Display Patient Information Leafelts

Postnatal Exercises

Date issued:  November 2020

For review: November 2022

Ref: C-438/VWH/Physiotherapy/Postnatal Exercises

PDF: Postnatal Exercises [pdf] 948KB

Introduction

This leaflet aims to provide you with exercises that are safe to do after your 6-week postnatal check with your GP.  It is important to start exercising slowly and progress gradually, listening to your body along the way.  If at any time you feel dizzy, pain or unwell please stop and if symptoms continue speak to a health professional.

Postnatal changes

The weight of the baby and the softening and stretching of your soft tissues in pregnancy will have changed your body shape and posture in many ways. This takes time to return to normal, sometimes as long as 3-5 months postnatally.

The healing of your perineum will vary depending on the amount of trauma.  Healing of any stitches and swelling you may have had would have taken about two weeks.  Recovery of your pelvic floor muscles will take a lot longer.

Your ribcage circumference returns to normal to some degree, but you may notice differences throughout your body.

Your tummy (abdomen) often remains soft and poorly toned for a few weeks/months.  You may have also noticed a ridge down the middle of your tummy, or a midwife may have told you that you have a DRAM.

What is a DRAM?

DRAM stands for Diastasis (or divarification) of the Rectus Abdominus Muscle.  It is a condition where the rectus abdominis (‘six-pack’) muscle spread apart at the stomach midline (linea alba) to allow room for the growth of your baby.  This can happen in 90% of pregnancies during the third trimester and spontaneously recover within the first 6-8/52 postpartum. 

Benefits of exercising postpartum

  • Prevention of incontinence
  • Weight loss/ prevention of obesity
  • Strengthening abdominal muscles
  • Recovery of a DRAM (if you have one)
  • Maintenance of bone density
  • Improve fitness
  • Social interaction
  • Psychological well being
  • Reduce anxiety and postnatal depression
  • Increase energy levels
  • Avoid physical problems later on

Postpartum exercise guide

This is just a guide and should be considered on an individual basis.  Factors such as type of delivery, vaginal tears and infections (in stitches or mastitis) should all be considered.

0-6 Weeks

  • Pelvic floor exercises
  • Pelvic tilts and transverse abdominis exercises
  • Walking

6-12 Weeks

  • Low impact exercise
  • Gradually introduce cardio like static bike, walking faster, but not running yet
  • Yoga/Pilates

12 Weeks +

  • Gradually increase impact and cardio as per individual assessment

Warning signs to slow down

  • Increased fatigue
  • Heavy vagina
  • Feeling of ‘pushing down’
  • Muscles aches and pains that continue beyond days
  • Vaginal bleeding
  • Doming of the tummy muscles
  • Incontinence or urgency of urine

Anatomy of your abdominal muscles

The main muscles involved in supporting your trunk especially during pregnancy. You might hear us refer to them as the ‘core’ muscles or the primary/local sling.

Neutral spine

Tilt your pelvis forward and then back.  Establish where your natural midpoint is and maintain this whilst performing your exercises.  During all exercises try to maintain activation of your transverse abdominis, pelvic floor muscles and keep a neutral pelvic alignment.

Transverse Abdominis (Deep tummy muscle)

These muscles span from side-to-side and form the front part of your deep trunk muscles.

  1. Sit, stand or 4-point kneeling
  2. Gently draw your lower tummy muscles (below your belly button) in towards your spine, maintaining a relaxed normal breathing pattern
  3. Hold the contraction 10-30 seconds and repeat up to 10 times

Pelvic Floor Muscle (PFM) exercises

It is important to train this muscle too as it works together with the transverse abdominis muscle.  The pelvic floor muscle is like a sling/hammock that runs from inside the front of your pelvis to the coccyx.  Like all muscles there are deep and superficial layers and fast and slow twitch muscle fibres that need to be worked differently.

Try these two ways of working the PFM, firstly trying in lying or sitting and then working towards standing.

  1. Tighten the back passage, close around the vaginal exit and lift the muscles at the front, as if you are stopping the flow of urine or squeezing tight inside your vagina
  2. Try to hold for as long as you can and then relax and repeat, aiming for 10 seconds and 10 repetitions
  3. Now try squeezing quickly then relax, repeat 10 fast repetitions.

The following exercises are safe to start after your 6-8 week check.  They aim to improve your strength and mobility, in order to reduce the incidence of back, pelvic pain and incontinence.  The reps/sets and frequency is individually set.

Hundreds

  1. Find neutral spine in crook position
  2. Inhale to prepare
  3. Exhale and engage your centre, pulse arms up and down in a small arc or movement (Aim for 5 arm movements on inhale and 5 on exhale).  Aim to get to 100 arm pulses in total
  4. You can make this hard by lifting one or two legs to the table top position but you must not show any signs of doming in your tummy muscles

Shoulder Bridge

  1. Find neutral spine in crook position and inhale to prepare
  2. Exhale, peel spine off the mat lifting your hips to ceiling
  3. Inhale and hold the bridge position
  4. Exhale and slowly place spine onto the mat, the last part to return should be your tail bone and find neutral spine
  5. To make harder lift one leg in the air, or challenge different muscle groups: squeeze small ball between your knees (work adductor muscles) or place resistance band around your knees (work gluteals)

Roll up with band

  1.  Inhale to prepare, as you exhale, roll off the back of the sitting bones in a small range to round the pelvis and lower back
  2. Inhale, roll forwards onto the top of the sitting bones back to the starting position
  3. To make harder roll further back and add in a twist/rotation of your trunk

Abdo prep (If you have a DRAM please ask your therapist before doing this exercise)

  1. Inhale and lengthen through the back of the neck
  2. Exhale, slide the shoulder blades down the back, lifting the head and upper back off the mat, hover arms off the floor and reach forwards.
  3. Inhale to hold the position
  4. Exhale and lower the upper body

Oblique Prep (If you have a DRAM please ask your therapist before doing this exercise)

  1. Inhale to prepare, then exhale and lift your right shoulder blade off the mat drawing across your body towards your left hip.  Allow your head to lift-off the mat with the movement, simultaneously reach forwards with the left hand
  2. Inhale to hold and exhale to lower your upper body to the mat

Side leg press

Inhale and lift the top leg up, bending it towards your chest, but keeping it at hip height

  1. Exhale and straighten the hip and knee back to the starting position

Side leg circles

  1. Inhale to prepare
  2. Exhale, lift the top leg and complete small circles
  3. Completing 8-10 reps in a clockwise direction and 8-10 reps in an anti-clockwise direction

Clam

  1. Inhale to prepare
  2. Exhale, lift the top knee upwards keeping the feet together
  3. Inhale and lower the top knee back onto the bottom knee
  4. You can make this exercise harder by lifting both feet into the air before doing the same action as before
  5. The final level of difficulty is to straighten the bottom leg and keeping the top knee and hip bent, hooking the top foot behind the knee.  Then raise the top knee up to the ceiling and lowering back down towards the floor

Side bend (If you have any pubic pain, please ask your therapist before doing this exercise)

  1. Inhale to prepare
  2. Exhale, gently engage your buttock muscles to lift your hips off the mat, reaching your top arm over head
  3. Inhale and hold the side bend
  4. Exhale and lower your hips back to the mat
  5. Make harder by straightening arms and legs

Airplane

  1. Inhale to prepare
  2. Exhale, lift one arm with palm facing to the floor, move the arm out to the side keeping the resistance band taut
  3. Inhale and return to the starting position, repeat 8-10 times before changing sides

Swimming side leg reach

  1. Inhale, lift the leg behind you then take it out to the side, trying to keep the pelvis still
  2. Exhale and return the leg to the starting position
  3. For end stage postnatal rehabilitation try the same movement in standing (known as scooter/skater exercise)

Breast stroke prep (1 & 2) in prone

Inhale to prepare

  1. Exhale, slide the shoulder blades down your back lifting your upper body/breastbone off the mat, inhale and hover
  2. Exhale and relax back to the mat
  3. Make harder by having your arms at 90 degrees next to your head, on the exhale lift up floating your arms up (keep  neck long)

Modified Press up

  1.  4-point kneeling, arms slightly wider than shoulder width apart with soft elbows
  2.  Pelvis neutral alignment
  3.  Inhale and bend elbows sideways to lower chest to floor
  4.  Exhale to straight elbows and push back up

Chest stretch with band

  1. Hold band in front of chest and inhale to prepare
  2. Exhale, lift arms above head keeping band taut
  3. Inhale, bend elbows to lower band behind head
  4. Exhale, straighten elbows above head and then lower arms back to start position in front

Standing Scissors

  1. Inhale to prepare
  2. Exhale and float one knee upwards to 90 degrees
  3. Inhale to hold this balanced position
  4. Exhale and slowly lower your leg to the floor
  5. Repeat on the other leg (engage pelvic floor throughout)

Wall squats with calf raises

  1. Inhale to prepare, exhale and bend your hips and knees as far as you feel comfortable
  2. Inhale and hold
  3. Exhale and straighten back up the wall
  4. Make harder by adding in a calf raise when in the deep squat position Draw the sword
  5.  Inhale to prepare
  6.  Exhale and lunge forwards, imagining you are drawing a ‘sword’ out of your pocket into the air on the opposite side
  7. Inhale, return the ‘sword’ back into your pocket and step back to the standing position

Spine Twist

  1. Maintain neutral spine as you inhale to prepare
  2. Exhale, rotate your spine to the left moving as one unit
  3. Inhale and return to forward facing position
  4. Repeat on the opposite side

Cat stretch

 4-point kneeling, exhale and arch spine

  1.  Inhale to hold position and stretch
  2.  Exhale to return to neutral
  3. Inhale to prepare, on the exhale lift your head and stick  your tail bone out, dropping your hips forward

Thread the needle

  1.  Exhale and rotate one arm to the ceiling
  2.  Inhale and hold
  3.  Exhale to rotate and thread arm under body

Tail swish

  1.  Exhale and move tailbone horizontally to one side
  2.  Inhale to return to starting position, repeat both sides

Mermaid (standing or on ball)

  1. Inhale lift arm overhead
  2. Exhale to lengthen curve of the spine maintaining neutral alignment
  3. Inhale to return to starting position

Hip twist

  1. Exhale and roll both knees to one side, simultaneously roll the head and neck towards the opposite side
  2. Inhale when you have rolled the spine as far as is comfortable
  3. Exhale and roll the head and neck back towards the centre

Glut stretch on ball (Avoid if you have pubic pain)

  1.  Sit on the ball/chair, cross one leg over the opposite knee
  2.  Lift chest and lean forward until you feel the stretch in your gluteal (bottom) muscle

Hamstring stretch

Sitting on the edge of a chair (or gym ball), straighten one leg, lift chest and lean forwards

  1. Aiming to hold the stretch for 30 seconds
  2. Repeat 3 times on each side

Hip flexor stretch

Step one leg (lunge) forward, tucking tail bone under

  1.  Aiming to hold the stretch for 30 seconds
  2.  Repeat 3 times on each side

Final word

The importance of this treatment and exercise programme is to enable you to improve strength and fitness during your postnatal journey.  Please listen to your body and if in doubt ask your physiotherapist

Further information

If you are continuing to have difficulties with the recovery after giving birth, please be aware you can self-refer to the physiotherapy department at Derriford Hospital

Physiotherapy Department

Derriford Hospital

Derriford Road

Plymouth

PL6 8DH

Tel: 01752 432233

www.plymouthhospitals.nhs.uk

Other sources of information:

IOC, Part 3 2017; ACOG 2015; Davenport et al 2011

www.pogp.csp.org.uk

images: www.dianneleephysio.com

www.completephysiotherapy.co.uk/core-muscles

UK Chief Medical Officer’s physical activity guidelines 2019

 

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