My Postpartum Rehab: Finding My Core & Building A Firm Foundation

I’m finally at that stage I always heard about. Almost daily a Facebook friend makes their big announcement! Many of these friends are PTs as well, so if you guys have anything to add, share it in the comments! I see so many posts, questions, & tips about pregnancy, but not much about the recovery, except “Be careful not to hurt your back,” almost like it is inevitable! Pinterest is loaded with “postpartum exercises” that may actually cause more harm to our post-baby bodies, especially if we don’t start with a good foundation! (literally…)

I COMPLETELY get it now. After carrying this little guy for 9 months & 2 days, then pushing him out for an hour, I feel like I left the hospital with a new body. One with no pelvic floor & layers of mushy flesh where my abs used to be. A body that needed help getting out of bed & felt pain with every movement. My abs are STILL sore 6 weeks later…

I decided I could either a) fulfill the stereotype that PTs make the worst patients ever, or b) crawl out of my mom brain fog & stick to the recovery plan I decided on prenatally. First, a crash course in the science behind the Deep Core that I learned in my doctoral program. Knowledge is power, especially when it comes to our bodies!

Deep Core: (NOT your washboard abs, that’s your rectus abdominis.) A “binder” of muscles around your trunk that create proximal stability, allowing distal mobility. In other words, your core has to be nice & tight before your extremities can move efficiently. Your Deep Core is made up of…

Pelvic Floor: The base of your Deep Core.

Diaphragm: The top of your Deep Core.

Multifidi: A long muscle along your spine that forms the back of your Deep Core.

Transverse Abdominis: The deepest ab muscle that is shaped like a corset & acts like a Chinese handcuff. As it tightens, it pulls inward & upward. This forms the front of your Deep Core.

Think about an unopened Coke can. All the pressure creates a lot of stability, but as soon as you pop the top, the sides collapse easily. Like that can, when one part of our Deep Core is compromised, the other parts are prone to injury. Vaginal delivery = stretched ( & torn?) pelvic floor & transverse abdominis. C section = surgically separated abdominals. This places our spine in a precarious position! So what do we do? Think of “training” your core instead of “strengthening” it; the goal is for your brain to have a strong connection with it again so it fires appropriately. Strength comes after stability…

Stages of Recovery: If you sprain your ankle, no one expects you to run the day you get off of crutches. You would follow this progression – recovery, rehabilitation, return to play. This applies to postpartum bodies, too.

Recovery: It takes 28 days for soft tissue to heal in a perfect environment. So please give yourself some grace & at least 4 weeks to heal. Do what you need to do for that baby & nothing more! Think of this like being on crutches after your ankle sprain…

Rehabilitation: It’s not standard practice to be seen by a physical therapist postpartum in the US, but if you have pain, incontinence, or diastasis recti, you should look into it! Just like the injured athlete, our bodies need to relearn how to function properly. We need a firm foundation to build upon so that we can keep up with our kids, get back to our hobbies & workouts, or prepare for another baby. This stage is skipped all too often!

Return to play: Back to your sprained ankle – you would only be allowed to begin to return to play when your strength & balance is at least 80% of your other ankle. What does this mean for us post-baby? Returning to Beach Body, yoga & running will be & should be a longer process than we might expect. But taking the time to establish a firm foundation can keep us from YEARS of residual postpartum issues.

For major pelvic floor issues, please seek out a women’s health physical therapist. For now, here is how to activate your transverse abdominis (TrA) correctly PRIOR to ANY OTHER ACTIVITY besides taking care of that baby.

1. TEST: Lie on your back & place your hands on your hip bones. Lift each leg about 6″ off the ground. Does your hip bone drop toward the ground when you lift your leg? Does one leg feel heavier than the other? If so, the connection between your TrA & your brain is not as strong as it needs to be. Note: it’s normal for one side to be harder. GOAL: you should be able to lift either leg off the ground without your hip bones dropping.

2. Supine marching on level surface: Breathe in –> March slowly while breathing out, focusing on what your trunk is doing. When this becomes simple…

3. Supine marching on foam roller. All the same principles apply! Breathing out as you lift your leg utilizes your diaphragm to activate your TrA. Remember the Coke can!

  • Does your back pop off the ground?
    Your back should NOT bow like this when you lift your leg. You should also feel no “pulling” in your back. If you do, focus on your breathing & just INITIATE the march, not letting your foot leave the ground until your trunk is nice & stable.
  • Do your abs bulge up like a bell curve?
  • Do your obliques contract out into your hands?
  • Do your hips drop or do you roll?
  • Your tummy should be sinking toward your back & no other movement should be felt if your TrA is working properly.

Once I reintroduce my TrA & my brain, I can move on to more difficult stability exercises. Stay tuned!

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Questions? Leave a comment below!

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