Physical Therapy for Postpartum Problems

“After having twins, I felt very weak,” Moore said.

That’s not unexpected, but she didn’t bounce back like she did after her first pregnancy three years ago. This time, there was hip pain, and then back problems started.

Moore enrolled in the Women’s Health Physical Therapy “Postpartum Strong — From the Inside Out” program after finding it on an Internet search for “pelvic rehab” and getting a recommendation from her obstetrician.

“There is so much conflicting information out there about what you should or shouldn’t do to get your body back,” Moore said. “My abdomen was not the same as it once was. I had had a diastasis, separation of the rectus abdominal muscles.”

Diastasis recti is not uncommon in pregnant women as the baby grows and the muscles stretch. It is more common with women carrying multiples, and it can take up to a year for the muscles to return to normal, if they ever do.

Some common abdominal strengthening exercises can actually make diastasis worse, said Cora T. Huitt, who created the Postpartum Strong program at her physical therapy practice in Chesterfield County to provide guidance to women before, during and after pregnancy.

Huitt answered questions about the Postpartum Strong program, which includes an assessment and therapy sessions focused on the pelvic area.

QUESTION: What is a posture picture?

ANSWER: We actually have a graph made of tape measures on the wall. We have them stand. We correct them by helping them engage their muscles correctly, especially the lower abdominals to help support the spine. It makes a world of difference.

Many women, after they’ve had their babies, for years continue to stand like they are pregnant even if they have lost half of their (baby) weight or all of their weight. As a result, muscle imbalance develops.

QUESTION: Is this sort of instruction a part of regular obstetrical or postpartum care?

ANSWER: In other countries … often the midwife will come for five visits — in France, every day after you have a baby. Then you’ll have 10 to 20 visits after that for education (about) the perineal area and the pelvic floor.

The reason that is done is to try to prevent the problems of incontinence, back pain, sexual dysfunction, because sometimes the muscles are too tense after you’ve had a baby or too loose, and then, also prolapse, that feeling of heaviness and the organs tend to descend until the pelvic floor muscles re-engage and can help support lifting the organs and pulling the pelvis together.

QUESTION: How does a woman know if she may benefit from help with recovery?

ANSWER: We try to ask the questions: When you laugh, sneeze or cough, do you leak (urine)? Are you having, are you interested at all even in, intercourse? Are you having discomfort down in your pelvis? Do you have a feeling of heaviness, of organ descent?

QUESTION: You mentioned that proper breathing is important. Explain.

ANSWER: As soon as you have the baby, you have this nice little baby to carry around. People hold their breath and, when they hold their breath, the diaphragm descends, and it puts more pressure on the pelvic floor. So it takes even more effort of the muscles — in strength as well as endurance — to be able to help support the structure.

We teach people to coordinate their breathing. When they do an exercise, they should really exhale. Or when they are picking up the baby, they should exhale.