2. Intentional Pelvic Floor and Core Rehabilitation
Pelvic Floor Muscle Training (PFMT) is a supervised intervention and should be offered as a first-line treatment to women with Urinary Incontinence (UI). The American Academy of Family Physicians recommends pelvic floor muscle training (PFMT) as a supervised, first-line intervention for women with urinary incontinence, including stress, urge, or mixed types, based on consistent, good-quality patient-oriented evidence. PFMT involves repeated voluntary contractions of the pelvic floor muscles (Kegel exercises), typically advised one or more times daily for at least eight weeks during and after pregnancy.
DRA Management: Physical therapy that incorporates abdominal and core rehabilitation exercises is an effective, conservative intervention to reduce the inter-rectus distance associated with DRA. Training often focuses on activating the deep core muscles (Transversus Abdominis (TrA), pelvic floor, and multifidi).
Progressive Loading: Muscles need intentional overload to stimulate tissue remodeling. Once the client has proper function, exercises are progressed from unloaded to loaded, and simple to complex, while continually monitoring for signs of doming or pressure pushing down onto the pelvic floor.
3. Scar and Incision Management
For women who have undergone a cesarean delivery, PT is beneficial immediately following surgery. PT interventions address multiple layers of scar tissue (from skin to deep fascia) and include:
Education and Early Movement: Patients are taught proper breathing, early bed mobility, and correct posture during feeding.
Scar Mobilization: Once the incision is well healed (around 4–6 weeks postpartum) and cleared by a medical professional, scar massage and mobilization are initiated to increase tissue circulation, promote healing, and prevent adhesions. Scar tissue can create numbness, pain, and restriction, affecting the function of surrounding muscles.
4. Biomechanical Strategies for Daily Life
PT addresses how women navigate daily life and infant care, which often involves repetitive, strenuous movements. PT provides interventions for:
Safe Movement: Strategies for getting out of bed, transitioning to/from the floor, and lifting/carrying your infant.
Pain Reduction: PT emphasizes that pain is not a symptom of pregnancy that must be endured, and it can often be minimized or eliminated with physical therapy. PT can also address specific issues such as wrist pain (e.g., de Quervain's tenosynovitis) commonly associated with fluid retention and overuse during childcare.
Bracing/Support: PTs can recommend and fit supportive devices such as sacroiliac (SI) belts for SI pain or abdominal binders for support after cesarean or for lumbosacral pain.
Long-Term Recovery and Setting Expectations
True recovery takes time and consistency.
Timelines: While many women feel ready to resume exercise quickly, the deep core and fascial tissues require a progressive timeline for healing. The first 2–4 months are essential for rebuilding a solid base. According to Fukano et al., abdominal tissue recovery can take 4–6 months for deep muscles and Deerenberg et al., states that fascial healing can take a year or longer for fascial remodeling.
Return to Activity: Women who exercised during pregnancy often feel ready to jump back into strenuous activity, but they must be convinced to give the pelvic floor and core time to catch up. The solution is not to minimize the exercise level but to improve its guidance and execution. PT helps clients progress safely, increasing load and volume gradually (often no more than 10% per week).
A specialized physical therapist helps women establish their baseline strength, efficiently integrate their pelvic floor and core, and create a roadmap to return to whatever activities they desire, confidently and safely. Click below to get started!
