POSTNATAL EXERCISES

Postnatal exercises are important for you to regain the strength of your abdominal muscles, after the birth of your baby as strong muscles help prevent lower back injury, prevent abdominal organs from " dropping forward" through lack of support and help you to regain a flat stomach. You can find your pelvic floor muscles by stopping and starting the flow of urine when you urinate. The squeezing that stops the flow of urine are the pelvic floor muscles contracting. Now try contracting and relaxing your Kegel muscles while sitting at your desk, driving in your car and watching television! Aim for a goal of 100 Kegels each day.

Almost ever women experience trouble bringing their abdomen back to its original tone and size after childbirth. Postnatal exercises, a combination of Kegel and abdominal exercises will work. This change in a most women's bodies is due to the laxity of the abdominal muscle wall. It is important to remember that your body has simply changed, and not necessarily for the worse. Post natal exercises can help your abdomen return to its original size.

The pelvic floor is a "sling" of muscles that supports your internal organs, e.g. your uterus, bladder and kidneys. To keep the pelvic floor (also called the Kegel muscles) strong, you need to exercise them.

Women commonly experience muscle and joint pain and post pregnancy pain the following are contributing factors:

• Weakness of the lower abdominal in both vaginal and cesarean deliveries.
• Long periods spent sitting while feeding the baby can contribute to tightness in the upper body.
• The presence of the hormone relaxin in the weeks post delivery and whilst breast feeding loosens ligaments which are then more vulnerable to sprains and strains.
• Unaccustomed lifting and bending over cots, car seats etc.
  

AIMS OF PHYSIOTHERAPY MANAGEMENT

• Electrotherapy for lower pelvic pain, perineal pain, musculoskeletal discomfort , pain arising due to circulatory problems and incontinence.
• Manual therapy for musculoskeletal dysfunction.
• The important ones are pelvic floor exercises, which you may start soon after delivery. These exercises reduce the possibility of lasting stress incontinence and help to alleviate lower pelvic pain . Besides they tone up the muscles of the vagina to make sexual intercourse more pleasurable.
• Abdominal exercises to improve muscle tone.
• Establishing Breast feeding.
• Advice with regard to everyday functional activities such as baby bathing, lifting or carrying, cot or pram heights etc.
• Posture correction and ergonomic advice.
• Relaxation exercises to reduce tension and maternal fatigue.
• Psychological counselling.
  

If your muscles are weak, concentrate on the regaining the strength by performing "Pelvic tilt" before trying anything harder.

1. Pelvic Tilt-: Lie on your back, knee bent up and feet flat on the floor. Place hands on your stomach so that you can feel the tightening muscles. Gently tighten your stomach muscles and push the arch of your back towards the floor. Squeeze your bottom tight. Hold the position till the count of 6, and then relax.

2. Elbow to Knee lifts-: Gently bring one knee and your opposite elbow together. Then bring your other elbow and knee together. Work up to 20 rep, altering sides.

3. Ab Crunch-: Lie on your back with your knees bent, feet on the floor and ankles pressing down on the floor. Hold your hands behind you head and then raise your head as you contract your stomach muscles. Breathe properly and work up to 10 rep.

4. Sit-Ups-: Lie on your back with your knee bent and hands alongside your head. Sit up and touch you knee. Swing your hands up into the air repeat at least 10 times.

5. Elbow to the Floor-: Sit on the floor, knee bent and hands together in the front. Slowly lean backwards, pressing each elbow towards the floor. Repeat 2 one each side, and gradually work back to your starting position. Repeat the whole sequence, working up to 10 repetitions.

6. Reach your toes-: Lie on the floor with your hands just above your shoulders and bend your hips so that your legs are vertical and crossed at your ankle. For a beginner, you can bend your legs at the knees.

7. Lift your head and shoulders off the floor, gently reach up towards your toes and return to the starting position. Work up to 12 repetitions.

8. Stomach Tightner-: Lie on the floor, knees bent and arms resting on your thighs. Lift up slowly, sliding your hands up your thighs towards your knees. Breathe out as you lift up. Work up to at least 12 repetitions.

9. Bi-cycling on Elbows-: Lie on your elbows and keep your lower back on the floor. Now tighten your stomach muscles and alternatively kick your legs out in front of you. Repeat 10 times on each leg.

10. Leg Stretch: Lie flat on the floor and hold your knees towards your chest. Place your hands just below your knee for support. Lift your other leg off the floor at 45 degree angle, pushing your lower back to the floor. You can leave your head on the floor or lift your head and shoulder off the floor, as your stomach muscles become stronger. Change legs. Repeat 10 times alternating legs.

11. Elbow to opposite knee-: Lie on your back, knee bent close to the chest, arms behind head and elbows touching the floor. Straighten right leg forward, slightly off the floor. Lift head, touch opposite elbow to left knee. Repeat on opposite side. Working up to 15 repetitions.

These are some of best post-natal exercises. As pregnancy and childbirth can weaken the pelvic floor muscles which support your bladder, it is important that you make Kegel a part of your workout routine. Postnatal exercises strengthens muscles that hold the bladder and many other organs in place.

PELVIC FLOOR MUSCLES

Its is important to start pelvic floor exercises or post pregnancy exercises with in 6 hours of the delivery to regain the strength of these stretched muscles as soon as possible. The contraction may be felt only around the anus. Encourage the mother to practice the contraction 4-5 times at frequent intervals throughout the day. The mother may be afraid to try because of the lochia (post-delivery discharge) or pain of stiches. Postnatal exercises will increase the circulation, promoting healing and removing inflammatory exudate which will in turn relieve pain because muscles have been stretched it is important to tighten and relax slowly. The number of contraction should be increased to 50 per day in small group of five at a time and linked to a daily activity, e.g. when washing hands, feeding baby. Interferential therapy is very useful in re-educating the pelvic floor muscles and lower pelvic pain reduction.

RELIEF OF PERINEAL PAIN

Sitting is more comfortable on a ring cushion or between folded pillow so that pressure on the perineum is relieved. Side-sitting od side lying may be tried for breast feeding prone lying with pillows under the lower legs and the abdomen to relive pressure on the breast may be restful. Ice may be applied as a pack for 4-5 minutes or as an ice cube wrapped in a wet swab moved gentle over the area for 2-3 minutes twice a day. Pulsed electromagnetic energy can be applied to the area at a low intensity for 5- 10 minutes to promote healing. Ultrasound may be applied under water with the mother in the bath because scar tissue around the vagina can be soften by the effects of the ultrasound.

STRENGTHENING THE ABDOMINAL MUSCLES 

Immediately after the birth, the muscles are slack, and intra-abdominal pressure is reduced. The women is concerned about 5 months pregnant. With the help of postnatal exercises ,Abdominal muscles may take 6 weeks to return to the pre- pregnant state. Diastasis of the rectus abdominis, women lies in crook lying with the lumber spine flattened and the head is lifted to produce an abdominal contraction. Strengthening exercises are: 

• Crook lying, Pelvic tilting.
• Crook lying, tighten the abdominal muscles, lift head and shoulder and lower slowly.
• Half crook lying, hip hitching on the side of the straight leg.
• To work the hip extensors which help to maintain the backward/ forward pelvic tilt.
• Prone lying, alternate leg raising and lowering.
• Prone lying, tighten the buttocks, hold for count 10 and rest.
• The abdominal muscles should be contracted released slowly at first and jerking must be avoided.

POSTNATAL PHYSIOTHERAPY FOLLOWING CESAREAN SECTION

First day postnatal exercises:

• Breathing exercises.
  
• Huffing with a pillow held over the wound.
• Foot and leg exercises are performed to assist circulation.
• Teach mother how to move about and to roll onto the side for getting in and out of bed.
• Feeding the baby in the bed- have a pillow under the thighs to prevent sliding down and an extra pillow under the knee on the side of feeding.

Second day postnatal exercises:

• Add pelvic floor exercises.
• Straight abdominal exercises.
• Pelvic tilting.
• Continue deep Breathing exercises.
• Standing, stretch tall, tighten buttocks.
• Walk tall to prevent backache.

Subsequent days:

• Progress postnatal exercises along the same lines as for the vaginal delivery.
• Stitches are generally out by 7 days.
• Abdominal contractions are very important to maintain mobility of the healing tissue as well as increasing circulation to promote healing.

AEROBIC EXERCISES

• Give yourself sufficient time to heal, particularly if you have had a caesarean birth.
• Consult with your doctor or midwife before starting any postnatal exercises – you may be advised to wait, or adapt your exercises.
• If you are having trouble with the techniques required in the above postnatal exercises, please consult a physiotherapist, exercise physiologist or other appropriately qualified and certified fitness professional.
• Aim for slow, gradual weight loss of around half a kilogram per week.
• Wear a supportive bra.
• Avoid any activities that place stress on the unstable pelvic floor and hip joints until strength and stability has improved. Be careful about activities that require sudden changes in direction (for example, high impact aerobics, running and contact sports). This varies depending on the type of pregnancy and delivery you may have had.
• Initially, perform postnatal exercises for only five to 10 minutes at a time. Increase the length of your workouts gradually.
• Ideally, your postnatal exercises session should eventually last between 30 and 50 minutes.
• Drink plenty of water before, during and after exercise.
• Don’t push yourself too hard – if you feel breathless, slow down.
• If you experience pain, slow down or stop postnatal exercises. Remember that it may take you months to return to your pre-pregnancy shape and weight, so don’t be discouraged by slow progress.

 Content created by Gaganika Kapoor

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