The Pelvic Chronicles Blog ⋆ Foundational Concepts

Returning to Exercise After Having a Baby: Why Pelvic Floor Physical Therapy Matters

August 4, 2026
Sarah Dominguez
*Postpartum

Having a baby is an incredible experience, but pregnancy and childbirth place tremendous demands on your body. Throughout pregnancy and delivery, your core and pelvic floor muscles stretch, work hard, and may become weakened or overworked. After giving birth, many new mothers are eager to return to exercise but aren’t sure when it’s safe, what symptoms are normal, or how to rebuild strength without causing problems. Pelvic floor physical therapy can play an important role in recovery by helping your body heal and giving you the confidence to return to the activities you enjoy.

The American College of Obstetricians and Gynecologists (ACOG) recommends that most women can gradually resume exercise as soon as they feel ready after an uncomplicated vaginal delivery. There is no mandatory waiting period—even for activities such as running—provided your recovery is progressing well. Many women begin with gentle movement, such as walking, within days of giving birth.

One of the first exercises you can safely begin is pelvic floor muscle training. According to ACOG, these exercises may start immediately after delivery, even while you’re still in the hospital or during your first week at home. Early pelvic floor exercises help restore muscle awareness, improve circulation, and support healing.

As activity levels increase, it’s important to listen to your body. If you notice increased bleeding, pelvic pain, pressure, or a feeling of heaviness in the vagina, these are signs to slow down and seek guidance. Every woman’s recovery is unique, so returning to exercise should be based on your individual healing rather than a fixed timeline.

ACOG also recommends postpartum follow-up with your healthcare provider within the first three weeks after delivery, followed by a comprehensive visit by 12 weeks. These appointments should include an assessment of healing, bladder and bowel function, pain, emotional well-being, and readiness to return to physical activity. Women experiencing urinary or fecal leakage, pelvic pain, pelvic pressure, or difficulty engaging their core should be referred to a pelvic floor physical therapist. Early intervention can help prevent long-term problems and speed recovery.

For mothers who are breastfeeding, a few simple strategies can make exercise more comfortable. Feeding your baby or pumping before a workout may reduce breast discomfort, and staying well hydrated before, during, and after exercise helps support both recovery and milk production.

Returning to Running After Pregnancy

Running is one of the most common fitness goals after childbirth, but it is also one of the highest-impact activities for the pelvic floor.

Research shows that women who continued running during pregnancy are nearly three times more likely to return to running postpartum than women who stopped during pregnancy. Women who experience less fear of movement and do not have symptoms such as vaginal heaviness also tend to return to running sooner.

However, women who leaked urine while running before or during pregnancy are more likely to experience leakage after delivery. Although cesarean delivery appears to reduce the likelihood of running-related urinary leakage, many women who deliver vaginally successfully return to running after appropriate healing and rehabilitation.

Fortunately, research provides reassuring news. Moderate exercise beginning around six weeks postpartum does not increase the risk of pelvic organ prolapse or worsen urinary incontinence. In fact, women who begin low-impact exercise early often experience less pelvic girdle pain, while bladder symptoms frequently remain stable or improve. Women who avoid exercise altogether may actually experience worsening stress urinary incontinence during the first year after childbirth.

Interestingly, studies suggest that the relationship between exercise and pelvic floor symptoms is not simply “more is better.” Women with either very low or very high levels of physical activity tend to report more symptoms, while those who gradually return to moderate levels of exercise experience fewer problems. This highlights the importance of a balanced, progressive return to activity.

How Pelvic Floor Physical Therapy Helps

Pelvic floor physical therapy is one of the most effective ways to prepare your body for exercise after childbirth.

Following delivery, the pelvic floor muscles may be weak, painful, slow to activate, or unable to relax appropriately. They may also have difficulty coordinating with your breathing, abdominal muscles, and posture. Because activities such as running create repeated impact forces through the pelvis, restoring strength, endurance, coordination, and timing is essential for preventing leaking, pelvic pressure, and pain.

A pelvic floor physical therapist performs a comprehensive evaluation that may include:

Internal and external assessment of the pelvic floor muscles
Evaluation of core muscle function
Assessment of breathing patterns
Hip and trunk strength testing
Posture and movement analysis
Discussion of your daily activities and exercise goals

Based on these findings, your therapist develops an individualized rehabilitation program that may include pelvic floor strengthening, relaxation techniques, breathing retraining, functional movement training, and core stabilization. Many therapists also use Rehabilitative Ultrasound Imaging (RUSI) to visualize the abdominal wall and pelvic floor muscles during exercise. This real-time feedback helps patients learn proper muscle activation more quickly and accurately than verbal instruction alone.

Women also learn how to coordinate their breathing and core muscles with movement so the pelvic floor is supported rather than overloaded during exercise.

What Does the Research Show?

The benefits of pelvic floor physical therapy are well supported by research.

One study found that women who began pelvic floor physical therapy around nine weeks postpartum reduced urinary incontinence from 82% to 57% by six months while significantly improving pelvic floor strength and endurance.

Research also shows that pelvic floor muscle training can:

Reduce the odds of urinary incontinence by 37%
Reduce the odds of pelvic organ prolapse by 56%
Improve pelvic floor strength and endurance
Increase confidence when returning to higher-impact activities

Supervised rehabilitation is especially valuable because many women are unable to perform an effective pelvic floor contraction without guidance. A physical therapist can identify incorrect muscle activation and teach the proper technique before progressing to more demanding exercises.

A Whole-Body Approach to Recovery

Returning to exercise after childbirth involves much more than rebuilding pelvic floor strength. Recovery also depends on restoring flexibility, core strength, hip stability, balance, coordination, breathing mechanics, and confidence.

Many experts now recommend a phased return-to-exercise program that considers musculoskeletal healing, pelvic floor function, emotional readiness, and overall physical recovery before progressing to higher-impact activities such as running. Addressing concerns like fear of movement, urinary leakage, pelvic pressure, or feelings of heaviness early can reduce setbacks and improve long-term outcomes.

The Bottom Line

Every woman’s postpartum recovery is different. Some feel ready for walking and gentle stretching within days, while others need several weeks before increasing their activity. There is no single timeline that fits everyone.

Pelvic floor physical therapy provides individualized guidance to help your body heal safely and efficiently. Whether your goal is walking, strength training, running, or simply feeling confident carrying your baby without leaking or pain, working with a pelvic floor physical therapist can help you return to exercise stronger, safer, and with greater confidence.

Your body has accomplished something remarkable. Give it the support it deserves so you can get back to doing what you love.

Back Fusion Recovery: Why Physical Therapy Can Make or Break Your Results

March 25, 2026
FCN Admin
*Pain

Recovering from sacroiliac joint (SIJ) fusion or lumbar fusion surgery is not just about letting bones heal. It is also about learning how to move your body again to prevent reinjury. Many patients think surgery alone will solve their pain, but without proper rehabilitation, stiffness, weakness, and abnormal movement patterns can continue long after the operation. Physical therapy plays a major role in helping patients regain strength, improve mobility, reduce pain, and protect nearby joints from extra stress. After SIJ fusion or lumbar fusion surgery, the body’s mechanics change, and physical therapy helps patients safely adapt to those changes while returning to daily activities.

The sacroiliac joints connect the spine to the pelvis and help transfer forces between the upper body and legs. When these joints become unstable or painful, SIJ fusion surgery may be recommended to stabilize the area. Lumbar fusion surgery stabilizes painful or damaged segments of the lower spine. Although both surgeries can reduce pain, they also reduce motion in the treated area. When one area of the body becomes less mobile, nearby joints move more to compensate. This creates a “biomechanical cascade,” where extra stress is placed on the hips, pelvis, and lower spine.

Research has shown that SIJ fusion can increase forces at the L5-S1 level of the spine, especially at the facet joints. One cadaver study found that unilateral SIJ fusion increased L5-S1 facet joint forces by 55%, while bilateral fusion increased forces by 100%. This means the joints above the fusion may experience greater wear and tear over time. Similarly, lumbar fusion surgery can increase stress and movement at the SI joints. Studies have shown that up to 75% of patients develop SI joint degeneration within five years after lumbar fusion surgery. Because of these changes, rehabilitation must focus not only on healing the surgical site but also on protecting the surrounding joints and muscles.

The best available guidance on postoperative physical therapy after SIJ fusion comes from the American Society of Pain and Neuroscience (ASPN) expert panel best practices document. The recommendations describe a phased rehabilitation approach that includes wound care, medication management, physical activity progression, and therapeutic exercise. While many rehabilitation protocols are based on expert opinion instead of large clinical trials, these guidelines provide a structured framework that helps patients recover safely.

One of the main goals during this stage is pelvic girdle stabilization. The pelvis relies on coordinated muscle activity to remain stable during walking, standing, and lifting. Important muscles targeted during rehabilitation include the abdominal muscles, pelvic floor, gluteus medius and maximus, and even the contralateral latissimus dorsi muscle. These muscle groups work together to stabilize the trunk and pelvis during movement.

Stretching is also an important part of recovery. Patients with SIJ dysfunction commonly develop tightness in the iliopsoas, piriformis, and hamstring muscles. Tight muscles can create abnormal movement patterns and increase stress on nearby joints. Gentle stretching exercises help restore mobility and reduce compensation patterns that may contribute to pain. Therapists may also use soft tissue mobilization, foam rolling, and thoracolumbar fascia techniques to decrease stiffness in the connective tissues surrounding the lower back and pelvis.

Core stabilization exercises become especially important. Studies have shown that core stability training combined with mobilization techniques can significantly reduce pain and disability in patients with SIJ dysfunction. Therapists gradually progress strengthening exercises for the hips, gluteal muscles, and hamstrings. Strong hip muscles are critical because SIJ fusion can increase stress at both the hip joints and lower lumbar spine. Improving hip strength helps absorb forces more efficiently during walking and daily activities.

Physical therapy is also important because it helps retrain movement patterns. Patients often unconsciously develop compensations to avoid pain prior to and after surgery. Over time, these altered mechanics can create problems in other areas of the body. This relationship between the spine, pelvis, and hips is commonly referred to as “hip-spine syndrome.” When motion is restricted in one area, another area is forced to move more. For example, limited hip mobility may increase stress on the lumbar spine, while lumbar stiffness may increase motion demands at the SI joints and hips. Physical therapists evaluate the entire movement chain and help restore balanced mechanics.

Manual therapy combined with exercise appears to provide better long-term results than exercise alone. Research has shown that SIJ-specific pelvic stabilization exercises outperform general lumbar exercises in improving pain and function. Motor control exercise programs are also more effective than unsupervised home exercise alone for chronic low back pain related to SIJ dysfunction. These findings highlight the importance of guided rehabilitation rather than relying solely on rest or independent exercise.

Ultimately, physical therapy after SIJ fusion or lumbar fusion surgery is more than exercise. It is a critical part of protecting the body’s long-term function. Fusion surgery changes how forces move through the spine, pelvis, and hips, which can increase stress on nearby joints if rehabilitation is neglected. A structured therapy program helps improve strength, flexibility, stability, and movement patterns while reducing the risk of future degeneration. By addressing the entire lumbopelvic-hip complex, physical therapy helps patients return to daily life with better function, less pain, and greater confidence in their movement.

Seeing the Pelvic Floor in Real Time: How Rehabilitative Ultrasound Is Changing Physical Therapy

March 25, 2026
FCN Admin
*Education

Pelvic floor physical therapy is changing in exciting ways. One of the biggest advances is the use of Rehabilitative Ultrasound Imaging (RUSI). This tool helps therapists and patients better understand how the deep core muscles work together. These muscles include the pelvic floor and the abdominal wall, especially a deep muscle called the transversus abdominis (TrA). When these muscles work well, they support the spine, control pressure in the abdomen, and help with everyday movements like lifting, walking, and reaching. When they do not work well, people may have pain, weakness, or trouble with bladder and bowel control.

RUSI has two main roles in rehab. First, it serves as a tool to assess muscles. Therapists can see the size and shape of muscles and how they change during contraction. Second, and just as important, it acts as a biofeedback tool. This means patients can see their muscles working in real time on a screen. Instead of guessing if they are doing an exercise correctly, they get clear visual feedback. This makes learning faster and more effective.

View of Bladder and Pelvic Floor Muscles
Photo courtesy of Ramona Horton, DPT

Many people struggle to activate their deep core muscles correctly. They may overuse larger, more superficial muscles instead. This is where RUSI shines. Research shows that visual feedback from ultrasound is more effective than just verbal cues or touch. When patients can see their muscles, they are better able to perform motor control exercises. These exercises focus on gentle, precise muscle activation rather than big, forceful movements.

One key exercise in pelvic floor and abdominal rehab is abdominal activation, sometimes called “hollowing” in fitness classes. This exercise targets the transversus abdominis. Studies show that when people use ultrasound feedback during this exercise, they activate the TrA more selectively. In simple terms, they use the right muscle at the right time. This is important because proper muscle coordination helps protect the spine and pelvic organs.

Lateral Abdominal wall: Transverse Abdominus (TA), Internal Oblique (IO), External Oblique (EO) muscles at rest.
Photo Courtesy of Ramona Horton, DPT

Another benefit of RUSI is improved endurance. It is not just about turning a muscle on—it is about keeping it on. With ultrasound feedback, patients can better maintain a contraction over time. For example, during a 30-second hold, people using RUSI show stronger and more consistent muscle activity. This matters because daily activities often require low-level muscle activation over longer periods, not just short bursts of effort.

As patients improve, therapy does not stay on the treatment table. A key goal is to transfer these skills into real life. Research shows that training the TrA in a lying position with ultrasound feedback can carry over to standing tasks. These include lifting, reaching, and other functional movements. Even better, these improvements can last for months after training ends. This supports a step-by-step approach: start with simple positions, then progress to more complex, weight-bearing tasks.

Muscle function changes depending on the task. For example, how the TrA works during standing or a single-leg squat is different from how it works lying down. Because of this, newer methods look at functional activation ratios. This means comparing muscle activity during real tasks instead of just at rest. This gives a more accurate picture of how the body works in daily life.

RUSI is also helpful for people with pain, especially low back pain. Studies show that individuals with ongoing back pain often have reduced activation of the transversus abdominis during standing tasks. By using ultrasound during these activities, therapists can identify these deficits and guide treatment more effectively. This helps patients retrain their muscles in a way that directly relates to their symptoms.

Another important area is post-surgical rehabilitation. After procedures like hernia repair or abdominal wall reconstruction, proper muscle function is critical. Research shows that structured rehab programs can reduce the risk of complications, such as hernia recurrence or abdominal bulging. Strengthening the abdominal wall and improving coordination with the pelvic floor are key parts of recovery. RUSI can play a role here by guiding safe and effective muscle activation during the healing process.

While RUSI is a powerful tool, it is important to understand its limits. Changes in muscle thickness seen on ultrasound do not always equal muscle strength or activity. The relationship is strongest during low-level, controlled contractions. Factors like body position and effort level can affect the readings. This means therapists must use RUSI along with clinical judgment and other assessments.

In pelvic floor physical therapy, the connection between the abdominal wall and pelvic floor is essential. These muscles work as a team to manage pressure, support organs, and stabilize the body. When one part is not working well, the whole system can be affected. By combining RUSI with functional training, therapists can help patients rebuild this coordination step by step.

In practice, a typical program might start with simple breathing and gentle activation exercises in a lying position. Using ultrasound, the patient learns how to engage the deep core without overusing other muscles. As control improves, exercises progress to sitting, standing, and eventually more dynamic tasks like lifting or squatting. Throughout this process, the focus remains on quality of movement, not just quantity.

This approach fits well with modern rehabilitation principles. It is patient-centered, evidence-based, and focused on real-life function. Instead of just treating symptoms, it addresses the underlying movement patterns that contribute to pain or dysfunction.

In summary, rehabilitative ultrasound imaging is a valuable tool in pelvic floor and abdominal wall rehabilitation. It helps assess muscle function, improves exercise performance, and supports the transfer of skills to daily activities. For patients, this means clearer guidance, better outcomes, and a more active role in their own recovery.

The Surprising Link Between Hip Pain and Constipation

March 25, 2026
FCN Admin
*Bowel

Hip pain and constipation may seem like two completely separate problems, but in many cases, they are closely connected. This connection can be confusing for patients and even for healthcare providers at first. However, understanding how the body works helps explain why pain in the hip and trouble with bowel movements can happen at the same time. These symptoms can be linked through several pathways, including referred pain from the abdomen or pelvis, problems with the pelvic floor muscles, and shared nerve connections known as viscerosomatic convergence.

Hip pain and constipation can be related through several mechanisms, and recognizing this link is important for proper diagnosis and treatment. When these symptoms appear together, it is a signal to look beyond the hip joint itself and consider what may be happening deeper in the body.

One of the most important explanations is referred pain from bowel pathology. Referred pain occurs when a problem in one part of the body is felt in another area. In this case, issues in the intestines or pelvic organs can cause pain that feels like it is coming from the hip. This happens because the nerves that carry pain signals from the abdomen and pelvis overlap with those that serve the hip region. As a result, the brain may interpret the pain as coming from the hip instead of the bowel.

For example, a person with constipation may develop pressure and stretching in the intestines. This can irritate nearby nerves and lead to discomfort in the front, side, or even back of the hip. A key clue that the pain may be referred is when it occurs along with bowel symptoms such as constipation, bloating, or changes in stool patterns. In these cases, treating the bowel problem often improves the hip pain as well.

Another major factor is pelvic floor dysfunction, which plays a central role in both constipation and hip pain. The pelvic floor is a group of muscles located at the bottom of the pelvis. These muscles support organs like the bladder and intestines and help control bowel movements. When these muscles do not work properly, a range of symptoms can occur.

Pelvic floor dysfunction can cause the muscles to become too tight, weak, or uncoordinated. When the muscles are too tight, they may not relax enough to allow stool to pass. This leads to straining, incomplete emptying, and ongoing constipation. At the same time, tight or irritated pelvic floor muscles can cause pain that spreads to nearby areas, including the hips, lower back, and thighs.

Research shows a strong connection between pelvic floor muscle pain and constipation. People with pelvic floor myofascial pain are much more likely to have problems with bowel movements. They may also experience symptoms like pain during defecation, a feeling that the rectum is not fully empty, or even accidental leakage of stool. The more severe the muscle pain, the more severe the bowel symptoms tend to be.

This relationship works both ways. Constipation can also make pelvic floor dysfunction worse. When a person repeatedly strains to pass stool, the pelvic floor muscles may become overworked and tense. Over time, this creates a cycle where muscle dysfunction leads to constipation, and constipation further worsens muscle dysfunction.

A third important concept is viscerosomatic convergence, which helps explain how internal organ problems and muscle pain are connected. In the pelvis, many organs and muscles share the same nerve pathways. This includes the intestines, bladder, uterus, and the muscles of the pelvic floor and hips.

Because these structures share nerve signals, the brain may have difficulty telling exactly where the problem is coming from. This overlap can cause pain from the bowel to be felt in the muscles, or pain from the muscles to affect how the bowel functions. Over time, this can lead to a condition called central sensitization. In this state, the nervous system becomes more sensitive, and pain signals are amplified.

Central sensitization can make both hip pain and constipation more severe and harder to treat. A person may feel widespread discomfort in the pelvis, hips, and lower back, along with ongoing bowel issues. This highlights the importance of treating both the muscular and digestive aspects of the condition rather than focusing on just one.

When a patient presents with both hip pain and constipation, a careful clinical evaluation is essential. This should include not only an examination of the hip but also the abdomen and pelvic region. Healthcare providers may ask detailed questions about bowel habits, such as how often the patient has bowel movements, whether there is straining, and if there is a feeling of incomplete emptying.

In some cases, a digital rectal exam may be performed to assess the pelvic floor muscles. Tenderness in a muscle called the puborectalis can suggest pelvic floor myofascial pain. Patients with defecatory disorders may also report needing to use manual techniques to help pass stool, which is another important clue.

Understanding the root cause of symptoms allows for more effective treatment. One of the most helpful treatments for this type of problem is pelvic floor physical therapy (PFPT). This therapy focuses on retraining the muscles of the pelvic floor to work properly. It is considered a first-line treatment for pelvic floor dysfunction and related conditions.

Pelvic floor physical therapy uses a variety of techniques. These may include manual therapy to release tight muscles, exercises to improve strength and coordination, and rehabilitative ultrasound imaging (RUSI) to help patients learn how to elongate and coordinate the pelvic floor muscles during bowel movements. RUSI is very helpful as it gives the patient and PT visual cues to guide treatment in real time.

Studies show that RUSI therapy can be highly effective, especially for conditions like dyssynergic defecation, where the muscles do not coordinate properly. In many cases, patients who undergo this therapy experience significant improvement in both constipation and pain. Some research suggests success rates as high as 80% for certain pelvic floor disorders.

In addition to improving bowel function, pelvic floor therapy can also reduce pain in the hips and surrounding areas. By addressing the underlying muscle tension and improving coordination, the therapy helps break the cycle of pain and dysfunction.

Treatment usually involves several sessions over a period of weeks. Patients are also given exercises to practice at home. Consistency and active participation are key to success.

A multimodal approach often works best. This means combining different types of treatment to address all aspects of the condition. For example, a patient may use stool softeners or laxatives to manage constipation while also participating in pelvic floor therapy to improve muscle function. Education about proper toileting habits and posture can also make a big difference.

Hip pain and constipation are more connected than they may first appear. Through mechanisms like referred pain, pelvic floor dysfunction, and shared nerve pathways, problems in the bowel can lead to pain in the hip and vice versa. Recognizing this connection is important for accurate diagnosis and effective treatment. With the right approach, including pelvic floor physical therapy, patients can find relief from both symptoms and improve their overall quality of life.

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