by: Heather Jeffcoat, DPT - Women's Health Physical Therapy, Los Angeles CA
Pregnancy is a period of significant change in a women’s body. The growing fetus leads to an altered posture and over-stretched abdominal muscles. Due to the growing fetus, the belly is pulled forward, creating increased sway (Lordosis) in the lower back. The hip flexor and lower back muscles tighten as they are placed in a shortened position due to postural changes that are occurring. Postural changes may also lead to pain in the neck, shoulders, back, hips and elsewhere. In order for pregnant women to maintain their balance and also due to contributing hormonal influences, the knees will hyper extend and the head and shoulders will go forward. Wearing a proper support that cradles under the belly, like The Motherload™ pregnancy support will help alleviate strain on these areas. After delivery, the muscles do not always bounce back to their original state, leaving behind muscles that exhibit a “stretch weakness”.
When muscles are overstretched, they develop what is called a “stretch weakness”. This means that there is not adequate overlap of the muscle fibers to perform at an optimal level. This may lead to pain or dysfunction in this area. When this stretch weakness occurs in the abdominal muscles, there is the potential for developing lower back pain, pelvic or hip pain. In the pelvic floor, this stretch weakness may present as incontinence, prolapse or both.
There is also the potential for separated abdominal muscles (the “six pack” muscles), also known as a diastasis rectus abdominus (DRA). After delivery, the separation may persist. Women may not be aware that this separation is occurring. A women’s body also changes again after delivery, but much more rapidly. The fetus that was once occupying the mother’s uterus is now a beautiful baby in her arms. With this sudden change, however, the body is required to make very quick postural adjustments, without the proper muscle support to do so.
Many changes also occur in the musculoskeletal system during the postpartum period. The hormone Relaxin has influenced every joint in the body, creating ligamentous laxity, which will last for 3-4 months post-delivery. This effect is longer in breastfeeding women. With delivery, a women’s center of gravity is suddenly shifted, which can create problems with balance. The abdominal muscles become gradually overstretched and weakened with pregnancy. Additionally, the pelvic floor muscles are stretched relatively quickly during vaginal birth, and tearing may occur. Unfortunately, these muscles don’t always immediately return to their pre-pregnancy states.
Performing deep abdominal muscle contractions and Kegel exercises are essential during the first six weeks. They should be started within the first 24 hours to prevent muscle atrophy. Performing Kegels will also increase local circulation, assisting with the healing process.
I also frequently recommend compression garments to be used by patients during the postpartum period, regardless of whether they’ve had a vaginal or cesarean delivery, like the Sienna C-section and the Angelica Abdominal recovery garments. The abdominal compression provides support for the overstretched skin and abdominal muscles and are a great first step towards restoring normal muscle and tissue anatomy during healing and recovery.