Postpartum physical therapy essentials for the pelvic floor: 5 exercises to elevate your postpartum recovery

HEY NEW MAMAS! Are you ready to get moving again but don’t know where to start? Or, are you experiencing pelvic floor symptoms and not sure how to fix them without making them worse? You’re going to want to keep reading.

Maybe you’re experiencing:

• Pelvic heaviness/ feeling like your vagina is falling out of your body

• Hemorrhoids/ butt pain

• Pain from perineal tearing 

• Leaking urine when you sneeze

• Back pain when you lift your baby in his car seat on the way to the pediatrician

  
  UGH! Postpartum can be rough. 

I see you late night googling things like: 

• Why am I leaking postpartum?

• How to heal prolapse?

• Exercises for belly pooch / diastasis recti 

• When can I start exercising postpartum? 

Whether you’re feeling great or dealing with pesky pelvic floor symptoms, starting postpartum physical therapy exercises can expedite your physical recovery, reduce symptoms, and get you back to the exercise that brings you joy (and not to mention, help you lift all that baby shit you now have to carry around everywhere. Forget Crossfit, I need to be able to get that Doona car seat in and out of my car without tweaking my back on the daily)

I’m a doctor of physical therapy specializing in the pelvic floor, and I’ve been through postpartum twice myself. I support moms through postpartum recovery with a holistic approach to exercise and healing - and trust me when I say, I’ve seen it all. (if you need 1:1 support, I’m here for you- just reach out)

With all that said, Let’s get into my favorite postpartum physical therapy exercises!

First, let’s talk about postpartum recovery, return to exercise, and where postpartum physical therapy exercises fit in. 

Ever wonder why your doctor or midwife told you to wait till you are “cleared” at 6 weeks postpartum to return to exercising? 

This is because those first 6 weeks are an essential time where your body’s tissues are healing from birth - whether you had a vaginal delivery or cesarian section, this holds true.

During a vaginal delivery, your muscles and tissues of your pelvic floor stretch a CRAZY amount - so allowing them time to recover before introducing too much load can help you heal faster, while also reducing the risk of ongoing pelvic floor issues like prolapse, diastasis, leaking, and pelvic pain. 

However, This advice can be construed such that new moms do NO form of exercise for 6 weeks, then are given the “all clear” to return to whatever exercise floats their boat. 

The problem with the “All-Clear” to exercise at 6 weeks postpartum is two-fold:

1. At 6 weeks postpartum, your tissues ARE STILL HEALING. Jumping back into a high impact activity like running or cross fit without appropriate preparatory work, like postpartum physical therapy exercises, can set you up for injury and pelvic floor problems both in the immediate future and farther down the road. 

2. Just as you would heal from an ankle sprain, you wouldn’t go back to running without first healing and strengthening your ankle.

All that to say, most new moms, barring an outstanding medical complication, actually DON’T  have to wait 6 weeks to start moving!

In fact, as a pelvic floor PT specializing in postpartum recovery and return to exercise, I recommend starting pelvic floor physical therapy exercises EARLY. 

Now, a few caveats before I share my favorite postpartum physical therapy exercises: 

1. The FIRST part of postpartum recovery is REST. I highly recommend following the postpartum 5-5-5 rule, protecting those first 2 weeks (if not up to a month) as much as possible. 

2. The best Postpartum physical therapy exercises for BEFORE 6 weeks are things like diaphragmatic breathing, gentle core activation, and mobility work. 

3. The exercises I am going to share below MAY be started at 4-6 weeks postpartum, provided that they don’t cause any increase in pelvic floor symptoms or pain, and they feel GOOD. 

4. I highly recommend consulting with a pelvic floor physical therapist to come up with an early postpartum recovery plan, and to screen you for any issues you may have doing these exercises. 

5. Finally, if you aren’t ready to exercise yet - whether physically, or emotionally, or just logistically - I get it and I want you to know that there is NO RUSH to return to exercise. If it something you WANT to do now, then let’s help you get there!

6. Remember, this is not medical advice and these exercises are best done with the guidance of a pelvic floor therapist after assessing your postpartum pelvic floor healing.

In my 1:1 programs, I love to help mamas come up with an individualized program to heal from birth in the early days of postpartum (0-6 weeks) so that once they reach that “all clear” appointment, they can continue their pelvic floor recovery with postpartum physical therapy exercises that really move the needle toward their exercise goals. 

The following postpartum physical therapy exercises are meant to be started at approximately 6 weeks postpartum, and build on a gentle pelvic floor rehab foundation built from day 1 postpartum, starting with things as simple as BREATHING and mobility work. If you need help building this foundation prior to 6 weeks, please reach out!

At 6 weeks postpartum, I add in more challenging core, pelvic floor, and hip stability exercises to begin progressing to higher level strength training. 

Alright - here are my favorite postpartum physical therapy exercises.

1. Quadruped hovers

 This exercise helps incorporate your breath into core activation, and is a great precursor to planks . As a reminder, this particular exercise may not be appropriate for you if you have more intense symptoms of things like prolapse or diastasis recti. Check in with a Pelvic floor PT if you aren’t sure! Here’s how to do it: 

• Start on all fours. 

• Inhale to expand into your ribcage, back, and belly (I call this 360 degree breathing)

• As you exhale, push into your hands, draw your ribs down, and lift your knees 1-2 inches off the ground. 

• Hold this for 5-10 seconds, then lower back down. Repeat 5-10 times for one set.

2. Bird dogs

Bird dogs are my favorite exercise for connecting breath to core with upper and lower body movement. PLUS there are so many variations you can do to add a challenge as you get stronger. Here’s how to do it. 

• Start on all fours

• Inhale with your 360 degree breath

• Exhale and lift your right arm while sliding your left leg back and lifting it off the ground. 

• Lower arm and leg back to the start position, and reset with a preparatory inhale..

• Exhale and lift your LEFT arm while sliding your RIGHT leg back and lifting it off the ground

• Repeat, alternating arms and legs. MOVE SLOWLY.

3. Fire hydrant

This one activates your core while getting into those juicy gluts for better pelvic stability 

• Start on all 4s (are we surprised?)

• Lift one knee out to the side, and lower back down slowly.

• You can use a mini band for an added challenge

• Perform 10-15 on one side, then switch legs

4. Side plank clamshell

This is one of my all-time favorites for putting alllll the pieces together - breath, abdominals (transverse and obliques), gluteus medius and maximus (side and back butt muscles), and of course, your pelvic floor. This one takes regular clamshells up a notch while strengthening everything else 🔥

• Start On your side with knees bent, and supporting yourself with your elbow

• Inhale to prepare, then exhale to Push through your elbow and your knees and lift your butt up AND slightly forward (to straighten the line between your shoulders, hips, and knees

• Lower down slowly with control, and repeat.

• Add a low-resistance mini band if desired 

• Perform 10-15 and switch sides

5. Bridge

This is a staple for working  your glut max- but did you know this is an extremely effective exercise to strengthen your pelvic floor? (you can ditch the kegels!) 

• Start laying down on your back with knees bent. 

• Push through your feet to lift your bottom up off the ground, then lower back down slowly

• Make sure you are feeling it mostly in your butt - this should not cause back pain,  although you will feel your back muscles working too!

There you go! Those are some of the best postpartum physical therapy exercises to elevate your pelvic floor recovery.

And by the way, you don’t HAVE to do any of these if you aren’t ready or just feel too overwhelmed to exercise. You’re already doing SO great mama!! 

Need more help in your postpartum recovery? 

In this blog, we’ve talked about some of the best postpartum physical therapy exercises you can try out on your own. They are a GREAT start to your postpartum recovery and return to exercise plan, but you may need more help to be able to do these exercises symptom free, especially if you are dealing with: 

• Postpartum pelvic pain

• Prolapse

• Urinary incontinence

• Diastasis rectus abdominus (separation of the abs)

• Low back pain

If any of the above sounds like you, My 1:1 postpartum recovery program is for you.

In this fully-digital program, you have 1:1 support from me through:

• 1:1 coaching sessions with a doctor of physical therapy and pelvic floor specialist (HI! that’s me) where we determine the root cause of any pelvic floor symptoms you are having, and where to start with your healing process.

• Trauma-informed support to address the emotional components that may be impacting your recovery

• Customized exercise programming you can access anywhere through an app on your phone that addresses your unique problems and progresses you toward your goals

• Direct messaging access so you are fully supported through every step of the way

I am a doctor of physical therapy specializing in the pelvic floor in pregnancy and postpartum, and as a mom of 2 littles, I’ve been right where you are and I know the unique barriers you face to getting back to exercise postpartum.

I want you to feel your absolute best during this postpartum season, and confidently get back to doing what you love most, all while being a badass strong mommy. 

My Signature 1:1 postpartum program includes customized exercise programing with virtual coaching sessions with me to help you heal your body postpartum - whether you’re struggling with ongoing pelvic floor pain, leaking, and heaviness, or just want to get back to exercise safely under the guidance of an expert .

(and if you’re in New Orleans, I can see you in-person for pelvic floor physical therapy)

BTW - Hi!!!

I’m Dr. Jackie Joy, a New Orleans Pelvic Floor Therapist and fertility coach. Think of me as your preconception to postpartum bestie. If you’re looking for more support on your fertility, pregnancy , or postpartum journey - whether that’s to understand your pelvic floor and how to keep it healthy during this season of new motherhood, fueling your body’s nutrition needs as you grow your family, how to exercise during and post-pregnancy, or preparing and recovering from birth, I’m your girl!