The first months after the birth of a baby are a time of tremendous physical and emotional changes for a new mother. During this period of recovery, many women feel discouraged about their body shape and lack of abdominal tone. Although muscles and skin that were stretched to allow for a baby's growth will take time to return to their original state, post natal women can speed abdominal recovery by incorporating specific exercises that target the lower abdomen.

It’s important for personal trainers who are interested in working with postpartum women to understand the physical changes of the post natal period and be familiar with exercise techniques that target this population’s specific fitness needs. Starting a gentle, progressive exercise routine as soon as your client feels ready and has her healthcare provider’s approval is the first step in regaining strong, supportive abdominal muscles. Keep in mind that women who are recovering from a cesarean section should avoid any abdominal exercises until they are fully healed and have consulted with their healthcare provider.

Traditional abdominal exercises such as sit ups put too much stress on a postpartum abdomen and back and are not recommended for new moms. The most effective postpartum abdominal exercises are the series developed by Shirley Sahrmann, a physical therapist who specializes in abdominal rehabilitation. These exercises are designed to target the muscles of the lower abdomen without creating stress on the back or a diastasis recti (a thinning and widening of the connective tissue between the recti muscles that occurs during pregnancy).

Monitor your client closely as she progresses through each step, and avoid jumping ahead to the next level until she’s able to do 20 repetitions each leg without losing her abdominal contraction. If you notice your client is unable to hold her basic breath contraction while doing her leg slides, have her decrease her repetitions to the point where she can maintain a contraction.

The purpose of this series of exercise steps is to isolate the abdominal muscles and incrementally build strength. If a woman is working at a level that is too difficult for her abdominal muscles, her body will recruit other muscles groups to do the movement and possibly cause injury to her weakened back and recovering abdominal wall.

Sahrmann Abdominal Rehabilitation Exercises

The first exercise is called the basic breath. It will teach you how to isolate and control your abdominal muscles as you move your legs through a series of exercises.

• Lie on your back with your arms at your side, knees bent and feet resting on the floor. Inhale and exhale a few times. Don't flatten your back or tilt your pelvis, just let the natural curve in your back remain. Breathe in slowly and deeply.

   

• Now breathe out and tighten your abdominal muscles, pulling your navel towards your spine. Remember to concentrate on contracting the muscles below your belly button and don't flatten your back.

   

• When you are able to contract and relax your abdominal muscles without moving your back, you have learned to properly isolate the correct muscles. You can then try the next step.

Step #1

Figure 1	Figure 2

• Lie on the floor with knees bent, feet resting on floor and arms at your side (see Figure 1).

   

• Hold your abs in by doing your basic breath contraction. Keep breathing as you hold the muscles in and, keeping one leg bent, slowly slide the other leg out until it is straight with the floor and then slide back up to bent knee position (see Figure 2). Relax your abdomen.

   

• Repeat the process for the other leg. Remember don't flatten you back and keep the curve relaxed.

   

• When your abdominal muscles are contracted, it helps to stabilize your pelvis while your legs and lower ab muscles work. This prevents strain in your back muscles, and it trains your abdominal muscles to protect and support your spine.

   

• When you can comfortably do 20 legs slides on each side, you can move to the next step.

Step #2

• Lie on floor with knees bent, feet resting flat on the floor and arms at side. Pull in on your tummy and hold, then raise one knee towards your chest (see Figure 3) and slowly straighten it out parallel to (about two to three inches above the floor) but not touching the floor (see Figure 4). Return extended leg to starting position, knees bent, feet resting on floor and relax your tummy.

   

• Repeat on opposite side, keeping one knee always bent as you extend the other leg. Work up to five repetitions on each side without stopping, building to 20 repetitions or more on each side.

Step #3:

Figure 5	Figure 6

When you can comfortably do 20 of Step #2 Sahrmann exercises with each leg, you can move on to Step #3.

• Lie on the floor with your knees bent and your arms at your side (see Figure 5).

   

• Use your basic breath as you bring your legs up one at a time toward your body with knees bent at a 90 degree angle.

   

• Keep one leg bent as you slowly lower the other leg down to the floor and back up (see Figure 6). Repeat on the opposite side, working up to 20 times each leg.

Step #4:

If you can comfortably do 20 repetitions each leg of Step #3, you’re ready to move on to Step #4.

• Do your basic breath as you bring both legs up and bend knees to 90 degrees (see Figure 7).

   

• Slowly extend one leg out parallel with the floor but not touching it (see Figure 8).

   

• Bring the leg back and repeat with opposite leg. Work up to 10 repetitions each leg.

   

• With each repetition, remember to keep breathing. Contract your abdomen as you move your leg, and don't let your back pop up. If the arch in your back keeps popping up during the exercise, it means you're not strong enough to progress to this level and need to go back to the previous exercise until you build greater strength.

Step #5:

You may try this exercise when you can do Step #4 20 times each leg while maintaining your abdominal contraction without your back arching.

• Using your basic breath, bring both legs to your chest one at a time.

   

• Straighten both legs up at a 90 degree angle from your hip (see Figure 9).

   

• Slowly lower your legs down together toward the floor (see Figure 10). Go only as far as it feels comfortable, and if you feel your back beginning to arch, bring your legs back up and lower them again only to the point were you notice your back arching. Work up to 20 repetitions.

   

• If you notice back pain with this exercise, discontinue doing it and maintain at Step #4. Step #5 may not be appropriate for women who have low back pain.

With each exercise, remember to keep breathing, contract your abdominals as you move your leg and don't let your back pop up. If the arch in your back keeps popping up during the exercise, it means you're not strong enough to progress to this level, and you need to go back to the previous exercise until you build greater strength.