Post-natal Recovery Physiotherapy is an essential component of post-natal care, focusing on recovery after childbirth – both C-section and vaginal – to prevent long-term dysfunctions of the pelvic floor and tummy muscles. It is recommended from 6 weeks to years after delivery.
Perineal scar massage
You may have a perineal scar as a result of a perineal tear or episiotomy. Scar tissue can often feel stiff and ‘stuck’ once healed. This can affect the perineum tension and can contribute to tight pelvic floor muscles, painful sex, constipation, hemorrhoids and coccyx pain.
It is important to soften and mobilise this scar to restore the natural movement of these tissues. Specialist pelvic health Physiotherapists can have and advise you how to do this.
C-section recovery
C-section recovery is a critical period requiring specialised attention to restore pelvic health and core function.
In the early stages (0 – 6 weeks) post c-section, you could start with gentle stretching and breathing techniques. Diaphragmatic breathing and gentle stretching increase circulation to the incision site encouraging the natural healing process, may help you with pain relief, help you reconnect with your body after surgery and post-pregnancy, and prevent adhesion (scar tissue) build up. You want to prevent adhesions to ensure tissues can glide over one another rather than feeling stiff or ‘stuck’.
Examples include: deep diaphragmatic breathing (expanding the abdomen as you inhale rather than the upper chest), cat / camel stretch (pictured below) and standing open the book (pictured below).
Scar massage around and over the c-section scar can prevent the build up of adhesions. You can either use non-perfumed lotion / cream or a suction cup.
Pelvic floor muscle training
Post-natal pelvic floor muscle training is essential for restoring strength, coordination and function after childbirth. It is part of the first building block to return to normal activity, whether that is picking baby up, going for a walk or returning to sport. It helps address issues like incontinence, prolapse risk and pelvic pain.
Generally pelvic floor muscle training involves exercises like Kegels – where the pelvic floor muscles are contracted and relaxed – which could be short or long squeezes, can be performed in different positions and with other exercises. This is tailored to individual needs and goals.
Split tummy muscles (diastasis recti)
Diastasis recti is the separation of abdominal muscles that occurs in 100% of pregnant women at 35 weeks. This separation of your six pack muscles (rectus abdominis) will weaken your core strength and stability, which could lead to back and pelvic pain and pelvic floor dysfunction. It is key to follow an individualised rehabilitation programme to improve the strength and stability of your core, preventing any future problems.
Returning to impact exercise
It is recommended to avoid returning to running until at least 12 weeks after having a baby, and this return should be gradual.
Before you think about returning to running you should have: good pelvic floor muscle strength and coordination (e.g. can you coordinate contract and relax quickly or over a sustained hold), good core strength, good single leg strength and stability (e.g. perform a single leg squat and single leg bridge with good control and technique) and able to manage some impact movements like jumping and hopping without pelvic pain, leaking or heaviness.
At Head2Toe Physio, we can expertly assess your post-natal function and provide you with an individualised rehabilitation programme to help your return to what you enjoy and prevent long-term complications.
If you or anyone you know, would like to have a Women’s Health Physiotherapy assessment with Evie or Anna at Dorking or Leatherhead, book online here or contact us here.
Blog post guest written by Evie Spreadbury, Women’s Health Specialist Physiotherapist, member of Pelvic, Obstetric & Gynacological Physiotherapists (POGP), Dorking, & Leatherhead Clinics.
References:
Benjamin, D. R., et al. (2019). “Diastasis recti: Mechanisms, assessment, and management.” Journal of Women’s Health Physical Therapy, 43(4), 10–15.
Bø, K., et al. (2017). “Pelvic floor muscle training in prevention and treatment.” Obstetrics and Gynecology Clinics, 44(3), 489–508.
Bo, K., et al. (2017). “Postpartum exercise guidelines.” Obstetrics and Gynecology Clinics, 44(3), 503–517.
Chiarello, C., et al. (2019). “Postpartum recovery: Physical therapy interventions.” Journal of Women’s Health Physical Therapy, 43(3), 121-127.
Davenport, M. H., et al. (2019). “Exercise guidelines for postpartum women.” British Journal of Sports Medicine, 53(2), 100–107.
Dufour, S., et al. (2021). “Postpartum abdominal recovery.” International Journal of Pelvic Floor Dysfunction, 27(2), 103–110.
Hay-Smith, E. J. C., et al. (2019). “Pelvic floor muscle training for urinary incontinence in women.” Cochrane Database of Systematic Reviews, (1).
Keeler, J., et al. (2022). “Core rehabilitation for postpartum recovery.” Physical Therapy in Women’s Health, 46(3), 215–223.
Smith, M. D., et al. (2020). “Post-cesarean section recovery and physiotherapy interventions.” Physical Therapy Reviews, 25(4), 258-265.
Thakar, R., & Sultan, A. H. (2021). Perineal Trauma and Postpartum Recovery. Best Practice & Research Clinical Obstetrics & Gynaecology, 36(2), 1-10. doi:10.1016/j.bpobgyn.2021.01.004
Van der Waal, J. M., et al. (2020). “Postpartum pelvic floor rehabilitation.” International Urogynecology Journal, 31(6), 1037–1045.
Van der Waal, J. M., et al. (2020). “Postpartum rehabilitation: A guide.” International Urogynecology Journal, 31(6), 1037–1045.
