At Little Venice Pilates and Physiotherapy we advise our clients to wait 6 weeks before returning to Pilates classes after giving birth. This blog will discuss why this is important. Some of our new mothers are keen to return to exercise even earlier and so we will also look at appropriate exercises which can be started straight away as soon as you have delivered your baby (if you have a spare moment and are not too tired of course!!)
Why do I have to wait?
After pregnancy, your hormone levels take a while to return to normal levels. This means that your ligaments and joints are still quite pliable. Whilst you may feel more limber without your big bump in front, it can be easy to overdo things and inadvertently cause an injury from overstretching vulnerable joints
Your body has been through a lot and is still recovering, particularly in areas such as the pelvic floor. If you overstress this area too quickly even with fairly basic Pilates exercises, such as hundreds, you can cause or exacerbate a dysfunction. Classes are an hour long and whilst you may find you can do some exercises during the first 6 weeks (see below), it may be better to stick to 10-15 minutes each day initially to avoid overexertion.
Your abdominal muscles split along the middle during pregnancy to accommodate the growing baby. This is called ‘Rectus abdominus diastasis’. Skin pigmentation changes mean you will often see a dark line running down the centre of your tummy after giving birth. The two parts of this muscle will come back together for most women. Your physiotherapist or specialist Pilates instructor can palpate the muscle to see how big the gap is. 1-2cm is about normal. You can check yourself by doing a small abdominal crunch and palpating the sides of the muscle just above your belly button with your fingers. If you can fit two fingers or more between the two sides then it is a significant diastasis and you need to be careful. It is important not to overdo any abdominal exercises initially which would cause doming of the muscles as this might result in an increased gap more permanently.
What if I am in pain?
Often clients contact us before the 6 week deadline to say that they are experiencing back, shoulder or neck pains in the weeks after giving birth and they are keen to get back to their Pilates exercises regimes which they usually find important in relieving these kinds of symptoms.
When this is the case we will usually advise an appointment with one of our physiotherapists first. During this appointment the therapist, who is trained more specifically to diagnose pain symptoms can advise you on appropriate relieving exercises and may provide hands on treatment such as manual therapy or massage to help alleviate the pain.
Top Tips for avoiding pain
- Your stomach muscles are naturally weaker after giving birth and provide less support for your lower back when lifting. Therefore you must be careful how you lift and carry your baby to avoid straining the back. Try and avoid carrying any heavier toddlers for a few weeks if possible. Minimize the distance you are carrying your baby in a car seat.
- If you use a sling, make sure it is adjusted properly and avoid carrying the baby for long periods like this if you have a history of upper back pain.
- Avoid excessive bending of your back. Adjust your cot height to avoid bending over too far when lifting up your baby. Kneel down when you are washing your baby in the bath. Change your baby on a surface that is waist height.
- When you are feeding your baby (bottle or breast) make sure you sit in a chair that supports your back and shoulders. Use pillows to support underneath the baby to avoid bending forwards too much. If you are breastfeeding then try alternative feeding positions such as lying on your side with pillows supporting you behind your back
Are there any exercises which are safe for me to start right away?
If you have had a straightforward delivery then there are some gentle exercises which you can start right away.
- Pelvic floor contractions
These can be started immediately after the birth as they are thought to help healing of the area if you have had stitches or an episiotomy as well as strengthening the muscles. Imagine you are trying to stop yourself passing urine or wind. Squeeze and lift the pelvic floor muscles drawing forward the front and back passages. Hold the squeeze for a few seconds and then relax. Gradually increase the hold time up to 10 seconds and the repetitions to 10 per session. Aim to do this 3 times per day.
- Contractions of the lower abdominal muscles.
Lying on your back, with your knees bent up. At the end of an exhale draw your tummy button towards your spine, hollowing your abdominals, hold for a few seconds whilst you continue to breathe normally and then relax. Build up to holding this contraction for 10 seconds and increase to 10 repetitions per session.
- Pelvic tilts
Lie on your back with your knees bent up. Tilt your pelvis back lifting the tail bone and flattening your spine on the floor. Relax and repeat up to 10 times. These exercises can also be done in standing with your back to a wall.
- Modified ‘hundreds’
Lie on your back with your knee bent up. Draw in your lower abdominal muscles and lift one knee up to a 90degree angle at the hip and knee. Hold this position, keeping the abdominal contracted and breathing normally for 3 breath cycles. Replace the foot and repeat on the other side. Build up to 10 repetitions for each side, taking care to avoid any bulging out of the abdominals.
- Knee rolls
Lie on your back with your knees bent up. Maintain a lower abdominal contraction as you roll your knees to one side, allowing the spine to rotate but keeping your shoulders in contact with the mat. Hold for a few seconds, breathing normally with the lower abdominals contracted and repeat 5 times to each side.
Don’t forget about your posture!
Your posture will likely have changed as your pregnancy advanced to accommodate the increased weight at the front. After giving birth, with the abdominal muscles being weak and lengthened it is easy to get into bad habits and many women find they are standing with an increased sway in their back, putting increased strain on the lower back joints and increasing tension in the neck and shoulders. Try to keep your pelvis and rib cage in line when you are standing and practice drawing in your abdominal as in the above exercises in order to support this posture. If you were doing Pilates pre-natally you can easily put into practice all the principles of good posture, which you remember.
Your body has undergone a lot of changes over the last 9 months. For many women it takes time to recover and return to pre-pregnancy shape. Whilst low impact exercises like Pilates are fine to start for most women at the 6 week stage, it is a good idea to wait several months before restarting higher impact exercise such as running.
If your birth was complicated, for example a forceps or caesarian delivery, make sure you discuss any concerns about returning to exercise with your midwife or GP at your six-week postnatal check. This is the time to flag up any urinary incontinence issues as you may then be referred to a specialist women’s health physiotherapist for further assessment and treatment if it is required.
Don’t put too much pressure on yourself and remember to take time out to relax and enjoy your new born baby!
The association of Chartered Physiotherapists in Women’s health. http://pogp.csp.org.uk/
By Nikki Richards MPHTY(Sports) MCSP BSc(Hons)Physio