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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

Urinary Incontinence (Accidental Leakage): Myths & Reality

Urinary Incontinence (Accidental Leakage): Myths & Reality 2046 1364 ResilientRx

According to recent statistics from the National Association for Continence, over 25 million adult Americans experience temporary or chronic urinary incontinence. This is a common, widespread, but oftentimes very overlooked and misunderstood issue. What most people don’t know is that there are different therapeutic solutions to help reduce daily leakage, or even eliminate it altogether. 

If this sounds like you, wouldn’t you want to know how to overcome urinary incontinence? 

What is urinary incontinence?

Urinary incontinence is the accidental leakage or increased urgency to urinate often. It can be felt by anyone of all ages.  It can range drastically from person to person – and can be managed or treated by exercise, lifestyle changes, or dietary changes. 

What causes urinary incontinence?

There is a lot of misinformation surrounding the causes of urinary incontinence, or UI. In a broad sense, the types of UI can be put into two different categories: urge and stress urinary incontinence.

Urge urinary incontinence

Urge urinary incontinence can be caused by certain drinks, foods, and even medications and stimulants. Included in this list are things such as: 

  • Alcohol, caffeine, carbonated beverages
  • Artificial sweeteners, chocolate, overly spicy and sweet foods, citrus fruits 
  • Heart and blood pressure medications

Here are common examples of urge incontinence

  • Feeling the urge to pee as soon as you put your key in the door to your house
  • Worried about prolonged walking because you won’t find a bathroom
  • Feeling the need to pee after you just peed

Stress urinary incontinence

Stress urinary incontinence is accidental leakage when there is extra stress placed on the pelvic floor. Below are some common reasons that it can occur

  • Pregnancy and childbirth (ie tearing during child birth)
  • Poor breathing form (not using your diaphragm so your pelvic floor muscles are not as active throughout the day)
  • Pelvic surgery
  • Poor exercise or running form

Here are some examples of SUI (stress urinary incontinence)

  • Peeing when you cough, sneeze or laugh
  • Peeing when you jump, lift or exercise

Myths about urinary incontinence

Because urinary incontinence can be an embarrassing condition, those who suffer from it may do so in silence. This is what prevents so many people from getting the care they need — and we want that to end.

Myth #1: Only elderly people, or people who have been pregnant, suffer from urinary incontinence

While it is true that many people who have been pregnant do face increased likelihood of UI, it also can affect those who are pre/post menopause.  Either way, you are not alone. Bladder dysfunctions can start in people regardless of gender, as young as 18 years old. And if people with penises have any type of prostate gland issue,  whether it be serious or minor, they are at a risk of incontinence.

Myth #2: If you suffer from urinary incontinence you should drink as little fluid as possible to improve your symptoms 

The only thing that limiting fluids does is further concentrate your urine, which then leads to a higher chance of bladder irritation — making the symptoms of UI worse. Always drink adequate fluids, you may have to temporarily stay away from any that you have found cause symptoms to worsen, in order to keep urine diluted.

Myth #3: Nothing can be done about urinary incontinence OR surgery is the only option to treat urinary incontinence

In most cases, urinary incontinence can be managed or treated successfully. Surgery is only ONE of the options for treatment — and that’s to be used only after all other avenues have been exhausted. Urinary incontinence treatments include behavioral and physical therapies, lifestyle modifications, and medications. Treatment plans depend on many different factors, including age and gender of the patient.

Find relief from urinary incontinence with ResilientRx

At ResilientRx, we offer modern physical therapy to target pelvic floor pain and dysfunction, which provides much-needed treatment for people who suffer from urinary incontinence. 

We go beyond just the pelvic floor with this therapy. We target your mobility and movement patterns that may help explain why these problems are occurring. By hitting the root cause of your urinary incontinence, we have a better chance of reducing your incidents — and possibly relieving them entirely! Our urinary incontinence and pelvic therapy treatments can be performed internally (intra-vaginally) and/or externally to reduce pain/dysfunction and ensure long-term results. 

If you’re someone who is struggling with UI and has been told that constantly doing kegels is the only way to fix the problem, reach out to us today. We’ll begin a therapy regimen designed to not only to strengthen your pelvic floor muscles but also target the root cause of the bigger issue. 

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