Postpartum Physical Therapy

Postpartum Physical Therapy


Medically reviewed by Ashlie Crewe

During pregnancy, the body undergoes immense changes to accommodate the growing fetus. For many, these changes are quite painful. After pregnancy, many individuals find their bodies don’t feel the same.

Postpartum physical therapy is an effective approach to treating symptoms to help you feel and move better after pregnancy. After all, the birth of a child is an incredibly joyous experience to be savored, not overshadowed by aches and pains, pelvic floor dysfunction, and other common postpartum symptoms.

What Are Common Postpartum Conditions?

During pregnancy, the body literally changes its shape to make room for the growing baby. These shifts may come with some unwelcome physical symptoms. Common postpartum conditions include:

Ligament Changes

The body secretes a hormone called relaxin during pregnancy to loosen the joints and ligaments in preparation for childbirth. This can cause pelvic pain during pregnancy that continues into the postpartum phase for some people.

Diastasis Recti

The abdominal muscles stretch during the last two trimesters of pregnancy as the uterus expands. In some people, the tendinous structure that runs along the long muscle of the anterior abdominal wall (rectus abdominis) can widen and even separate.

This condition, called diastasis recti, affects nearly 60% of people after pregnancy It can cause a visible bulge in the stomach, particularly when you strain or contract the abdominal muscles. Some postpartum folks also notice discomfort in the area as well.

Back Pain

Postpartum back pain is extremely common and has a few possible causes, including common musculoskeletal changes that occur during and after pregnancy. Changes to the pelvic bones, joints, and soft tissues that can occur during pregnancy and delivery is linked to low back pain.

The hormonal changes mentioned earlier can lead to difficulty with joint stability and changes in muscle tone. This can cause other muscles to overcompensate for weak areas, another cause of postpartum pain. All of the tasks that come with caring for a new baby also contribute to upper back pain including nursing, bottle-feeding, and carrying the baby (and all their gear.)

While more severe conditions like fractures and/or dislocations can be a possible source of postpartum back pain, they are less common that the other issues mentioned above.

However, it is important to see your healthcare provider to diagnose the cause of pain so you can move forward with the appropriate course of treatment and avoid complications that may occur if pain or dysfunction is left untreated.

Pelvic Floor Pain and Dysfunction

The pelvic floor is comprised of muscles and connective tissues that surround and support organs within the pelvis including the bowel, bladder, and internal reproductive organs. The pelvic floor absorbs outside pressure from motions like lifting or coughing, and it assists with bodily functions like going to the bathroom and having intercourse.

Pregnancy, labor and both vaginal and surgical childbirth impact the pelvic floor muscles, often making them less effective for supporting these key bodily functions. That’s why sex may feel different, or you have urinary leakage after having a baby. Bowel issues, and lower back, pelvic, or abdominal pain are also common signs of pelvic floor dysfunction.

What Is Postpartum Physical Therapy?

Postpartum physical therapy focuses on the treatment and management of pregnancy-related musculoskeletal conditions that cause pain and dysfunction. It is designed to accelerate the healing process so you can improve strength and function in shorter amount of time.

Postpartum physical therapy treatments and techniques include:

Core Strengthening Exercises

Abdominal muscle weakness is a common postpartum issue. However, the exercises that you might usually do to build a strong core, like sit-ups, are often inappropriate to begin right after. Your physical therapist prescribes safe, gentle, and effective exercises that gradually increase in intensity over time to rebuild a strong core.

Pelvic Floor Therapy

Pelvic floor therapy focuses on the muscles, ligaments, and other tissues that hold the pelvic organs in place. Pelvic floor therapy often works to train you to strengthen weak pelvic floor muscles and release trigger points in areas that are “stuck” and stiff. Pelvic therapy also works on improving your posture which may be impacted after months of carrying your baby and the extra weight that often comes with pregnancy.

Diastasis Recti Correction

Many patients find that physical therapy can significantly improve diastasis recti. To improve this condition, therapists often start with posture training and targeted stretching and strengthening exercises to rebuild and repair the core and pelvic floor muscles.

Pelvic therapists also teach breathing techniques that engage, release, and stretch the diaphragm to resume normal breathing patterns and take pressure off the injured rectus abdominis muscle. As you progress, therapists will also show you how to perform basic tasks like lifting, standing, and sitting without overstressing the healing muscles, while prescribing exercises to strengthen the impacted muscle.

Body Mechanics Education

Healthy body mechanics will help you immensely after having a baby. Proper posture when sitting, standing, and walking will alleviate pressure on your back and lower body. Pelvic therapists will educate you on good ergonomics for your home, workspace and other environments that will help promote good posture and prevent pain.

Additional Modalities for Postpartum Health

Physical therapists have a wealth of evidence-based treatments at their disposal to enhance your postpartum recovery. Some address pain, while others promote tissue recovery. You may benefit from:

  • Soft tissue and/or joint mobilization
  • Scar mobilization
  • Heat and cold therapy
  • Electrical stimulation
  • Dry needling
  • Aquatic therapy

Postpartum therapy may include some or all of these treatments. Every physical therapy program is customized based on your initial evaluation, your symptoms, and your treatment goals.

Health Benefits of Postpartum Physical Therapy

You’ve probably been incredibly diligent about attending all of your medical appointments and screenings throughout your pregnancy. But that shouldn’t stop during the “4th trimester.” When you incorporate physical therapy into your postpartum journey the results may be better than you ever thought possible.

Physical therapy after pregnancy can:

  • Reduce your pain
  • Strengthen the pelvic floor
  • Restore core stability and strength
  • Heal diastasis recti
  • Speed up your recovery time
  • Improve sexual function
  • Reduce pelvic dysfunction symptoms like leakage, constipation, or prolapse
  • Improve your mental well-being

The body is subjected to incredible stresses during the process of creating and nourishing life. These take time to heal and recover from. It’s not easy with a newborn baby, but we do encourage parents to prioritize their own health and wellness.

Postpartum physical therapy is a regular “date” you can make with yourself to focus on your recovery. Your physical therapist will be cheering you on every step of the way.

When to Start Postpartum Physical Therapy

The American College of Obstetrics and Gynecologists advises that it is safe for who have had a normal vaginal delivery to start exercising within a few days of giving birth. But you should always follow your provider’s guidance and wait to be cleared for activity, especially if you had a cesarean birth or complications during labor.

The good news is you don’t have to wait to schedule your initial postpartum physical therapy screening. Find a physical therapy clinic near you to get started today.

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Medically reviewed by

Ashlie Crewe

Certified Pelvic Rehabilitation Practitioner

Ashlie Crewe received her Bachelor's in Psychology and her Doctorate of Physical Therapy degrees from Gannon University. She then moved to Pennsylvania and began her specialized training in pelvic health physical therapy, finding her passion in combining the knowledge from pelvic health courses with the neuroscience of persistent pain conditions. She achieved her Board Certification as a Women's Health Specialist in 2017 and is a Certified Pelvic Rehabilitation Practitioner. Specialty interests in the field of pelvic health physical therapy include patients with sexual dysfunctions and providing gender-affirming care, and she treats patients while also developing and supervising a development program for therapists who pursue a specialization in pelvic health physical therapy. She enjoys reading, gardening, traveling, and spending time with her family, preferably at the beach.

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