When I gave birth to my little girl 2,5 years ago in Morocco, I naturally became even more interested in post-natal rehab. It was slightly chocking to me to have had delivered my girl with a C-section, but also how I experienced my body as a new mum. For sure, it was a different feeling to before I was pregnant, but also different from being pregnant!
Thanks to that I found a method that I used to restrengthen myself, I find it very important to share this knowledge with other women. And inform them about what is actually available to take advantage of. This blog post is based on an interview that I’ve done with the certified physiotherapist Helena Jönsson, who also is further educated within the field of women’s health.
I hope you will benefit and enjoy reading this blog post, as much as I loved to write it.
What is recommended that a woman keeps in mind concerning her abdominals and pelvic floor during a pregnancy?
It’s beneficial to strengthen the pelvic floor and truncus/pelvic stability during a pregnancy. Research shows for example that pelvic floor exercises during pregnancy reduces the risk for urine incontinence both during- and after the pregnancy. What’s good to keep in mind is to not stretch the distance between the abdominals more than necessary. An example that is beneficial, is for example to roll over to the side, as you’re getting up to seated.
How does a strong pelvic floor and strong abdominals effect the childbirth?
It’s always of advantage to have control over your muscles; in order to be able to active them correctly, to be strong and have stamina. But it’s also an advantage to be able to relax, which you also need during childbirth.
Please talk a little bit more about what’s actually happening with the abdominals during a pregnancy? And do all women get separated abdominals? What does that actually mean, and how does that effect the posture? How does that effect other exercise such as running or strength training after a pregnancy?
During a pregnancy, the belly is getting bigger as the baby in the belly is growing. When the belly is growing, the abdominals has to separate in the end in order for the baby to have space. Almost all women will experience a separation of the abdominals (diastas recti) at the end of the pregnancy.
Then when the baby has been birthed, the belly will go back to normal again, but for some women there can be a separation even after. A diastas means about 3 cm between the abdominals, but the width isn’t almost what’s the most important. What is important is the function. We can see that some women have a small distance between the abdominals, but they can have problems, while those with big distance don’t have any issues. Therefor, it’s relevant to assess the function instead of only the distance!
If it’s not considered to function properly, it’s similar to walk around with a corset, but without tighten the corset around the waist. Which means that the core stability is effected and the posture is worsened. Therefore, as we just mentioned, it’s relevant to asses the function, before any heavier exercises or load is added!
How do you know if you have separated abdominals?
As a physiotherapist I perform various tests and assessments, as well as that I touch the stomach in a variety of positions. You may also asses with for example ultra sound. The one with a disfunction of the abdominal wall will often experience symptoms in form of for example bad posture, tiredness in the back and pain. You can make a test on yourself to feel if there is any separation, by laying down on your back with bend knees and lift your head. But again, it’s important to not only assess this, but also functions and surrounding structures.
Please say something about that the abdominals can be separated, but that you still can be strong in your deep abdominals, and also have stability in your body.
It’s about the function, and not the number of centimeters between the straight abdominals that explains if there is a disfunction in the abdominal wall or not!
Can the abdominals ever return back to some kind of normal state if they are very separated, or do you have to make surgery?
It’s very different and individual. First of all, it’s absolutely relevant to do rehab training. Because, even if you do a surgery and this is needed, if complete function cannot be achieved with only exercise, exercise is still an important part. Just like when you for example make a knee surgery.
How important is it for you as a new mum, to restrengthen yourself and start with the deep abdominals? Why is this so important?
It’s important to regain the function and ensure that the muscles are activated again. Because the belly was bigger during the pregnancy and because the muscles have had another position for a while. Therefore, exercise is needed to regain the contact with the muscles in order to later be able to perform more advanced exercises.
Sometimes you hear women saying that, if you have delivered with a C-section, you don’t have the same need to strengthen up your pelvic floor compared to women who delivered vaginally. But maybe that isn’t true, because the pelvic floor has anyways been under load from the baby?
The pelvic floor is effected during a pregnancy, both because of the weight of the baby down towards the pelvic floor, but also because of hormone changes. Because of that, it’s important to have your pelvic floor assessed after a pregnancy to check the status of it, regardless of how you delivered your baby.
Additionally, it should also be said that some childbirths that end up with a C-section, can have started as a vaginal childbirth and this can also effect the pelvic floor.
It’s not common, except in France, that you’ll go to a therapist and do rehab training of your pelvic floor after a pregnancy. Often it’s just spoken about making contractions of this region. What is your opinion on that? With your knowledge and skills, what would you advice new mums to do?
Ideally, all postnatal women would be offered a more thorough assessment. In Sweden for example, and unfortunately, you have to ask for help yourself. It would have been desirable that more women are informed that there is actually help to get. To assess more thorough concerning activation, speed, stamina, reflexes and so on, in order to eventually create a rehab plan, feels very relevant. Research shows for example that about 30% of women have incorrect activation when it come to squeezing the pelvic floor, which then is of advantage to get help with in order to be able to exercise correctly. In some cases even some tools can be needed, such as electronic stimuli or EMG, which some women even don’t know that it exists.
Do you need to have had an injury from childbirth in order to meet with a physiotherapist? Or do you recommend all new mums to actually restrengthen their pelvic floor after a pregnancy?
You don’t need to have had any injury from childbirth, and if you by any means feel that you need help, you should ask for help! If you have a twisted ankle, you’ll go to a physiotherapist for help. Similarly, it should be the same of importance to go to a physiotherapist if you have these types of concerns! Many women in Sweden are in need of strengthening up after pregnancy.
Many women love jogging. When do you know that you safely can start with that again? What should you keep in mind?
Pelvic stability and core stability are required for jogging and running, because jogging is a load on the pelvic floor. I can therefore see it relevant to have a thorough assessment of all components performed, and after that individually give the woman a good foundation and plan to increase the load in a safer way!
In order to be conscious; what can happen if you have separated abdominals, weak inner abdominals and a weak pelvic floor and you start to lift heavy weights or start to run?
There is a risk that our inner organs, our back and our pelvis aren’t ready or prepared for the challenge, neither for the requirements. This can lead to other injuries, pain and/or compensated strategies that aren’t beneficial in a long term perspective.
Why isn’t the knowledge about this important matter more widely known?
Unfortunately, the topic of women’s health has been a down prioritized topic. But I can tell that more women are getting knowledgeable now. But at the same time it feels like something needs to happen in the society in order for all women to get the same opportunities for this type of health care. More research about women’s health is needed, and we who are working within the field, actually need to go out in public and show that we exist.
Do only mummies need to strengthen up the pelvic floor and the deep abdominals, or also women?
Women in general (but also men), do actually need to exercise these important muscles. For us women, we are often challenged a little bit more such as during pregnancy, childbirth, menopause and so on. Stages in life, that all effects our muscles and our tissue.
What else important would you like to add?
We women are good in taking care of everyone else, but very often we are bad in taking care of ourselves. But please don’t forget to prioritize yourself, you are important!
How can women get in touch with you?
From May 2019 I will be working in Helsingborg (in Sweden) at a private clinic called Fysiokliniken City. At www.fysioklinikencity.se you’re welcome to fill out a patient questionnaire or call the front desk at 042-4508550. You may also follow my Swedish Instagram account at gynfys,https://www.instagram.com/gynfys/.
Thank you so much Helena, for sharing of your expertise! I loved reading your answers and I’m absolutely sure that many women have benefitted. To all my dear readers, what are your questions? Please don’t hesitate to let me know, by replying on this email. I’d love to hear from you.