A 2019 expert consensus statement on the postpartum period recommended the following:
“… It is an important time to promote optimal recovery. Movement is important through this period and should not be feared; however the emphasis is on gentle restorative exercises that are tailored to each woman’s needs.’
What is the role of physiotherapy?
New mothers present to physiotherapy for a range of different reasons, some related to pregnancy and birth, others are not. This means physiotherapists are often involved in the assessment and management of many postpartum presentations including:
– Pelvic floor dysfunction
– Persistent lumbopelvic pain
– Abdominal separation
– Returning to activity
– Musculoskeletal injuries
Pelvic Floor Dysfunction
Is a very common issue during and after pregnancy. It can be influenced by the type of delivery but is largely due to the increasing pressure on the bladder and pelvic floor muscles as the baby grows through pregnancy. Early intervention is essential to prevent a persistent problem with incontinence and/or pain. Like any muscle group of the body the pelvic floor, the core, abdominals and pelvic muscles all require rehabilitation following strain or injury. It is also important to have guidance on the type of pelvic floor and core exercises to do so they are effective; but are not disrupting any of the other healing processes occurring in the early postpartum period. In most cases it is safe to commence these soon after birth (within the first 6 weeks).
Persistent Lumbopelvic Pain
As discussed earlier in the series, pregnancy related pelvic girdle pain (PRPGP) is extremely common and can affect the hips, the pelvis and the lower back. In most cases it will resolve after birth but for some women there is some residual pain, that if not managed early can lead to ongoing pain and limitations. There are a lot of structural changes to the muscles of the lower back and pelvic region that change during pregnancy and sometimes they need more targeted rehab to return to normal. As with pelvic floor exercises, most women can commence some gentle exercises within the first 6 weeks to assist in this recovery.
Returning To Activity
One of the most common questions asked after giving birth is “when can I return to running, pilates or the gym?”. For a lot of activities it will depend on the circumstances of the birth and the recovery after. Each mother should seek individual advice for their circumstances to guide this decision and not be influenced by other people’s experiences, social media or unqualified advice. Healing of any injuries in the body takes a minimum of six weeks, the same principles apply if you are recovering from a sprained ankle or from child birth. You wouldn’t go straight back out onto the netball court with no advice or try to run 10km’s with no rehab after injury, and the same should be considered for post partum mothers to prevent further injury or developing a new one.
A common symptom in the early post partum period is abdominal separation. This happens as the connective tissue between the abdominal muscles is stretched to allow for growth of the foetus. The amount of separation varies significantly between women, and can depend on a number of different factors. For a large proportion of women it resolves gradually after birth, for others it can remain which results in discomfort and difficulty with some activities. It can also contribute to a negative body image and post natal depressive symptoms. The main issue with an abdominal separation is that it reduces abdominal strength, which is noticeable for mothers when performing core exercises, heavy lifting or bending. A physiotherapist can assess the degree of separation, advise on the appropriate management based on this assessment, and provide the right exercises to encourage a full recovery. It used to be considered a bad thing to do any abdominal exercise in the early post partum period as it could detrimentally affect recovery, however this understanding of this has changed and instead specific abdominal exercises in consultation with a physiotherapist are now encouraged.
Reduced activity, change in routine, reduced or altered sleep patterns, repeated lifting, sustained, repeated or awkward postures and stress are all factors that are considered when diagnosing and managing injuries in any population. These are all also very common for most new mothers in the post partum period. It is not uncommon to experience neck and shoulder pain from breast feeding, upper back pain from holding an infant and low back pain after repeatedly bending down into a crib. Not to mention the terrible positions sleeping on the couch, the floor, the rocking chair at any opportunity to squeeze in a few minutes rest. So it comes as no surprise that we often have new mothers presenting for management of all kinds of musculoskeletal issues in the post partum period. As they say “you have to take care of yourself, to take care of others” and this could not be more true for new mothers.
If you need more information on this topic or some guidance, come in and see one of our Physiotherapists here at 13th Beach Health Services. In addition we offer individual and group pilates that are suitable for women at all stages of pregnancy.