According to the 2016 study (and previous studies) on postnatal pelvic girdle pain, Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study  , women with pain activate muscles differently.  There's help for this! 

The important findings are: 
During the subsequent ipsilateral leg lift (lifting  the  leg  on the same side as the painful  pelvic region):
* pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women
*Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles and the muscles of the lower lateral abdominal wall

 We know from previous studies (one of many) that  there are many prognostic factors that  can relate to  persistent pelvic girdle pain  such as  age, muscle function, disability, and previous  fitness level/pain  levels . What  does this all mean for patients ? How  can we help  those of you who are dealing with lumbar and pelvic pain , even years after having a  baby? 

The key is to address  each patient individually. There are numerous layers to  the pain experience  - beyond just the location of pain.  It  is likely also simplistic and  erroneous to assume that the pelvis is  "too unstable" or that the  sacroiliac joint  is just hypermobile  (there are certainly cases of  people who have hypermobility as a component such as with Ehler's Danlos Syndrome, but even then, there are other factors). If you find that you have been seeing other healthcare professionals for years telling you that your leg, sacroiliac joint, or pelvis keeps going "out," that's likely not the issue.   From a whole-person perspective, there are  factors to consider such as hormonal, physical, sleep/lifestyle, social, and psychological (not "it's-in-your-head type, but rather effects of anxiety, stress, previous pain, or previous trauma, etc) .  Therefore,  addressing  these factors AND  taking a closer look at  the  pre-activation/motor control of the muscles and general movement patterns  is  an ideal approach.  

If you are a patient dealing with  pelvic  girdle pain,  sacroiliac joint pain, lower back pain  after having a baby (even years later), there's a  lot of hope for getting better!  A pelvic physical therapist  can assess you individually to  facilitate the best plan for your daily life and also provide an optimal exercise plan to  guide you to relatively pain-free  movements! This goes beyond simply giving a list of exercises and  saying good luck!  That's why so many women continue to have pain for years later.  We can also work closely with your pregnancy /postpartum specialists  - there are some incredible ones out there too. 

For professionals - The key is how do we improve/facilitate the proposed disturbed motor activation patterns that influence women's ability to stabilize the pelvis during leg? How much do we train "pre-activation?"
There seem to be distinct professional views: 1. Some say just get patients moving in pain-free ways and this will help with improving neural/motor activation and don't focus on pre-activation and minutia; or 2. Others focus heavily on individual "pre-activation," movement patterns, segmental/"core" strengthening. Couldn't it be the case that we include both of these strategies (and individualize as needed) - not so much thinking we are increasing strength, but rather improving motor patterns and activation on a neural level? 

Another consideration:  EMG testing can be subpar for understanding the underlying issue regarding muscle activation. In other words, patients may not be pre-activating pelvic floor as a result of shortening of the muscles rather than simply not activating due to weakness or other. Therefore, just working on activating the pelvic floor prior to an activity, may not be the best treatment. We still have to look at each individual and assess  all of the  variables.
**  Did you know that Tracy Sher, MPT, CSCS and Alma Bautista, SPT,  at Sher Pelvic Health are both Certified MuTu  Pros™ in  postnatal fitness?  Minal Saraf, MSPT also specializes in  Pelvic PT for pregnancy/postnatal. 

We receive many questions about postnatal exercise concerns and online programs.  We hope you find this information helpful!

The  American College of  Obstetricians and  Gynecologists has general guidelines on this topic.

In addition to those general guidelines, it is important to remember that  having a baby  via  C-section or vaginal delivery is a  big deal! Your body is incredible, strong and beautiful. Honor your body during this time and allow the tissues to heal  ( vaginal delivery as an extreme sport  and  returning to exercise after a C-section). 
​Movement is very beneficial to healing  such as  walking, breathing  exercises and pelvic floor exercises.  Generally, after 4-8 weeks (based on  your  medical  visits), you can  increase to higher intensity aerobic exercise and weights.  If you try to go back to  the same exact exercises that you were  doing during pregnancy or  before, you may  realize you have changes affecting the way you move and feel such as: scar tissue  adhesions at your abdomen,  a prolapse starting, separation of the abdominal muscles,  leaking with jumping.

 Once you are cleared by your OB medically,  we highly recommend you see a  Pelvic  Physical Therapist  (Women's Health Physical Therapist). This is exactly what we do! We help you maximize your pelvic, abdominal, and back health to be able to return fully to your daily activities, including exercise programs. We  can do postnatal screenings to  identify  these conditions  and provide individualized  treatment and home programs for you. 

There are numerous  postnatal exercise programs out there,  which is why we want to highlight the very best!  The programs  listed here are  ones that specifically take  pelvic health into consideration. They are  developed by  fitness trainers  or PTs we trust.
**  These exercise programs are  not just for  up to 1  year postnatal. They are safe for  most people at any age because they are meant to  facilitate proper form  and optimal pelvic/core health. 
** Concern: Classes that focus on the  BOOT  CAMP mentality . Some of the exercises can be okay, but often women  are pushed to do crunches, planks,  high-intensity jogging and jumping with the motto "get your body back into shape quickly." These  exercises  are typically not appropriate  for many women  in the first year after baby.  Many women go to  countless exercise classes  for their abdominals  only to learn that it was making the diastasis recti and pelvic floor issues worse.  
**  We receive questions about the Tupler  Technique often.  It involves using  a splint  for a certain period of time while doing specific exercises. It can work for some, but we find that it is not  applicable to  daily function and many women have difficulty adhering to the program.  We  didn't feel comfortable putting it on our "best" list. 
 * We will  continue to  modify and add to this list. 

"Had enough of the baby belly? Strengthen your core, improve pelvic floor function + get strong, fit + body confident… however long ago you had your baby!"

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We recommend this  to  new moms  in conjunction with our  pelvic PT sessions OR  this program can serve as a stepping stone to  more advanced exercise programs (getting back to high-intensity weight lifting classes  and/or aerobic exercises) . Tracy Sher serves as Medical Advisor for  MuTu  and affiliate and fully endorses the program.  The online program also includes access to  a very active  online  support  group. The founder, Wendy  Powell, is very passionate  about this system and  heavily involved in online support. 
* We will soon offer  LIVE MuTu  classes in Orlando starting in  July/August of 2016! 

"Wholesome fitness for the whole family.  You crave modesty, affordability, and accountability." 

Another  program that is always rated with high satisfaction  is Fit2B , by Beth Learn.  The primary feature is a monthly or yearly membership that provides online options such as:  access to over 100  workouts,  a supportive Facebook community, discounts on eCourses , and  a  Fit2B mobile app. 

"Hab-it: Pelvic Floor is a DVD [now digitial download] that gives women suffering from the symptoms of a weakened pelvic floor (urinary incontinence, pelvic prolapse) the experience of working with a physical therapist from the comforts of home. The intent of the DVD is to help, if not eliminate, the symptoms of a weakened pelvic floor...designed with input from physicians, physical therapists, and real patients to ensure that viewers receive expert guidance that addresses the most common mistakes and frustrations of physical therapy"

The website features  a  series of  digital  download exercise programs:  Hab-It  Pelvic Floor Exercises,  7 Day Advanced Stabilization Program,  Interval  Cardio Workout,  Interval Plyometric  Workout. 
We  heard a lot about  this from patients. They enjoyed the program, but  were looking for more individualized programs as well. 

"The pelvic floor has long been the only muscle targeted in the battle against incontinence, and yet ignored in our pursuit of a strong ‘core’. New research has helped us understand that the pelvic floor is actually a critical part of the ‘core’ team and collectively that team works together to keep your center anchored and dry. Integrated teamwork, linked to the up and down pistoning action of our breath, provides a sturdy foundation that supports our joints and movement, accelerates fitness, and keeps us dry.  Also recommended for minimal to moderate prolapse, diastasis, and pelvic pain."

Physical Therapist Julie Wiebe is a leading clinician and educator on the topics of returning to high-level athletics after changes at the pelvic floor and core.  Foundation for Fitness is your first step toward resolving leaks and restoring a strong foundation for your movement and fitness.
* This is an educational online course rather than an exercise system.  Highly recommended to understand the pressure system of the core.  You can view  this as a great complement to the full programs listed above. 

We hope this has been helpful!  
If you would  like to set up a  consultation with  one of our Pelvic  PTs , you can fill out the  registration form on our    welcome page HERE or call 407-900-2876

​~  Tracy Sher and the Sher Pelvic Health  team!