Q&A: Hi Jen… I just gave birth two days ago and I’m wondering which exercises I can already start doing for pelvic floor strengthening and DR rehab. I recall during our training session that you said there are some things that can be done right from the beginning. If you have any video resources even better!
Hey Ilana. Thanks for the question. First of all, Congrats! And secondly, well done for being so pro-active with recovery!!
I’m going to do my very best to answer your question as I think it’s really important and can benefit lots of others in this group, but please be warned! It’s not that simple and it might not be the answer that you’re hoping for… And it’s looooong!
It’s really important to point out that you only gave birth a week ago, so your body has a lot of healing to do. It’s really important to give it the rest that it needs, and you shouldn’t be starting any kind of exercise programme before getting the all clear from your doctor at your 6 week check-up.
WHAT DOES POST-PARTUM RECOVERY INVOLVE?
Before prescribing any exercises for recovery, any professional working with post-partum women would need to ask the following questions:
1. Did you have a vaginal delivery? Were there any tears/stitches? What grade? How are they healing? Episiology? Is the pelvic floor actually weak? (it might not be…)
2. Did you have a C-section? How is the scar healing?
3. Do you have an abdominal separation? How wide is it? How deep is it? How does it react to different exercises (does it bulge or “tent”?)
4. Can you do a pelvic floor contraction? Is it even? (Is one side weaker than the other?)
5. Do you have even a mild grade of prolapse?
6. How much are you sleeping?
I don’t expect you to answer these kinds of questions here of course! But just so you know that these are the kinds of questions that a trained professional has in mind (or should have in mind) that will dictate exercise selection.
There are only a few things that I can really suggest at this stage, ESPECIALLY at this stage after birth and without having the answers to the questions above (and without actually seeing you with my own eyes).
GENERAL GUIDELINES FOR THE FIRST 6 WEEKS POSTPARTUM
Diaphragmatic breathing (or the “Piston Breath”) into the belly and pelvic floor. This ensures that the tissues are moving through a small range of motion constantly and will assist with healing.
2. "Blow Before You Go"
Make sure you use the mantra “blow before you go” from Julie Wiebe. When you lift your baby, child, washing (try to avoid lifting if you can, but when you do need to lift something, make sure you aren’t holding your breath. Exhale on the effort, and don’t strain. This can put a lot of pressure down on the pelvic floor and abdominal muscles.
3. Toilet Habits
Likewise, pay attention to toilet habits. Don’t push or strain on the toilet, and don’t hold your breath. This also puts lots of pressure down on the pelvic floor and organs. Lean forward with a number one, rest your elbows on your knees, let your belly go (don’t pull it in) and focus on RELEASING and OPENING the pelvic floor. For a number two, the same guidelines apply, just use a stool or a squatty potty so that your knees are above your hips. Lot’s of women experience constipation after giving birth. Try not to strain on the toilet as this can do a lot of damage to your pelvic floor muscles and/or fascia that may be weak, swollen and damaged.
4. Gentle Core Exercises
At some point you may be able to incorporate some gentle core exercises, like heel slides, [here's an example at 3:20]. and you may want to try increasing the amount you are walking, although you should pay attention to any feeling of heaviness at this stage. However I’m not entirely sure that I can legally recommend even that, so I’m not, but keep in mind that there may be things that you can do before you’re 6 week check up.
5. Glutes, not Core!
When you are ready to start to incorporate some gentle exercise, try to prioritize gentle glute exercises like glute bridges, clam shells and hip thrusts. Try to leave the core alone at this stage unless you are sure that you are not doing anything too strenuous. Strong glutes will support the pelvic floor, back and core, and they are easy to do at home with no equipment.
THAT’S IT! That’s all the GENERAL guidelines that I can give and be sure that it won’t do any harm. These are the only GENERAL guidelines I can give – anything beyond this depends a lot on the questions above and should be highly personalized. I know it might feel like I’m holding out on you, but it really wouldn’t be ethical to pretend that I know exactly which exercises will be right for you and your body without a full assessment (although there are a lot of fitness professionals that will try).
HEALING THE PELVIC FLOOR
It’s a really popular belief that you can just “do pelvic floor exercises” or “kegels” and that’s how you strengthen the pelvic floor, and that’s the ONLY way to strengthen the pelvic floor, AND that it’s a must, all the time, everyone must do this, no exceptions.
Specifically in terms of pelvic floor exercises, beyond breathing and good toilet habits (which is mainly to protect the pelvic floor from damage), there is NOTHING that I can prescribe. It is impossible for me to know what your pelvic floor is doing, if it is weak, how it is weak and what would strengthen it if it is. I mean I can take a stab at it, working closely with pelvic floor physios I’m getting pretty good at guessing based on the symptoms you describe – but there are certain things that ONE CANNOT KNOW without an internal assessment (like mild prolapse, which you would want to do you very best to manage and avoid worsening). All women should be assessed by a pelvic floor physio, or Women’s Health Physio 6-8 weeks post-partum. This professional can then do an internal and external assessment of your pelvic floor function. Trust me you don’t want someone guessing when it comes to this stuff.
Just a note on ethics here: I am a “Pre- and Post-Natal Fitness Specialist” and it’s important for professionals like me to fully understand our scope of practice. We have a very in-depth understanding of the pelvic floor, but we are not trained to assess your pelvic floor function, nor is it our job to dish out kegels or any other pelvic floor strengthening exercises – ESPECIALLY over the internet. Anyone who tells you otherwise is unaware of the damage that they can potentially do (and is less trained than the ones who won’t tell you exactly what to do!)
In terms of healing the diastasis, it’s equally important to individualize such exercises to the woman, at whatever level she is at. It’s important for me to see how the muscles and connective tissues respond to different exercises. Again, it’s a really popular belief that you can just “do these 3 exercises to fix your diastasis!” and that certainly sells! But in truth exercises need to be carefully selected. In a nutshell, you need to ensure that you are CHALLENGING the core, without OVERWHELMING it (so “tenting” would be an example of overwhelming the core, losing form, or holding the breath – these are all signs that the exercise is too hard and won’t be helping you heal). I have made a video library on youtube of “No-crunch core” which can give you some ideas for exercises that MAY suit you – you are absolutely welcome to try and do this yourself, that’s what I made the videos for! Just be sure to pay attention to what your tummy is doing in each exercise.
As a general rule, if you have DR, planks, crunches, sit ups and anything with leg raises is usually not appropriate – which means that it is too challenging and intra-abdominal pressure will leak out through the linea alba, or the front of the abdomen will bulge – but this also depends greatly on the “size” of the diastasis.
Healing diastasis is a whole other topic in and of itself. I made a video on fixing diastasis a little while ago, which may shed some more light on the topic. You can follow the link or watch the video below.
HOWEVER – it’s really important to note that this kind of work isn’t really appropriate right now. Regardless of the type of labour and birth that you had, the “6 week postpartum period” is there as a safety net – your body has a lot of healing to do! A lot of tissues (muscles, organs, ligaments) have been stretched and pulled and pushed and maybe even torn! Breathe, rest and roll to your side to get up, blow before you go, sleep and if you’re feeling good start to move a little more every day. Listen to your body and let the tissues do their thang for a while! When you are ready to get back into training, it takes a bit of individualization, and isn’t a one-size-fits-all. There are a lot of factors that influence the training decisions that a coach will make.
I could go on and on, but I hope this helped. Here is a quick summary of the major takeaways…
1. Go to see a pelvic floor physio 6-8 weeks after birth to assess pelvic floor function, bring your awareness to any issues and give you personalized treatment/exercises to remedy any issues
2. Don’t start doing any formal exercise until at least your 6-week check-up with a gyno
3. Over the next six weeks, prioritize rest, sleep, good nutrition, diaphragmatic breathing, don’t do any sit-ups, blow before you go. Start to incorporate gentle movement like walking and maybe some gentle exercises WHEN YOU FEEL READY. Focus on the glutes and leave the “core” alone for now.
4. Enjoy the time with your baby! It’s a wonderful and challenging time. Let yourself off the hook and don’t put pressure on yourself.
To learn more and book a 1-1 session with Jen Click here.
Jen is a specialist pre and post natal trainer. She is located in the tel aviv area where she runs both classes and private training sessions. Jen is passionate about empowering women to take control of their fitness and health through understanding their bodies, finding strategies that work for them. She specilises in pre- and postnatal training, including: diastasis, prolapse, pelvic floor dysfunction as well as women's health, including: nutrition, fat-loss, strength training.