Your Core Connection and How to Strengthen Your Deep Core Postpartum
Throughout the 40 or so weeks of pregnancy our core weakens as the rectus abdominis slowly separates to accommodate the growing uterus and baby. The separation happens in almost all pregnancies and is often viewed as functional since it allows for increased space to baby. As this separation occurs, unfortunately the core weakens - many women have a tough time engaging the rectus abdominis and deeper layers of the core including the transverse abdominis and multifidi. These muscles all work together in coordination with the pelvic floor to manage abdominal pressure and provide support and strength throughout the core as we lift, move and go about our day to day activities. The weakness experienced can be even greater for women who experience a cesarean delivery, as the core expands and separates throughout the pregnancy and then experiences 7 layers of tissue being cut through for delivery.
After delivery the weakness can feel shocking and astounding for many women - struggling to sit up on their own, difficulty standing up while holding a relatively light load, perhaps increased back or pelvic pain. There are some simple exercises that can be done starting just days after delivery that can help begin to reconnect the core with the pelvic floor and the rest of the body. Reestablishing this connection early on can help prepare you to be able to do more specific core strengthening work as your body heals and recovers. These exercises are also great for anyone to try to help strengthen and increase awareness of the deep core musculature. Below are 3 exercises you can try on your own.
Breathing with Pelvic Floor Coordination: Lay on your back with your knees bent and feet flat on the floor/bed. Take a deep breath in, thinking about expanding 360º around your torso as your chest and upper abdomen fills with air. As you breathe in try and “bulge” your pelvic floor muscles out - as your pelvic floor is an elevator and going down to the basement or you are trying to push a tampon out. Then as you let the air out of your lungs, contract your pelvic floor - bring the elevator up to level 4 or 5 (this may feel like a kegal, or trying to suck a smoothie up through a straw using your pelvic floor muscles).
TA Contraction with Pelvic Floor: Start in the same position as the first exercise. Take your first 2 fingers on each hand and find your hip bones, from there walk your fingers in about 2 steps towards your belly button and then 2 steps down towards your pubic symphysis. Gently push into the tissue and let your fingers “observe” the muscle action. Now, do some pelvic floor elevators. Bring your pelvic floor up to level 4 or 5, do you feel a small divot forming or ever so gentle muscle contraction pulling between your hip bones. This is the transverse abdominus and it should work in coordination with the pelvic floor. You can also try just the TA contraction by imagining there is a string running between your hip bones and drawing those hip bones together. If you feel a bulging out into your fingertips you’re likely activating too much musculature and kicking on the internal obliques or the rectus abdominus. It should feel like a very minute contraction under your fingers.
Leg Slide with TA and Pelvic Floor Engagement: Start in the same position, perform the previous muscle engagement from exercise 2 - engage the pelvic floor, draw the hip bones together. Hold that muscle engagement and keep the pelvis and back still as you slide one leg out as straight as possible and then slide it back in. The goal is to eventually be able to slide it completely straight and back in without losing any muscle activation. Work up to performing 10 reps on each side.
Written By Dr. Holli Utama, Physical Therapist