Hunter Bennett

Childbirth is an incredible thing. It does come with an associated cost (albeit a small one in the grand scheme of things). Namely the fact that the muscles of your core see a huge decline in strength and function.

In the short term, this can result in chronic lower back pain, as the muscle of the trunk no longer provides you with any real support. If left unchecked, this can lead to more chronic muscular dysfunction. Working on your core strength helps to prevent long-term pain.

All of which can become a rather problematic day to day, while also inhibiting your ability to return to exercise in a rather big way.

Which is exactly where postnatal exercises enter the discussion.

What happens to the core during pregnancy?

Most people associate the word ‘core’ with visible the abdominal muscles that sit at the front of the trunk. However, it is important to note that in a functional sense, the core actually consists of all the muscles that encompass your midsection, including the muscles of your back, trunk, and hips.

And pregnancy wreaks absolute havoc with all of these areas.

During pregnancy, the abdominal muscles spend a prolonged period of time in a lengthened state. As a result, they become globally weak, in which the back muscles must then compensate to provide stability to the spine.

Over time, the muscles of the back then become short, tight, and chronically overworked.

And finally, to top it all off, the anatomical changes that occur at the hips (in which they become both wider and laxer) causes the muscle of the hips to become weak and dysfunctional.

And the result?

Your ability to create the intra-abdominal pressure required to stiffen the trunk, keep your torso erect, and stabilize the spine, becomes severely inhibited. This can obviously affect you day to day, while also making the return to normal exercises a serious challenge.

So, with all this in mind, rebuilding the muscles of the core as soon as humanly possible is imperative to maintaining your long-term health and function post pregnancy. It is also essential to getting you back into normal exercise as soon as possible without the risk of further injury.

But where do we start?

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Postnatal Core Exercises

There are a number of benefits of postnatal exercise (Tseng, 2015) – but one of the most important is stimulating the return of normal core function.

And the first component of this is re-developing the ability to stabiles the spine.

As a result, isometric exercises are going make up the bulk of your training for the first couple of months after childbirth. These exercises are safe and effective and provide the perfect method of retraining the capacity to stabilize the trunk and resist movement functionally.

Additionally, these same exercises also provide the perfect entry-level stimulus to increase the strength of your entire mid-section (Mordved, 1996).

The following exercises are perfect examples of key isometric core exercises that can be implemented almost immediately after childbirth. They each offer an excellent method of training the trunk and have research supporting their ability to activate the core musculature to a very large degree (Maeo, 2013; Escamilla, 2016).

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Abdominal Bracing

We are certainly starting simple with this exercise, in which the sole focus is to retrain the body’s ability to brace the trunk in its entirety.

Begin by lying on the floor, flat on your back. Brace your abdominals by contracting your entire stomach as hard as possible (imagine you are about to get punched in the stomach). Hold this brace for 5-10 seconds and then relax.

Pelvic Tilts

Start by lying flat on your back with your knees bent to 90 degrees and the heels of your feet flat on the floor. Proceed to brace your abdominals and tilt your pelvis in a posterior direction by pressing your lower back into the floor. Hold this position for 5-10 seconds with an active abdominal brace, then relax.

Bird Dog

Our next exercise begins to challenge the muscles of the trunk in a more global manner, while also integrating the action of the hip extensors and abductors (with specific emphasis on gluteus maximus and medius).

Begin this exercise on all fours with your hands directly under your shoulders and your knees directly under your hips. Using the above methods, forcefully brace your abdominals, and keep your back and pelvis as still and as stable as possible.

From this position, reach one arm out in front of you, while simultaneously driving the opposite leg out directly behind you. Don’t allow your pelvis or trunk rotate or rock, and focus on not letting your rib cage sag toward the floor. This movement should be slow and controlled.

Return to the starting position. Repeat on the other side to complete one rep. Do five to 10 reps per side.

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RKC Plank

At first glance, the RKC plank looks a whole lot like a normal plank. The slight changes within this variation increase trunk activity and enhance glute involvement, providing you with much more bang for your buck.

Start by getting into a normal plank position, but with your hips elevated slightly more than normal. Proceed to clench your hands together in front of you as hard as you can, while actively dragging your elbows towards your knees (your elbows won’t actually move, you are just creating tension). And finally, squeeze your glutes as hard as you possibly can.

Hold this for 5-10 seconds, then relax.

Side Plank

Our final exercise is a plank variation that targets the hip abductors and the obliques.

Start by lying on your side with your elbow directly under your shoulder. Your head, trunk, hips, knees, and feet should all be in a straight line. Proceed to brace your core and lift your hips off of the floor.

Hold this position for 10-20 seconds, then repeat on the other side. While your hips are elevated, you should be working hard to stay as stable as possible.

Putting It All Together

Now although these post-natal ab exercises should be safe in most scenarios, they do need to be progressed slowly. With this in mind, we have provided an example program that can be followed after birth.

This program has been designed so that it can be completed 2-4 times per week, as long as you have around 24 hours rest between sessions.

It is important to note that these progressions are simply guidelines, and you should not progress to more demanding exercises if you do not feel comfortable to do so.

Take your time and make sure you master each variation before moving onto the next stage.

A Note on Postnatal Exercise After C Sections

Now, you might be wondering whether there are suitable postnatal exercises after C-section. The above exercises are extremely beneficial no matter how you gave birth.

However, a C-section is a fairly serious surgery. We want to do everything we can to avoid damaging the surgical wound in any capacity. This means that you may need to take a little bit more time before starting the above exercises. You want to ensure that the wound has healed completely before commencing.

But once the healing is done, you should be perfectly fine to get straight into it.

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What About Those Who Suffer Prolapse During Child Birth?

Approximately 50% of women will suffer some degree of Pelvic Organ Prolapse (or POP) after pregnancy and the resulting childbirth (Olsen et al., 1997).

POP describes when one or more of the pelvic organs have begun to lose their position in the pelvis and drop downwards. This typically happens when there is either weakness or damage to the pelvic floor, in which a decline in strength is observed.

While POP is relatively common after childbirth, it comes in five distinct grades that describe its severity. As a result, the associated symptoms can differ from none whatsoever to severe discomfort.

The grades:

• Grade 0 (no prolapse at all)
• Grade 1
• Grade 2
• Grade 3
• Grade 4 (the prolapsed organ is bulging out of the vagina)

With grade 2, 3, and 4 POP you may experience urinary incontinence, difficulty with bowel movements, a feeling of heaviness in your pelvic floor.

Now, the first thing to state is that you certainly can still exercise with POP, although certain considerations are required.

First and foremost, it is essential that you limit the amount of impact to the body during exercise. With this, you should also avoid movements that cause large increases in intra-abdominal pressure. Running, jumping, sprinting, and heavy strength training is out of the question until your POP is almost completely healed.

While this can be quite disheartening for those of you who love HIIT and heavy weight training, it is imperative to ensure that you don’t make your current POP any worse.

Now, the exercises that you should be doing in this specific scenario are those that strengthen the core and support pelvic stability in a safe and effective manner.

However, they need to be progressed slowly.

In this instance, your first few weeks of training should actually consist of diaphragmatic breathing exercises. Combine this with gentle abdominal bracing (Sapsford, 2004). These exercises work as a way to retrain the pelvic floor muscles to work normally. Once you’ve accomplished this you can move into the more demanding abdominal exercises programmed above.

Conclusion

Postnatal core exercises are essential to restoring the strength of your abdominals. Improving your core strength will increase your ability to stabilize the spine during movement.

By taking the time to appropriately integrate these exercises into your routine, you will not only stave off that pain and dysfunction that often comes post-childbirth but also prepare yourself to recommence your pre-pregnancy exercise routine in a safe and effective manner.

References

Tseng, Pei-Ching, et al. “A systematic review of randomized controlled trials on the effectiveness of exercise programs on Lumbo Pelvic Pain among postnatal women.”.  BMC pregnancy and childbirth 15.1 (2015): 316.

Mordved, Siv, and Kari Bo. “The effect of post‐natal exercises to strengthen the pelvic floor muscles.” Acta obstetricia et gynecologica Scandinavica 75.4 (1996): 382-385.

Maeo, Sumiaki, et al. “Trunk muscle activities during abdominal bracing: comparison among muscles and exercises.” Journal of sports science & medicine 12.3 (2013): 467.

Escamilla, Rafael F., et al. “Muscle activation among supine, prone, and side position exercises with and without a Swiss ball.” Sports health 8.4 (2016): 372-379.

Olsen, Ambre L., et al. “Epidemiology of Surgically Managed Pelvic-Organ Prolapse and Urinary Incontinence.” Obstetrics and gynecology 89.4 (1997): 501-506.

Sapsford, Ruth. “Rehabilitation of pelvic floor muscles utilizing trunk stabilization.” Manual therapy 9.1 (2004): 3-12.