Post Partum Corrective Exercise

Question

My wife is postpartum. As you know during pregnancy the symphis pubis separates temporarily then goes back into place. Anyway, when I have her perform the overhead squat I notice that her left hipbone dips further down then her right. I cannot figure out which hip is in the right spot. The rest of the assessment went as follows: toes slid out slightly, knees had slight pronation, and her lats were tight. What type of program would you recommend for her?

Answer

As you know, pregnancy takes a huge toll on the human body. Pregnancy alters a woman’s center of mass, and forces the rest of the kinetic chain to compensate in many ways including increasing the lumbar lordotic curve and widening the hips. In doing so, muscle imbalances occur which force compensation patterns that will continue past delivery. When a woman gives birth, the birthing canal has to open wide enough to perpetuate the baby’s expulsion, often times tearing the pubic symphysis. When this occurs, a change in structure dictates a change in movement patterns, altering the length-tension relationships, force-couple relationships, and recruitment from the nervous system.

Given these changes, a comprehensive assessment is necessary as well as incorporating an integrated flexibility and strength-training program to correct imbalances. A chiropractor is a helpful tool to alleviate discomfort, but remember that the kinetic chain is made up of the muscular system, articular system and nervous system. Each branch of the chain needs to be addressed in order to affect postural deviations and faulty movement patterns. A chiropractor can adjust an articulation, but without addressing the root of the problem, the muscle lengths surrounding the articulation, the problems will re-occur.

The nervous system recruits muscles to do a job, the muscles respond by activating and then move the skeletal system, which provides the leverage and support for the movement. All three links in the chain have to communicate properly. When the toes evert, the soleus/gastroc complex is too tight and limits range of motion at the ankle, forcing the foot to turn out. This is usually followed by pronation at the ankle, i.e. feet flattening, and can lead to or be caused by tight peroneals. This leads to compensation at the knees, forcing them to turn in, or adduct, and thus, moving up the chain, this affects the hips. If the femur adducts, the muscles that externally rotate the femur at the hip become lengthened.

These lengthened muscles are not able to produce optimal force due to the altered length-tension relationships and in turn, cannot perform proper hip abduction or extension. This leads to synergistic dominance of the lateral hamstrings, which are forced to “sub” in for the glutes. Since the hamstrings are not mechanically or neurologically predisposed to take on the responsibility for those activities, this only leads to further kinetic chain compensation, and eventually breakdown.

With this in mind and given the deviations seen in the individual’s overhead squat assessment, look to the following chart to incorporate corrective strategies.

For the purposes of increasing the extensibility of soft tissue, begin with self-myofascial release to release adhesions within the tissues. This acts as a supplement to flexibility because releasing those “knots” allows for more muscle elongation when stretched. Place a foam roll underneath the muscle designated to be “rolled” and slowly move up or down the muscle pausing where tenderness is felt. Hold that spot for 30 seconds and then slowly proceed to the next tender point. Follow self-myofascial release with static stretching (see Alan Russell’s PTontheNET.com Self Myofascial Release article for more information on this form of corrective flexibility). When performing a static stretch, slowly ease into the stretched position and hold that position for 20-30 seconds. Repeat each stretch as necessary. Tight muscles are partnered with weak muscles. In other words, if a muscle is too tight, it is reciprocally inhibiting its functional antagonist, limiting the antagonist’s ability to perform tasks. Therefore, a strengthening program is imperative to the success of a client. An integrated strengthening program should consist of slow progressions that develop neuromuscular control, challenge proprioception, and strengthen weak or inhibited muscles for better functional strength. Below is an example program you can use to help correct the compensations listed above. Remember to continually assess your client and only progress them to exercises and proprioceptive tools that they can safely execute.