The following exercises, demonstrated by Renée Knowles, physiotherapist at Up and Running Dubai, can be introduced gently in the weeks after giving birth, however there are special guidelines for those who have had a caesarian section. Always ask your doctor for advice first. If you are experiencing pain, or have a known pelvic pain disorder, consult a women’s health physiotherapist for guidance.
Breathing correctly
Learning to breathe into the diaphragm and belly is important to help counteract the effect pregnancy has on breathing mechanics.
Lie on your back, with your knees bent and shoulders relaxed. Place one hand on your chest and the other on your belly/ribs. Your hand should rise with your belly, while your chest remains still. Relax your abdominals and pelvic floor as you inhale. Take 10 breaths like this throughout the day.
From the same position, wrap a Thera-Band or some stockings around your lower ribs. As you breathe into your belly, feel some gentle resistance. As you breathe out, try to contract the muscles to soften your ribs down.
Deep abdominal activation – lying, sitting on chair/ball, standing
Stomach muscles are naturally weaker after pregnancy and women often experience diastasis rectus abdominis – a separation of the two parts of the abdominal muscle. To strengthen and tone your abdominal muscles appropriately, you must work from the inside, out, with specific exercises, in the correct order.
Lie back with your knees bent or sit up tall, with your back in a neutral posture – not too flat or arched. Relax your stomach muscles and breathe in. Breathe out and gently draw in your belly button, lower abdominal muscles, and the pelvic bones together. Do not allow your back to move. Relax as you breathe in again. Progress with holding the activation for two breaths, then three etc. Placing a pillow or ball between your knees can also help you increase your pelvic-floor contraction.
Pelvic floor muscle exercises
Looking after your pelvic floor muscles (PFMs) is essential after birth and throughout life. It can also reduce post-partum discomfort and swelling, leakage from your bladder or bowel, and safeguard against prolapse.
Imagine you are trying to stop yourself passing wind then urination together. Feel your PFMs squeeze and lift up inside. Focus on both slow (endurance-based), and faster contractions. Ensure you are relaxing completely before and after a contraction.
Slow: squeeze and lift and hold for as long as you can, but no longer than 10 seconds. Release completely and rest for 10 to 15 seconds. Keep your buttocks relaxed and don’t hold your breath. Repeat up to 10 times, allowing your stamina to build over time.
Faster: follow with 10 quicker contractions as you breathe out and release as you inhale. These will help your muscles react quickly when you cough, sneeze, laugh, or lift. Repeat these four to five times a day.
Pelvic tilt – lying, sitting and standing
Do this as early as week one if you have had a natural delivery to help relieve backache and begin to retrain your abdominal muscles.
Lie on your back with your knees bent. Breathe out as you gently pull in your lower abdominals and feel your lower back flatten to the floor. Relax your tummy muscles and buttocks, and let your back uncurl as you breathe in. Repeat 15 to 20 times, three times a day. Do not push into pain. Try it sitting (on a chair or gym ball), and standing.
* If you have had a caesarean section, you may have to wait until your six-week postnatal check to do this exercise.
Heel slide
Lie on your back with your knees bent and your back in a neutral posture – not too flat or arched. Activate your deep lower abdominal muscle and PFMs. Breathe steadily while you slide one leg out straight along the floor, keeping your back neutral and ribs down. Return slowly to the start and repeat with the other leg. Repeat 10 times slowly with control on each side.
* If you have had a caesarean section, you may have to wait until your six-week postnatal check to do this exercise.
Overhead arms – breathing and rib control
Lie on your back with your knees bent up in parallel lines and your spine and pelvis in neutral. Glide your shoulder blades gently back and down, and widen your collarbones. Lengthen the back of your neck and soften your chin down. Inhale to prepare into your belly, exhale and slowly lift the arms over your head, keeping your ribcage down and core engaged. Inhale, then exhale to lift the arms back to the start. Be mindful not to flare your ribs.
* If you have had a caesarean section, you may have to wait until your six-week postnatal check to do this exercise.
Thera-Band pull back (lying, sitting, then standing)
Tie the lightest resistance Thera-Band around a door handle. Lie in front of the door handle with your knees bent, with your head by the door. Your spine and neck are neutral, shoulder blades back and down, and ribs soft. Keeping your elbows locked, breathe in, and as you exhale, engage your core/PFMs and pull the band down to your sides. Breathe in to return to the start position. Repeat 15 to 20 times. To progress, try it sitting tall in a chair. Progress to standing after six weeks.
* If you have had a caesarean section, you may have to wait until your six-week postnatal check to do this exercise.
