Exercising after childbirth

During pregnancy there are many changes in the physiological functions. If we talk about the musculoskeletal system, it is mainly considering the changes in breathing (breathing into the chest become predominant). It can also lead to increased laxity (looseness) of the ligaments, which results in looseness of the ligaments in the pelvic area, coccyx, and pubic bone. Another emerging thing is diastasis recti (abdominal separation) of the abdominal muscles, which disrupts the function of the deep stabilizing system. Due to this reason, pregnant women may feel pain in the spine or in the hip joints. It is therefore ideal to exercise diaphragmatic breathing, relaxation and activation of the muscles of the pelvic floor and abdominal muscles in pregnancy.
Every woman wants to get after pregnancy back into shape, but don’t rush it. Your body needs time to return back to its original condition. Therefore don’t expect any cardio exercises for burning calories in this article. From a physiotherapeutic point of view the most important thing is to secure the stabilization of the center of the body and from that bounce off towards more dynamic exercises

POSTPARTUM PERIOD

Natural childbirth

• You can start to exercise the second day after natural birth
• First day is focused on the respiratory gymnastics and diaphragmatic breathing, capillary gymnastics as a prevention against thromboembolic diseases, activation of the pelvic floor.
• Another days continue in previous exercising with higher intensity, lighter strengthening of the deep stabilizing system (diaphragm, deep abdominal and back muscles and muscles of the pelvic floor). With repeated and increasing exercise intensity your body adjust its posture.

Caesarean section

• The main goals after the caesarean section, is to restore the condition of the patient and preventing secondary changes.
• The exercise first day after the operation should take at least 15 minutes. Perform dynamic respiratory gymnastics with simultaneous movement of your upper limbs (for example on your back, with inhale and lifting your arms above your head, with exhale placing your arms back alongside your body). You can also train rotating on bed and getting up from bed.
• The second day continue to do the exercises for activation of the pelvic floor, for improved blood circulation in the pelvic area and mobility of the hip joints in bigger range of movement.
• Third day after the operation do the exercises and lay on your stomach in order to stretch out your abdominal muscles and the scar.
• After removing the stitches we add the treatment for the scar by performing the deep tissue massage as a prevention against adhesion in the abdominal cavity.

RESPIRATORY GYMNASTICS - TRAINING OF THE DIAPHRAGMATIC BREATHING

Lay on your back, bend your legs and rest them against your feet. Place your hand below your navel and breathe into your stomach. Feel how your abdomen is increasing with every inhale. During a maximal inhale, let your lower ribs expand to the side as well as to the back and front. Then start to exhale. Let your chest drop down as well as your ribs, and after you exhale as much as possible you will feel the activation of the deep abdominal muscles. You can verify this contraction with your fingers placed in depth above your pelvic bone, where you will feel muscles being activated.

EXERCISES OF THE DEEP STABILIZING SYSTEM

The deep abdominal muscles (musculus transversus abdominis) belongs to the group of the deep stabilizing system, along with short muscles in the deepest layer alongside the spine (multifidus muscles), muscles of the pelvic floor and diaphragm. Together these muscles create a complex, which holds the correct position of the spinal segments.

Exercises for activation of these muscles:

• Exercise no. 1.
• Exercise no. 2.

ACTIVATION AND RELAXATION OF THE MUSCLES OF THE PELVIC FLOOR

Before starting to exercise the pelvic floor, it would be ideal to undergo an examination by a professional physiotherapist. It is necessary to find out which muscles of the pelvic floor are weakened and which are in spasm. From that is determined the therapy itself, when we either strengthen the muscles or we learn to relax them. Common finding in the area of the pelvic muscles is functional disorder in the sense of inability to isolate the the activated or relaxed muscles. Clinically these disorders can be manifest by decrease of the organs of the small pelvis, incontinence or with pain in the genitalia during urination or sexual intercourse.

The therapy of the pelvic floor begins when you lay on your back with bending knees, and activation - pulling the urethra inwardly. It is good to imagine the pelvic floor as a developed flower which is closing with activation.

Exercises can be divided into 3 series:

1. series of exercises

• With first activation try to involve your gluteal muscles as much as you can and after 3 seconds completely relax and imagine the flower developing again. Don’t forget to completely relax all the muscles of the pelvic floor, keep breathing. Repeat 5x.
• In the second phase try to activate your pelvic floor with 50% of strength and hold it for 3 seconds and then completely relax the muscles similarly as in the previous case. Repeat 5x.
• In the last phase try to activate the muscles of the pelvic floor with 15% of strength and hold it for 3 seconds. Then relax and try to sense the difference between the activity and complete relaxation.

2. Serie of exercises

• Repeat the same activation as in the previous series. Try to hold the activation for 7 seconds and repeat the exercise 8x.

3. Serie of exercises

• Repeat the same activation as in the previous series. Try to hold the activation for 10 seconds and repeat the exercise 12x.

Don’t forget to keep the sufficient relaxation of the muscles between the single contractions. Pause for few minutes in between each serie and breathe freely - diaphragmatic breathing.
If your pelvic floor muscles were during the childbirth significantly damaged, another option of therapy is electrical stimulation of the muscles.


Author: Mgr. Zuzana Dvořáková, FYZIOklinika, physiotherapy Ltd., Prague, Czech Republic