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Postnatal exercise

Woman stretching to prepare for exerciseYou may have noticed your body has changed since the birth of your baby.

Some things you might’ve noticed include weight gain, abdominal muscle separation and/or weakness, pelvic floor weakness, lower back pain from constant lifting, upper back and neck pain from breastfeeding, and just other little niggles that come with carrying a baby and giving birth.

Early motherhood is a demanding time both physically and emotionally, and finding time to exercise can be just as challenging. However, making time for exercise is of vital importance. Research has proven exercise to assist with weight loss, improved sense of wellbeing, decreased symptoms of depression, decreased pain and increased energy.

So, what type of exercise is best?

There are a number of considerations that need addressing before you should commence a postnatal exercise program.

The Pelvic Floor

All women should perform pelvic floor exercise postnatally, regardless of the type of delivery they have experienced. The pelvic floor is a group of muscles that form a hammock, supporting your bladder, uterus, and bowel. Although you may not have experienced any symptoms of pelvic floor dysfunction (leakage, heaviness, urgency to urinate) they have had to work very hard to support the extra weight of your uterus for the past 9 months of pregnancy, and need strengthening. You should start pelvic floor exercises as soon as possible after delivering your baby – and it certainly helps if you’d been doing pelvic floor exercises during pregnancy too.

How do I do my pelvic floor exercises?

  • Sit or lie in a relaxed position.
  • Squeeze your pelvic floor muscles as though you are trying to stop yourself from peeing.
  • You should feel a lift upwards and tightening sensation around your bladder and vaginal opening.
  • Hold for 3-5 seconds and continue to breathe naturally.
  • As you get better, aim to hold for longer until you can hold for 10 seconds.

Abdominal Muscle Separation & Strengthening

Before you launch into doing abdominal crunches or sit ups, have you had your abdominal muscles checked by a physio for any abdominal separation?

The abdominal muscles provide an internal corset protecting your vital organs and providing support to your spine and pelvis. The abdominal muscles are made up of different layers of muscle. These are the rectus abdominis, internal and external obliques, and transversus abdominis.

Diagram of rectus abdominusDuring pregnancy the rectus abdominis (or six pack muscle) needs to stretch to accommodate for your growing baby. Each side of the rectus abdominis muscle meets in the midline of your body to form a fibrous structure called the linea alba. This is the weakest point of the abdominal corset.

Diagram of abdominal separation

Normally, the muscles stretch to accommodate for the growth of your baby. In some cases when the linea alba is placed under too much pressure, rather than the rectus abdominis muscles stretching, the linea alba overstretches or in some cases tears. This is known as a diastasis (or separation) of the rectus abdominis. The rectus diastasis will look like a vertical bulge in the midline of your body. You will notice this bulge when you do certain movements that increase the pressure within your abdomen and stress this area.

How to test for a rectus diastasis?

  • Lie flat on your back with your knees bent.
  • Place your fingers across the midline of your tummy just above the belly button.
  • Perform a sit up and feel for a vertical gap between your fingers.

If you think you have a rectus diastasis see your physiotherapist for a specific abdominal muscle exercise program. Your physiotherapist will also ensure you are bracing and using your deep abdominal muscles (transversus abdominis) correctly and avoiding movements that are likely to increase the diastasis. Remember, a poorly managed rectus diastasis can lead to an abdominal hernia.

Start your abdominal muscle training by learning how to brace your transverses.

  • Ab exercise demonstrationStart on your hands and knees,
  • Your hands should be directly under your shoulders, and your knees should be under your hips. Keep your back straight (see image),
  • Relax your abdominal muscles forward,
  • Slowly and gently draw your abdominal muscles inwards towards your spine,
  • Continue to breathe normally,
  • Practice holding for 5 seconds and repeat 5 times.

Once you have mastered the bracing technique you can progress onto some harder abdominal exercises. Try the following abdominal exercise.

Heel Taps

  • Ab exercise demonstrationLie flat on your back with your legs at table top position (both knees up off the floor),
  • Inhale and brace your pelvic floor,
  • Exhale as you lower one leg towards the mat,
  • Stop if you feel your lower back lift off the mat or if you release the pelvic floor,
  • Return to the starting position,
  • Repeat 10 times on each leg.

Weight Loss

It is important to commence some form of aerobic exercise to regain general fitness and lose any excess body fat gained from pregnancy. You can commence a gentle aerobic exercise program from 6 weeks after you deliver your baby.

If you are breast feeding it is important to choose a form of exercise that is low impact and of moderate intensity. Research has concluded that exercise of low to moderate intensity will not affect production of breast milk or lactic acid build up. Ensure you are wearing a good fitting supportive bra. Aim for 45-60 minutes of aerobic exercise 3-5 days per week. Try walking, swimming, low impact aerobics, cycling etc. Remember the following simple formula: Energy Input (from food) must be less that Energy Output (from exercise) for weight loss. Don’t forget to stay hydrated by drinking an extra litre of water during your exercise session. Speak to a dietitian if you are concerned about your diet whilst breastfeeding.

Resistance training is another important form of postnatal exercise. Increasing your general strength will help decrease symptoms of back pain by increasing your strength, making lifting your baby easier. Weights training will also assist with weight loss by increasing your metabolism. A simple weights training program can be performed at home, such as wall squats, lunges, and pushups. Try the following exercise at home.

Wall squat exercise demonstration

Wall Squats

Lean back into a wall (or place your fitball against the wall and lean back into the ball so your lower back is supported by the ball). Lower into a squat by bending your knees, keep your knees in line with your toes, push through your heels and return to the starting position.

 

Talk to your physio about prescribing a resistance training program that you can perform at home.

 

Image credit:mindof/123RF Stock Photo

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