After the Baby - Rehab for Moms

Low back, pelvic and hip pain, bladder incontinence and uterine prolapse are some of the common short and long term problems facing women following pregnancy and childbirth. However, these conditions can be prevented or at the very least improved with specific exercise to rehabilitate the damaged core (or trunk) muscles.

What are the core muscles? They are comprised of four muscle groups which work together to support and stabilize the low back and pelvis. If you imagine your trunk as a flexible barrel, the transversus abdominus muscle (one of the abdominal muscles) is the front of the barrel. The multifidus muscles along the spine and sacrum are the back of the barrel. The pelvic floor muscles support the bottom of the barrel and the diaphragm is on the top of the barrel.

After nine months of pregnancy followed by labour and delivery, a woman's body, particularly the core muscles, has had quite a workout. During pregnancy the additional weight that a woman carries in front of her creates postural changes which result in compensatory strategies for stabilizing the low back and pelvis.

The transversus abdominus muscle becomes very stretched reducing its ability to stabilize the low back and pelvis. If you have a Caesarian section there is further weakening of the front of the core. The pelvic floor muscles also become stretched due to the increasing weight of the uterus, further decreasing effective stabilization. The pelvic floor muscles are stretched even more and sometimes torn or cut (episiotomy) during childbirth. To compensate for less support from the transversus abdominus and the pelvic floor muscles, the multifidus muscles (in the back) can become tight as it is overused as a stabilizer. However, the multifidus muscles can also become weak and atrophied (smaller) if the sacroiliac joints are strained during childbirth.

After delivery the body usually needs about eight weeks (twelve if you've had a Caesarian section) to recover before the new mother can resume exercising and begin to rehabilitate the core muscles. In order to avoid chronic low back or pelvic pain and to avoid bladder incontinence and uterine prolapse in the future, it is essential that a new mother perform specific exercises to;

• Isolate and strengthen the deep abdominal muscles (flatter bellies);
• Retrain the stretched pelvic floor muscles (kegels aren't enough);
• Stretch or strengthen the multifidus muscles (back); and
• Re-educate correct stabilization strategies

A more stable core will prepare a new mother to resume other exercise or sport activities. It will also make it easier for her to lift and carry her baby properly.

A new mother need not have low back or pelvic pain to benefit from core strengthening. In fact, she need not even be a new mom. Women can benefit from core stabilization exercises even years after having children to reduce the risk of developing back or pelvic pain, bladder incontinence or uterine prolapse.

For those women with postpartum low back or pelvic pain, a thorough assessment by a physiotherapist will determine if you require core strengthening as well as other physiotherapy interventions.