Okay Mamas! I’m ready to lose the postpartum weight and start to get back in shape. Who’s with me? One problem in my case: C-Sections are gnarly. Before I start to get REAL serious (and will update you along the way), I need to remember that my insides have been toyed with. Breezy Mama turned to Cindy Furey, owner of Comprehensive Therapy Services, Inc., — a full service physical therapy clinic specializing in Women’s Health and Pelvic Floor Dysfunction — to get the safest exercises to start with (because, as she says, “If your abdominal muscles and pelvic floor are not strong enough, doing sit ups, especially if you allow your belly to pooch out, can lead to pelvic organ prolapse. Which means your organs can start to sag, drop and feel like they are falling out. Strengthen with these exercises [first]“). Even if you haven’t had a C-Section, but are looking to start things slowly, make sure to begin with the following moves and you and I can get started together! (Never do any exercises without your Dr’s approval of course).
So you had a cesarean section, now what do you do for exercise? Whether it was planned or an emergency cesarean, it’s time to rehab those core muscles. But first, there are a few things you should know about your C Section:
The external bikini scar is horizontal, but the inside incision of the abdominal wall is vertical. Trust me you wouldn’t want it any other way. The good news is that if you had a diastasis rectus (split of the abdominal wall) or a hernia, it was repaired during the surgery. Just remember that the scar is layers deep. Your internal organs were also moved around and exposed to air. It takes a few weeks for things to find their position again. In the meantime, gas pains and little twinges are normal.
Physiological healing time for any body part is about 6-8 weeks. Give yourself some time to heal. That being said, some of us need to ask for extra help and be nudged along the way. Nudging is what our Mom’s and friends are for, so take the help and get moving.
Although your pelvic floor wasn’t traumatized by the birth, bladder position may be altered due to the procedure. It’s just another reason to do your Kegels! More on that later.
Most C-section scars heal without any need for extra measures. Occasionally, scars are sensitive to touch. You can do a few things to help that along. First, once the stitches or staples are removed any scab is gone, gently massage the scar in all directions. Here at CTS, we also offer silicone gel sheets to be worn 24/7 to cover, protect, desensitize, and flatten the scar. Let us know if you need, extra help in the scar department. Physical therapists can also facilitate healing with modalities and specific soft tissue techniques.
Get your cardio going by walking….a lot. Yep, put that baby in your stroller and start walking. When I was recuperating the following morning after the birth of my daughter, I held onto that IV pole and walked the perimeter of the hospital floor. When I got to the nurses station, they were surprised to see me. I explained that they had instructed me to walk. The nurse responded, “Yes, but nobody actually does it.” Well, those nurses know something. Walking is the best way to get moving, manage the lingering discomfort and drop the baby weight. Practice walking as tall as you possibly can to strengthen your core.
The abdominal wall needs rehab and conditioning just as any other body part would need after surgery. So here is a sequence of exercises that should be started within 24 hours of delivery.
Lay on your back with knees bent. Take deep breaths expanding your ribcage. When you breathe out, make sure you exhale completely which will facilitate a light contraction of your abdominal wall. As you improve straighten your legs until you are completely flat on your back. Repeat 10 times. 2 times per day.
Lift your pelvic floor muscles up and in. Hold up to 10 seconds. Relax and drop your muscles completely and repeat 10 times up to 3 times per day.
- Pelvic Tilt:
Lay on your back with knees bent. Pull your belly button to your spine to tilt your tailbone up while flattening your back. Relax down. Repeat 10 times.
Place your finger tips just inside your pelvic bones. Maintain your neutral spine. Activate the muscles under your finger tips by pretending to zip up a tight pair of jeans. Your pelvis should maintain this same position as you straighten one leg, return to start, and repeat on the opposite side. Repeat 10 times maintaining the same position.
Start on your back with your knees bent. Roll through your pelvic tilt to lift your buttocks all the way off the floor. You should be able to make a straight line between your shoulders and knees…..no sagging. Roll back down through your pelvic tilt and repeat 10 times. As you improve, hold the up position and add a slight twist from side to side. As you improve further, bring your arms overhead and perhaps close your eyes. This is also a great exercise to do with your feet over a ball.
This yoga move is a great way to get your core activated. On your hands and knees, pull your belly button to your spine to round your back while exhaling. Sag your back as you raise your head on inhale. Coordinate the motion with your breath as you repeat 10 times.
- Kiss the Baby:
From your hands and knees, bend your elbows to kiss your baby. Babies love to watch you go up and down. Repeat at least 10 times. This exercise progresses to knee push ups or the plank maneuver.
- Bird Dog:
From hands and knees, activate your core muscles and raise one arm and the opposite leg. You can look down at your baby, maintaining neutral posture while you alternate sides. Repeat 10 times. Add a rattle or toy to your hand and really make your baby giggle while toning at the same time.
As stated, you can start any of these exercises within 24 hours of your cesarean. Start with just a few repetitions, maybe 3-5 and progress to 10. Eventually, you should get up to at least 30 reps of all these exercises. These exercises should become easy for you before starting any other “core classes”, like Pilates. These exercises should also be painless. If you have any trouble, please contact your women’s health physical therapist. We can help.
Breezy Tip: Cindy recommends this site for finding a physical therapist in your area: http://www.womenshealthapta.org/plp/index.cfm (Scroll down to find your state).
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About Cindy Furey:
Cindy Furey, PT started Comprehensive Therapy Services, Inc., a full service physical therapy clinic in San Diego, which specializes in Women’s Health and Pelvic Floor Dysfunction in 1997. Cindy graduated from Northwestern University Physical Therapy in 1990. CTS is now a multi-disciplinary clinic, including physical therapy, massage, acupuncture, psychology, personal training and clinical nutrition for clients battling the conditions of incontinence, pelvic pain, prolapse, and obstetrical/gynecological/urological complications. Cindy’s ongoing continuing education in the areas of orthopedics, women’s health, and pelvic floor is extensive. She also works as guest professor at the University of St. Augustine Physical Therapy Program here in San Diego. Cindy Furey, PT partners in research projects, educates the fellows in physical therapy options for clients, and participates in grand rounds with UCSD Pelvic Medicine and the Naval Medical Center San Diego-Balboa. She is currently involved in the Interstitial Cystitis Collaborative Research Network for the study of manual physical therapy effects on bladder pain. She is a member of the American Physical Therapy Association Section on Women’s Health, International Pelvic Pain Society, Interstitial Cystitis Association, National Vulvodynia Association, and Vulvar Pain Foundation. She lectures throughout the local San Diego community, including the upcoming California Midwives Association Conference, on topics in Physical Therapy and Women’s Health. She is the proud mama of a 4 year old daughter.