Pelvic floor exercise for the post partum woman has evolved dramatically - even in just the last few years.
If you're still having core control issues - whether you just had a baby, or whether your baby now has babies of their own - consider these 10 steps as an essential part of your training:
There's a lot of information out there teaching us to treat our pelvic floor like strength muscles. We've been told to "clench" and "squeeze" and "tighten" for as long as -or as hard as - we can.
This leads to overactivity in the muscles - know as hypertonicity. The muscles become irritated, they start to overcompensate - and they actually function less.
This can result in increased frequency and urgency to urinate, painful sex, and an overall irritated feeling 'down there'.
The pelvic floor is a group of muscles that surround the openings to the anus (back), the vagina (middle) and the urethra (front). Each of these areas need to be consciously activated in order to have the entire group of muscles work together. Ensure that you are gently drawing in the back, middle and front areas as listed above.
All muscles are designed to contract, coupled with the ability to relax. Without the relaxation component they become shortened, weakened, hypertonic (as mentioned above) and can develop trigger points (irritations).
The pelvic floor works on a neurological loop with the diaphragm, which, when used correctly, creates an automated relaxation through the pelvic floor. Most of us a taught to relax by actively 'letting go' or 'pushing out'. This is to much force generated through the pelvic floor and does not achieve a true release.
Our transverse abdominis is the largest muscle in our core, and is responsible for pulling everything up and in. It supports our internal organs (preventing prolapse) and is the underpinning mechanism to healing abdominal separation.
Without a connection between the pelvic floor and transverse abdominis, a lot of women end up controlling their core through 'bracing' instead. This uses the outer muscles of the core and is a common compensation pattern - creating an imbalance between outer muscle strength, and deep inner muscle stability.
This leads to the underlying connective tissue never really healing properly. If you have to clench, brace and push your abdomen out to do even basic exercises lying on the floor, you're overusing the outer muscles.
The body sends signals to the inner stabiliser muscles to kick into a higher gear when needed. The problem with training the pelvic floor in isolation (like clenching as hard as you can, but you're sitting down doing nothing else with your body) is that it never learns how to integrate - which is the key role of the pelvic floor.
It is largely a group of assisting muscles - which means they need something to assist! If the rest of your body is working at a 1 out of 10 - so should your pelvic floor. If it's working at a 9 - that's when you need to know how to gradiate the intensity of your core to match the movement.
There are 6 muscles that work together with the pelvic floor, 5 of which run on the same neurological loop as the pelvic floor. Most of us are never taught about these muscles - or how to activate and then strengthen them. If the nervous system tries to activate the whole loop, and some muscles work and others don't - you end up with compensations and imbalances. Typically this looks like an overactive pelvic floor, with back pain. Or needing to brace instead of activate your deep core stabilisers.
The way to rehabilitate the core muscles post partum has evolved. We now know that training muscles to be strong in isolation, without training the nervous system to combine them all together does not lead to proper healing.
We now know that neuromuscular stabilisation is essential post partum recovery - and that if you don't actively wake up the nervous system through deliberate exercise - it doesn't do it on it's own.
That's why, no matter how long ago you had your babies, this work is effective.
I won't make it too complicated by explaining the physiology - but the core needs to be trained in specific patterns in order to successfully rehabilitate and then strengthen. Lying down exercises do not carry over to standing up exercises.
That can come as a huge shock to people who have spend years in classes on the mat - but once you've mastered the mat - you must stand up. There are 8 essential patterns that pelvic floor needs to be trained within to ensure it knows how to work in all movements.
The best time to train the pelvic floor to be strong, is when it needs to be strong with a bunch of other muscles in the body - like in lifting something heavy. The best time to train postural endurance and support - is when the rest of your body is also working that way.
You can't take a weak pelvic floor and go out and run tomorrow and expect it to hold up - but you can build up your strength and endurance levels gradually - until things like running are easy for the pelvic floor - because you built the stability from the ground up.
If you're voluntarily doing exercise that causes you to leak or become irritated, you may be going too hard for your pelvic floor at this time. When you aren't taught the logical sequence of progressions, it can be frustrating. And because you aren't getting anywhere with your pelvic floor, you put up with the symptoms and keep doing what you're doing.
The thing is - you've probably been given old advice. Advice we now know doesn't fully work. We now know the exact sequences to take the pelvic floor through in whole body exercise - so that you never create weak links in the chain.
Kristy Ahale is a Clinical Exercise Therapist.
She has been working in clinical rehabilitation and strength for 18 years, and specialising in pre and post partum exercise for the last 5.