Postpartum Posture: Nicki Philips, Pilates and Fitness specialist

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13th January 2020

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POSTPARTUM POSTURE

At the risk of making the understatement of the year, pregnancy followed by giving birth, is no walk in the park! Once our beautiful bundle of joy has arrived, we often assume that our bodies will snap back into shape with no problem.  For some lucky ladies, they may pop back into their pre-pregnancy clothes relatively quickly, however, we all go through huge physiological changes during pregnancy & there is no escape from the effects it has on our postpartum body, whether we can see it or not.

OUR AMAZING BODY:

If we take a moment to understand just a few of the changes that occur during pregnancy, it’s no wonder we don’t go through pregnancy unscathed. Our bodies are truly amazing – adapting and growing one, if not more, small humans at once.

Changes to our bodies during pregnancy stem from the growth of the uterus along with physical and hormonal changes that directly affect posture, ligaments & joints. Hormones such as Relaxin, cause laxity in the joints particularly the pelvis, which can lead to pelvic and lower back pain during and post pregnancy. As the bump size increases, the position of the pelvis alters and tilts to allow the baby space. This change in alignment puts more pressure through the low back.  General core strength will be compromised as the muscles stretch to allow space for the baby and the continued laxity means pelvic stability is challenged. Glutes tend to weaken, hip flexors tighten, pelvic floor strength is tested and diminishes – all of which leads to bad posture and alignment.

The above shows the postural changes during pregnancy.  It’s not surprising that almost 80 percent of women suffer with back pain throughout and after pregnancy. Much of that pain comes from this postural malalignment.

Cardiovascular and hormonal changes also affect our bodies. With an increase of blood volume during the first trimester, this has a direct effect on the cardiovascular system with an increase in blood pressure. Progesterone helps the arteries to expand to allow for the additional blood, resulting in a decrease in blood pressure within the first trimester. This can make mums to be feel slightly lightheaded or breathless. The growing bump then reduces lung capacity as you move into the second and third trimester, leaving mums feeling breathless and puffed out.

Hormonal changes in women are variable throughout pregnancy. However, during the first trimester an increase in Oestrogen, Progesterone and the hormone Relaxin plays a role in the mechanics of movement, as it provides greater ligament laxity in the pelvis and on the joints. Ligament strength decreases, and mobility increases in joints, causing joints to be prone to instability. This can cause pelvic, back and joint pain throughout pregnancy.

POST PREGNANCY CHANGES

After going through the physical challenge of childbirth, our bodies then have to deal with a variety of, often-unspoken, post-birth realities:

  • Your uterus is still swollen, your organs are still disarranged, and your skin is still stretched with possible stretch marks.
  • You bleed. This can continue for 2-8 weeks.
  • Your breasts will more than likely get larger and painful!
  • Any increased weight won’t just disappear overnight!
  • Your feet may have grown. Due to the increase weight during pregnancy (about 25-35lbs) the arch of the foot is flattened, widening the foot.
  • Bladder weakness and incontinence is common. This can affect everyone whether you have had a c-section or vaginal birth.

With all of the above and more happening, of course our bodies are going to have changed.

In addition to the effects of pregnancy and birth, postpartum our bodies have to then cope with motherhood, hunching over to breastfeed, carrying ever-growing babies/toddlers on shoulders/hips, weakened abdominal & pelvic floor muscles and postural alignment concerns. It’s no wonder most women soon develop, slumped shoulders, tucked under tailbones, saggy bottoms and an overly forward head & neck – all known as a postpartum posture.

POSTURE
We all may recognise the image on the left below. Whist having perfect posture may not be sustainable all of the time, the postpartum body tends to suffer from malalignment more than others.

Vanity aside, this type of posture can leave us with excruciating neck pain, pelvic instability and pain, headaches and a general sapping of energy. When it comes to postpartum posture, some of most important areas to focus on are lengthening out short, tight muscles in the front of the body, working the posterior chain (back of the body) to strengthen the glutes and back muscles, retraining the pelvic floor & core and addressing any abdominal separation (diastasis). All of which will help realign the body.

This may all sound incredibly daunting and even more so when you have recently given birth. As a pre & postnatal specialist I look to reassure new mums.

EXERCISES TO SUPPORT THE POSTPARTUM BODY:

Initially, exercises that help the body move more freely, whilst strengthening are key.  Mobilisation can help open tight chests, hip flexors and backs, making you feel reinvigorated and more able to cope.

Starting slowly is also essential. The work you do now are the foundations to your recovering body.  Rushing back to high impact or heavy weighted exercises should be avoided until muscle memory and strength has returned to the pelvic floor, glutes & deep core muscles which will help a safe return to fitness.

THINGS TO WATCH OUT FOR:

Often the postpartum body has a few alignment or muscular issues (such as Diastasis Recti) that need particular attention.  If you are feeling increasingly uncomfortable, make sure you listen to your body and get seen by a practitioner, so you can get the correct treatment.

Pelvic Girdle Pain can often be the result of Symphysis Pubis Dysfunction (SPD). Simply put, this is where the front of the pelvis can slip or move causing sharp pains in the pubic area or groin. This is an unpleasant side effect of pregnancy and childbirth that can continue into postpartum life until pelvic stability improves, hormonal changes stabilise and the correct treatment is given.

A pelvic belt can be used to help support the pelvis but appropriate rehabilitative exercises are essential. Almost all women with SPD will find parting their legs causes pain. So, exercises should be small, controlled and symmetrical, focusing on pelvic awareness, connection and strengthening. Functional exercises (that help with sitting, lying down and walking) will help you learn how to manoeuvre comfortably in everyday situations until you recover.

Sacro-iliac (SI) Pain is another pelvic girdle issue which can present during and most certainly after pregnancy. The pelvis is made up of more than one large circular bone; it consists of paired hipbones, connected in front at the pubic symphysis and behind by the bottom of the spine (sacrum) each made up of three bones. During pregnancy, the soft tissues supporting the SI joint loosen due to increased levels of the hormones which puts abnormal wear and excessive stress on the SI joints. This change can cause low back pain, sciatic symptoms and can be felt whilst driving, walking and lifting.

Again, the good news is that it is treatable.  Side lying, asymmetrical rotation and exercises that mean parting the legs should all be avoided. Instead working the core and pelvic floor will help to support and stabilise the pelvis.

While we’re all understandably keen to get our ‘pre-baby’ body back, it is important to take it steady. Jumping back into old workouts can actually make postnatal problems worse and more serious. Instead, abdominal workouts should focus on ‘knitting’ muscles back together.

GETTING BACK TO FITNESS

Controlled mobility and strengthening are key when reintroducing yourself to exercise.  Building posterior chain strength (the back of your body – saggy bottoms, hamstrings, and weakened back muscles) is essential to regaining correct posture, along with your deep core stabilising muscles & pelvic floor. After 6/8 weeks postpartum (and once signed off by a doctor) these are great to practice aiding your body’s recovery, building foundations of strength, power & flexibility.

Core Breath: A fundamental part of exercising is the use of your core breath.  This is where the outbreath is used to connect the pelvic floor and abdominals prior to movement. This will create a connected place from which to move from, working the deep abdominal muscles (TVAs) rather than the superficial surface muscles. As you exhale, connect your pelvic floor from front to back.  Then think about your abdominal muscles wrapping around you as you lift your belly button up and inwards towards your spine. Your stomach will lift and visually reduce in size as you hold this connection.  On the inhale release and allow the tummy to rest.

Kneeling hip flexor stretch: Great for tight hip flexors which are often seen during and after pregnancy. Kneel on a mat and bring one foot forward placing your foot on the floor whilst kneeling on the back leg (in a lunge position). Keeping a soft tuck of the pelvis to lengthen the lower back as you shift your weight forward until you feel a lengthening in the front of the hip (in the back leg). Hold for 30-40 seconds, then repeat for your other side. Place the hands on the floor for extra support if necessary.  Avoid extending in the lower back.

Spine curls: This helps with mobilisation of the spine whilst strengthening glutes & hamstrings. Lie on your back, with your knees bent and legs in alignment with your hip joints. Inhale to prepare and on the exhale (connect your pelvic floor and your abdominals) initiate the exercise with a tilt of your pelvis & then lift your spine off the floor in a sequential movement until you feel weight at the bottom of the shoulder blades and across the upper back (avoiding the neck). Maintain the position ensuring the pelvis is in neutral with a slight tuck of the pelvis. Connect the inner thighs to stop the knees flaring outward. Avoid a high bridge. Roll back down initiating the move by softening the breastbone and then wheeling the spine one vertebrae down at a time followed by the pelvis. 2 sets of 5-6 reps

Squats: Stand with your legs slightly wider than hip width. Inhale to prepare and on your exhale sip up your pelvic floor from front to back and lower your bottom towards the floor hinging at the hips and keeping as upright as possible. Allow the arms to come in front of you. Aim to lower your bottom level with the bent knees, to challenge your core and mobilise your hip joints. On your next exhale drive back up through the heels, pelvic floor, core, glutes and legs. 2-3 sets of 10 reps

Cat: Starting in four-point kneeling. Lengthen your spine and pelvis into a neutral position. Inhale to prepare and on the exhale connect the pelvic floor and abdominals and initiate the exercise with a tilt of your pelvis sending your coccyx towards your heels. Flex the entire spine moving one vertebra at a time. Allow only a slight flexion in the mid and upper spine and finish the move with a gentle nod of the head. Maintain this position for a breath. On the next breath, lengthen the spine from the top and bottom at the same time back to the start position. 2-3 sets of 5-6 reps

REMEMBER:

Be kind to yourself.  Your body has been through a great amount of change and trauma.  Take your time to focus on your posture and not rush back into over doing it with traditional or high impact exercise, until your body has had a chance to heal and recover.

 


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