FITNESS

Common Musculoskeletal Issues Postpartum

by Megan Hoover, DPT, contributor to Prenatal & Postnatal Fitness Specialist Course

Immediately after delivery, the uterus contracts as it begins to return to its pre-pregnancy size. The body, again in an amazing feat, does all of this as soon as the placenta is delivered. Within the first two weeks, the bump caused by the expanded uterus is less noticeable. By six to eight weeks postpartum, the uterus attains its normal non-pregnant size. But your body will hold extra weight and experience musculoskeletal issues for several months — after all, it just housed a tiny human!

For a comprehensive guide on how to approach postpartum fitness safely and effectively, download our Prenatal and Postnatal Exercise Guide.

Back Pain

Back pain is one of the most common musculoskeletal complaints. Our bodies have just remodeled their structure to support these incredible little miracles, then they are here, and your body has to hold up to the demands of caring for these sweet lil’ babies. Not only do our biomechanics change (pelvic widening, increased swayback, external rotation of hips due to tight rotators), our bodies are still producing relaxin, a hormone released during pregnancy to relax all our tendons and ligaments to prepare for delivery. We continue to produce relaxin up to six months after discontinuing breastfeeding. So … now we are dealing with changed mechanics, laxity in ligaments, and the new positions we find ourselves in when caring for our kiddos. It’s important that we learn the correct ways to hold, carry, and lift so we don’t injure ourselves.

Our bodies are truly amazing, but we can reach mechanical failure, which can cause back pain. Back pain has many drivers/causes, but especially after pregnancy, our muscles need to be retaught to fire correctly, our mechanics need to be addressed, and core stability and muscle flexibility all need to be taken into consideration. Just a few drivers of back pain include: altered pelvic mechanics, laxity and weakness in the pelvic floor, inhibition of deep hip rotators and transverse abdominis, excessive lordosis/swayback, tight hip flexors … and the list goes on.

If you find that you are having back pain post pregnancy and have tried to address it through our Ab Rehab or Postnatal Program without significant improvement, you would benefit from following up with a physical or physiotherapist to help you address your pain and get back to the things you love! You are worth it, mama!

Postnatal Programs in the Studio

Musculoskeletal issues can stick around for years after having a baby. If you need a great program to address any core issues, try 30 Day Core Restore.

Pelvic Pain

Pelvic pain is also very common during pregnancy and following delivery. Your pelvic floor just carried all the weight of that baby for 10 months, and then you went through delivery. Vaginal deliveries involve the trauma of making room for the baby to come through, and cesarean deliveries involve disruption of the tissues in the front of your abdomen. Both have a significant impact on our pelvic mechanics and ability to perform all our normal activities and jobs in a pain free manner. As mentioned above, relaxin causes laxity in our ligaments. Our pelvis is made up of bones that are tethered together by the ligaments and muscle tendons surrounding the pelvis and sacrum. And there are a bunch them!

It is important to keep working the core with the pelvic tilts, kegels, and foundation moves. Download our Prenatal and Postnatal Exercise Guide for more info! Additionally, some women find it feels better to have compression through the pelvis and use a support belt.

It is best to avoid certain moves and exercises. You should avoid the following:

  • Abductions (where the leg moves away from the body)
  • Uneven leg distribution, such as side squats
  • Moves where the feet are further than hip width apart
  • Or any move that causes pain or distributing the pelvis area unevenly, such as crossing the legs

Pelvic pain can be tricky to address on your own as there are so many things that impact pelvic mechanics, pelvic floor health, and trauma that can occur during delivery. If you are having pelvic pain that is not going away with gentle exercise, stretching, or a postnatal exercise program, please follow up with a women’s health physical or physiotherapist. Their job is to assess the cause of your pain and help you get back to life faster and teach you how to take care yourself. You could be sitting or standing with a slight pelvic rotation and this can cause other issues like knee pain. Do not put up with pelvic pain, ladies! It can be so debilitating.

Sciatica

Sciatic pain, which is described as pain that radiates down your buttock and sometimes into your leg, is also a common musculoskeletal issue both during pregnancy and postpartum. Unfortunately, this one can be tricky as well. There can be many sources that cause this common pain. It can be dysfunction in the low back irritating a nerve within the back. It can be a tight piriformis putting pressure on the sciatic nerve. It can be an issue at the pelvis causing altered leg length and overload of our muscle system, which aggravate the surrounding nerves. Boy, we are complicated, amazing creatures! A physical therapist can help you assess your cause and give you exercises or stretches.

Lordosis/Kyphosis

Yes … your grandmother was correct … posture matters! It’s not just the 30 minutes of exercise, but the other 800 minutes of the day that matter just as much! Our muscles, joints, nerves, bones, and connective tissues all have to work together to get us through our day. The position we hold our bodies in matters. Poor prolonged posturing can drive excessive lordosis (swayback) and kyphosis (hunchback).

Pregnancy changes our entire structure and causes increased lordosis due to weight of baby in front. This can get better after delivery but think about how you hold your baby. Most of us (myself included) have locked out our knees when we are rocking our sweet bundle to sleep or when trying to wrangle them with one hand on your hip while also trying to cook dinner. We lock out our knees, which drives our behinds further behind us creating that excessive lumbar lordosis or swayback. Nursing and wrangling kiddos can aggravate and drive thoracic (upper back) kyphosis because we are in a forward position for long periods of time. Kyphosis is a posture that all of us must work on because life happens in front of us.

Do not beat yourself up about your posture! The important thing is to know how to correct it through body mechanics, core and postural stability, and muscle flexibility. Moms Into Fitness Studio has excellent resources on stretching, core stability, and functional movement.

Diastasis Recti

Many moms experience postpartum body changes. One of these is an incredibly common condition called diastasis recti, which affects up to 45 percent of women six months postpartum.

Diastasis is the term for the separation of parts of your body that are normally not separated. One of the most common types of diastasis in the human body is diastasis recti, which is the separation of the rectus abdominis muscle.

Your rectus abdominal muscles, which hold in your internal organs, run along your abdomen from your sternum to your pubic bone in two parallel bands. These muscle bands are connected by a bit of connective tissue in the middle called the linea alba. This connective tissue is where the separation occurs. All bodies have some separation due to the fact that the recti bellies are connected with this connective tissue. How wide this diastasis (or separation) is determines if you need to modify your exercise routine.
Diastasis recti can happen to anyone, including men, babies, and children. However, most cases occur in women due to pregnancy.

Browse our Diastasis Recti Resources or try the Diastasis Recti 3-phase program.

Incontinence

Both vaginal and cesarean deliveries can cause incontinence postpartum. Mommas who have had vaginal deliveries tend to have more difficulty with incontinence, but not always. From overloading of our pelvic floor during pregnancy to the trauma of delivery, our plumbing takes a hit. But there is hope! We need to train those pelvic floor muscles that hold up our bladder and give the bottom of our abdominal canister some integrity. Our transverse abdominis and pelvic floor muscles have fascial ties (part of our connective tissue) that help them work together. So, when you work your TA, you are also getting those pelvic floor muscles to fire.

However, we also need to intentionally activate those muscles as well to get them stronger and have better endurance. We can selectively train our pelvic floor muscles! Kegels are a great place to start. If you are a runner, be sure to check out Running and the Pelvic Floor.

For those of you moms that had significant trauma during vaginal delivery (e.g., extensive tearing, use of suction or vacuum, or episiotomy), I beg you to go in and get evaluated by a PT. Incontinence can be hugely improved if not be eliminated with the help of a women’s health physical or physiotherapist. They have specialty training to help activate those muscles and retrain them how to fire. When your body has gone through something that extreme, it is very difficult for our muscles to know how to function effectively on their own. These specialized PTs can be superheroes in your journey back to feeling like a more normal woman! Please do not put up with incontinence just because someone says it’s “normal” after having kids. It may be common, but it is NOT NORMAL!


Download the Prenatal and Postnatal Exercise Guide

Smart fitness for moms in any stage: bump, new baby, and beyond.