Postpartum Comeback
A Guide to the 4th Trimester
Women’s healthcare has really begun to gain some momentum in the past few years, but there’s no secret that we have a long way to go. One main area of concern is the fourth trimester, the three months that follow a woman's pregnancy & delivery. In the past, it’s been an area that most just completely ignore. Professionals let down a lot of women by not conveying to them how important this time is for proper healing & recovery of the mother.
Sure we’ve all giggled when we hear stories of women struggling to not pee a little while jumping, sneezing, laughing, etc. However, are we aware that this is something that is completely not normal. One should realize that even though we receive the most precious gift from this time, it is also a traumatic experience to the body that we must help the body recover from and I’m not just talking with time.
One of the biggest concerns with the postpartum comeback is regaining core control, but what really makes up your core? Think of your core as a team of muscles. Yes the core members can function alone at times, but they always work best as a team. The core’s main function is to help with midline stability, which in turn keeps your spine safe & strong while you move. When one or more of those team players are at their weakest, say during the 4th trimester, the core cannot function at it’s best.
The team players are:
Front = rectus ab.
Sides = transverse ab. & internal + external obliques
Back = paraspinals + QLs
Top = diaphragm
Bottom = pelvic floor
Most women are very concerned with regaining the front, when in fact the top, bottom & sides are actually of the utmost importance. When we focus on training only the front in our comeback period, we put ourselves at a much higher risk of developing or worsening diastasis recti. We begin with foundational work such as belly breathing, pelvic and rib-cage positioning. We have to remember that these simple things have been transformed by the pregnancy. Once normal patterns and movements of your body have been disrupted and now needs to be re-learned.
Client’s Role
During this time it is very important to seek out the advice and wisdom of professionals, such as a chiropractor, pelvic floor PT, licensed therapist, etc. Build yourself a team that you can trust and rely on. This can be a very overwhelming and stressful time, especially for new parents, so this becomes a priority. This is also supposed to be a time of great rest & recovery for mother. Know that recovery takes time, much longer than you really want to admit to yourself, but you must. It took nine months to get here, things will not happen overnight.
Headspace during recovery is one of the most serious and important things that I notice is hardly discussed. Probably because emotions make most very uncomfortable. Showing vulnerability brings out fear in us, what will others think if they knew what was really going on?
However, we must acknowledge that the postpartum period is also when your hormonal system is going crazy trying to find it’s new normal. It’s totally normal to not feel ok during this time. What’s not ok is us not acknowledging the issue or asking for help.
Your headspace doesn’t need to be all rainbows and unicorns all the time, that’s impossible. What makes the biggest difference during this time is recognizing you may have some unhealthy thought patterns that are holding you back from truly enjoying moments with your new family. Working on seeing what all you have to be grateful for and what truly matters. To learn to live in the moment, not worrying about the future or living in the past. Just the here and now, with your beautiful life.
Learning to control manage your stress and/or anxiety really does make your recovery that much easier. We all have been apart of a team at some point and we all remember how much better we felt when our teammates lifted us up, rather than tear us down? Same concept, but with our own self talk and criticism. What are we accomplishing with saying negative or critical things about ourselves? If we think that we will perform better the next time because of this, then we are lying to ourselves. Research actually proves the opposite. The results are drastically better when we felt lifted, rather than put down.
So, take a moment. Thank your body for all that it has done for you, I promise it’s more than you could ever imagine. Now continue to thank it every single day for giving you the best gift you could ever receive, a child.
Treatment
The most important thing in rehabilitating the body back from pregnancy is to get the core to work together as a team. The foundational work begins with re-learning how to engage & connect your upper & lower core together while also belly breathing. During this time we focus heavily on training the diaphragm and pelvic floor, in a supported position. During pregnancy a lot of organs have to shift internally in order to make room. We all know the pressure placed on the bladder during this time, but often forget the pressure placed on the diaphragm as well. The pelvic floor injuries arise from the birth.
Once we feel more confident in areas we begin to focus on the core engaging as a whole, with the spine still supported by the floor. These exercises focus on bringing the team back together all at once. Once we gain midline stability and can breathe without losing it all, we move on to learning to move the arms & legs while keeping it all together.
Shoulder stability is usually another area of concern as women develop what I like to call, “new baby back”. We can’t help but just stare at this wonderful thing we just created - for hours. That constant shrugging and neck cranking down while holding baby eventually adds up. We learn how to calm down those overactive upper traps and recruit the shoulder blade depressors.
Once we regain a solid foundation is when we can get right back into whatever it is that we love, with ease though! Strength training is absolutely essential in a women’s lifetime. We need to keep our bones strong and healthy, which can only be accomplished through weight bearing activities. It may be a great idea to grab a trainer, doesn’t have to be forever but it is nice to be able to just show up and focus on you, while another professional watches over your form & technique.
In the gym we want to really focus on gaining strength in the glutes, hamstrings, adductors, thighs and hip flexors in the lower half. In the upper half really focusing on the upper back, shoulders, pecs and deep neck flexors.
BELLY BREATHING → DIAPHRAGM
Breathing Phase I
Supported 90-90 Position → Hips and knees flexed to 90 degrees, legs resting on the couch, swiss ball, bench, etc. One hand on chest, other one on the belly. Focus on only allowing your belly to move while you breath. As you inhale your belly should rise and as you exhale your belly should fall. Practice filling your belly with your breath. This includes the sides and down low, right above pubic bone.
Breathing Phase II
Supported 90-90 Position → Repeat the setup from Phase I. Breathe into belly for couple minutes to warm up. Now begin to make your exhale longer than your inhale; 3 sec inhale - 6 sec exhale. During the exhale push the air through pursed lips to help emphasize the drawn out exhale.
When you exhale, notice how your lower ribs lower down. This is what you want when you’re bracing your core, to connect your upper abs to your lower abs. Bracing your core requires bringing together the upper & lower abdomen, sides and back. During training you want to keep your core braced during all movements, so keeping those lower ribs down and engaged requires a quick short inhale.
Breathing Phase III
Unsupported 90-90 Position → Remove support for this phase. This tests the core connection & continuing to breathe correctly. Do not do more than 60 seconds at a time, do multiple sets.
During this phase focus on setting up correcting and creating that core connection between upper & lower abs. We do not want the lower ribs to begin to flare up & out, creating an arch in the mid-to-lower back. Keep shoulder blades down on the ground and pinned to the ribcage, don’t allow them to shrug towards the ears. Keep knees directly over hips, knees bent at 90 degrees.
You can begin this phase by just working to hold this position, without compensation occurring, for 60 sec. Once you can complete this, you can create a whole array of ways to challenge your dead bugs. Moving just the arms, the legs, alternate between both, add weights or resistance. Get creative!
Recovery
During recovery it’s quite normal to get aches and pains along the way. We are working on muscles that are not only trying to recover from injury, but grow in strength as well. Symptom control is important, because too much pain or chronic pain will lead to compensation patterns. Since we are in a “re-coding” phase of your healing, where we work to make good movement patterns muscle memory, it is going to take some time & patience.
Mobility work is always necessary to help our body recover and keep up with us along the way. Especially during strength training because the myofascial (muscle - fascia) connection can become very restrictive. When our body cannot move through it’s full range of motion is when we also tend to develop compensation patterns in order to make up for what it’s lost.
Mobility work is also a great time to check in with your body. Learn what feels good, maybe what doesn’t feel so great. Are you different from side to side? Does it feel the same on each side? Do you move the same on both sides? These are some of the questions that I always ask my clients and you’d be surprised at how many of them can’t answer them. Knowing your strengths & weaknesses is your greatest weapon against injury.
In conclusion, there’s a lot we have to learn about taking care of our own bodies. Just because you may not know how, doesn’t mean you cannot construct a team that totally can. This is where you can take control of your healthcare and therefore life. We’re not working on making you a better version of yourself, we are working on creating an environment in which you can become the person that you were always meant to be. Removed from the overwhelming stress and anxiety that motherhood can bring. Stepping onto a new path that takes life day by day and learning to stay in the moment.
Xo - Dr. Shanele
January 8, 2020