Postnatal Physiotherapy – What is it and how can it help?
Written by Casey Trevenna, Women’s Health Physiotherapist – Whittlesea Physiotherapy & Clinical Pilates
Postnatal (or postpartum) physiotherapy is a branch of women’s health that focuses specifically on building strength and promoting healing in the first year after the birth of a new baby.
Each program is individual, based on the needs of the client, but common areas of concern include returning to normal activity safely, managing any pain or scar tissue healing (including caesarean and perineal tear/episiotomy scars), pelvic floor muscle weakness, and abdominal muscle separation. It is also common in the postnatal period to develop pain in the back and hands due to the demands of looking after a new baby.
Let’s take a look at each area in depth to see details of what a physiotherapy assessment and treatment may involve:
Return to exercise
- Generally, it is recommended to keep exercise very light and build gradually over the first 12 weeks postnatally. Running, lifting heavy weights, and jumping activities should be minimised until this time.
- If you’re experiencing any concerns regarding the function of your pelvic floor, core or back muscles, or are experiencing any leaking or pain, it is strongly recommended to get these “on track” before progressing beyond walking and light weights.
- Even when everything’s feeling good, it can be helpful to have a physiotherapy check around the 6-to-12-week mark. This is to ensure that the abdominal separation is in the process of closing, the pelvic floor muscles are building a good level of strength and endurance, and the rest of the body can cope with increased exercise load while hormones levels and sleep are still variable.
- Some women find that returning to exercise to early or too fast can contribute to the development or worsening of pelvic floor, abdominal muscle, or pain problems.
- As physiotherapist, we can write tailored rehab/prehab programs to help you get back to your specific sport – e.g. building up the leg muscles for jumping in netball.
pain
- Within the first 6 weeks, it is normal to have manageable levels of pain around the birth site – i.e. perineal, abdominal, or both depending on the mode of delivery.
- Beyond this time, pain levels really should be quite low and going away. In addition to a GP check, it is worthwhile seeing a physio to ensure there is no stiffness around any scars, the muscles are working well, and the nerve are healing properly.
- Depending on the cause of the pain, treatment might include massage on hands on therapy, deep breathing and relaxation, and/or exercise.
Pelvic floor muscle dysfunction
- This refers to when the pelvic floor muscles – that sit at the base of the pelvis and work to support the function of the bladder, bowel, and vagina, aren’t working as well as they should. This can lead to common problems like leaking (urine, stool, or wind), or the sensation that something is heavy or bulging (prolapse).
- While common, these concerns are not something you have to put up with or “just the way it is”. A pelvic floor physio can assess exactly what’s contributing to the problem and give you a pathway to recovering – specific exercise, lifestyle modifications, and extra supports as needed.
- While having a C-section can protect the pelvic floor from the most intense strain, the reality is these muscles have helped carry a baby around for the last 9 months, and undergone the same hormonal changes as the rest of the body. In addition, the pelvic floor muscles have strong connections to the deep abdominal muscles – the same ones cut through in a C-Section. But just as injury to one can impair the other, and effective rehabilitation for one can help overall recovery for the other too.
Abdominal muscle separation
- Some degree of abdominal muscle separation is needed to allow baby to fit inside the abdomen. The amount that these muscles “come back together” depends on how far the connective tissue in the middle has stretched, and how the muscles are supported in their recovery. Some will experience near complete return of the muscles in 8 weeks to 6 months, but recovery can continue for 2 years or more.
- Generally, we hope to see the muscles come together within 2cm, however more important than the exact distance is the function of the muscles – is there a noticeable, floppy gap in the middle that bulges when we engage our or, or does it stay taut and strong, even if it is a little wider? A women’s health physiotherapist can assess this accurately and help you find the right level of exercise to encourage muscle recovery.
- Some people feel that strengthening the core also helps improve upper or lower back pain, while many can find it helps with any leaking or pelvic floor dysfunctions as mentioned above.
Other common conditions postnatally include carpal tunnel syndrome, De Quervain’s tenosynovitis, lumbar or thoracic back pain, shoulder pain, and mastitis. Through a combination of hands-on therapy (e.g. massage, dry needling), exercise, lifestyle management, and bracing/external supports, a post-partum physio check can help with these too.
There’s no need to suffer and wait (hope) for things to get better on their own, a women’s/pelvic health physio can help get you moving and pain free sooner.
You do not need a referral to see a physiotherapist. We can help clarify what is going on, provide hands-on support, and work with your GP or specialist as part of your care team.
Call us on 03 9716 2250, book online at www.whittlesea.physio, or come and see us at 73 Church Street, Whittlesea.
Open Monday to Saturday: we are here to help.
Whittlesea Physiotherapy & Clinical Pilates has been serving the Whittlesea community since 2005. Our experienced physiotherapy team provides evidence-based assessment and treatment for tendon conditions, sports injuries, and musculoskeletal pain across all ages and activity levels.
This blog is intended as general health information only. It does not replace individualised professional advice. Please consult a qualified physiotherapist for assessment and management of your specific condition.