The Physical Side of Postpartum Recovery

Every postpartum woman should understand how to engage the muscles, how the pelvic floor can work properly with a proper neutral spine, and some of the posture changes that often occur during pregnancy and the impact that has on the body.

By Dr. Holly Durney, PT, OCS

Video Transcript:

Hi, everyone. I’m Dr. Holly Durney. And I’m a physical therapist specializing in women’s rehabilitation postpartum, as well as pelvic floor rehab. I have a strong background in orthopedics, which means I see a lot of neck pain, back pain, knee pain, ankle sprains, you name it. But my real love and my passion is to help women reclaim their bodies postpartum.


In my opinion, pregnancy is as much of a trauma to the body as the ankle sprains or the back pain that I see walking through my doors and orthopedic physical therapist. The stress on the ligaments, the stretching of the muscles, the changes in the posture, and in the spine, it’s as much of a trauma as I would see, again with a back strain or something that is unrelated to pregnancy. So, I hope by making this video, teaching you a little bit about what happens to your body and helping you understand that pregnancy is a trauma and an injury to the body that should be treated with love, care and rehabilitation, that I can empower you to reclaim some of what you feel like was missing postpartum to help the muscles fire again, and also to prevent any sort of injury down the line.


As much as I would love to work with any one of you. The last thing I want is for you to have a back strain, or to have incontinence issues or sacral pain because you did not rehabilitate the muscles as you should postpartum. So my goal today is to teach you briefly how to engage the muscles, show you how the pelvic floor can work properly when you find a proper neutral spine, and to help you understand some of the posture changes that do occur during pregnancy.

While the baby is present, the spine moves further and further forward and the center of gravity changes. After delivery when there's no baby there anymore, the spine does not automatically just go back to where it was before. This requires some rehabilitation and some muscle re-education.

So to start, I’m going to demonstrate what happens during pregnancy and then I’m going to go straight into an exercise that is a great initial exercise that I work on with most of my postpartum patients from day one to help them understand how to find their pelvic floor and how to fire the abdominals again.


In this position, I’m going to show you what occurs to the spine, something called a lordosis. A lordosis means an arching of the spine into this direction. While the baby is present, the spine moves further and further forward and the center of gravity changes. After delivery when there’s no baby there anymore, the spine does not automatically just go back to where it was before. This requires some rehabilitation and some muscle re-education.


So one of the first exercises that I teach my patients is something called a pelvic tilt. This is an anterior pelvic tilt, increasing the lordosis or the arching of the spine and stretching, expanding the abdominals and expanding the rib cage. In order to undo this you will do something called a posterior pelvic tilt. That is where you tuck the tailbone, scoop the abdominals and soften the rib cage. You’re going to inhale and then exhale and posterior pelvic tilt, force the air out. As you force the air out like you’re blowing up a balloon, you’ll feel your abdominals kick in, and you should feel your pelvic floor lift. If you feel your pelvic floor descend, this could potentially be why you have some issues like postpartum incontinence, which is urinary leakage with coughing and sneezing. So again, this is lordosis. And this is a posterior pelvic tilt, engaging the abdominals, exhaling the air and engaging the front of the body.


This exercise can be performed in this kneeling position. It can be performed on your hands and knees. Here’s a posterior pelvic tilt, and an anterior pelvic tilt. You also can perform it in sitting, as well as in standing whatever works with your day knowing that you’ve got a busy day as well as children potentially running around. So my advice is to figure out what position your body is in, use a mirror, look at yourself from the side, see how much lordosis that you have in your spine. And then practice the pelvic tilt. Use the breath, again exhaling, like you’re blowing out through a balloon in order to engage the pelvic floor. Pay attention to what happens when you blow out through that balloon. Does your pelvic floor lift? Or do you feel a little bit of leakage or bearing down? Again, just understanding what happens there your pelvic floor should lift up and in. If you feel that lift, then you’re good to go. If you feel it descending, sometimes all it takes is just understanding that your pelvic floor should be lifting and not descending. So my advice again is to use a mirror. Try to practice this up to 10 repetitions or do as many as you want. But try once a day for a week or two and see if you can help your body understand where those muscles are again.


I encourage women not to attempt this until they’re about six weeks postpartum and the healing has occurred. Again remember, pregnancy is a trauma to the body. So you want to allow some healing to occur before you increase your demand on your body. I hope that this video has helped please feel free to reach out to me with any comments or concerns. And I really hope that this gives you the leg up that you need to reclaim your body and to get back to exercise. Thanks!

Dr. Durney is an APTA Orthopedic Certified Specialist and has pelvic floor rehabilitation training from the Herman and Wallace Pelvic Rehabilitation Institute. Her pelvic health training focuses on treating pelvic floor dysfunction and related issues in the pelvis, hip, and spine. Her pelvic floor treatments involve assessment including movement patterns, ligament structure, current activity level, and pregnancy history. Holly has continued to advance her manual skills with a certification in dry needling through Kinetacore and additional courses through the Maitland and McKenzie Institutes. She also is a certified Kinesiotaping practitioner with additional training in the treatment of TMD and cervicogenic headaches through the use of craniosacral therapy and upper cervical manual techniques. She practices at Smart Athlete Physiotherapy in Raleigh, NC.

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