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Postpartum

core weakness after giving birth

Why Is My Core So Weak After Pregnancy?

Why Is My Core So Weak After Pregnancy? 1280 1019 ResilientRx

“Why is my core so weak after pregnancy?”

I get this question ALL of the time, even from people who have given birth many years ago. 

core weakness after giving birth

The answer to this question is: your abdominal muscles have been stretched for about 9 months, and if you have had a c-section, this is a major abdominal surgery that can weaken the abdominal muscles on top of being stretched.

And no, this does not mean you are doomed if you had a c-section, it just means that you may need to build up that strength at a slower pace than someone who did not.

Your abdominal muscles are like any other muscle in your body

I think it is important that we think of your abdominal muscles as any other muscle in your body. 

For example, if you could do 20# bicep curls then kept your bicep in a stretched position for 9 months, you wouldn’t start right up with 20# after the fact, you would gradually increase the weight.

You could start at 5lbs, then 10lbs weaning your way back up to your goal.

If you didn’t wean into building the strength a few things would happen:

  1. You could develop tendonitis (the load to the bicep is too much and causing too much tension to the bicep tendon–this is the part that connects the bicep muscle to the bone.)
  2. You will use momentum to help, you may swing your hips or back forward to help complete the curl.
  3. You would hike your shoulder blade and upper body to help make the elbow bend with the weight.

Either way, none of these are ideal. 

I think it’s interesting that we don’t think of the abdominals, and the pelvic floor muscles, this way. 

Let’s now apply this to the abdominals.

If the load to the abdominals is too much, you make feel:

  1. Your low back arching
  2. Unable to keep your belly from pushing upward
  3. You may see diastasis recti (bulging from the middle part of the abdominals)

It’s harder to quantify abdominal strengthening exercises because they aren’t as objective as weights.

Here are some general guidelines:

-You should feel the muscle burn in the abdominals you are targeting

-You should be able to maintain pelvic control (not arching the back or twisting the pelvis)

-It should not be painful to your hips or back

How to plank after giving birth

Next you can progress abdominal strengthening in different ways.

Here is an example:

Tina was a client of mine and she has been complaining of constant weakness of her abdominal muscles despite working out for years after her pregnancy. At this point she was about 5 years since her latest pregnancy

The major thing she was doing was pushing herself back into the old routines she was doing prior to pregnancy. Because of this other muscles compensated to help:

-Low back muscles were tight

-And the hip flexors continued to be bothersome.

The biggest change we made was modifying her abdominal exercises. 

Let’s go back to physics: when something is further away from our body, we know that it will be heavier than if it is closer. 

For example, If you hold a 5# weight at your chest, then you hold it away from your body with your elbows extended, it is going to be harder even though it is the same weight.

The same goes for abdominal strengthening, if your legs or arms are further away from the abdominals the harder it is going to be. Here is an example.

It is important to gradually load the abdominals after pregnancy

Here are some examples of how to modify:

Flutter kicks

  • Lay your upper body on the mat and bend your knees vs keeping them straight
  • Bring your legs higher up in the air (vs lower down toward the floor)
  • Try laying your upper body on the ground and complete marches vs legs straight

Planks (start from higher surface and gradually work your way to the ground)

  • Try a plank a wall
  • Then progress to a lower surfaces, like the back of a couch or counter
  • Then to a bench
  • Then to your knees
  • Then to a full plank

Here is an idea of the movements

Planking form that is too hard

Try these plank progressions

Each of these progressions can take weeks to move to the next one.

Gradual core strength after having a baby

Remember to be patient with your body. It has pushed out a human which is a beautiful thing.

Give your body the time it needs to ease into your activities. 

And yes, you may have had an easier time after your first baby, or in your 20s, but each birth and each pregnancy is different.  

And everyone else has their own journey, some people may return to exercise more easily but may have other issues that they are dealing with (postpartum mental health issues, social support, breastfeeding issues, etc).

Be kind to yourself!

-Dr. Mary

Pelvis

Postpartum Urinary Incontinence

Postpartum Urinary Incontinence 1200 799 ResilientRx

Will I ever get back to working out without leaking?

“Why did I just pee all over myself after exercising?”

”I want to get back in shape after just delivering my baby!”

”Will I ever get back to working out without peeing myself?

These questions are all too common when we speak to our postpartum patients and their sentiments are completely valid! We’ve some exciting news- YES! You can get back to working out without peeing yourself!

It is critical to know that pregnancy and delivery may affect pelvic floor function, including urinary incontinence.

Particularly, the abdominal and pelvic floor muscles are stretching throughout pregnancy and during labor, which can lead to weakness and incoordination of the muscles. Due to these changes, returning to certain activities and getting around in your new postpartum body may lead to urinary leakage. Overall, the pelvic floor and core musculature may not be functional enough to support activities that increase pressure on the bladder, like running or jumping.

Types of Urinary Incontinence:

STRESS URINARY INCONTINENCE:

This is the involuntary loss of urine due to increased pressure on the bladder. This pressure can come from coughing, sneezing, jumping, running, etc. With stress incontinence, the pelvic floor muscles have to be strong enough to withstand increases in pressure.

In the clinic, I notice some clients who may think they have strong pelvic floor muscles, however they are actually over-activating or tightening their muscles and in return, the muscles become weak. It is important to note that your pelvic floor muscles need to be able to fully relax in order to fully contract. Additionally, holding your breath during physical activity also increases pressure on the abdominopelvic system which is another cause of leaking urine- don’t forget to breathe!

URGE INCONTINENCE:

This is a sudden urge to urinate and involuntary loss of urine. These urges can be associated with exposure to the cold, running water, walking by a bathroom or putting a key in a lock. Often, the muscles of the bladder contract and relax and result in urinary leakage. Urge incontinence can also be associated with frequent bad bladder habits such as going to the bathroom “just in case”. Doing this a lot can lead to mixed signals with the brain and the bladder thinking that you have to pee even when your bladder isn’t full with urine. Urge incontinence can be associated with urinary frequency or urinary urgency.

MIXED INCONTINENCE:

This is a combination of stress and urge incontinence mentioned above.

Urinary incontinence after delivering a baby is common, but that doesn’t mean you have to continue to endure this for the rest of your life.

Whatever your activity level was, is or could be, pelvic floor physical therapy can support you in getting to where you want to be. It’s all about baby steps!

If you continue to have persistent incontinence after 6 weeks from delivery, it may be a good idea to get evaluated by a pelvic floor physical therapist in order to educate yourself on your pelvic floor and learn what you can do to exercise without leaking again.

Written by: Dr. Michelle Andoy, PT, DPT,

Don't Panic

Postpartum Body Changes

Postpartum Body Changes 1200 799 ResilientRx

After giving birth you probably thought your body was ready to get right back in the swing of things, or you were even told that after 6 weeks everything would be “fine.”

You might have asked yourself, “Then why am I peeing my pants?” or “Why does lifting anything hurt my back?” You are not the first and unfortunately not that last person to give birth and have these questions– but have no fear!

There is no need to continue to live with pain or peeing your pants.

A task force for the American College of Obstetricians and Gynecologists (ACOG) says it’s time to frame postpartum care as an “ongoing process” requiring a personalized, cross-disciplinary approach—including the use of physical therapy when appropriate (APTA, 2018). A physical therapist specializing in postpartum care can help you get to where you need to be.

How does the body change during pregnancy and postpartum?

Throughout pregnancy, there is increased pressure and stretching in the abdominopelvic region. High levels of Relaxin hormone in the body lead to more movement in the pelvis, and in addition to this, increased weight results in the center of mass shifting the body forward. These changes allow for greater muscle activation and the body to compensate in new ways.

After giving birth (either vaginal or cesarean), the pelvic floor and abdominal muscles may have become weakened and uncoordinated. Furthermore, any perineal trauma such as an episiotomy or tearing, or tissue scarring/adhesions from a c-section also affect muscle movement and ability to contract. Because of this, it is vital to allow time for your postpartum body to heal but also recognize any signs and symptoms of the body if they continue to persist for more than 2-3 weeks.

Common postpartum problems and diagnoses:

  • Pelvic Floor Dysfunction
  • Dyspareunia (pain with sex)
  • Incontinence (involuntary urinary or fecal leakage)
  • Back Pain
  • Pelvic Girdle Pain
  • Pelvic Organ Prolapse
  • Diastasis Recti (Midline separation of the connective tissue at the 6-pack muscles)

Although these matters are common, they are not normal.

Oftentimes after giving birth, there is no conversation of these issues and women are left to deal with it on their own during such a significant phase in their lifetime. By identifying these problems, it may be necessary to seek further treatment options if it continues to get in the way of living your life.

As a physical therapist specializing in prenatal and postpartum care, I encourage women to seek help following birth. It is important to know there are solutions to get you to where you need to be.

At ResilientRx we perform a whole body evaluation, which includes analyzing your mobility, range of motion (ROM), posture, strength and stability. Furthermore, we figure out what is going on in your body, the root of your symptoms, and come up with a personalized treatment plan so you return to a functional lifestyle.

By: Michelle Andoy, PT, DPT

Sources:

APTA. (2018, July 11). OB-GYN group Embraces ‘Fourth TRIMESTER’ Concept, ACKNOWLEDGES role OF Phys… Retrieved January 7, 2021, from https://www.apta.org/news/2018/07/11/ob-gyn-group-embraces-fourth-trimester-concept-acknowledges-role-of-physical-therapy-in-postpartum-care

Running on Track 2

Postpartum Running: When Can I start?

Postpartum Running: When Can I start? 1200 629 ResilientRx

After delivering a baby, you might be wondering when can I start running again? This is a very common question clients ask at the clinic. It’s important to consider a more gradual return to pre-pregnancy fitness levels, especially when it comes to running.

According to a group of physical therapists’ research on returning to running postnatal, they recommend that “returning to running is not advisable prior to 3 months postpartum or beyond this if any symptoms of pelvic floor dysfunction are identified prior to, or after attempting, return to running” (Goom et al 2019).

Why wait 3 months?

For many, this may be hard to follow. However, consider that women require adequate time to heal and regain strength after giving birth. Pregnancy and birth (whether vaginal or cesarean) have a huge impact on the abdominal and pelvic floor muscles, often leading to muscle weakness, incoordination, and dysfunction.

During pregnancy and early postpartum, increased body weight has allowed for a forward shift in your center of gravity causing your body awareness in space to be totally thrown off and your body learns to compensate. During this 3 month period, you’ll likely notice that doing certain activities you did before now feel completely different. In addition, you may be experiencing pain, discomfort or urinary leakage with those activities.*

Low Impact Exercises Postpartum:

During your three month healing period, the following can be generally helpful:

  • Basic core activation
  • Walking
  • Squats
  • Lunges
  • Lifting
  • Swimming
  • Cycling

What’s next?

Prior to getting back to running, your physical therapist will help you achieve adequate strength and control of your pelvic floor and hip musculature and help you manage impact and load on the body.

Once cleared by your physical therapist, a “graded return to running” plan (e.g. starting with short distances to longer distances) can be implemented. During this period, you should continue to monitor for signs and symptoms while building training volume.

At ResilientRx, we offer 1:1 care and work with you to meet your individual needs. If you are experiencing symptoms of urinary incontinence, pain, pelvic organ prolapse, or any other musculoskeletal issues, and want to get back into running again, seek help from us to guide you in the right direction.

Written by Michelle Andoy, PT, DPT

*Remember to reach out to your healthcare providers, including a pelvic health physical therapist, to figure out the root causes and address these symptoms. Although not traditionally routine after every birth, there is always an option to receive a comprehensive pelvic health assessment from a pelvic floor physical therapist.

Sources: Goom, T, Donnelly G, Brockwell E (2019). Returning to running postnatal–guidelines for medical, health and fitness professionals managing this population. Retrieved from: https://www.researchgate.net/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population