Post Natal Musculoskeletal Pain

• Laying in bed on your back bend your knees and place your feet flat on the bed
• Roll onto the side closer to the bed edge
• Then lower your legs over the side of the bed and push with your arms to bring yourself up into a sitting position.
• Sit for a few moments until you are ready to stand up.
• When you are ready to stand, lean forwards and push yourself up from the side of the bed using your hands.
• Do the opposite to get into bed.

Pelvic Floor Exercises

Pelvic floor muscles will be stretched and weakened with the extra weight of your baby through your pregnancy. After caesarean delivery it is still important to do pelvic floor exercises. After vaginal delivery it can be difficult initially to feel the right muscles, it is okay to start right away even if you have stitches. You can start these exercises once the catheter has been removed if you have one.

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The pelvic floor muscles are a made up of several layers of muscles which stretch from the front of your pelvis to the tail bone. They support your internal organs, so are working all the time. The pelvic floor muscles help control your bladder and bowel function and prevent leakage of urine, faeces, and wind. Strong pelvic floor muscles also enhance sexual function.

The diaphragm (your breathing muscle) and the pelvic floor work together, as you breathe in your pelvic floor should relax slightly and as you breathe out the pelvic floor naturally lifts, it is important to do the exercises with your breath. Start the exercises in lying and progress to sitting and standing as you improve.

To build endurance and strength

• Start gently breathing in and out of your tummy.
• As you breathe out gently tighten and draw around your back passage as if you are stopping wind, then draw up your muscles at the front as if you are trying to stop passing urine
• Try to hold the lift as you breathe out. You may only manage a couple of seconds, with practice you can build to 10 seconds.
• It is important to feel the let go of the muscles as you relax otherwise you may over tighten the muscles or they may have relaxed without your awareness.
• Repeat 10 times. You may need a rest between each hold

To make muscles work quickly when you need them (cough, sneeze, laugh)

• As you breathe out tighten and draw in the pelvic floor muscles as above as strongly and quickly as you can and then let go.
• Aim for 10 in a row; a short break between each one can help initially. Sometimes other muscles will try to switch on while doing the exercises but it is important that you:
• Do not squeeze your big muscles of your bottom
• Do not tighten your abdominal muscles
• Do not hold your breath No one should be able to tell that you are doing the exercises.

 Aim to do the exercises four to six times a day. It takes three to six months to strengthen the pelvic floor, so don’t be disheartened if the improvement is slow. Remember the pelvic floor muscles are like any other muscle in the body; they get weak if not exercised regularly; try to set up a routine that you can continue forever. It is easy to forget to do exercises for muscles that you can’t see. To prevent leakage and pressure on the pelvic floor it is good to tighten the muscles before activities that put pressure on your pelvic floor for example coughing, sneezing or picking up your baby.

 More information is available from:  https://www.nbt.nhs.uk/maternity-services/after-birth/pelvic-floor-stomach-exercises

• In the first 6 weeks mainly focus on gentle walking, your body is healing.
• After six weeks to eight weeks it is safe to return to swimming and low impact exercise gradually increase your fitness e.g. Pilates, low resistance gym work. If you have had a caesarean section or you are unsure whether to return to activity, please wait until your 6 week post-natal check to ask your GP if it is ok.
• Do not return to high impact such as aerobics, running and resistance/ weight training for a minimum of 12 weeks if you have had a natural birth. If you have had a caesarean section it may be advisable to wait 4-6 months before safely commencing high impact exercise. It is important to be mindful that even at this stage there will be hormones in the body that lead to increased elasticity in the tissue which can make it at higher risk to damage it is important to gradually increase exercise.
• If you have any urinary leakage with exercise or you have concerns about return to exercise seek help from a pelvic health physiotherapist to guide your return to exercise

• Remember it took you 9 months to get your body to where it is at delivery, it can take 12 months recover from pregnancy and delivery.

During pregnancy, as your baby grew your stomach muscles will have stretched along with this, in most women there will be a separation between the muscles.

This is normally 5cm and should resolve after birth.

If at 8 weeks after delivery you have a 2-3cm gap or more you should seek help from a pelvic health physiotherapist or request a referral from your GP or midwife.

The stomach muscles support your pelvic organs and back. These muscles help prevent back pain, incontinence and pelvic organ prolapse.

How to do a self-check of your abdominal muscles:

• Lie on your back with your knees bent, feet flat on the bed
• Place fingers just above your belly button and gently press into your tummy • Gently tighten your stomach muscles and lift you head off the bed
• You should feel the two bands of muscle at your fingers tighten. Test how many fingers you can get between the bands and how deep you can push in.

The following exercises will help improve your abdominal tone and help to support good posture.

Try exercises 3 times a day with 10 repetitions each time

Deep abdominal exercises

• Lie on your back with your knees bent
• Place hands on the tummy below the belly button, breathe in and as you breathe out gently draw your pelvic bones together, gently drawing tummy away from your hand.
• Hold as you breathe out and relax as you breathe in.
• Progress as able to doing these exercises in sitting and standing

Pelvic Tilt

• Lie on back with knees bent
• Gently tighten your pelvic floor and lower tummy muscles and flatten your back into the bed as you breathe out
• Hold for 3-5seconds

Leg slides

• Lie on your back with your knees bent
• As you breathe out gently tighten pelvic floor and lower tummy as you straighten out the leg, keeping the pelvis steady
• Breathe in as you bend the leg up again
• Repeat on other leg

Single knee drop out

• Lie on your back with knees bent
• As you breathe out gently tighten pelvic floor and lower tummy as you move one knee out to the side keeping the pelvis steady
• Slowly bring leg back to the middle
• Repeat on other leg

Hip bends

• Lie on your back knees bent
• Breathe in then as you breathe out gently tighten the pelvic floor and lower tummy as you bring your knee up
• Slowly lower down again
• Repeat on the other leg

Clam

• Lie on your side with your hips and knees bent
• Breathe in, as you breathe out gently tighten your pelvic floor and lower tummy, bring your knees apart keeping ankles together
• Try to keep your pelvis still through the movement
• Repeat on the other leg

Lifting

• Avoid lifting anything heavier than your baby for six weeks.
  If you have had a caesarean section it is important to avoid lifting and twisting movements or movement which stress the oblique muscles in the abdomen

• To lift gently engage your pelvic floor and lower tummy as you breathe out. Bend from the hips; keep your back straight using your legs and buttock muscles to lift. Keep the load close to your body to reduce strain on your back.
  Avoid lifting toddlers, encourage them to climb up to you while you are sitting.

If you have had a caesarean section it is advisable not to drive for 6 weeks after the birth.

Housework

• Avoid activities which cause strain to your abdomen and pelvic floor for the first few weeks e.g. prolonged standing 6
• In the first 6 weeks avoid vacuuming and heavy lifting e.g. full basket of wet washing

A pelvic girdle belt might have been suggested for you during your pregnancy to help stabilise the pelvis from the outside whilst your muscles are weakened and the baby is loading your pelvis so making them harder.

It should be comfortable to wear and can be worn for standing or walking activities inside or outside of the home. It will likely be uncomfortable to sit in for long periods of time so this is not advisable.

The list below is only a guide to help you find a belt that is right for you, you can find alternatives by searching for Maternity Support belt – try to get them looking like these belts as much as possible. They generally range between £20 - £45

The belt we have as a demo in the department is called the:

ProMedics Wiltshire belt –  Approx £45

The following belt is also a good option and slightly cheaper

Jojo Maman Bebe – Maternity Medical Grade belt Approx £30

How to wear it:

CORRECT	INCORRECT

For pelvic girdle pain (SPD, PGP, SIJ pain) make sure that the belt sits low at the hips and UNDER the bump. This will make it more comfortable and stabilise the pelvis, where you need the support.

Some people prefer more bump support so could wear the belt higher.