Rebuilding Your Core: Safe and Effective Postpartum Strength Guidelines
The postpartum period is known as the 4th Trimester, although it is important to note that the body requires more than three months to recover fully from the changes of pregnancy and childbirth. The focus of exercise in the postpartum period should be on strength training. The pelvic bones and ligamentous support have been altered as a result of pregnancy in what is known as form closure. This requires extra help from the muscles, or force closure, to function optimally. Once you have had a baby, your body will be different, but it can be stronger than before pregnancy, with proper training.
The deep core is a team of muscles that works as a system to maintain intra-abominal pressure, stabilize the low back and pelvis and maintain continence of urine and stool. The deep core muscles include the diaphragm, pelvic floor, transverse abdominus and multifidus (see image below). Exercise in the postpartum period should be aimed at retraining these muscles especially the tranverse abdominus, or deepest abdominal muscle and it is the timing and sequencing of these muscles with your breath that is so important to regain automatic function.
Ideally, the pelvic floor and abdominal wall should be assessed before beginning an exercise program in the postpartum period, especially if you have concerns or feel you need direction on what is safe and appropriate. Click here to read more about DIASTASIS RECTI, a vertical abdominal split between the rectus abdominus muscles. Risk factors of an abdominal split include low back pain, urinary incontinence (involuntary loss of urine) and pelvic organ prolapse.
The six-week check-up is when you will be given the green light to return to all activity, including exercise and sexual activity, however you will most likely have to seek out information on your own as postpartum rehabilitation is unfortunately not the standard of care in the United States. If there is a delay in healing or an infection, the time frame will be longer. The postpartum period is a great time to exercise, when motivation is high to regain your waistline and maintain the physiological training effects of pregnancy (your body thinks you ran a marathon). If you started training the deep core before or during pregnancy, it will be easier to return to exercise. If you haven't gained sufficient core strength, we recommend postponing high impact activities until the core is able to transfer the load from your feet to your pelvis effectively. Read our blog on returning to running here.
Pelvic girdle weakness can persist in the postpartum period due to hormones that contribute to joint laxity. Some of these hormones remain in high concentrations, especially if you are breastfeeding and during the luteal phase (second half) of your menstrual cycle. An important aspect of returning to exercise is to manage intra-abdominal pressure properly, which means mastering the timing of your breath with lifting, carrying or anything strenuous. A forced exhale when you lift anything, including yourself or the baby, is what we recommend to help activate the deep core muscles. The larger the load or weight, the bigger the exhale should be. Think "blow as you go" and before long, your baby will be blowing out before you do as a conditioned response. The deep core muscles can be further activated by adding glute (buttocks) and quad strengthening to engage synergistic or helper muscles and to save time not doing separate exercises. This will maximize your functional ability to do daily activities and take care of your family. For example, when you do a bridge or return from a squat, blow out to activate your core simulataneously. This is the foundational concept of Pilates.
Whether you had a vaginal birth or a c-section, the following symptoms are a result of the core not working properly and are a guideline of when to seek help after birthing a baby.
Severe back, pelvic or hip pain in the first few weeks following pregnancy
Back, pelvic or hip pain during or after activity that persists beyond 6 weeks
Pain during or after intercourse, or lack of sensation
Fear of pain with intercourse
Pain with urination or bowel movements
Urinary leaking, urgency or frequency (>8 voids in a 24-hour period)
Urinary retention or inability to empty the bladder completely
Diastasis recti or doming of the abdominal wall with exercise or activities
Muscle weakness
Inability to perform a Kegel or pelvic floor contraction
If you have any of the above symptoms or attempt to return to exercise and develop problems, it is time to seek the help of a pelvic health therapist who specializes in treating postpartum dysfunctions. With proper training and hands-on treatment, the muscles can return to optimal function, no matter how much time has passed. To find a qualified physical therapist in your area, click here or schedule with one of our expert physical therapists. The demands on your body will be greater than ever and your body needs to be trained to do the job of motherhood. You not only deserve to live optimally but your family is depending on you to be the best version of yourself!
References:
Lee L-J, Lee D. 2011. Chaper 7: Clinical Practice - The Reality For Clinicians. The Pelvic Girdle, 4th edition. Elsevier, Edinburgh.
Janda V, Va'Vrova'. 1996. Sensory motor stimulation. In Liebenson C (ed). Rehabilitation of the Spine. Wilkins & Wilkins: Baltimore. 319-328.
written by Janine Laughlin, PT - January 2017; revised April 2024
