Essential exercises and information after birth

Thanks to Amber Whiteford for putting together this great blog on essential exercises and information after child birth.

Many women are unsure how to return to exercise after childbirth and which exercises are important.

Amber gives some great advice on how and when to return to exercise.

For further information please don’t hesitate to contact Southcare and speak to one of our friendly Physiotherapists.

Pelvic floor muscle (PFM) exercises

Aim for 30 good contractions a day:

• 5 quick (1 sec lift, 1 sec relax)
• 5 long (your maximum, i.e. 5 seconds lift, and 5 second relax)
• Repeat at least 3 times per day

PFM can be performed in sitting, standing or lying on your back. Try in different positions to see what works best for you.

The ‘knack’ is a functional pre-contraction before lifting, coughing, sneezing, getting out of bed (anything that increases abdominal pressure)

Ideally you should have these muscles checked with real time ultrasound by a women’s health (WH) physio, around 6 weeks after birth.

Abdominal muscle exercises

There are 4 layers of abdominal muscles, however, we do not want to exercise all of them!

You should avoid using these muscles until:

• Your rectus abdominus diastasis (RAD) is less than 1 finger. This can be checked by a WH physio.
• Your pelvic floor can withstand the force of using the ‘six-pack’. This can be checked by a WH physio with the help of a real time ultrasound.
• You are more than 3 months postnatal after a Caesarean section.

Avoid sit-up exercises!

This includes sitting up to get out of bed! Continue to roll onto your side, as you would have late in pregnancy, up until the 6 week check up with a WH physio

Transverse abdominals (Lower or deep abdominal)

• Do a PFM contraction and then draw in your lower tummy towards your spine, as if you’re trying to button up tight jeans!
• Ensure that your upper abdominals are relaxed and you continue to breathe during the contraction.
• If you are holding your breath, you are increasing abdominal pressure and therefore making it harder for the PFM and transverse abdominal muscles to work.
• Do this at the same time as PFM exercises (i.e. 3 times per day), and with functional activities

Obliques (internal and external)

• These can be exercised safely as long as you pre-contract your PFM
• Sit up tall at the front of the chair, place one hand on the inside of the opposite knee. Lift your PFM, draw your lower stomach in, then push your hand into your knee and your knee into your hand.
• Hold for 5 sec, repeat 5-10 times each side

Posture education

Always aim to maintain the ‘S’ shape of your spine when breastfeeding, changing and bathing the baby, pushing the pram, getting baby/capsule/pram into and out of the car.

Ensure change table, pram handles, bath are all at hip height to avoid bending to far forward. Avoid combined twisting and lifting movements.

During breastfeeding:

• Ensure you sit in a supportive chair that allows you to have your hips and knees at 90 degrees with your feet flat on the floor, if required use a foot stool.
• Position a rolled up towel in the lower arch of your back
• Keep your shoulders relaxed during the feed
• Support the weight of the baby on a pillow to reduce excess strain on your shoulders and neck
• Once bub is settled, perform regular neck and shoulder exercises to prevent upper back pain and tightness
  • Turn your head side to side
  • Gently tilt your ear down to your shoulder while looking forward
  • Roll your shoulders forward and back
  • Repeat all of these 5-10x when feeding

Back exercises for spinal mobility

Lying on your back with knees bent and feet flat on the floor:

Pelvic tilts – Tilt your pelvis so that your lower back flattens into the bed/floor and then slightly arch your back. Alternate between these for 10-20 reps

Knee rolls – Keep the knees together and rock them side to side while keeping your shoulders flat on the mat. (You can also do this with legs draped over a fitball).

Gradual return to activity

• As a general rule, the first 6 weeks should involve a graduated return to walking as well as the above pelvic floor and abdominal muscle exercises.
• Start with a slow walk for about 10-15 minutes to see how your body responds, and then slowly increase the distance and intensity, adding on about 5 mins each day.
• Any other activity should be discussed with your WH physiotherapist at the 6 week check up. If your pelvic floor and abdominal muscles are sufficiently recovered, you should be able to gradually return to higher intensity exercise (jogging, boot camp, competitive sport).
• Keep in mind: Your pregnancy hormones have made your pelvic joints and ligaments more ‘stretchy’. Unfortunately, this is not isolated to the pelvis. Your back, hip, knee and ankle ligaments are also more ‘stretchy’ meaning you are more at risk of injury. If you are breast feeding, these hormones stay in the body for longer, delaying your return to high impact exercises.
• Mother and baby Pilates and pool classes are great pelvic floor friendly exercise and allow for mother and baby bonding.
• Women who have had caesareans will require extra caution, with limited weight lifting and high impact exercise for the first 3 months.

Breast care

• WH physiotherapists can assist with two main areas of breast care:
• Damaged nipples– painful cracked, bleeding, blistered, bruised nipples can be treated with laser therapy by a licenced WH physio. Laser treatment administers energy in the form of light to speed up healing of nipple trauma. It can also have a desensitising effect, therefore helping to reduce pain and hypersensitivity. You should always be working with your midwife and lactation consultant to ensure correct attachment.
• Blocked ducts and mastitis – regularly assessing your breasts after a feed will allow you to quickly determine if there is a blockage in your breast (a hard lump).
• This lump may be able to be cleared with gentle massage towards the nipple, or adjusting your feeding position so that the baby’s chin is pointing towards the lump.
• If the lump persists after 3-4 feeds, ultrasound treatment can be used to break down and clear the lump.
• If signs and symptoms of Mastitis occur (redness over lumpy area, flu-like symptoms) you should see your doctor ASAP for a prescription for anti-biotics. Ultrasound can then be implemented after 24 hours of antibiotic therapy.

Physiotherapy treatment

While in hospital, a physio can come to your room to see you for:

• Laser treatment to assist healing of painful, cracked and blistered nipples
• Ultrasound treatment to reduce pain, swelling and inflammation in perineal tears, episiotomy, haemorrhoids and bruising of the perineum
• Check your abdominal muscles and, if required, provide Tubigrip for abdominal support
• Treatment for any musculoskeletal complaints, i.e. back pain, neck pain, wrist pain

6 week check up with a WH physiotherapist is recommended to check PFM function, abdominal muscle integrity and any other pregnancy related issues.

Summary

1. In hospital – get your abdominal muscles checked (RAD assessment)
2. Exercises you should do – PFM exercises (everyday!), deep abdominal exercises, walking, neck stretches, spinal mobility stretches/exercises, low impact activity – swimming (after 6 weeks), mother and baby hydrotherapy, Pilates, FitRight
3. Exercises to avoid – sit ups, running, jumping, boot camp, high impact activities (to prevent injury)
4. Take care of your back! Maintain a neutral ‘S’ shaped spine when sitting for long periods
5. Laser and ultrasound treatment is available in hospital and in outpatient clinics with a WH physio
6. Don’t forget to book a 6 week check up with a WH physio to ensure safe return to exercise

As always feedback is always welcome.