Prenatal Massage Denver & Postpartum: Exercise for Before & After

The American College of Obstetricians and Gynecologists states that “pre-pregnancy exercise routines should be resumed gradually, based on a woman’s physical capability.” Dr. John Clapp, in his book, “Exercising Through Your Pregnancy,” states that after extensive research, he now recommends that any new mom start exercising early and increase the level and amount gradually, avoiding any pain or heavy bleeding.

Once you have received the consent of your physician/healthcare professional, it is highly recommended that you begin working on your core musculature to offset the effects that pregnancy has on your posture, childbirth has on your pelvic floor musculature, and the overall effects on your basic center of gravity. The core musculature consists of the Transversus Abdominus, the Multifidus, the Diaphragm and the Pelvic Floor muscles. Your transversus abdominus muscle lies inferior to your belly button deep to your rectus abdominus, or 6 pack abdominals. Your multifidus lie segmentally along your spine and coordinate with your Tranversus abdominus to support your low back and pelvis. Your diaphragm sits under your lungs along the rib cage and your pelvic floor supports your pelvis, sitting as a bowl to attach your sacrum and pubic bones, as well as to support your sphincter.

This entire area serves as your core musculature to work synergistically to provide support and stability for the lumbar spine and pelvis. Please keep in mind that it is important to not jump out of the gates by resuming sit ups and leg lifts. Instead, we recommend first working on the deep core muscles (as described above) to provide proper coordination and support for your low back and pelvis. As this area improves in function, then resumption of higher level activity will be appropriate.

All of the following exercises are appropriate whether you give birth vaginally or via cesarean section. Of course, ensure you get approval from your physician before resuming any exercise program:

Phase 1 program

(24 hours after giving birth to four weeks postpartum):
 

Diaphragmatic breathing:

  • Lie on your back in neutral spine position with hands resting on your lower rib cage.
  • Relax jaw, place tongue on roof of mouth, and slightly separate teeth.
  • Inhale through the nose, flaring the rib cage and drawing the air into the lowest lobes of your lungs.
  • Exhale through your mouth, funneling the rib cage, hollow the belly and feel the depths of your lungs empty.
  • Repeat for 30-60 seconds, up to five times a day to help with relaxation.
     

Pelvic floor activation, better known as kegels:

  • Lie on your back, with knees bent and feet hip width apart (we recommend your pelvis be elevated up on 1-2 pillows to allow gravity to help you contract).
  • Relax and take a deep diaphragmatic breath.
  • As you exhale, draw your pelvic floor up and in, and tighten your anal sphincter as if performing an anal "wink.” Attempt to hold this contraction for up to 10 seconds.
  • Gradually relax the pelvic floor muscles for 10 seconds.
  • Repeat up to 10 times, up to five times daily, in multiple postures, including hooklying, sitting and standing.
  • Goal: 30-80 repititions per day, 10 times 10-second holds, with functional activity.


Transversus abdominus contraction exercise:

  • Lie on your back with knees bent and feet shoulder-width apart.
  • Maintain a neutral spine (don’t let your back arch too much or let it press into the table) and breathe in through your nose.
  • Exhale, pulling your belly button toward your spine, as if you are pulling a corset tight against your lower abdominals.
  • Relax your abdomen as you inhale, feeling your ribcage expand.
  • Repeat up to 10 times, up to five times daily, in multiple postures, including hooklying, sitting and standing.

 

Multifidus exercise:

  • Lie on your back with your knees bent, feet shoulder-width apart.
  • Maintain neutral spine by gently drawing the lower abdomen toward the spine.
  • Swell the lower back muscles on each side of the spine by imagining that you're moving your tailbone and lumbar spine together. Contraction of multifidus should occur without physical motion of extraneous muscle groups, while maintaining your abdominal contraction. Hold up to 10 seconds.
  • Repeat up to 10 times, up to five times daily.

 

Pelvic tilting exercise:

  • Lie on your back, knees bent, feet shoulder-width apart.
  • Inhale gently and then exhale. Gently draw your belly button toward your spine, then squeeze your two sit-bones together and flatten your back. Hold 10 seconds.
  • Repeat up to 10 times, up to three times daily.

 

Gentle articulated bridging:

  • Lie on your back with knees bent, feet shoulder-width apart.
  • Inhale gently and then exhale, gently drawing your belly button toward yourspine, first rocking back into a pelvic tilt.
  • Keeping your abdominal muscles engaged as well as your buttock muscles, begin to lift your tailbone off the floor, one vertebrae at a time. Think of a strand of pearls being lifted off a table.
  • Hold at the top before hyperextending the back. Inhale and exhale, then roll gently back to starting position.
  • Repeat up to 15 times, up to three times daily.

 

Special tips for incontinence:

1. Postpartum bladder fitness goals:

  • Urinate every 3-4 hours – remember this is a goal and may take time to achieve.
  • Aim to urinate seven times in every 24 hours.
  • Avoid constipation.
  • Increase kegels and goal of orgasm — once per day (try to urinate before and after sex)
  • Avoid “just in case” urination.
  • Sit down when you feel an urge-to-urinate wave.
  • Avoid bladder irritants.


2. Bladder irritants:

  • Alcoholic beverages
  • Carbonated beverages
  • Caffeinated beverages, including coffee and tea
  • Milk and milk products
  • Citrus fruits and juices
  • Tomatoes
  • Spiced foods
  • Sweets
  • Artificial sweeteners
  • Chocolate

Foods that do not contribute to bladder irritation include grapes, apples, cranberries, plums and prunes.


3. Output recommendations:

  • Urinate for 8 seconds, drink lots of water, and try not to strain when urinating.
  • Goal: Urinate every 3-4 hours. Achieving this may take time.
  • Focus on relaxing when you feel a sense of urgency to urinate.
  • Sit when you use the toilet.


4. Exercise recommendations and biofeedback tools for exercise performance:

  • Elevate your hips on pillows when you perform your kegels. Gravity will assist you in contracting the pelvic muscles .
  • Use a mirror to see yourself when you are doing your kegels. Visualize a good contraction and an anal "wink."
  • If, after following this program, you still suffer from incontinence, low-back pain or pelvic irritation at your six-week postpartum appointment, let your doctor know.
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