Postnatal Exercise Class

This leaflet explains more about the postnatal exercise class run by the Pelvic Health
Physiotherapy service at St George’s Hospital. If you have any further questions
please speak to the physiotherapist caring for you.

What is the postnatal exercise class?

The postnatal exercise class is for women who have musculoskeletal pain, rectus
abdominis diastasis (RAD) or pelvic floor muscle dysfunction after having their baby.
The class will help:
 you to have a safe, controlled return to exercise after having your baby
 improve your awareness and knowledge of postnatal symptoms and how to help
them
 improve your core strength and control
 improve your weight, mood and energy levels
 improve your confidence to do exercises at home.
Classes last for an hour and a half and run over six weeks. To get the most out of them, try
to come to all the classes. Please let us know at least 24 hours before if you can’t come so
that we can give your space to another patient.

Who can attend the service?

You can attend if your physiotherapist has enrolled you into this class to help you return to
exercising after having your baby.

What exercises should I do at home?

You should only do these exercises if you have been advised to do so and taught by
a physiotherapist or have attended the class.
It is important to do the exercises from the class at home at least two or three times each
week to get the most from them. After completing the six sessions, you should continue
with the exercises at home at least three times a week. Below are the main strengthening
and stretching exercises you will do in the class. Pick at least one strengthening exercise
and one stretching exercise to practice regularly at home. You can mark in this leaflet the
ones you plan to practice.
Posture in Pilates
Good posture helps with low back and pelvic pain, so try to be aware of your posture
throughout the class, and keep good posture while you do all your exercises. Use these tips
to help:

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 1. If you are standing, stand with your weight equally between the front and back of
your foot.
2. Imagine your pelvis as a bucket of water. Tip your pelvis backwards as if you were
spilling water out of the back of the bucket. You will feel your back gently lengthening
and your tailbone gliding towards the floor. Now tip your pelvis forwards, as if you are
spilling water out of the front of the bucket. You will feel your lower back arch slightly.
Find your ‘neutral spine’ by resting the bucket halfway between these two
movements.
3. Lengthen the back of your neck by nodding your chin downwards slightly.
4. Engage your ‘centre’ by gently contracting your pelvic floor muscles and transversus
abdominis (see below).
Keep this posture all through the class and while you are doing your exercises at home.

Strengthening exercises
1. Pelvic floor muscle exercises
The pelvic floor is a large group of muscles which form a bowl shape from your pubic bone
at the front to your tail bone (coccyx) at the back. These muscles support your bladder,
uterus and bowel.

It is extremely important to strengthen your pelvic floor muscles (PFM) after your
pregnancy, to help prevent problems with incontinence (leakage of urine), prolapse, lower
back and pelvic pain, and to increase sensation during sex.
To exercise your pelvic floor muscles, slowly tighten the muscles around your anus and
vagina, lifting up and in as if trying not to pass wind and urine. Do this either sitting or lying
on your side.
Avoid tightening your buttocks, squeezing your legs or holding your breath.
Do this 3 times a day in the following two patterns:
1) Hold for 10 seconds, relax for 10 seconds, and repeat 10 times.

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2) Imagine the muscles are a lift and lift up as high as you can for about one second, then
fully relax. Repeat 15-20 times.

2. Transversus abdominis (TVA) muscle exercises

This muscle is a key stabiliser of your low back, acting like a corset. It works with your
pelvic floor muscles to improve your posture, which can reduce back and pelvic pain.
To strengthen this muscle, begin on all fours, keeping your shoulders over your hands and
your hips over your knees. Try to keep your back flat.

Breathe in, and then as you breathe out, slowly draw in your lower tummy towards your
spine. Hold this position while you take three or four breaths, then release.
You should be able to keep breathing normally all through this exercise. If you can’t,
you may be bracing too much with your ‘six pack’ muscles, so try to relax these.

Class exercises
1. Chest press
Basic

Lying on your back with your knees bent, engage your TVA muscle. Draw your shoulder
blades back and down. Holding small weights (or you can use a tin of beans or a small
bottle of water), slowly raise your arms above your chest and then bring them down so your
elbows touch the floor in line with your shoulders.

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2. Press up
Kneeling on your hands and knees, gently bend your elbows out to the side, lowering your
chest towards the floor. Then press through your hands and straighten your elbows, bringing
yourself back up to the start position.

3. Gym ball
Basic

Sitting on the ball with your feet hip width apart, practise tilting your pelvis back and
forwards.

Progression

Sitting on the ball, gently draw your lower tummy in towards your spine. With your arms
out-stretched, slowly straighten one leg then lower. Repeat with the opposite leg.

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4. Squats
Basic

Standing with your feet hip width apart, squat down as if you are sitting onto a chair.
Keep your back straight all through the movement.

Progression

1. As above, maintain squat and add five pulses, then rise back up.
2. As above, squat down then raise your arms to shoulder height and circle whilst holding
the position.

5. Clean and press

Basic

Squat down, keeping your back straight. Pick up a small weight (or a tin of baked beans or
a small bottle of water instead) with your opposite hand then rise back up, extending your
arm above your head.
Squat down, lowering the weight to floor.
Repeat 10 times with each arm.

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6. Hundreds
Lie on your back with your knees bent and your feet flat on the floor. Engage your TVA
muscle by drawing your lower tummy in towards your spine (see strengthening exercise 2),
lift your arms one inch off the mat and gently pulse your arms up and down. Repeat for
10-20 pulses.

7. One leg stretch

1. Draw in your pelvic floor and lower abdominal muscles.
2. Slide your left heel along the floor and then return to the resting position.

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Progression
1. Draw in your pelvic floor and lower abdominal muscles.
2. Lift your left knee above your foot into the “table top” position.
3. Straighten your left leg away from you.
4. Bring your left leg back to the table top position, and then lower your foot back to the mat.
5. Repeat with the right leg.
Sets: 2 Reps: 10

8. Hip twist
1. Draw in your pelvic floor and lower abdominal muscles.

2. Roll your left leg outwards from your body, keeping your pelvis still.

3. Roll your left leg back inwards until your left knee is in line with the left hip.

4. Repeat alternating legs.

Sets: 2 Reps: 10
Tip: only move the leg as far as you can before your pelvis starts to lift or rotate.

Hip twist – level 2

1. Draw in your pelvic floor and lower abdominal muscles.

2. Roll both knees to the right, continue to roll your pelvis, waist and then lower back
towards the right.

3. Roll your head and neck towards your opposite shoulder, keeping your neck long.

4. Slowly roll your head and neck back to the midline.

5. Finally, roll your lower back, waist, pelvis and then legs back towards the midline.

6. Repeat alternating sides.

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Sets: 2 Reps: 10
Tip: keep your ribs flat on the floor.

9. Shoulder bridge
1. Draw in your pelvic floor and lower abdominal muscles.

2. Exhale and gently roll your lower back into the mat, scoop your tailbone upwards and
continue to peel your spine off the mat, bone by bone until you are resting on your shoulder
blades.

3. Inhale and hold the shoulder bridge position.

4. Exhale, lower the shoulder bridge by lowering one bone at a time back to the mat,
beginning with the highest vertebrae of your bridge and finishing with your tailbone, to
return to the neutral position.

Sets: 2 Reps: 10
Tips: Your head, neck and shoulders should be relaxed.
It is not about how high you can lift but how well you can control the movement.

10. Clam
1. Draw in your pelvic floor and lower abdominal muscles.

2. Lift the top knee upwards keeping the feet together.

3. Lower the top knee onto the bottom leg.

4. Repeat lying on your other side.

Sets: 2 Reps: 10

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Clam – level 2
1. Draw in your pelvic floor and lower abdominal muscles.

2. Lift the top knee upwards, keeping the feet together and lifted off the mat.

3. Lower the top knee onto the bottom leg, keeping the feet lifted off the mat.
Sets: 2 Reps: 10
Tip: pelvis and back should not move while you are moving your leg.

11. Swimming
1. Kneel on your hands and knees, with your knees directly under your hips and your hands
slightly forward of your shoulders. Keep your elbow joints soft.

2. Engage your lower abdominal muscles and slide your left arm and right leg out and away
from you.

3. Return your arm and leg to the mat.

4. Repeat with the opposite arm and leg.

Sets: 2 Reps: 10

12. Double leg stretch

1. Lie on your back with your lower abdominals engaged.
2. Raise your arms up towards your ears, keeping your pelvis and ribcage still.
3. Lower your arms back down towards your hips.

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Level 2
1. Lie on your back with your lower abdominals engaged.
2. Raise your arms up towards your ears. At the same time, straighten your right leg.
3. Lower your arms back down towards your hips, and slide your right heel back to the
starting position.
4. Repeat with the other leg.
Sets: 2 Reps: 10

13. Scissors
1. Draw in your pelvic floor and lower abdominal muscles.

2. Roll both knees to the right, continue to roll your pelvis, waist and then lower back
towards the right.
3. Roll your head and neck towards your opposite shoulder, keeping your neck long.

4. Slowly roll your head and neck back to the midline.

5. Finally, roll your lower back, waist, pelvis and then legs back towards the midline.

6. Repeat alternating sides.

Sets: 2 Reps: 10

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Stretching Exercises
1. Cat stretch
1. Get into the position in the picture below and draw in your pelvic floor and lower
abdominal muscles.

2. Roll your tailbone and pelvis downwards towards the floor, then round your lower, mid
and upper back, and finally your neck.

3. Hold the cat position.

4. Then roll your tailbone and pelvis to neutral, lengthen through your lower, middle, upper
back and finally your head and neck back to neutral. Draw your shoulder blades downwards
and lengthen the back of your neck.
Sets: 2 Reps: 10
Tips: do not push to the extremes of range. Arms should stay straight and legs should stay
still.

2. Side stretch

1. Stand with your feet just wider than hip width apart.

2. Lean over to the right, feeling a stretch in your left side.

3. Hold for 30 seconds, and then repeat to the other side.

3. Adductor stretch
1. Stand with your feet just wider than hip width apart.

2. Bend your left knee and bring your weight over towards your left leg – you should feel the
stretch in your left inner thigh.

3. Hold for 30 seconds, and then repeat to the other side.

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4. Gluteal stretch
1. Kneel on your hands and knees.

2. Cross your left foot over your right ankle.

3. Push your hips over towards the left, and then sit back towards your heels.

4. Hold for 30 seconds, and then repeat to the other side.

We hope these classes will help you feel stronger and more able to carry on exercising at
home.

Joining a local exercise class will also help you to carry on improving your strength and
ability.

Contact us
If you have any questions or concerns about postnatal exercise, please contact the Pelvic
Health Physiotherapy team on 020 8725 1333 (Monday to Friday, 9am to 4pm). Out of
hours, please leave a message on this number and we will get back to you as soon as
possible.
For more information leaflets on conditions, procedures, treatments and services
offered at our hospitals, please visit www.stgeorges.nhs.uk

Additional services
Patient Advice and Liaison Service (PALS)
PALS can offer you on-the-spot advice and information when you have comments or
concerns about our services or the care you have received. You can visit the PALS office
between 9.30am and 4.30pm, Monday to Friday in the main corridor between Grosvenor
and Lanesborough wings (near the lift foyer).
Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk

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NHS Choices
NHS Choices provides online information and guidance on all aspects of health and
healthcare, to help you make decisions about your health.
Web: www.nhs.uk
NHS 111
You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111
is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile
phones.
Tel: 111
AccessAble
You can download accessibility guides for all of our services by searching
‘St George’s Hospital’ on the AccessAble website (www.accessable.co.uk). The guides are
designed to ensure everyone – including those with accessibility needs – can access our
hospital and community sites with confidence.

Reference: PHY_PNE_02 Published: December 2019 Review date: December 2021

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