restoring your post-pregnancy body shape

Postnatal physiotherapy is the evidence-based way to recover from the musculoskeletal effects of pregnancy and childbirth — back pain, pelvic-floor dysfunction, diastasis recti, coccydynia, wrist pain — that affect roughly 1 in 2 new mothers but go largely unaddressed by the standard 6-week GP check. This guide explains what's happening to your body, what's safe to do and when, the strongest current evidence on diastasis recti and pelvic-floor recovery, the realistic timeline back to running and full activity, and how CK Physio supports new mothers across Hanwell, Ealing and West London — including in-home assessments so you don't have to leave your baby.

What does postnatal recovery actually involve?

Postnatal recovery is the gradual rebuilding of pelvic-floor function, abdominal wall integrity, spinal stability and overall fitness after pregnancy and birth — typically over 6 to 12 months, not 6 weeks. The official UK postnatal pathway (under NICE NG194) is a 10–14 day midwife visit and a 25–35 minute GP check at 6 weeks. That check screens for obstetric complications and mental health — but rarely includes a structured assessment of pelvic floor, abdominal wall or musculoskeletal recovery.

That gap matters. The body recovering from pregnancy is doing several distinct jobs in parallel: closing a 2–4 cm separation in the abdominal wall (diastasis recti), rebuilding pelvic-floor strength after stretch and possibly tear injury, recovering from the cumulative postural load of nine months of bump-carrying, and now learning to lift, feed, settle and carry an infant — which is, biomechanically, repeated forward-flexed lifting under fatigue, with disrupted sleep. No wonder roughly half of new mothers end up in pain.

Postnatal physiotherapy — sometimes called women's health physiotherapy or postnatal MOT — is the layer that most NHS pathways don't routinely include. A specialist assessment with a chartered physiotherapist typically covers pelvic-floor function, abdominal wall integrity, lower-back and pelvic-girdle pain, scar mobility (C-section or perineal), feeding/lifting posture, and a structured plan for safe return to exercise and sport.

How common are postnatal aches and pains? The evidence

Roughly 1 in 2 new mothers experiences musculoskeletal pain after childbirth, and a substantial proportion still has it 6 months later — which is why "wait and see" is no longer the right default. Here's what the data actually shows:

• 49.8% of postpartum women report pain after childbirth (mean Pain Rating Index 7.35 on the McGill questionnaire).
• 53% have persistent lower back pain after birth; 70% of cases start in the first month postpartum.
• Only 28.9% have resolved their LBP by 6 months postpartum — meaning ~71% are still managing pain that affects daily life in 75% of those women.
• Pelvic-girdle pain — pain in the front or back of the pelvis — affects 27% of women at 14 weeks postpartum, with notably higher prevalence (38%) in some ethnic groups.
• Urinary incontinence affects 24% at 6 weeks, dips to 21% at 3 months as natural healing progresses, then climbs back to 32% by 12 months as load increases (lifting, return to running). Stress UI accounts for 54% of cases.
• Diastasis recti (rectus abdominis separation >2cm) is essentially universal at delivery, falls to 39% by 6 months, and persists at ~30% in some women for life.
• Levator avulsion — partial detachment of the deep pelvic-floor muscle — occurs in 13–36% of vaginal deliveries, often without symptoms in the first weeks but predicting prolapse risk later.

The biggest predictors of persistent back pain aren't C-section vs vaginal birth, BMI or epidural use — they are pre-existing back pain (especially in previous pregnancies) and the volume of household and infant-care tasks. That's important because the second factor is modifiable. Mothers who shared infant-care responsibilities had a 53% lower likelihood of postpartum pain.

Common postnatal MSK problems and what to do about them

A proper pelvic-floor assessment is the difference between “just do your Kegels” and an actual recovery plan.

The most common postnatal physiotherapy presentations cluster into six conditions: lower-back and pelvic-girdle pain, pelvic-floor dysfunction, diastasis recti, coccydynia, C-section scar issues, and feeding-related upper-limb problems (de Quervain's, carpal tunnel, thoracic spine pain). Most respond well to structured rehabilitation when assessed early.

Lower-back and pelvic-girdle pain

Triggered most often by household chores (57%), prolonged standing (54%), prolonged sitting/feeding (52%) and lifting the baby. Treatment combines pelvic-floor activation, deep core retraining, manual therapy where indicated, and pragmatic ergonomic advice about feeding posture and infant handling. Most cases settle within 6–12 weeks of structured rehabilitation.

Pelvic-floor dysfunction

Symptoms include leakage with cough/sneeze/jump (stress UI), urgency or frequency, heaviness or dragging in the pelvis (suggestive of prolapse), or pain during sex. A specialist women's-health physiotherapy assessment — typically including internal pelvic-floor examination — is the only way to know whether you're contracting the right muscles. Up to 50% of women asked to do a pelvic-floor contraction without examination either can't isolate the muscles or actively bear down. NICE NG123 recommends supervised pelvic-floor muscle training as first-line treatment for stress UI.

Diastasis recti (abdominal separation)

Universal at delivery; resolves spontaneously in around 60% of women by 6 months. The remaining 39% with persistent >2cm separation benefit from structured rehabilitation. Critically, traditional sit-ups, crunches, planks and Pilates “Hundred”-style exercises are contraindicated in early postpartum and can worsen the gap. Evidence-based progression starts with diaphragmatic breathing, transverse abdominis activation, and the Sahrmann progression — gradually loading the deep core through controlled leg movements without bulging the abdominal wall. Surgical repair (abdominoplasty) is rarely needed.

Coccydynia (tailbone pain)

Common after a long second stage, an instrumental delivery, or a baby's posterior position pressing the tailbone backward. Sitting on hard surfaces, transferring from sit-to-stand and feeding sessions all aggravate. Treatment combines specific tailbone manual mobilisation, cushion/seating advice, and pelvic-floor coordination work. Most resolve within 4–8 weeks of treatment.

C-section scar adhesion and abdominal weakness

Scar tissue can tether overlying skin and underlying fascia, restricting movement, contributing to back pain and producing strange sensations on exertion. From around 6–8 weeks (once the wound is fully healed and approved by your GP), gentle scar massage and progressive abdominal retraining accelerate recovery. C-section mothers also need a longer onramp before high-impact activity (typically 16+ weeks).

Feeding-related upper-limb pain

De Quervain's tenosynovitis (thumb-side wrist pain), “mother's wrist”, carpal tunnel symptoms (often persistent from pregnancy fluid retention) and upper-back / shoulder pain are all common from the repeated holding, lifting and breastfeeding posture of the early months. Splinting, ergonomic adjustment of feeding position and targeted strengthening usually resolves things within 6–8 weeks of treatment.

What's safe to do, and when? The postnatal recovery timeline

Postnatal recovery is a graded re-introduction of load — not a binary “cleared at 6 weeks.” Safe progression looks like this:

This timeline is the consensus from NICE NG194, the Pelvic, Obstetric and Gynaecological Physiotherapy network (POGP), and the 2019 Goom-Donnelly-Brockwell “Returning to Running Postnatal” guidelines. Anyone telling you to start running at 6 weeks because you feel fine is offering a 1990s standard, not 2026 evidence.

Diastasis recti: the evidence-based exercise progression

Deep-core retraining starts with breath, not with the obvious abs.

The evidence supports a graded transverse abdominis (TA) and pelvic-floor activation progression — typically the Sahrmann sequence — as the safest and most effective way to recover diastasis recti. Aggressive crunching makes it worse. Here's the standard progression we use at CK Physio:

1. Stage 1 — Diaphragmatic breathing + TA activation (weeks 0–2): Lying on your back, knees bent. Inhale into your ribs and belly; on exhale, gently draw the lower belly toward the spine without holding the breath. 10 reps, 3× daily.
2. Stage 2 — Heel slides (weeks 2–4): Same starting position. On exhale + TA contraction, slowly slide one heel along the floor away from you and back. 10 each side. Stop if you see “doming” of the abdominal wall.
3. Stage 3 — Knee fall-outs (weeks 3–5): Same starting position. Keeping the pelvis still, slowly let one knee drop out to the side and bring it back, maintaining TA engagement. 10 each side.
4. Stage 4 — Single-leg lifts (weeks 4–6): Same starting position. Bring one knee toward your chest, then extend the leg, then return. 10 each side.
5. Stage 5 — Tabletop progressions (weeks 6+): Both knees up to 90°, alternate slow leg extensions/lowering, then both legs together once tolerated. Always with TA pre-activation.
6. Stage 6 — Loaded core (weeks 8+): Bird-dog, dead bugs with weights, side-plank progressions, hip thrusts. By this stage, the rectus is usually closing meaningfully.

Three principles run through every stage: exhale on effort, never bulge the abdominal wall, and pre-activate the pelvic floor. If you see a “doming” ridge in the centre of your abdomen during an exercise, you've progressed too fast — drop back a stage and re-establish control.

It's never too late to do this work. Women presenting years after delivery still close the gap meaningfully with consistent core rehabilitation. Surgery (abdominoplasty) is reserved for cases with significant functional impairment or umbilical hernia.

Pelvic-floor recovery: what the evidence supports

Supervised pelvic-floor muscle training is the first-line treatment for postnatal urinary incontinence and prolapse symptoms — recommended in NICE NG123, with strong evidence including the Hagen PROMISE trial showing 45% improvement in prolapse stage versus 0% in controls. Two things really matter: doing the contractions correctly, and doing them often enough.

The standard prescription:

• Slow contractions: Lift, hold for 10 seconds, then fully release for 10 seconds. 10 reps.
• Fast contractions: Lift quickly and fully release. 10 reps.
• Frequency: 3 sets of each, daily, for 16+ weeks before judging progress.
• Positions: Start lying down, progress to seated, then standing. Eventually integrate into functional tasks (lift baby = pelvic-floor pre-activation).

The single biggest mistake is technique. Up to half of women asked to do a pelvic-floor contraction without examination engage the wrong muscles (gluteals, abdominals, inner thigh) or actively push down. A specialist women's-health physiotherapy assessment — including internal palpation when appropriate — confirms you're using the correct muscles, which dramatically improves the effectiveness of every subsequent contraction. We can also use real-time ultrasound or biofeedback for women who want a more objective measure.

Returning to running and high-impact exercise

Returning to running before 12 weeks postpartum is the leading driver of new pelvic-floor symptoms.

The 2019 Goom, Donnelly & Brockwell “Returning to Running Postnatal” guidelines recommend a minimum of 12 weeks postpartum (16+ for C-section) before any running, and only after passing key strength and load-tolerance tests. Running before this is the leading driver of new pelvic-floor symptoms and back pain.

Our pre-running checklist (passed before progressing to run-walk):

• 30 minutes brisk walking pain-free
• Single-leg squat 10 reps each side without wobble
• Single-leg calf raise 20 reps each side
• Side-lying hip abduction 20 reps each side
• Forward jumping/hopping x10 each side without leakage, prolapse symptoms or pain
• Pelvic-floor contraction held for 10 seconds, repeated 10 times, plus 10 fast pulses

If any of those produces leakage, heaviness or pain — you're not ready. Take 2–4 more weeks of capacity-building and retest. The standard run-walk progression starts at 1 minute run, 2 minutes walk for 20 minutes, building over 4–6 weeks back to continuous running.

For higher-impact activities (CrossFit, HIIT, plyometrics, rugby, netball), we generally suggest 16–20 weeks postpartum minimum, with a similar capacity-test framework. Returning to heavy lifting follows the same principle: rebuild capacity progressively, with pelvic-floor pre-activation built into every rep.

When should you see a postnatal physiotherapist?

Every new mother benefits from at least one postnatal physiotherapy assessment in the first 12 weeks postpartum — the earlier the better. But there are specific situations where it shifts from “helpful” to “essential”:

• Any leakage of urine or stool, even occasional
• A feeling of heaviness or bulge in the vagina, especially worse end of day or after lifting
• Persistent back, pelvic-girdle or hip pain beyond 6 weeks
• Persistent diastasis — you can fit two or more fingers width into the gap above the navel
• C-section scar that's painful, tethered or sensitive beyond 8 weeks
• Coccydynia — persistent tailbone pain when sitting
• Pain during sex after the standard postnatal check (dyspareunia is not normal)
• Wrist pain from feeding/lifting that's not settling with rest
• Wanting to return to running, sport or heavy lifting — capacity testing protects you

Why home-visit postnatal physiotherapy makes sense

Home-visit physio means no travel, no stress, and your physio can assess your actual feeding posture and infant handling.

For postnatal mothers in the first 12 weeks, a home-visit physiotherapy assessment removes the biggest barrier to early intervention — travel friction with a newborn — and produces a more useful assessment because we can see your real feeding chair, baby-carrier, sleeping position and lifting habits.

CK Physio's home-visit service across Hanwell, Ealing and surrounding West London is particularly well-suited to early postpartum care. A typical home assessment includes:

• Full postural and lifting-mechanics review in your actual environment
• Feeding-position assessment (the single biggest cause of upper-back, neck and wrist pain)
• Pelvic-floor and abdominal-wall examination on your own treatment surface
• Baby-handling demonstration (lifting from cot, car seat installation, pram pushing)
• Personalised exercise prescription you can do during nap-windows
• No travel, no waiting room, no need to time-table around a feed

For mothers with mobility limitations after C-section, severe back/pelvic-girdle pain, or simply a baby who is not yet sleeping enough to leave the house, home-visit care isn't a luxury — it's the only way the assessment actually happens. Research on home-based postnatal rehabilitation shows substantially higher adherence and faster functional recovery compared with clinic-only care.

How CK Physio supports postnatal recovery in West London

CK Physio offers a complete postnatal pathway across Hanwell, Ealing and the surrounding West London area — clinic appointments, home visits, women's-health-trained chartered physiotherapists, BUPA and AXA PPP approved, with 22 years' experience supporting new mothers through recovery.

A typical postnatal pathway looks like this:

1. Initial 60-minute postnatal assessment (weeks 4–12 ideally): Full history including birth experience, MSK assessment, abdominal-wall and (where appropriate) pelvic-floor examination, scar review, posture and lifting analysis, treatment plan.
2. Foundation phase (3–5 sessions over 6–8 weeks): Core rehabilitation, pelvic-floor strengthening, manual therapy as needed, scar work, ergonomic correction.
3. Capacity phase (3–4 sessions over 8–12 weeks): Progressive strength work, return to specific activities (walking, swimming, gym), addressing any persistent symptoms.
4. Return-to-sport phase (where applicable): Capacity testing, run-walk progression, individualised return to running / impact / heavy lifting.

Standard postnatal physiotherapy session pricing in private West London is £65–£95 per session (initial assessments £75–£110); a 6-session foundation programme typically totals £390–£570 all-in. Home visits carry a small additional travel fee. We're registered with BUPA and AXA PPP for insured patients, and our chartered physiotherapists are HCPC-registered members of the Chartered Society of Physiotherapy.

Frequently asked questions

How long does postnatal recovery take?

Tissue healing largely completes by 6–8 weeks, but full musculoskeletal and pelvic-floor recovery typically takes 6–12 months — longer for first-time mothers, after C-section, or after a complicated birth. Most women feel substantially better by 3 months with the right support; full return to running and high-impact exercise sits at 12–20 weeks. The phrase “back to normal at 6 weeks” is a clinical myth that the evidence has thoroughly debunked.

Is the 6-week GP check enough postnatal care?

For most women, no — not for musculoskeletal recovery. The standard 25–35 minute 6-week check screens for obstetric complications and mental health and rarely includes a pelvic-floor or abdominal-wall examination. Up to 20–40% of vaginal deliveries result in pelvic-floor avulsion injuries that aren't visible during a routine check. A specialist postnatal physiotherapy assessment is the layer most NHS pathways don't include but most women benefit from.

What is diastasis recti and is it serious?

Diastasis recti is separation of the abdominal muscles along the central tendon (linea alba) that occurs to some degree in essentially all pregnancies. It's normal during pregnancy and not dangerous in itself. By 6 months postpartum, ~60% of women have spontaneously closed back to under 2cm; the remaining 39% benefit from structured deep-core retraining. Serious complications (umbilical hernia, severe functional impairment) are uncommon and surgical repair is rarely needed.

When can I start exercising after birth?

Day one for gentle pelvic-floor activation and diaphragmatic breathing. Walking from week one (start short). Pelvic-floor and deep-core work from week two for vaginal birth, week three for C-section. Low-impact strength work from week 6 once cleared. High-impact (running, jumping, plyometrics) from week 12 minimum (16+ for C-section) and only after passing capacity tests. Don't take "I feel fine at 6 weeks" as evidence you're ready — the pelvic floor and connective tissue need longer than the muscle does.

Is it too late to do postnatal physiotherapy if my baby is older?

No. Mothers presenting years after delivery still benefit substantially from structured pelvic-floor and core rehabilitation. The diastasis recti literature explicitly supports late intervention. Persistent stress urinary incontinence responds well to supervised pelvic-floor muscle training even decades after the original birth. Postnatal physiotherapy is calibrated for whoever turns up — first 12 weeks is ideal, but never written off if you're outside that window.

Is leakage of urine after birth normal?

Common, but not normal in the sense that it should be ignored. Around 24% of women have stress urinary incontinence at 6 weeks postpartum, falling to 21% at 3 months, then climbing back to 32% by 12 months as activity load increases. NICE recommends supervised pelvic-floor muscle training as first-line treatment — with strong evidence of effectiveness. If you're leaking when you cough, sneeze, jump or run, see a women's-health physiotherapist. Don't accept it as the cost of motherhood; it's reliably treatable.

Can postnatal physiotherapy help with pain during sex?

Yes. Postpartum dyspareunia is common but often comes from treatable causes — perineal scar tightness, pelvic-floor overactivity, healing tissue sensitivity or musculoskeletal contributions. A women's-health physiotherapist can identify the specific drivers and provide tailored treatment (scar mobilisation, pelvic-floor downtraining, education about positioning and pacing, sometimes a structured graded re-introduction programme). It's not a permanent change you have to live with.

Sources & further reading: NICE NG194 Postnatal care; NICE NG123 Urinary incontinence and pelvic organ prolapse in women; Hagen et al. PROMISE trial pelvic floor muscle training for prolapse; Goom, Donnelly & Brockwell 2019 “Returning to Running Postnatal” guidelines; Sahrmann diastasis recti progression; Pelvic, Obstetric & Gynaecological Physiotherapy network (POGP); Chartered Society of Physiotherapy guidance on women's health; Health and Care Professions Council professional standards. complete pelvic floor physiotherapy guide