the age of 7 to over 90 years old with a variety of different diagnoses, and the treatment plan for each patient varies just as much.

One reason I landed in this area of physical therapy is because it is very specific and very needed, but few people know about it. I wanted to be able to help those who did not know help existed for their problem, while also being a part of advocating for this area of physical therapy to become part of the norm. To me, the vagina and the pelvis are not “weird” – society and culture has created that stigma. It is NORMAL to pee, poop, have a period, and have sex, and your vulva, your vagina, and your rectum are simply ANATOMY – it’s only awkward if you make it awkward! I found that I could talk about these subjects in a way that seemed to normalize them for most people and could allow for a safe space to talk about vulnerable topics.

So therein lies another reason to start this blog! A place to discuss and learn about the pelvic floor and all of the body systems related to it – how they should work, what can go wrong, and how almost any pelvic dysfunction can be treated and managed. My goal is to guide others as much as I can along the way.

Onward & Upward,

Allison

Tag Archives: physical therapy

Restore Your Pelvic Floor

So Wait… What Exactly Do You Do?