Restoring the Floor While Integrating the Core

Monday, February 12, 2007 at 02:36PM
Jessica Cassity in Special Populations, Teaching Strategies

6 Essential Moves for Postpartum Health
Dawn-Marie Ickes, MPT, is a partner in the Los Angeles studio Core Conditioning, which offers Pilates, Gyrotonic and physical therapy at Burbank and Studio City locations. Ickes has lectured nationally on Pilates and is on the Board of Directors of the Pilates Method Alliance. She is often noted for her work with pregnant women and new mothers. Here, Ickes shares her approach to training women who have recently given birth.

By Dawn-Marie Ickes
Many women will spend hours each week exercising their legs and abdominal muscles in an effort to “get their pre-pregnancy body back.” The most crucial component of ANY sort of exercise in this immediate postpartum period is restoring the normal function of the pelvic floor muscles and integrating the core muscles. Women are very adept at identifying the changes in sensation and strength in their abdominal muscles following birth, yet few are able to tell or even consider how their pelvic floor and other core muscles have been affected by 9 months of pregnancy and a delivery.

One of the most important sets of muscles which is commonly overlooked and ignored is the pelvic floor. They form a sling or hammock across the opening of the pelvis and are responsible for completing the lower portion of your core while keeping all of the pelvic organs (bladder, uterus, and rectum) in place and functioning correctly. Women with weak or damaged pelvic floors may experience back pain, symptoms of pelvic pressure or pain. It is important to discuss any symptoms you may be having with your doctor and don’t wait for them to “just go away.”

Returning to exercise after the birth of your baby should be a gradual process. Your doctor may start you out with simple exercises for the first week or two, such as Kegel exercises and short, slow walks. Depending on the type of delivery you may have additional limitations so it is best to check with your doctor before beginning this or any other exercise program within the first 6-8 weeks following birth.

Maintenance of the normal curvatures of the spine is essential for good back health. By preserving the curves, one will minimize stress on the muscles, ligaments, discs and joints of the spine. Muscles which work synergistically to achieve and maintain neutral pelvis are the abdominals, back extensors, hamstrings and hip flexors. By focusing on restoring flexibility, core strength and awareness in these groups, you are ensuring a positive exercise experience.

There are 6 exercises which I find are essential components of any postpartum core conditioning program. These include:

1. Hamstring Stretches
Place one foot on a step or stool no more than 12 inches high. With your hips squared towards your foot, slowly bend forward from your hips keeping your back completely straight while reaching your tailbone out. (Do not round forward or tuck the tailbone under.) Hold for 20-30 seconds then return to your start position and switch legs. Alternate 3 times on each leg.

2. Hip Flexor Stretches
Stand near a wall or chair for support. Using a towel or your hand, lift your ankle up towards your rear. (You should feel a stretch in the front of your thigh) Once you are balanced, check to make sure that your knee is pointing down towards the floor. It should not be in front or behind where your hip socket is. Next, check to be sure that you are drawing your navel up and in and not arching your back too much to reach your foot. Lastly, be sure that your ribs are drawing in and not flaring in the front. Hold for 20-30 seconds then return to your start position and switch legs. Alternate 3 times on each leg.

3. Hip Rotator Stretches
Lie on your back on the floor with both knees bent. Cross one ankle over the opposite knee. Gently bring the knee in toward the chest until your feel a stretch in the hip/buttock region of the top (crossed) leg. Hold for 20-30 seconds then return to your start position and switch legs. Alternate 3 times on each leg.

4. Kegels
Kegel exercises—or small contractions of the muscles at the vaginal wall and opening—should be a priority. They will help to repair and strengthen the pelvic floor and they can also assist with managing common problems associated with an over-stretched pelvic floor such as a prolapsed or sagging uterus, a prolapsed or sagging bladder, and possible urinary stress incontinence (which is an uncontrolled leaking of urine which usually comes with sudden movement, cough or sneeze). If you had an episiotomy, doing this exercise will help increase blood flow to the region, reduce swelling, and speed up the healing process. Kegels may also help with incision sensitivity, constipation and “looseness” of the vagina.

Level 1: Locate the muscles on your pelvic floor by contracting the muscles around your urethra as if trying to hold back the flow of urine. Next, try urinating when your bladder isn’t completely full, stopping and starting the flow of urine several times. Gradually allow a smaller flow of urine to escape each time. Stopping the flow will tighten the pelvic floor while releasing the flow will relax the pelvic floor. Both contraction AND relaxation of the pelvic floor is essential!!

Level 2: Once you get the sense of what contracting the floor feels like, transition to contracting and releasing the pelvic floor muscles while you are doing other activities such as washing dishes, folding laundry and my personal favorite—changing diapers. If you figure that the average baby has their diaper changed 8-12 times per day, you could have all of your exercises done by noon.

Level 3: Now that you have the contraction and relaxation part down, let’s work on endurance. Imagine your pelvic floor is an elevator. Contract the muscles upward from the basement to the first floor, then to the second all the way up to the fifth floor, stopping at each floor and getting tighter as you go higher. Then, release downward, releasing tension as you go down.
Note:  It is best to practice Levels 2 and 3 with your bladder empty.
The ideal number of repetitions is 5-10, practiced 3 times per day. Like any other muscle group, you don’t want to overdo it, so listen to your body.

Potential imbalances between the anterior and posterior pelvic floor muscles during strength and stabilization activities can develop if particular emphasis is not placed on the proper use of these group following pregnancy. Be sure to monitor excessive activation of the posterior muscles, including the posterior pelvic floor (near the rectum), piriformis, gluteals and external rotators. You will sense this is your feel like you are gripping your bottom each time you try to do a Kegel or abdominal exercise.

5. Isometric Transverse Abdominus Activation
An Isometric contraction of the transverse abdominus muscle is similar to the feeling of pulling the navel in and up at your waistline, as if trying to zip a tight pair of jeans. If you are correctly using your transverse abdominal muscles you should feel it wrap around toward your back as you engage. You can feel the TA muscle contract the most in the lower abdominals.

To test: Lie on your back with your knees bent. Place your fingertips on the front of your hip bones, walk them in 1-2 inches, inhale to prepare and as you exhale, draw your navel towards your spine without pressing your low back into the floor. When you contract you should feel the tensing of the TA muscle into your fingertips. If you are unable to sense or feel this contraction try coughing while placing your fingers there to get a sense of what type of tensing you should be feeling.

If you are still unable to feel the TA contract, try getting onto your hands and knees, let your belly relax down towards the floor without sagging into your low back or arching excessively. Inhale to prepare, exhale and draw the navel up towards the spine without moving the spine (no arching or curling). Hold for 5 second as you exhale. Inhale releasing the contraction, then repeat, drawing the navel up and in away from the floor. Repeat this exercise 10 times, then try the original position again lying on your back.

6. Grounding
In Grounding there are 9 steps to remember for correct positioning. Grounding is a fundamental exercise for Pilates and a great way to reconnect to your body.

1.) Lie on your back with your knees bent, the heels approximately 8-10 inches from your buttocks, in neutral pelvis (back is not excessively arched or pressed into the floor) and correct body alignment. Knees are not knocking in or falling outside of where your hip joints lie.
2.) Plant the feet into the mat. Drawing the heels toward the SITS bones, without actually moving them.
3.) Squeeze a ball between the knees.
4.) Draw the pelvic floor up connect to the anterior pelvic floor, then engage the whole floor.
5.) Gently draw the SITS bones together.
6.) Draw the navel to the spine and wrap it around to the back.
7.) Keep the T-point planted.
8.) Draw the scapula downward toward the hips while keeping the ribs connected in the front , don’t flare. Lengthen the neck.
9.) Remember to breathe.
Hold this contraction from the heels to the top of the head for 5-10 seconds, release and repeat 10 times.

Ground Rules for New Moms
Before you begin to work with a new mom, share these goals with her, making sure she understands the approach you will be taking in your instruction, as well as what is expected from her to ensure safe practice.

*Emphasize proper postural alignment with all exercises and stretches
*Resume exercise routine gradually
*Exercise to improve circulation, strength, and body awareness
*Use good body mechanics with ALL activities
*Resume exercise routine gradually
*Avoid inverted exercises until all bleeding has ceased

Keep in mind that there is increased risk of developing adverse compensatory strategies for ALL types movement during the postpartum period. In addition to increased fatigue, the muscular imbalances which normally occur during pregnancy and the demands of new baby care, the body frequently adapts abnormal movement patterns to compensate for the imbalances which are present. If these strategies are not corrected after delivery, they can cause multiple postural and internal organ problems years later.