Postnatal Exercise

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Exercise & Your New Postnatal Body
Bub Hub E-Newsletter, October 2007, Issue 62 - Article 1

You may have noticed your body has changed since the birth of your baby.

Weight gain
Abdominal muscle separation and/or weakness
Pelvic floor weakness
Lower back pain from constant lifting
Upper back and neck pain from breastfeeding

Early motherhood is a demanding time both physically and emotionally. 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 the 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.

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?

Our abdominal muscles provide an internal corset protecting our vital organs and providing support to our 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.

During 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. 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.

Start 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 photo).
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
Lie flat on your back with your legs at table top position (both knees up off the floor). Inhale and brace your pelvic floor, exhale and 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 delivery of 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 exercise postnatally. 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 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.

Article kindly provided Paula Hindle; Physiotherapist, Exercise Physiologist and owner of Yummy Mummy Physio in Brisbane. If you have any questions regarding postnatal exercise Paula is happy to help.

ph: (07) 3352 3666
website: www.yummymummyphysio.com.au
email: paula@yummymummyphysio.com.au