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.

Diaphragm

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.

Pelvic Floor

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).

Hip Stability

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.

ACOG Guidelines

The American College of Obstetricians and Gynecologists notes that the physiological and morphological changes of pregnancy may persist for 4–6 weeks postpartum. Women are therefore advised to resume exercise programs gradually and in accordance with individual needs after pregnancy. Clients should always obtain clearance from their physician before starting a postpartum exercise program, and instructors should be familiar with the following current ACOG exercise guidelines:

  • Physical activity can be resumed as soon as it is physically and medically safe.
  • Resumption of activities should be gradual and should be tailored to individual needs.
  • A return to physical activity after pregnancy has been associated with decreased postpartum depression but only if the exercise is stress relieving and not stress provoking.

For further information on current ACOG guidelines, please see “Resources & Publications” at www.acog.org.

Diastasis Recti Abdominis

Diastasis recti abdominis (DRA) is the vertical splitting or separation of the rectus abdominis into right and left halves along the linea alba. This occurs in approximately 30% of pregnancies. Some women find that the split closes spontaneously to less than two finger widths, but for many the tissue separation remains wide or even increases with time. Many in the medical community consider DRA surgery cosmetic; however, complications of the condition include umbilical hernia, loss of functional strength in the abdominal wall, and chronic low-back pain. Although DRA treatment is commonly surgical repair, women can lessen the problem’s severity and rebuild strength and integrity in the abdominal wall by minimizing use of some poses and movements and modifying others.

Pelvic floor and transversus abdominis training can improve stability through the inner core. Cross-body activation in a variety of postures and positions can help weave together the internal and external obliques, thus drawing the fibers back and increasing the strength of the abdominal superficial and deep fascia. An example of cross-body activation in table position is bringing the left hand to the inner right knee and pressing both against each other on an exhalation. The rest of the body stays still as you press the hand and knee against each other. Make sure this contraction is medial, not pressing downward or upward.

Manual splinting—by drawing the abdominals together with the opposite arm—during core work, as well as avoidance of yoga poses and abdominal exercises that flex the upper spine off the floor or against gravity (e.g., roll-ups and roll-downs where the abdominals bulge out upon exertion), can prevent or lessen the severity of DRA.

When the muscles have pulled back to less than two finger widths or when the midline connective tissue has regained its former density and elasticity, clients have minimized their risk for hernia or other associated problems.


References

Byrne, H. 2001. Exercise After Pregnancy: How to Look and Feel Your Best. Berkeley, CA: Celestial Arts.
Christie, C.M , & Colosi, R. 2009. Paving the way for a healthy pelvic floor. IDEA Fitness Journal, 6 (5), 42–49.
Franklin, E. 2003. Pelvic Power for Men and Women. Highstown, NJ: Princeton Book Company.
Kaminoff, L. 2007. Yoga Anatomy. Champaign, IL: Human Kinetics.
Keller, D. 2010a. Yoga as Therapy Volume One: Foundations. South Riding, VA: DoYoga Productions.
Keller, D. 2010b. Yoga as Therapy Volume Two: Applications. South Riding, VA: DoYoga Productions.
O’Byrne, S. 2006. Yoga for the Core: Finding Stability in an Unstable Environment. Seattle: Eastland Press.

Suzette O'Byrne

Suzette OÔÇÖByrne started working as an educator, instructor and manager in the health and fitness industry in 1989. In addition to being the owner of a successful yoga therapy and personal training business, Suzette is a Master Trainer with Keiser Corporation and TRX Senior Suspension Trainer, teaching at conferences, workshops and teacher training programs throughout North America. Suzette is a faculty member and advisory committee chair with Mount Royal UniversityÔÇÖs Yoga Therapy Program in Calgary, Alberta and is the author of the book Yoga for the Core: Finding Stability in an Unstable Environment. SuzetteÔÇÖs credentials include Bachelor of Science in Kinesiology, Yoga Association of Alberta Certified Hatha Yoga Instructor, Yoga Alliance Registered Yoga Teacher (500 level), AFLCA Trainer of Fitness Leaders (Group Fitness, Resistance Training, Older Adults, Aquatic Fitness), Keiser Master Trainer, TRX Suspension Trainer, STOTT PILATES* trained mat & reformer instructor, ACE personal trainer and the

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