72% of women complain of back or pelvic pain in the first year postpartum and many still have complaints for up to 3 years. It is clear that work needs to be done to restore core control and strength postpartum. This means we need to encourage a progression of recovery and core activation. The shifts in workload, posture and muscle activation patterns during pregnancy may not spontaneously return to your pre pregnancy motor pattern. It doesn't mean you are destined to have back pain because you had a baby. It means we need to re-think recovery.
Recovery Weeks 1-2 "HEAT" and "BRICE"
Hydrate- Your body needs to cleans our waste and needs lots of water to fuel recovery and nursing.
Eat- Eat plenty of nourishing soups and stews to have the fuel to heal.
Accept- Accept help. Your body needs to recover, just like if you had an injury. Yes your body was "designed" to give birth. That doesn't mean it is an easy task.
Tend & Temper- Make your primary focus tending to your baby and to yourself. Listen to your body. Rest when you need to without heeding your internal desire to push through things and get going with your postpartum body. Temper the desire to "get back to normal." This is a process that determination can't rush.
Breathe- the best way to reactivate your core stability and reduce the risk of pelvic floor dysfunction and back pain is to breathe! (Not sure how- watch my video!)
Rest- rest- sleep when you can. Allow your body to begin to restore energy and to begin the recovery process.
Ice icing perineal area (ask your healthcare practitioner for details), will help reduce pain and decrease swelling of the pelvic floor.
Compress- when your up out of bed, you may feel heavy and sore in your pelvic floor. Wearing supportive underwear or shorts with some support may help to give support to your tired pelvic floor.
Elevate- just like you would elevate a sprained ankle, laying down to unload your pelvic floor will help it to heal.
During pregnancy evidence indicates that the walking patterns of women changes along with the position of the spine, center of gravity and therefore head/neck, shoulder positions. Studies are sparse with regards to providing exact values on all of these shifts and the long term effects. Until we have substantial studies to review, it remains unclear if all of the shifts return to baseline postpartum. From studies in other arenas, we know that it is very easy for the human body to adapt and create a new norm. To assume that pain and the mechanics you needed to use when pregnant will "just go away" postpartum is perhaps idealistic.
Walking is good. Slowly build your tolerance to avoid pelvic heaviness, increased bleeding or back pain. Walk around the bed/ in the home for the first 3 weeks postpartum and slowly progress walking distances from there if you have no medical complications where your doctor has advised you to limit activity. It is good if you can walk without pushing a baby or holding your baby for some walks. Walking mindfully will help you to reconfigure your body awareness to midline and symmetry. Don't worry about speed or distance. Focus on how your muscles feel left to right, sensations of pelvic heaviness and breathing with the activity.
Restoring Your Core
Dare I say it again??? Breathe. Breathe Breathe. And, begin to assess your motion. Are you feeling tight when you turn one direction? Do you feel like your pelvic floor is still on high alert even though tears are healing? Or do you feel like you can;t connect at all with your pelvic floor?
Think posture. It is easy to fall asleep in wacky positions in a nursing chair and slouch when nursing for what seems like hours on end. Slouching can put your pelvic floor in an unsupported or strained position. It also detracts from the efficiency of breath to activate your core. Lastly, maintaining the over arched position you rocked during pregnancy inhibits breath by reinforcing malalignment and forces upper abs to grip for dear lift to hold you up while your lower abs become more and more disconnected from their participation in core stability and posture. It doesn't mean you can't slouch or arch your back to hold your baby, but be sure to move in and out of a variety of positions.
What core exercises are best? Sorry ladies. You are all different and that means what you need to do to connect with your core postpartum can't be googled. Studies show that it is often not what you do but how and why you do it. I can't recommend enough a postpartum assessment by a whole body movement expert who is competent in pelvic health awareness.
Want to learn more? Are you uncertain about really connecting with your body postpartum? Call for your complimentary Discovery Session!
Is a mom of two, life long exercise & nutrition enthusiast, women's health specialist & physical therapist.