Sometimes I see clients who feel awful postpartum. They are leaking urine, have pain in their sacroiliac joints and/or pubic symphysis, and have a large and deep separation in their abdominal muscles. These clients know that they need my help. They can feel it in they abdomen, back, and pelvic floor. These clients contact me, start feeling better right away, and no one could convince them to stop seeing me for weeks. They had symptoms and as those symptoms improve they feel better and can feel the improvement in their abdomen, back, and pelvic floor.

Other clients just know that something is “off”. They feel weak getting off the couch, taking care of their baby, or playing this their older kids. A lot of these clients need a little educating on why they need me. They miss moving and exercising. They miss working with their trainer or taking their favorite exercise class and they don’t feel the familiar fatigue and post workout soreness after our sessions. These clients sometimes feel like physical therapy is just holding them back. I get it, I love to move and exercise as much as the next person, but physical therapy (especially early on) is not about feeling the burn and getting a great workout in.

Physical therapy early postpartum is about setting yourself up for success in the future by getting a really solid base by reeducating your brain and muscles to communicate more effectively and efficiently. Some of the skills and awarenesses that I want to see prior to exercising with a trainer or participating in higher level exercise classes are:

• Awareness of your pelvic floor - you have to know where your pelvic floor is, whether your pelvic floor is contracting and clenched or relaxed, how to contract your pelvic floor, and how to relax your pelvic floor

• Being able to to contract your pelvic floor and abdomen against increases in intraabdominal pressure

• Knowing what it feels like when you are not managing intraabdominal pressure well so you know when an exercise or movement is too much

• Understanding how to tell when you are clenching your gluts or pelvic floor so that you can stop yourself from clenching

• Being able to maintain contraction of abdominal muscles and pelvic floor for stability while inhaling and exhaling with a healthy breathing pattern

• Successfully reeducating your body to have a consistent and effective unconscious engagement of your pelvic floor and abdominal muscles

It takes time to rehabilitate your body postpartum. Time to reeducate your body and if you do exercises that feel challenging too early then you will be reinforcing the poor habits and compensations that your body has developed. By taking the time to reeducate your body now you ensure that you do not develop low back pain, urinary incontinence, coccyx pain, pain with sex, hip pain, constipation, hemorrhoids, prolapse, sacroiliac joint pain, or any other symptom indicative of poor postpartum movement and muscle activation patterns. In the long run, it is worth it to build the foundation so that you can enjoy the training sessions, classes, and workouts you love once again.