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Updated: Oct 31, 2020

Due to pregnancy and delivery, many women suffer from back pain, neck pain, abdominal pain, lack of core coordination, inability to control the bladder, etc. So what happens to a woman's body after giving birth?


We know that, as the pregnancy progresses, the abdominals stretch, and the back muscles shorten. We also know that the pelvic floor often weakens under the weight of the fetus. But how does a body returns to its pre-pregnancy condition - is it really that simple as we see it on social media? What exercise helps? We asked Kathleen McDonough, a local physical therapist who specializes in Pilates-based rehab and Sports Performance to share her own experience, knowledge, and advice with our community. And here is what she says:


Forever Post-Partum

The female human body undergoes tremendous change during pregnancy, labor and delivery and the first post-partum year; it really is a remarkable machine that can transform itself so completely to produce and sustain another human being, and then even more remarkably return to a non-pregnant state. I think that at other times in history, women had physical and emotional support from other women in their community. They learned how to take care of their babies and their bodies; something often lacking in modern times. In other parts of the world, post-partum physical therapy (PT) is the norm, along with extended maternity leave for both parents. But instead of this cultural support, what we often experience are images of celebrities getting back into their bikinis almost immediately after giving birth, and we think that we should be able to do that easily too (even without nannies, personal chefs, and trainers).

I am an orthopedic physical therapist with over 35 years of seeing patients, and a majority of my clientele over the years have been women. When I first meet a new client, I spend quite a bit of time listening to their story – what hurts where, when did it start, what other trauma, injuries, or surgeries have happened? I am not a specialist in pelvic floor PT (I do often share clients with a pelvic floor PT!), but I always ask women about pregnancies, labor and deliveries, and past and current symptoms of incontinence or any pelvic pain. So many times, women have told me about leaky bladders when they run or sneeze, an inability to control their bladder, persistent pelvic pain, an ongoing split of their linea alba (diastasis recti) or an inability to feel their core muscles. And then they invariably say “but that’s just normal, right?” and or “no one has really talked with me about that before.” And that is a shame. Urine and/or fecal incontinence is the number ONE reason women are admitted to nursing homes later in life.

So, let me just say this: although it is not uncommon, it is NOT normal or acceptable for incontinence, lack of core coordination (and the back pain that can result), and diastasis recti to continue untreated.

I had persistent Sacro-Iliac and hip joint pain during both of my pregnancies and for about 11 years after my youngest son was born. It wasn’t bad. It didn’t keep me from step classes, running and doing yoga or working. I just didn’t feel stable, and sometimes I hurt. I saw many practitioners – traditional and alternative - that could help with the symptoms, but they did not go away. And then I started doing much more Pilates.

I had been incorporating Pilates into my practice since I learning about it in graduate school while working at the New Your City Ballet. I owned and used Pilates Apparatus as another exercise tool, but it wasn’t until I started a comprehensive 1000-hour classical Pilates training program that I started to see the benefit of the Pilates Method as a whole, and to realize that this was the thing my body was aching for -literally! I had spent YEARS in anatomy labs dissecting the human body and could reel off any muscle origin and insertion you could throw at me, but I could not FEEL those parts of me working as nature intended them – until I started doing Pilates. My hip and sacroiliac pain went away, my core reconnected, and my bra band measurement went down 2 inches. I felt my body coming back together after being stretched apart by those 2 sweet aliens that had taken it hostage.

Many people see the crazy Cirque du Soleil-type moves that are done in Pilates or have taken a mat class at a gym (along with 30 others, and minimal instruction or supervision!), may have felt pain, or nothing at all, and think that this is Pilates. I will tell you that this is not what I do with post-partum women. We do precise, thoughtful, coordinated movements, using the breath, at a level that is appropriate for that body, and most importantly, is pain-free. Forget the “seven-minute plank challenge” -99% of the clients I see cannot do a good plank for 10 seconds-, Pilates is the ultimate core connector.

A physical therapist can also show you how to lift, nurse, change diapers, get a squirmy child out of the car seat, or carry a sleeping deadweight without hurting or peeing your pants. We can help you make small changes to your COVID-19 working-from-home office so that you feel better at the end of the workday. We can help you to do specific exercises that are tailored to your needs and goals, and supervise to make sure that you are doing them well and understand their purpose. We can help you successfully and safely return to your favorite activities. We are health coaches, and really the most specifically well-educated health coaches you will find. You don’t have to have a physician’s referral to see a Physical Therapist in California, and with most of us successfully using telehealth to deliver very effective care, you don’t even have to leave home.

Don’t wait 11 years putting up with pain or feeling disconnected from your body. Call a physical therapist. We can help.

Written by Kathleen McDonough PT MA NCPT

Physical Therapy  |  Pilates-based rehab  |  Sports Performance


Kathleen has integrated Pilates and orthopedic physical therapy for 30+ years. A graduate of UC Davis and Stanford University, the Pilates Center, Boulder, and Polestar Pilates, she serves as secretary on the PMA Certification Commission and chairs the PMA Exam Item Writing Committee.

Kathleen created and taught spine stabilization programs nationally, and brought Pilates into a major spine specialty practice. She has presented at APTA, World Confederation for Physical Therapy and PMA conferences, UCSF’s PT, and Kaiser Orthopedic Residency Programs.

Kathleen is passionate about youth sports and has brought Pilates into her community schools, running clinics, and injury prevention programs. To learn more about Kathleen, visit her website at


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