Why is a postpartum strengthening programme important for preventing or recovering from injury?

Function for daily activity - load vs demand
Often a cause for injury or pain is when tissue is struggling to cope with the demand we place on it. For example if you are overloading the tissue, either by introducing too much load too soon, or by repetitively loading it - it can start to cause pain. Preparing the tissues for this activity can reduce pain, or prevent injury.

Pregnancy can place a huge amount of load and pressure on some tissues, for a prolonged period. Many women also reduce their usual level of physical activity during pregnancy which affects how well the body will cope with the increasing load and demand throughout those 9 months. Similarly, birth can stress the body or even cause some trauma to some muscle groups and other soft tissue which means they will struggle to perform well. If we do not allow appropriate time for those tissues to heal or provide the necessary rehab to return the tissue to good function then injury risk is high.

The pelvic floor muscles and core system is under much greater pressure for the duration of the pregnancy, often leading it to be vulnerable in the postpartum phase. If you are also struggling with a lack of strength in other areas of the body then a greater force is transferred to the core and pelvic floor during some movements or physical activity such as lifting. It is this imbalance between the amount of force against the tissue vs what it can cope with that leads to injury. In the postpartum phase this can include prolapse or hernia, but also general musculoskeletal injury.

A good example of this is a postpartum woman who may be doing less exercise than before as it's hard to find time for herself, she's tired and she may have physical wounds from a c-section, tearing or episiotomy that is causing some pain. Because of this she may be fearful of returning to exercise if she doesn't know what is safe to do after birth. This leads to her becoming deconditioned and her muscles become weaker. However, her daily activities involve carrying a baby for long periods of the day, lifting heavy pushchairs and car seats up and down steps or pushing a heavy buggy uphill. Eventually her baby will be getting heavier. It is therefore quite likely that there will come a point at which her tissues cannot cope with that level of demand and she may start to suffer with pain or recurring injuries. 

Targeted strengthening that focuses on areas or muscle groups that need it can prevent this situation from happening. Strengthening should be progressive, meaning that we start at a tolerable level and build up gradually as we can cope with more load. A physiotherapist can help to create a specific programme for you, that takes into account your pain, your tolerance levels and encourage you to progress when it’s time.

You may well benefit from some periods of rest, manual therapy and pain management to help you recover, but ultimately it will be necessary to do the strength work to return to full function.