Today I am continuing my series on Postnatal Training, looking at how to get new Mums back on a safe and sensible road to recovery.  Let’s take a look at correct posture – how to understand it and to correct it. We will also go through the first few exercises my new Mums receive to get them up and moving.

Correct Posture

Let’s be honest, the time after the birth can be busy, demanding and exhausting. Your body will naturally feel the strain.  I know this to be true because of conversations I have had with Aishling Burke, an established Men & Women’s Wellness Physiotherapist, based at the Tonbridge Clinic, Kent.  

Many new Mums often present with neck and back pain, normally attributed to a mixture of poor posture, weak post-baby core muscles and technique for daily baby tasks.  But there are ways to be mindful, to minimise or prevent these issues.

Breastfeeding

  • When breastfeeding you need to make sure you sit tall, in an armchair (if possible) with your elbows supported to prevent your arms and shoulders from relaxing.  I always recommend a feeding pillow to new Mums, which prevents Mum from bending forward to reach baby. Use a footstool and a small roll at the small of the back to help support the lower body (particularly the lower back). 
  • This can sound like a lot to organise, but once it’s done it will be ready each and every time. This will prevent Mum from a slouching position on the sofa, which means a knock-on strain to the neck, shoulders and back. 

Nappy Changing

  • When changing baby’s nappy always try to use a changing table.  If you don’t have one and instead use the bed, make sure you kneel down in front of the bed rather than standing and leaning over.  This may seem obvious but trust me you will thank me for this, as will your back because avoiding this recurring type of posture where you are repeatedly caring for your baby such as nappy changing or bath time will prevent back pain.

Lifting and Carrying Your Baby

  • Yup there is A LOT of this when little one is born, so Mums need to be extra vigilant and mindful about how they lift and carry, and not just their babies.  First rule of thumb, avoid any unnecessary lifting and take smaller loads. It is better to make a few more trips than try to do it all, and hurt yourself. For example, car seats can be very heavy and awkward, so avoid trying to carry them on one side whenever possible. 
  • The same applies to your little one, try carrying him/her directly in front, facing you. Just like car seats, carrying a child on one side, no matter how handy, is often a common cause of pain and muscle imbalance. 
  • So when lifting remember to bend at the knees, keeping your back straight, core and pelvic floor engaged and braced when lifting. Make your leg muscles do the work for you.

Getting in and Out of Bed

  • During the first few weeks after the birth every Mum should be mindful not to put any extra pressure on their back and tummy, when getting out of bed.  Something so simple can cause a lot of trouble if not taken care of. I ask my Mums to bend both knees, press them together and roll over onto her side before even thinking about getting up.  They should repeat the same when lying down.

Diastasis Rectus

This leads me nicely onto diastasis rectus; a gap in Mummy’s tummy muscles. If you notice that six weeks after delivery the gap is still there, then I strongly recommend an assessment with a Women’s Wellness Physiotherapist like Aishling Burke, as it is unlikely that the gap will heal by itself. Did you know that in France, all new Mums routinely attend a women’s health physio check in the weeks after delivery? This is to ensure that everything is returning to normal and that Mum is able to do her pelvic floor exercises.

In an ideal world all Mums should receive this here but for the moment, sadly this isn’t the case. Therefore, if you notice anything, no matter how small, (e.g. pain, bladder or bowel problems, or something just doesn’t feel right) then book for an assessment. A physio like Aishling, will have you back to normal in no time.  In that assessment she will be looking at the spine and pelvis, any weaknesses or imbalances within the pelvic floor and, of course, checking for the presence of “mummy tummy” or Diastasis. Then when you have the all clear, you will be able to train with me, a specialised Pre & Postnatal Trainer.

Getting Started with Exercises

As a Personal Trainer to Mums I am also trained in detecting “mummy tummy”. I know how to work with Mums with this condition.  However, there may be occasions when I feel it prudent to refer to a physio for the sake of my client, particularly if there are deeper pelvic floor issues present e.g. prolapse, hernias, extreme diastasis or other postural misalignments.

Good vs Bad Posture

Before I move onto the first stage of exercises I take my new Mums through, take a look at the picture below to see the difference of bad vs good posture.  The lady on the left is displaying “bad” posture. This shape typically happens to a Mum through pregnancy if the correct muscles aren’t trained properly.  The shoulders will round causing a Kyphotic Curve. Symptoms include back pain and stiffness in the upper back, a common problem amongst a lot of pregnant Mums. 

At the same time Mum can also experience a Lordotic Curve in the lower back. Symptoms include muscles being pulled in different directions causing them to tighten (lower back pain) and in some cases spasm.

Maintaining Good Posture

Going forward during recovery and to achieve “good” posture (the lady on the right) practise the following to maintain and be mindful of correct posture when standing:

  • Stand with feet hip width apart (i.e. beneath the hip bones)
  • Weight should be distributed evenly between both feet, between the big toe, little toe and heel
  • Soften the knees and ensure they are aligned over the ankles
  • Find neutral pelvis
  • Slide your shoulders down and relax your elbows
  • Lengthen the tailbone towards the floor, keeping your butt muscles relaxed
  • Extend the spine upwards
  • Lengthen the neck, keeping the chin parallel to the floor
  • Look to the horizon


The Exercises

Now let’s take a look at the first few exercises my new Mums start with. These will get them moving safely, and start improving their muscle strength and range of movement (ROM).  It is a journey that if started correctly will gain you a body that not only see Mum through pregnancy and birth, but way beyond into older years.

Looking After Your Core

As soon as Mum is able, it is important to start with core restoring. Remember to maintain good posture throughout, thereby providing great stability to the body. The following exercises are for training the abdominal muscles (particularly the Transverse Abdominals – TrA) as well as other local muscles to improve lumbopelvic stability. 

  • This is great for all lower-level movement.
  • Each exercise needs to be performed slowly and thoughtfully, ensuring full range of movement (ROM) to maximise benefits.
  • Upper body exercises are helpful for increasing upper body mobility and helping with ribcage closure, which has expanded during the pregnancy. 
  • Breathing is important during these exercises. Once the core muscles have been recruited they should continue to work throughout the move.

Scissor arms

  • Lie on the floor in neutral spinal alignment, floating the arms up towards the ceiling at chest height until directly above the shoulders. 
  • Inhale to prepare and as you exhale recruit your core muscles and release the shoulder blades into the floor
  • Think about moving the arms from the middle of the back as opposed to the shoulders, right arm towards the floor above and left arm down by your side.

Chest flye

  • Same starting position as above, floating the arms up towards the ceiling in line with the shoulders, releasing them into the floor. 
  • Inhale to prepare and as you exhale recruit core and lower the arms to the side of the floor at chest height. It is important not to touch the floor as they will provide a small release to the recruitment of the muscles.
  • Return the arms to the ceiling and repeat.
  • Remember to keep the ribcage soft and shoulder blades down as they open.

Arm Circles

  • Same starting position as above, floating the arms up towards the ceiling, chest height and in line with the shoulders.
  • Inhale to prepare and exhale to recruit your core as you lower both arms towards the floor above the head.
  • Stop for a moment before circling both arms around and down by your side, scooping the air and drawing the shoulder blades down. 
  • Lift the arms back up and repeat.

Leg slides

  • Same starting position as above, inhale to prepare.
  • As you exhale recruit your core muscles and then slowly slide one leg out along the floor until the knee straightens. 
  • Pause in this extended position to ensure you haven’t come out of neutral spinal alignment, then return this leg and repeat the other side.
  • Remember to soften the ribcage into the floor, keeping the upper body stable throughout.

Bent knee fall-out

  • Same starting position as above.
  • Bend elbows and rest fingertips on hip bones
  • Inhale to prepare and as you exhale recruit core muscles and open the right knee to the side, ensuring the foot rolls outwards and that the opposite hip does not lift. 
  • Briefly pause to once again check you haven’t come out of neutral spinal alignment.
  • Return knee back to the starting position and repeat, alternating the legs.

Knee raise

  • Same starting position as above, inhale to prepare.
  • As you exhale recruit your core muscles peeling one leg off the floor bringing your knee over your hip. 
  • Once again pause to ensure you have maintained neutral alignment and then gently lower your leg maintaining that spinal alignment repeat, alternating the legs.

Kneeling leg and arm raise

  • This exercise is in four-point kneeling with spine in neutral alignment. Imagine you are like a table – four strong supports (arms & legs), back is long, core engaged and head in line with the spin and sacrum.
  • Inhale to prepare and exhale to recruit the core muscles, sliding one arm forwards, lengthening through the fingertips as the arm lifts, until it is parallel to the floor.
  • Pause, check neutral alignment, sliding the shoulders down at the same time. 
  • Lower and repeat the other side.

For the legs:

  • Prepare as above, sliding one foot out along the floor, keeping the pelvis level and lengthening through the leg.
  • Pause, check neutral alignment, then slide the leg slowly back again. 
  • Repeat the other side, alternating.

These exercises will start any new Mum on a time sensitive, healthy road to recovery.  Be mindful of these first exercises and how your body and mind will feel when completely slowly and correctly.  Once these movements have been mastered progression is the next level, which we will be looking at in my next blog.

Happy Body, Happy Mind, Happy Mum!

References:

  • Postnatal Fitness by Judy DiFiore (no copyright infringement is intended)