Many women enjoy the benefits of yoga or other exercise during pregnancy, but then become inactive postpartum—perhaps because they don’t know which activities are safe or appropriate. Sadly, they miss the opportunity to restore a gateway to stability in the body, and later they may find themselves hampered by weaknesses in the pelvic floor and the abdominal wall.
This article explores the components of a healthy pelvic floor and abdominal wall, examines sources of compensation in the body and suggests yoga poses and techniques for restoring healthy function. Even though many of these methods and inquiries are vital as soon as the postpartum client is ready to start exercising, they can still make a difference years later, even if the key areas have received no care or attention in the intervening period.
Retraining the pelvic floor starts with the diaphragm.
During pregnancy the uterus can press up against the diaphragm, the rib cage can change shape, and women may experience various breathing difficulties. As the roof of the inner core, the diaphragm is attached to the xyphoid process, the top of the transversus abdominis, the ribs and upper lumbar vertebrae, and the arcuate ligaments. The arcuate ligaments are commonly described as condensations of fascia covering the psoas and quadratus lumborum muscles (Kaminoff 2007).
These attachment sites, compounded with improper breathing practices common in our society, can lead the diaphragm to become tight and strong. When the diaphragm is firm and unyielding, the pelvic floor must move the abdominal contents against this brick wall. Unless the diaphragm releases, it will not matter how strong the pelvic floor is—it will never hold against the diaphragm’s strength, and the participant will experience a feeling of weakness and/or leaking. The following poses stretch and release the diaphragm, allowing it to move freely with core activation and breath.
Once the diaphragm has been restored to its fluid function, you can address weaknesses in the pelvic floor. These can be caused by asymmetrical loading during pregnancy, weight on the pelvic floor, and tearing and stretching during delivery. Effects may include long-term asymmetrical weakness, front-to-back weakness, the inability to release the pelvic floor muscles, disconnection to these muscles, and an inability to activate the pelvic floor in a variety of positions.
Ask your clients to consider how they void. Can they void without any forcing or pushing? Can they release the pelvic floor muscles and void, and is this a complete void? This simple inquiry and the practice of voiding by releasing can make a significant change to the ability of the pelvic floor muscles to release between contractions. It is vital to ensure that these muscles release throughout the day versus staying contracted. Muscles that stay contracted perform as if weak.
Activation of the pelvic floor can be difficult to feel for many clients. Women have three pelvic openings (urethra, vagina and anus) and need to be able to “close” all three equally. Typically, postpartum clients have a weakness in various muscles of the pelvic floor, making it challenging to activate or produce any strength or endurance in these muscles. As weak as they may be, by changing the resting muscle length, the orientation of the body or how activation is achieved, you can help most postpartum women find their muscles and learn how to activate and relax them properly.
Once clients are able to activate the pelvic floor comfortably and in a variety of positions and speeds, then you can change the focus of pelvic floor training from voluntary to involuntary (Christie & Colosi 2009). During involuntary pelvic floor training, the focus shifts from activation to stabilization. An example is learning to maintain a low, level-pelvis bridge (little bridge) while rotating the right knee in and out (foot on or off the ground) and then repeating the motion with the left knee (Christie & Colosi 2009).
Changes in center of gravity, loosened ligaments, muscle lengthening and a shift in the position of the pelvic bones during pregnancy can leave postpartum clients experiencing instability in the hips. The hip flexor muscle complex may become tight and overactive, the hip abductors may be weak, and the gluteus maximus and hip external rotators may be inactive and/or very tight as the pelvis and hips try to “hold together” (Keller 2010a). We can help restore healthy hip function by teaching clients to connect with the hip abductors while moving into balance poses. Standing on a block or rolled yoga mat, lifting the pelvis laterally to a neutral height and then moving into a variety of simple balance poses will allow clients to reengage the hip abductors and deactivate the hip flexors. The hip-lift position can be emphasized or integrated throughout standing balance postures such as virabhadrasana III (warrior III) or vrksasana (tree).
Hip stabilization combined with balanced stretching in all planes of motion can work to quickly restore the position and function of the pelvic and lumbar spine.
An Opportunity Not to Miss
Utilizing yoga as therapy for the postpartum client can ensure that the pelvic floor, diaphragm, hip and core return to optimal function. The opportunity we have to help our clients rebuild and restore stability can create a solid foundation for the future as they move into their newly changed life.