It’s estimated that 50-70 percent of women will suffer back or pelvic pain during pregnancy. Loosening of the ligaments due to hormonal changes, additional weight, and stretching of the abdominal muscles increases stress to the lumbar spine. If you’re lucky enough to sail through pregnancy without back pain, you’re not necessarily out of the woods. New moms need core strength to support their spines while they tote around that precious bundle of joy – a bundle that is getting heavier every day. We habitually carry our children on one side of our body due to upper body strength differences and hand preference. This asymmetrical force through the spine can also lead to back pain in the months after childbirth.
WHAT IS THE CORE AND WHY IS IT IMPORTANT?
The spine is supported by several groups of muscles called the core. These muscles working together act like a corset. Your core muscles include the diaphragm, paraspinals (or back muscles), gluteals, the abdominals and the pelvic floor. Towards the end of pregnancy, the growing baby is placing outward pressure on your diaphragm, pelvic floor and abdominal muscles limiting their ability to help protect the spine. This places increased stress on the paraspinals, forcing this muscle group to work harder to compensate for the other muscles which have become too stretched to function properly. It’s important to tone these muscles after baby arrives to protect your spine from injury.
Remember to consult your physician before beginning any exercise routine after childbirth. If you’ve had a C-section, your doctor will likely limit your activity until your incision heals.
THE PELVIS AND DIAPHRAM
In most cases, Kegels and breathing exercises to strengthen the pelvic floor and diaphragm can begin almost immediately after childbirth. Kegels are performed by tightening the pelvic floor muscles as in stopping the flow of urine. This exercise has the added bonus of preventing incontinence in women who’ve had a vaginal delivery.
You can also begin deep breathing exercises by sitting or lying in a comfortable position, then taking a very deep breath, imagining you are filling in every nook and cranny in your lungs. Next, fully exhale, pushing out every bit of air you just pulled in. Isometric abdominal exercises are also safe to perform early after childbirth. These are performed while lying on your back and pulling in your abdominal muscles – think about pulling your belly button in towards your spine.
Now that you’ve strengthened the top and bottom of the “corset,” you’ll need to work on the front, back and sides. It’s hard to find time for exercise in the first weeks following the birth of a child, so why not exercise while enjoying some time with your baby?
Prone Plank –For the beginner this can be performed on your knees but for the more advanced, try lifting one foot off the floor.
Side Plank – Beginners can perform this exercise on the elbow and knees. Progress the exercise by moving to the feet and hands. You can even try lifting the top leg.
Floor Marching– For the beginner, keep your back on the floor and the abdominal muscles tightened while marching your feet up and down. This should be done slowly and the trunk should remain stable. As you advance, lift your back off the floor for the Marching Bridge.
Squats – this is great for the gluteals! Make sure you don’t let your knees come over your toes and keep your spine straight. You can start with a shallow squat and try going deeper into the squat as your strength improves.
I had back and pelvic pain during both of my pregnancies that resolved soon after birth. As a physical therapist and new mom, I can attest that taking just a modest amount of time to work on your core can really make a difference. Your spinal stability will gradually improve as your ligaments return to their pre-pregnancy state and your core muscle strength improves. If you have back or pelvic issues that persist, discuss these with your physician or physical therapist. You may have an alignment issue that needs to be addressed.
Diana Brooks, PT, DPT is a Physical Therapist with Tidewater Physical Therapy in their Iron Bridge clinic where she also serves as Clinical Director. Diana is Direct Access certified through the Virginia Board of Physical Therapy and can see patients without a referral from a physician.