Introduction: Postpartum recovery is a journey that involves healing from pregnancy and childbirth while adjusting to life with a newborn. As a licensed physical therapist, I often see new mothers in Manhattan experiencing a variety of postpartum issues after both vaginal and cesarean (C-section) deliveries. Common concerns include pelvic floor dysfunction, diastasis recti (abdominal muscle separation), urinary incontinence, back and pelvic pain, scar tissue problems, and posture changes. These issues can impact a mom’s comfort, confidence, and ability to return to normal activities. The good news is that physical therapy can play a key role in addressing these postpartum challenges in an evidence-based, supportive way. Below, we will explore each of these concerns, explain their effects on recovery, and discuss how physical therapy helps—all in a professional yet accessible manner for new moms.
Pelvic Floor Dysfunction After Childbirth
Pregnancy and childbirth (whether vaginal or C-section) put tremendous strain on the pelvic floor muscles and connective tissue. The pelvic floor is the group of muscles supporting the uterus, bladder, and rectum, and it stretches significantly during a vaginal delivery (sometimes up to 3 times its normal length). Pelvic floor dysfunction (PFD)refers to the inability to properly control or coordinate these muscles. Postpartum PFD symptoms can include urinary incontinence, fecal incontinence, pelvic organ prolapse (when pelvic organs drop due to weak support), and pelvic girdle or low back pain. Some women also experience pain or pressure in the pelvic region, and discomfort during sex, as part of pelvic floor dysfunction. These issues might improve over time for some, but many women continue to have symptoms for months or even years if left unaddressed, impacting their physical, emotional, and sexual health.
How Physical Therapy can help: Pelvic floor physical therapy (sometimes called pelvic rehab) is highly effective in restoring strength and function to these muscles. Treatment often includes pelvic floor muscle training (Kegel exercises), biofeedback techniques, and individualized exercise plans to improve coordination and endurance of the pelvic floor. The goal is to reduce or eliminate PFD symptoms and prevent long-term issues that affect a mother’s quality of life. In fact, many countries consider postpartum pelvic floor PT a standard part of care, and experts advocate the same in the U.S., given the low risk and high potential benefit of therapy in this stage. As therapists, we teach new moms how to correctly activate and strengthen their pelvic floor (often starting with gentle contractions soon after birth, if tolerated) and how to integrate those muscles into daily activities and exercises. This not only helps resolve immediate problems like leakage or pain, but also protects against future problems like pelvic organ prolapse.
It’s worth noting that pelvic floor dysfunction can affect mothers of all delivery types. While women who had vaginal deliveries have a higher risk of pelvic floor injury, C-section mothers are not immune – the weight of the baby and hormonal changes of pregnancy alone can weaken the pelvic floor. No matter the delivery method, a physical therapist can evaluate your pelvic floor and create a tailored plan to help these important muscles recover.
Urinary Incontinence in the Postpartum Period
One of the most distressing postpartum issues for many women is urinary incontinence – the unintentional leakage of urine (for example, when coughing, laughing, or exercising). You are not alone if this is happening to you: research indicates that urinary incontinence may affect up to 30–45% of women in the postpartum period (with some studies finding even higher initial rates that gradually improve within the first year). This leakage is often due to the pelvic floor being stretched or injured during childbirth, leading to weakness. It can be embarrassing and inconvenient, causing new moms to limit activities or exercise due to fear of leakage.
How Physical Therapy can help: The good news is that pelvic floor physical therapy is a first-line, evidence-based treatment for postpartum incontinence. By performing targeted pelvic floor muscle exercises (Kegels) and other techniques, women can significantly improve bladder control. In fact, a study found that regular pelvic floor training not only reduced the frequency and intensity of urine leakage in postpartum women, but also improved their quality of life. A pelvic floor therapist will ensure you are doing Kegel exercises correctly (many women initially don’t engage the right muscles on their own) and progress you through a tailored program. They might use biofeedback or electrical stimulation in some cases to help strengthen the pelvic muscles.
Most importantly, therapy will integrate these exercises into functional activities. For example, learning to engage your pelvic floor during everyday motions (lifting the baby, standing up, coughing) can prevent surprise leaks. Starting pelvic floor exercises soon after delivery is often recommended – even in the first days postpartum if you feel up to it, gentle contractions can promote blood flow and begin rebuilding muscle memory. In fact, you can typically begin doing simple Kegels right after a vaginal or cesarean birth; this may help prevent incontinence and even improve sexual enjoyment as you heal. Of course, always follow your provider’s guidance for activity based on your specific recovery. Over the ensuing weeks, a PT will progressively increase the challenge (longer holds, different positions, adding core coordination) to fully restore your bladder control.
If your incontinence persists or is severe (for instance, large volume leakage or lasting beyond the early months), don’t hesitate to seek help. There is no need to “just live with it” – postpartum pelvic floor rehab can be life-changing, giving you the confidence to sneeze, exercise, and play with your baby without fear of leaks. In our Manhattan clinic, we emphasize privacy and understanding – we know this topic can be sensitive, and we strive to make you comfortable every step of the way.
Diastasis Recti (Abdominal Muscle Separation)
During pregnancy, it’s common for the growing belly to cause a separation of the left and right halves of the abdominal muscles down the middle. This is known as diastasis recti abdominis (DRA). After delivery, many women find they have a persistent gap or bulge in the midline of their tummy – sometimes described as a “pooch” that doesn’t go away even with weight loss. Diastasis recti is extremely common: research suggests that about 60% of women have DRA at 6 weeks postpartum, and roughly 30% still have it at 12 months postpartum. In other words, for many moms the abdominal separation does improve over time, but about one in three will continue to experience a gap and related symptoms a year after birth if no intervention is done.
So why does diastasis recti matter? For some women, it’s primarily a cosmetic concern (a belly “bulge”). But DRA can also lead to functional problems. The abdominal muscles are important for core strength, posture, and spinal support. When they remain separated and weak, women may experience a feeling of core instability or weakness, low back pain, hip or pelvic pain, poor posture, or difficulty with certain movements. You might notice doming or coning of the abdomen when you try to do a sit-up or lift something, which is a sign of the separation. Additionally, a weak core from DRA can put extra pressure on the pelvic floor; in fact, 66% of women with diastasis recti also have at least one form of pelvic floor dysfunction (such as incontinence or prolapse). This means addressing your abdominal separation is not only about your abs – it’s about your overall stability and pelvic health.
How Physical Therapy can help: The rehabilitation of diastasis recti is one of our specialties in postpartum physical therapy. We start by assessing the width and depth of your abdominal separation and evaluating how well you can create tension in those muscles. Then we create a customized exercise program to safely strengthen your core and bring those muscles back together. This typically involves deep core activation exercises targeting the transverse abdominis (the deepest abdominal muscle), the obliques, and the pelvic floor in coordination. Early on, exercises might include gentle abdominal drawing-in maneuvers, breathing exercises, and posture training rather than traditional crunches. Learning proper breathing and posture is crucial, because how you stand, move, and even breathe affects abdominal pressure. We’ll teach you techniques to engage your deep core muscles during everyday activities – for example, how to roll out of bed or lift your baby without straining the weak midline.
Over time, as your gap decreases and strength improves, we’ll progress your exercises (e.g. modified planks or functional moves) to further build a stable core. We may also use techniques like core bracing or taping in the early phase for support; an abdominal binder or kinesiotape can provide gentle support and tactile feedback to help you engage your core properly during exercise. According to research, diastasis recti can usually be improved without surgery – even years later – with the right exercise approach, and surgery is only rarely needed (such as if there’s a very large hernia). Our aim is to help you close the gap as much as possible, regain strength, and eliminate any pain or instability associated with DRA, so you can resume all the activities you love.
Important note: Not all exercises are safe for a healing diastasis early on. We advise avoiding sit-ups, crunches, heavy lifting, or any move that causes your belly to bulge outward in the first 6–12 weeks postpartum. Your physical therapist will guide you on which movements to avoid and which ones to focus on instead. By working with a PT, you can be confident that you’re strengthening your core in a safe, effective way that helps your body recover from pregnancy.
Postpartum Back and Pelvic Pain
Aches and pains in the lower back, hips, and pelvis are another common postpartum complaint. After all, your body has undergone significant changes over 9+ months – including a shifting center of gravity, stretched ligaments, and altered posture – and now you’re lifting and carrying a newborn for hours each day. Many women experience low back pain, sacroiliac joint pain, or pain around the pelvis (pelvic girdle pain) in the weeks after delivery. For some, it’s a continuation of pains that started during pregnancy; for others, new pains develop postpartum due to the physical demands of childcare and recovery.
Studies show that pregnancy-related back pain often doesn’t disappear immediately after birth. In fact, approximately 25% of new mothers report ongoing low back and/or pelvic pain in the early postpartum period, and about one in three women still has significant lumbopelvic pain 2–3 months after delivery. If not addressed, these issues can sometimes persist long term – nearly 25% of women with pregnancy-related back pain continue to have chronic back pain even three years after delivery. Clearly, postpartum musculoskeletal pain is not something to ignore or just “tough out,” especially since it can interfere with your daily activities (imagine trying to care for a baby with a constantly aching back).
Why do back and pelvic pains happen postpartum? There are several reasons. Hormones like relaxin (which increase during pregnancy) can leave your ligaments looser for a while after birth, meaning joints like the spine and pelvis may be less stable and more prone to strain. The weakening of the core and pelvic floor muscles can put extra stress on the back. Also, new moms often adopt poor postures: for example, standing with the hips pushed forward and an exaggerated low-back arch, which can happen due to abdominal weakness and habit. This posture “hanging” on the hip ligaments instead of using your muscles can lead to back or hip pain over time. Additionally, constantly bending over to lift your baby, awkward breastfeeding positions, and carrying heavy baby gear can all create soreness in the back, neck, and shoulders.
How Physical Therapy can help: A postpartum physical therapist will perform a thorough evaluation to pinpoint the sources of your pain – whether it’s a joint misalignment, muscle weakness, or poor body mechanics – and then craft a plan to address it. Therapeutic exercise is a cornerstone: we will teach you safe strengthening exercises for your core, glutes, and back muscles to restore support for your spine and pelvis. Research has demonstrated that specific, individualized exercise programs can significantly reduce postpartum low back and pelvic pain and improve function. For example, gentle stabilization exercises that activate the deep abdominal muscles (like the transverse abdominis) in coordination with larger muscle groups are often very effective in alleviating lumbopelvic pain. We’ll also work on flexibility where needed (e.g. tight chest or hip muscles from all that sitting while feeding).
In addition to exercise, manual therapy techniques can be incredibly helpful. These may include hands-on mobilization of the spine or pelvis to correct alignment, massage to release tight muscles, or stretching techniques to relieve tension. If your tailbone (coccyx) is painful from childbirth, or if you have pubic bone pain from a separation (symphysis pubis dysfunction), specialized manual therapy can help realign and stabilize those areas.
Equally important, we educate you in proper posture and body mechanics for your daily tasks. Little adjustments can make a big difference in pain levels. For instance, when feeding your baby, we’ll show you how to support your back with pillows and bring the baby to your breast (rather than hunching forward to the baby). When lifting or carrying your infant or car seat, we remind you to bend your knees, engage your core, and avoid twisting. If you tend to hold your baby on one hip, we’ll encourage you to switch sides frequently and not jut your hip out to one side for long periods – instead, try to hold the baby centered in front of you or use a baby carrier with good support. We might also recommend strengthening your upper back and adjusting your ergonomics to avoid upper back and neck pain, which often accompanies caring for a newborn.
By combining pain-relieving techniques with targeted strengthening and posture training, physical therapy addresses both the symptoms and root causes of postpartum back and pelvic pain. Our aim is to get you back to being pain-free in your daily life – whether that’s lifting a stroller up Manhattan subway stairs, carrying groceries, or simply enjoying a walk with your little one – without nagging pain.
Scar Tissue Management (C-Section and Perineal Scars)
Healing from childbirth also involves scar care for many women. If you delivered via C-section, you’ll have an abdominal surgical scar; if you had a vaginal delivery, you may have a perineal scar from a tear or episiotomy. Scar tissue is a normal part of the healing process, but it can sometimes lead to issues like pain, tightness, or restricted movement if not properly managed.
C-section scar: A cesarean birth involves an incision through the abdominal skin and uterus. In the weeks and months after, the body produces scar tissue to close this incision. Often the area feels tight, numb, or even painful as it heals. If C-section scar tissue is left stiff and adhered, it can contribute to problems even years later. For example, rigid scar tissue can stick to underlying tissues (forming adhesions) that may cause localized pain or pulling, lower back or hip pain, pelvic pain, urinary or bowel issues (like constipation) due to tension on nearby structures. The good news is that with the right techniques, scars can be mobilized to improve their flexibility.
Perineal scar (vaginal tear or episiotomy): The majority of vaginal births involve some degree of tearing to the perineum (the area between the vagina and anus) or a surgical cut (episiotomy) to help deliver the baby. In fact, up to around 79% of vaginal deliveries may result in a tear or episiotomy that requires stitching, according to the American College of OB/GYN. These perineal scars can cause issues such as pain during intercourse, tenderness when sitting, a feeling of tightness, or even urinary difficulties if the scar tissue is excessive or not healing optimally. Scar tissue is less elastic than normal tissue, so if it isn’t addressed, it might continue to cause discomfort or restrict the normal stretching of the pelvic floor.
How Physical Therapy can help: Specialized scar tissue mobilization is a technique physical therapists use to help scars heal optimally. Scar mobilization involves gentle manual therapy on and around the scar to improve its mobility, flexibility, and circulation. Essentially, by massaging and stretching the scar tissue (once healing is sufficiently underway), we help the collagen fibers realign in a more orderly way, preventing adhesions and allowing the tissue to move freely with the body. For a C-section scar, a therapist might perform and teach you specific massage movements – such as circles or gentle cross-fiber friction along the scar – to soften the scar and underlying adhesions. This can relieve that stuck, tight feeling and often reduces pain in the area. Many women report improved sensation and a loosening of tightness after just a couple weeks of regular scar massage, along with benefits like flatter scar appearance, better blood flow, and reduced sensitivity or numbness in the area. By keeping the scar tissue supple, we also reduce the risk of secondary issues like those pelvic or back pains mentioned earlier.
For perineal scars, pelvic floor therapists can perform gentle internal and external scar release techniques once you are cleared (typically after 6 weeks, when the tissue has healed). This might include perineal massage to stretch the scar tissue and surrounding muscles, use of dilators or manual pressure to break up restrictions, and techniques to desensitize any overly sensitive nerve areas. Gentle perineal massage has been shown to improve circulation, elasticity, and comfort of the scar tissue, which in turn can alleviate pain with intercourse and daily activities. Essentially, massage helps remodel the scar to behave more like normal tissue, preventing long-term complications. It’s important to wait until incisions are fully closed and you have your provider’s okay, but starting scar mobilization in the early postpartum months (typically around 6–8 weeks post-delivery) can yield the best results in terms of flexibility and comfort.
What to expect: Your therapist will first assess the scar area (with your consent) and check for adhesions or restrictions. For abdominal scars, treatment is external on the skin surface. For perineal scars, treatment can be external and/or internal (vaginal) – always guided by your comfort. We often teach you how to do some of the scar massage on yourself as well, so you can continue it at home daily. Don’t worry – we will ensure the pressure is just right and not painful. Over time, you should notice the scar area becoming more supple, with reduced pain, itching, or pulling and improved pelvic floor function. By taking care of scar tissue, you’re investing in your long-term pelvic health; something as simple as dedicated scar massage can prevent a cascade of problems (for example, a tight C-section scar contributing to bladder or bowel dysfunction down the line).
Posture and Body Mechanics in the Postpartum Period
Have you caught yourself hunching over while nursing, or arching your back in an odd way to balance your baby on your hip? You’re not alone – postpartum life often challenges our posture and body mechanics. Good posture might be the last thing on a tired new mom’s mind, but it can make a huge difference in preventing pain and aiding recovery. During pregnancy, your posture likely shifted (e.g. an increased low-back arch and rounded shoulders), and after birth, the demands of infant care add new strain. Without awareness, new mothers often develop habits like slumping forward (which can cause neck and upper back pain) or swaying the lower back and abdomen forward (which, as mentioned, can strain the lower back and hips).
Common postpartum posture pitfalls include:
- Slouching while breastfeeding or bottle-feeding: It’s natural to bend toward your baby, but prolonged slouching can lead to upper back and neck stiffness.
- Holding baby on one side all the time: Many moms carry the baby on one hip, which causes you to jut that hip out and twist your spine. This uneven load can create back and pelvic pain.
- Bending from your waist (instead of your knees) to lift the baby, car seat, or diaper bag from the floor: This can strain your back, especially when done repeatedly.
- Pushing a stroller with poor posture: e.g. leaning into the stroller or rounding your back.
How Physical Therapy can help: A physical therapist can teach you proper posture and ergonomics for all these daily tasks. This is part of the education we provide in postpartum rehab – often called “body mechanics” training.We’ll show you simple adjustments, like bringing the baby up to breast height with pillows (instead of hunching down) and using a supportive chair for feeds. We emphasize keeping your head over your shoulders and shoulders over your hips to maintain a neutral spine alignment. When standing and carrying, we guide you to distribute weight evenly. For example, if you carry your infant in one arm, remember to switch arms every so often (every 15-20 minutes) to avoid overloading one side. Avoid letting your hip drift out to the side; instead, engage your core and glutes to support the weight of your baby close to your body. If using a baby carrier, we’ll ensure it’s fitted correctly (with straps at the right height and the waist belt on your hips, not your low back) to promote upright posture and spare your back and shoulders.
A physical therapist demonstrates proper baby-holding posture for new moms. Keeping the baby centered at your chest with even weight distribution (left) protects your back, whereas jutting your hip out to the side to carry the baby (right) can strain your spine and pelvis.
We also incorporate postural exercises into your routine. These might include strengthening the upper back (to counteract the forward hunch) and working on your core and gluteal muscles (to support the spine). Simple moves like shoulder blade squeezes, chin tucks, gentle chest stretches, and pelvic tilts can go a long way in restoring your postural muscle balance. Core and pelvic floor exercises (as discussed earlier) also improve posture from the inside out, since a stronger core makes it easier to sit and stand tall without fatigue. Many postpartum women are surprised at how a few tweaks to how they move or position themselves can dramatically reduce daily aches. Our goal in PT is not only to get you out of pain but also to empower you with knowledge of how to move efficiently. This way, you can confidently take on the physical tasks of motherhood – from lifting that adorable (but growing!) baby, to hauling strollers and groceries – while minimizing strain on your body.
Returning to Exercise Safely Postpartum
Getting back into exercise is a common goal for many new mothers, whether for health benefits, stress relief, or simply to feel like themselves again. However, postpartum is a time to progress gradually and thoughtfully. Your body is recovering from significant events (pregnancy and delivery), so it’s important to honor that healing process. Physical therapy can guide a safe return to fitness, ensuring you don’t rush into activities that could set back your recovery.
New mothers in a postpartum exercise class performing gentle workouts with their babies. Gradually resuming physical activity, with guidance from a professional, helps rebuild strength and confidence.
General guidelines: Always get clearance from your OB/GYN or midwife before resuming exercise, usually at the 6-week postpartum check-up for vaginal births (and around 8-10 weeks for C-sections, depending on how you’re healing). Once you have the green light, remember that “slow and steady” is the mantra. Start with small, achievable activities. For instance, begin with short walks and gentle stretching. Even 10-15 minutes of light activity is a good start. The American College of Obstetricians and Gynecologists (ACOG) recommends aiming for at least 150 minutes of moderate-intensity aerobic activity per week after pregnancy (the same guideline as for all adults), but you can build up to this over time. That could be 30 minutes of brisk walking five days a week, for example, but you can break it into shorter sessions that fit your schedule (and your baby’s schedule!). Early on, even pushing the stroller around the block counts.
Role of Physical Therapy in exercise return: A physical therapist can create a personalized exercise plan for you, taking into account any issues like pelvic floor weakness or diastasis recti. This is important because jumping into generic workouts (or trying to “crunch away” the baby weight too soon) could aggravate those conditions. In therapy, we focus first on rebuilding your foundation – core strength, pelvic stability, and overall endurance. We might start you on exercises such as pelvic tilts, bridges, gentle yoga poses, bodyweight exercises, and of course pelvic floor exercises, tailored to your level. As you get stronger, we incrementally add more intensity or specific activities (for example, light resistance training, longer cardio sessions, or mom-and-baby fitness classes).
One key principle is listening to your body. Postpartum exercise should be challenging but not painful. We educate our patients on signs to watch for: if you notice vaginal bleeding increasing, new pain, or symptoms like urinary leakage or a bulging sensation in your pelvis during a workout, those are signals to scale back and consult with your provider or PT. Our approach is evidence-based: studies show that postpartum exercise yields many benefits – it improves cardiovascular fitness, aids in weight management, and even reduces postpartum depression symptoms – but it must be approached correctly to be safe and sustainable.
Tips for a safe return to exercise: (these are often part of PT guidance)
- Stay hydrated and nourished. Your body needs extra fluids, especially if you’re breastfeeding, and plenty of healthy calories to support healing and activity.
- Include your baby when possible. This can make exercise more fun and practical – for example, incorporate your baby into workouts (like stroller walks, babywearing yoga, or gentle “mommy and me” fitness moves). It also helps strengthen your bond.
- Prioritize core and pelvic floor first. As we’ve emphasized, re-engaging these areas is key. We often give homework exercises focusing on deep abs and pelvic floor engagement. This lays the groundwork for more intense exercise later.
- Gradually increase intensity. Maybe you start with walking and pelvic floor exercises in the first weeks. By 3-4 months postpartum, you might progress to jogging or higher-impact workouts if your body is ready and your pelvic floor/core are sufficiently strong (many experts recommend waiting until around 12 weeks or more to resume running, to minimize injury risk). Your PT will help determine if you’re ready by checking things like your pelvic floor strength and dynamic stability.
- Set realistic goals and be kind to yourself. Every mom’s timeline is different. It’s okay if you’re not “back to pre-baby shape” in a few months. Focus on functional goals – e.g. “I want to be able to jog 1 mile without pain” or “lift my toddler without back pain” – rather than just a number on the scale. We work with you to reach those goals safely. Remember, consistency is more important than intensity at this stage. Small workouts spread through the week are great.
By following a structured rehab and exercise plan, you’ll gain strength and confidence each week. Many women find that working with a physical therapist postpartum gives them the guidance and reassurance they need to return to exercise without fear. Instead of guessing what exercises are okay, you’ll have an expert to ask – ensuring your workouts are not only effective but also tailored to your unique postpartum body.
Conclusion: Supporting Your Postpartum Recovery
Recovering from childbirth is a process that involves caring for yourself, not just your newborn. Physical therapy is a valuable part of that process, addressing the myriad postpartum concerns from pelvic floor dysfunction and incontinence to back pain and beyond. The aim is to help you heal fully, restore strength from the inside out, and give you the tools to move with confidence as you embrace motherhood.
If you’re a new mom in Manhattan (or the NYC area) facing any of these postpartum issues, our specialized physical therapy team is here to help. We take a professional, compassionate approach—always evidence-based—and we’ll create a personalized postpartum recovery plan that fits your needs and goals. You deserve to feel strong, pain-free, and supported in this chapter of life. Reach out to our Manhattan clinic to schedule an evaluation or to learn more about postpartum physical therapy services. We’d be honored to partner with you on your journey to recovery, so you can focus on what matters most: enjoying those precious moments with your new baby.
