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Springtime is a time of new beginnings. It reminds me of my post-partum period as my kiddos were born at this time. As I reflect, I realize how fortunate I am to have access to information to help understand the changes in my body and assist in decisions about what exercises would be optimal with pregnancy and recovery. I have an appreciation for the importance of the post-partum period and retraining the body to a foundational level to help restore my system back to its new normal. It is my hope to inspire you to have an appreciation for some of these changes as well as how they can be addressed to help you restore function. There are lots of changes which can be addressed and I will start with three.
1. Your ribcage expands which can affect your breathing and intra-abdominal pressure regulation, which helps with digestion and spine stabilization.
The diaphragm connects to your ribs. As you inhale, the diaphragm moves downward and as you exhale it moves upward. With the downward movement of the diaphragm, the pelvic floor can be facilitated to relax. With breathing out, the diaphragm can assist the pelvic floor to tighten. With pregnancy, the diaphragm may flatten out due to the ribcage expanding toward the sides and the uterus growing. With this flattening, it can be more challenging to not only take a deep breath, but also tighten the pelvic floor.
Thus in the post-partum period, it is important to help restore the ribcage to a more neutral alignment. Learning to balance the ribcage over the pelvis, stretches to lengthen tighten muscles and exercises to strengthen are just some elements to consider in an exercise program. For example, notice the difference in tightening the pelvic floor and/or core in a slouched or exaggerated upright posture. When the ribcage aligns itself over the pelvis, the muscles are in the most optimal alignment to work. If you can look in the mirror and retrain your alignment, then go for it! However, if you are like myself and others who need some assistance, then work with your physical therapist to help you.
2. Your feet can flatten leading to greater strain and pain to the feet, as well as, poor loading into the knees, hips and back.
Hormonal changes coupled with weight changes can contribute to the arches flattening. With these changes, the feet become less of a shock absorber and can inhibit the ideal mechanics of the lower body, especially the hip. Weakness of the gluteals (a group of muscles which brings the leg behind you into hip extension) can place greater strain on the sacroiliac join or low back. Furthermore, there is a hip to pelvic floor connection. When hip activation is altered, the pelvic floor may compensate leading to weakness or pain.
In the post-partum period, it is important to note how the foot is loading in standing. In other words, have the arches fallen given the appearance of a flattened foot? Do you feel any knee, hip or low back irritation that seems to linger despite continued exercises? Is your pelvic floor not working optimally to allow you to control urine or bowel in everyday or recreational activities? Talk to your therapist if you note any of these changes, as s/he can assess the mechanics and provide you exercises from your feet to your core.
3. Abdominals can separate. This is called diastasis recti, which can effect breathing, digestion, spinal stabilization and urinary and bowel continence.
The abdominals are connected in the middle by a thick piece of fascia called the linea alba. Fascia is like a plastic wrap which covers our organs, nerves, muscles and blood vessels. Basically it wraps itself around and through the body interconnecting us head to toe. The linea alba is located on the front side with connections from the ribcage to the pelvis and it connects the right and left sides of the abdominals. It helps to support the spine and assist with intra-abdominal pressure regulation. Intra-abdominal pressure regulation is important for such functions as spine stabilization, urine and bowel continence, digestion, breathing, and organ support (prevention of prolapse). During pregnancy, the linea alba can separate or overstretch due to the ribcage expanding, the growing fetus and poor postural mechanics. Post baby, the linea alba may remain stretched. Over time diastasis can contribute to incontinence, pelvic and/or back pain, and prolapse.
One's post-partum care would ideally include a diastasis check by a trained physician, therapist or trainer. However, rarely are women checked. Treatment of the diastasis is multidimensional in that posture, breathing (remember the ribcage section ☺), manual work, taping and core exercises are just a few aspects of treatment. Whether you had your baby years ago or just recently, it is wise to have your abdominals checked.
It is amazing how the body changes with pregnancy! Even if you have had an uncomplicated easy breezy pregnancy or one that has had challenges, the body is still adapting to the fetus. Although the extent of the biomechanical and physiological changes can separate pregnancy experiences, it would benefit us as mothers and women to encourage each other to seek help in restoring the body and returning to life as you design it!
Elizabeth Leeds,
PT, DPT
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