Postnatal physiotherapy: recovery after childbirth

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• Slug: postnatal-physiotherapy
• Metatitle: Postnatal Physiotherapy | Recovery After Childbirth
• Metadescription: Recover safely after childbirth: pelvic floor, diastasis, return to sport. Postnatal physiotherapy in Montreal.
• Collection: Complete Guide
• Phase: 11 (Populations)
• Type: OUTER/BREADTH
• Word Count Target: 2,200-2,800

Childbirth transforms your body in ways you might not have expected. You are often told that "six weeks should be enough" or "it's normal to have pain after a baby," which leaves little room to understand what is really happening and what you need.

Here's the good news: postnatal physiotherapy supports your recovery by helping you understand normal changes, identify what needs attention, and gradually regain your strength. Contrary to the common belief that you just need to "wait it out," an active approach can make a significant difference in your well-being.

As physiotherapists specializing in pelvic floor rehabilitation at Physioactif, we have been supporting new mothers through this transition for over 15 years. Our approach combines rigorous assessment, abdominal muscle rehabilitation, management of postural pain, and a gradual return to activity.

This article explains postnatal physiotherapy, when to consult a professional, and how a personalized approach helps you recover safely.

What is postnatal physiotherapy?

Postnatal physiotherapy is a specialization of pelvic floor physiotherapy that specifically addresses the physical and functional changes that occur after childbirth. It aims to support your recovery, restore your function, and prevent long-term problems.

Body changes after childbirth

Your body spent nine months adapting to pregnancy and needs time to recover. The main changes include:

Pelvic Floor: Stretched muscles, altered coordination, decreased protective reflexes. Abdominal Wall: Stretched linea alba, diastasis present in 60% of women at 6 weeks¹, altered muscle coordination. Musculoskeletal System: Ligaments loosened up to 6 months postpartum, new strains related to breastfeeding and carrying. Scars: Perineal tear, episiotomy, or C-section incision that can cause adhesions or sensitivities.

What postnatal physiotherapy can treat

Difference from general physiotherapy

Physiotherapists specializing in perineal rehabilitation have advanced training in internal pelvic floor assessment, treatment of pelvic dysfunctions, postnatal abdominal rehabilitation, scar tissue work, and safe progression to exercise. This specialization ensures an understanding of the nuances of postnatal recovery.

When to see a physiotherapist after childbirth?

The best time to consult depends on your symptoms and goals, but there are general recommendations based on research and clinical practice.

Recommended timing for the first assessment

Uncomplicated Vaginal Delivery:

• First assessment possible as early as 2-4 weeks if symptoms are concerning
• Systematic assessment recommended at 6-8 weeks for all women²
• Some countries (France, Belgium) systematically cover 10-20 sessions of perineal rehabilitation

C-section Delivery:

• First assessment possible as early as 4-6 weeks
• Initial focus on abdominal scar and muscle recovery
• Pelvic floor assessment often recommended (pregnancy alone affects the pelvic floor)

Situations Requiring Earlier Consultation:

• Urinary or fecal incontinence that concerns you
• Feeling of heaviness or "something coming down" in the pelvic area
• Significant pain in the perineum, scar, or lower back
• Difficulty urinating or having bowel movements
• Abdominal separation (diastasis) that concerns you
• Pain when resuming daily activities

Debunking the "6-week" myth

The idea that "everything should be back to normal by 6 weeks" is a persistent and harmful myth. Here's the reality based on research:

What Can Be Restored at 6 Weeks:

• Postpartum bleeding has generally stopped
• The uterus has returned to its normal size
• Superficial perineal wounds have healed on the surface

What Takes More Time:

• Pelvic floor strength: 3-6 months to regain pre-pregnancy strength³
• Diastasis closure: 6-12 months of natural progression, then a plateau¹
• Ligament laxity: up to 6 months after childbirth
• Neuromuscular coordination: varies depending on the individual and activity
• Adapting to new physical demands: an ongoing process

Important Message: Six weeks is simply when your doctor checks that immediate complications have resolved. It is NOT a magic deadline after which everything should be "normal." Your recovery is a process measured in months, not weeks.

Proactive vs. Reactive Consultation

Preventive Approach (Recommended):

• A systematic evaluation at 6-8 weeks, even without obvious symptoms
• Helps identify subclinical dysfunctions before they become problematic
• Establishes a plan for a gradual return to activities and exercise
• Prevents long-term problems (incontinence during menopause, prolapse)

Reactive Approach:

• Consultation only when bothersome symptoms are present
• Risk of normalizing dysfunctions that could be treated
• Can delay treatment for problems that develop slowly
• Potentially longer treatment because the problem is more established

European data suggests that systematic pelvic floor rehabilitation after childbirth significantly reduces urinary incontinence in the short and long term⁴. In Quebec, this preventive approach is unfortunately not the norm, but you can choose to seek preventive consultation.

What to expect during your first assessment?

The initial postnatal physiotherapy assessment is comprehensive and typically lasts 60 to 90 minutes. Here's what usually happens.

Discussion of your history

Your physiotherapist will ask you detailed questions about:

Your Pregnancy and Delivery:

• Type of delivery (vaginal, C-section, instrumental)
• Duration of labor and pushing
• Complications (tearing, hemorrhage, shoulder dystocia)
• Baby's weight and positioning
• Medical interventions (epidural, episiotomy, forceps, vacuum extraction)

Your Current Symptoms:

• Urinary incontinence (stress, urge, mixed)
• Bowel or gas incontinence
• Feeling of heaviness or prolapse
• Pain (perineum, scar, back, pelvis, tailbone)
• Constipation or difficulty with bowel movements
• Pain during sexual intercourse

Your Daily Activities:

• Breastfeeding (position, frequency, associated pain)
• Baby carrying (methods, duration, discomfort)
• Sleep and fatigue
• Planned return to work
• Physical activity and sport goals

Physical examination

Postural and Musculoskeletal Assessment:

• Observation of your standing and sitting posture
• Assessment of your spine, pelvis, and hip mobility
• Strength tests for your core, hip, and back muscles
• Palpation of painful areas (back, pelvis, tailbone)

Abdominal Wall Assessment:

• Measurement of rectus abdominis diastasis (separation, depth, tension)
• Abdominal function tests (coordination, control)
• Assessment of your ability to manage intra-abdominal pressure
• Observation of your breathing strategy

Pelvic Floor Examination (with your consent):

The internal pelvic floor exam is an important part of the assessment, but it is NEVER mandatory. Your physiotherapist will explain why this exam is recommended and what it helps to evaluate. You always have the right to refuse or postpone it to a later session.

The internal exam allows us to assess:

• Muscle tone (hypertonia, hypotonia, normal)
• Muscle strength (on a scale of 0 to 5)
• Endurance (the ability to hold a contraction)
• Coordination (activation, relaxation, speed)
• The presence of tender points or muscle spasms
• The condition of scar tissue (tear, episiotomy)
• The degree of organ descent (prolapse)

Scar Examination (if applicable):

• C-section: mobility, sensitivity, adhesions
• Episiotomy or tear: healing, sensitivity, restriction

Results and Treatment Plan

At the end of the assessment, your physiotherapist will explain:

• The results of the assessment in clear terms (no incomprehensible medical jargon)
• What is normal versus what requires treatment (contextualizing your symptoms)
• The recommended treatment plan (frequency, duration, goals)
• Home exercises to start immediately
• Modifications to make to your daily activities
• The realistic prognosis based on your specific situation

You will leave with a clear understanding of what is happening in your body and a concrete plan for progress.

What treatments are used in postnatal physiotherapy?

Postnatal physiotherapy uses a variety of techniques tailored to your specific needs. Here are the main approaches.

Pelvic Floor Rehabilitation

Pelvic floor rehabilitation is at the heart of postnatal treatment. Contrary to the idea that "doing Kegels" is enough, effective rehabilitation is nuanced and tailored to your situation.

For a weakened pelvic floor: Teaching correct contraction, progressing strength and endurance, coordination training, functional integration. For a tense pelvic floor: Some women have an OVERLY tense pelvic floor after childbirth. Treatment includes relaxation techniques, massages, diaphragmatic breathing, stretching, and reducing muscle guarding. Biofeedback: Sensors that show muscle activity on a screen in real-time, allowing you to visualize correct contraction, measure progress, and learn faster.

Abdominal Wall and Diastasis Rehabilitation

Diastasis recti (separation of the midline between the abdominal muscles) affects about 60% of women at 6 weeks postpartum¹. The good news: most gradually close with appropriate therapeutic exercises.

Progressive rehabilitation strategy: Phase 1 (0-6 weeks): Diaphragmatic breathing, gentle activation of deep abdominal muscles, movements without excessive pressure. Phase 2 (6-12 weeks): Core stabilization, progressive loading, more complex movements. Phase 3 (3-6 months): Standing exercises with weights, multi-plane movements, return to sports activities. Myths about diastasis:

❌ FALSE: "You should never do crunches if you have diastasis"

✅ TRUE: Some abdominal exercises are problematic in the early stages, but others are beneficial. The goal is to gradually progress towards ALL movements, including crunches eventually, when you are ready.

❌ FALSE: "A diastasis wider than 2 fingers requires surgery"

✅ TRUE: The width of the gap is less important than the tension and function. Many women function very well with a persistent 2-3 finger gap if the tension is good.

❌ FALSE: "If diastasis is not closed by 6 months, it will never close"

✅ TRUE: Changes can continue for up to 12-18 months with appropriate exercises. After this period, a residual gap is only problematic if it causes symptoms.

Scar Treatment

Scars (from C-sections, episiotomies, or tears) can cause pain, sensitivity, adhesions, and restricted movement if not treated properly.

C-section scar treatment:

• Desensitization massage (once healing is complete, around 6-8 weeks)
• Tissue mobilization to prevent adhesions
• Work on skin and fascia mobility
• Scar-friendly abdominal strengthening exercises

Perineal scar treatment:

• Guided self-massage to improve elasticity
• Internal treatment for adhesions and sensitive spots
• Gradual desensitization (important for resuming sexual activity)
• Gentle stretching of restrictive tissues

Scar massage may feel uncomfortable at first, but it is crucial for restoring tissue mobility and reducing long-term sensitivity.

Managing Postural Pain

The new demands of motherhood (breastfeeding, carrying your baby) often lead to pain in the neck, shoulders, back, and wrists. Physiotherapy addresses these pains by optimizing positions, strengthening muscles, stretching, and adjusting how you carry your baby. These pains are NOT inevitable and can be significantly improved.

Gradual return to exercise

Returning to exercise after childbirth should be gradual and tailored to your individual recovery. There is no universal timeline.

Principles of progression: 0-6 weeks: Comfortable walking, breathing exercises, gentle activation. 6-12 weeks: Progressive walking, core strengthening, cycling or swimming, avoid impact. 3-6 months: Gradual introduction of impact, symptom monitoring, adjustments based on the body's response. Signs you are progressing too quickly:

• Urinary leakage during or after exercise
• Feeling of heaviness or pelvic pressure
• Increased diastasis or abdominal bulging
• Persistent pelvic, back, or tailbone pain
• Bleeding that restarts or increases

If you notice these signs, it means your body is telling you to slow down, not that you are "weak" or "broken." Respecting these signals now prevents more significant problems in the long run.

How long does it take to recover after childbirth?

Postnatal recovery is an individual process that depends on many factors. Here are realistic benchmarks based on research and clinical experience.

Typical Recovery Timeline

0-6 weeks: Tissue healing, gentle mobility, reconnecting with the pelvic floor and abdominal muscles. 6-12 weeks: Progressive strengthening, working on diastasis, increasing activity. 3-6 months: Strengthening, progressing to more complex exercises, and returning to pre-pregnancy activities for many women. 6-12 months: New functional "normal," possible return to high-impact sports. 12+ months: Stabilization, long-term maintenance.

Factors influencing recovery

Typical number of sessions

The number of postnatal physiotherapy sessions varies considerably depending on your needs:

Simple preventive assessment (1-3 sessions):

• Initial Assessment
• Home exercise plan
• Follow-up 4-6 weeks later for adjustments
• Suitable if: no symptoms, uncomplicated delivery, goal of gradually returning to basic activities

Standard rehabilitation (6-10 sessions):

• Initial Assessment
• 4-8 treatment sessions (weekly, then bi-weekly frequency)
• 1-2 follow-up sessions before returning to sports
• Suitable if: mild leaks, moderate diastasis, postural pain, plan to return to sports

Intensive rehabilitation (10-20 sessions):

• Comprehensive assessment
• 8-18 treatment sessions (bi-weekly frequency initially)
• Regular follow-ups for progression
• Suitable if: significant leaks, symptomatic prolapse, chronic pain, complex dysfunctions, return to high-level sports

In some European countries, 10-20 perineal rehabilitation sessions are systematically reimbursed after each delivery. In Quebec, the number of sessions depends on your private insurance coverage.

What are the common myths about postnatal recovery?

Myth 1: "Urinary leaks after having a baby are normal"

Reality: Urinary leakage is COMMON (affecting 30-40% of women⁵) but it is NOT NORMAL and can almost always be improved or resolved with physiotherapy.

"Common" does not mean "acceptable" or "inevitable". If your friends experience leaks and tell you "that's just how it is after a baby," know that they could all benefit from physiotherapy. Do not normalize a symptom that can be treated.

Myth 2: "You shouldn't do Kegels if you have leaks"

Reality: Pelvic floor exercises (Kegels) are often beneficial for leakage, BUT:

• 30% of women perform contractions incorrectly without guidance⁶
• Some women have a hypertonic (overly tense) pelvic floor and need RELAXATION, not strengthening
• Kegels alone are rarely enough: functional integration is needed

This is why a professional assessment is important: your physiotherapist will tell you if you are contracting correctly and if it's the right strategy for you.

Myth 3: "Diastasis either closes on its own or never, there's nothing you can do"

Reality: Diastasis naturally improves within the first 6-12 months, BUT appropriate exercises can speed up this closure and improve function even if a gap remains.

Studies show that targeted exercises significantly reduce diastasis compared to no intervention⁷. The goal is not necessarily complete closure, but an improvement in tension and function.

Myth 4: "I can return to the gym after 6 weeks if I feel good"

Reality: Feeling good isn't the only sign of readiness. Your tissues, ligaments, and pelvic floor need time to recover, even if you don't feel any pain.

An assessment of the pelvic floor and abdominal muscles is highly recommended before resuming intense or high-impact exercise. Some dysfunctions (early prolapse, pelvic floor weakness) are asymptomatic at rest but become problematic with repeated impact.

Myth 5: "If I had a C-section, my pelvic floor is fine"

Reality: Pregnancy alone affects the pelvic floor (baby's weight, hormones, pressure for 9 months). Studies show that women who have C-sections also have risks of incontinence and prolapse, though slightly lower than with vaginal birth.⁸.

Furthermore, a C-section affects the abdominal muscles and creates a scar that can limit core function. Therefore, a postnatal assessment is also relevant after a C-section.

Myth 6: "If I have a pelvic floor problem, it's my fault (I pushed too hard, didn't do enough Kegels during pregnancy, etc.)"

Reality: Pelvic floor dysfunctions are multifactorial and often unpredictable. They depend on:

• Genetic factors (connective tissue quality)
• Course of delivery (often beyond your control)
• Baby's weight and position
• Duration of labor
• Hormonal factors

Performing Kegel exercises during pregnancy has NOT been proven to prevent tears or postpartum incontinence⁹. Stop blaming yourself: what happens to your body during childbirth is generally not your fault.

What are the frequently asked questions about postnatal physiotherapy?

What does Physioactif offer in postnatal physiotherapy?

At Physioactif, we offer an empathetic approach tailored to new mothers: comprehensive assessment (60-90 minutes), pelvic floor examination, diastasis and scar assessment, personalized plan, biofeedback, manual therapy, and gradual return to exercise. Our specialized physiotherapists understand the real challenges (fatigue, breastfeeding, carrying your baby) and work within your limitations. We offer flexible hours and the option to bring your baby.

When to See a Doctor Instead of a Physiotherapist?

Consult your doctor first if you experience: significant bleeding, fever, worsening severe pain, complete inability to control urine/stool, a visible mass in the vulvar area, chest pain, or symptoms of severe depression. For moderate prolapse, fecal incontinence, or chronic pelvic pain, physiotherapy and your doctor will work together.

Can I exercise while breastfeeding?

Yes, absolutely. Moderate exercise during breastfeeding is safe and does not affect the quantity or quality of breast milk¹⁰. Here are a few tips:

• Breastfeed or pump before exercising for more comfort
• Wear a well-fitting sports bra
• Stay well-hydrated before, during, and after exercise
• Start gradually and increase intensity over time

Some women report that their baby refuses the breast immediately after very intense exercise (possibly due to the slightly salty taste of sweat or lactic acid). If this happens, offer the breast 30-60 minutes after exercise instead of immediately.

My diastasis is 3 fingers wide. Do I need surgery?

Probably not. The width of the gap is only one factor to consider. What matters more is:

• The tension of the linea alba (can it withstand pressure?)
• Your function (can you perform your activities without symptoms?)
• The presence of bulging or doming during effort
• Your personal goals

Most diastases, even wide ones, improve significantly with appropriate rehabilitation. Surgery is rarely necessary and is generally only considered if:

• Significant symptoms (functional weakness, chronic pain) persist despite 12+ months of rehabilitation
• Associated hernia requiring correction
• Major aesthetic impact causing psychological distress

How long after childbirth can I resume sexual intercourse?

The standard medical recommendation is to wait 4-6 weeks to allow tissues to heal. However, this is a general guideline, not an absolute rule.

When you are ready depends on:

• Complete healing of tears or episiotomy
• No bleeding
• Physical comfort and no pain
• Emotional readiness and desire
• Contraception in place if you do not wish to become pregnant again immediately

If you experience pain during sexual intercourse (dyspareunia), consult a physiotherapist. We can treat:

• Restrictive or sensitive scars
• Tight pelvic floor muscles (vaginismus)
• Tender points (trigger points)
• Vaginal dryness (related to breastfeeding and hormones)

Do not normalize pain during intercourse. It is treatable.

Is it normal to leak urine when I run 6 months after childbirth?

No, it is not normal, although it is unfortunately common. Stress incontinence (leaking during coughing, sneezing, jumping, running) can almost always be improved or resolved with pelvic floor rehabilitation.

If you experience leaks while running:

• Stop running temporarily
• Consult a pelvic floor physiotherapist
• Work on strengthening and coordinating your pelvic floor
• Gradually resume running with protective strategies

Continuing to run with leaks can worsen the problem and lead to more significant long-term dysfunctions (prolapse).

My baby is 2 years old and I still have symptoms. Is it too late to seek help?

No, it's never too late. While rehabilitation is ideally started in the first few postpartum months, significant improvements are possible even years after childbirth.

We regularly see women 2, 5, 10, or even 20 years after their last childbirth who greatly benefit from pelvic floor rehabilitation. Tissues can still be re-educated, strength can be regained, and function can improve.

If you have symptoms that bother you, seek help. You deserve to feel good in your body, no matter how much time has passed since childbirth.

Are pelvic floor exercises safe during pregnancy?

Yes, pelvic floor exercises are generally safe and recommended during pregnancy. However:

• Avoid doing Kegels continuously throughout the day (risk of hypertonicity)
• Also learn to RELAX your pelvic floor, not just to contract it
• Consult a physiotherapist if you experience pelvic pain or urinary problems during pregnancy
• Stop if you feel pain or discomfort

Research suggests that pelvic floor exercises during pregnancy may slightly reduce the risk of postpartum incontinence, but do not prevent tears⁹.

What should you do now for a good recovery?

If you have just given birth or are pregnant:

• Don't wait until you have serious problems. A preventive assessment at 6-8 weeks can identify subtle dysfunctions.

• Listen to your body without comparing yourself to others. Every recovery is unique.

• Do not normalize symptoms (leaks, heaviness, pain). They can be treated.

• Be patient. Recovery is measured in months, not weeks.

• Ask for help if needed. You don't have to manage everything on your own.

To book an appointment at Physioactif: Book your assessment online. No prescription is needed. Bring comfortable clothing, a list of symptoms, and your insurance card.

References

• Mota P, Pascoal AG, Carita AI, Bø K. The Immediate Effects on Inter-rectus Distance of Abdominal Crunch and Drawing-in Exercises During Pregnancy and the Postpartum Period. J Orthop Sports Phys Ther. 2015;45(10):781-788. doi:10.2519/jospt.2015.5459

• Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014;48(4):299-310. doi:10.1136/bjsports-2012-091758

• Hilde G, Stær-Jensen J, Siafarikas F, Ellström Engh M, Bø K. Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance. Am J Obstet Gynecol. 2013;208(1):50.e1-50.e7. doi:10.1016/j.ajog.2012.10.878

• Bø K, Hagen RH, Kvarstein B, Jørgensen J, Larsen S, Burgio KL. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: III. Effects of two different degrees of pelvic floor muscle exercises. Neurourol Urodyn. 1990;9(5):489-502.

• Boyle R, Hay-Smith EJC, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012;10:CD007471. doi:10.1002/14651858.CD007471.pub2

• Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women. BMJ. 1999;318(7182):487-493.

• Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1-8. doi:10.1016/j.physio.2013.08.005

• Press JZ, Klein MC, Kaczorowski J, Liston RM, von Dadelszen P. Does cesarean section reduce postpartum urinary incontinence? A systematic review. Birth. 2007;34(3):228-237. doi:10.1111/j.1523-536X.2007.00175.x

• Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017;12:CD007471. doi:10.1002/14651858.CD007471.pub3

• Lovelady CA, Garner KE, Moreno KL, Williams JP. The effect of weight loss in overweight, lactating women on the growth of their infants. N Engl J Med. 2000;342(7):449-453. doi:10.1056/NEJM200002173420701