They should be initiated and progressed at the intensity that the woman is able to safely control. Slow, controlled breathing is emphasized while developing the stabilizing function of the muscles.

Precautions
• Because the trunk muscles are contracting isometrically in many of these abdominal exercises, there is a tendency to hold the breath; this is detrimental to the blood pressure and heart rate. Caution the woman to maintain a relaxed breathing pattern and exhale during the exertion phase of each exercise.

• If diastasis recti is present, adapt the stabilization exercises to protect the linea alba as described for the corrective curl-up. Any progression of postpartum abdominal strengthening exercises should be postponed until the diastasis has been corrected to two fingerwidths or less.

Pelvic Motion Training
These exercises are helpful in cases of postural back pain; they are beneficial for improving proprioceptive awareness as well as lumbar, pelvic, and hip mobility.

“The Pelvic Clock”
Patient position and procedure. Hook lying. The patient’s legs may move slightly while performing this exercise. Ask the woman to visualize the face of a clock on her lower abdomen. The umbilicus is 12 o’clock and the pubic symphysis is 6 o’clock.

• Have her begin with gentle movements from 12 to 6 o’clock (the basic pelvic tilt exercise).

• Then ask her to move from 3 o’clock (weight shifted to left hip) to 9 o’clock (weight shifted to the right hip).

• Then move in a clockwise manner from 12 to 3 to 6 to 9 and then back to 12 o’clock.

With practice, this will become a very smooth and rhythmical movement and will not require such concentration on each number of the clock. Continue relaxed breathing throughout the exercise and do not force any part of the movement. If the patient has difficulty with the motion, make the clock “smaller” until coordination improves.

Pelvic Clock Progressions
• Use the visual imagery of cutting the face of the clock in half so that there is a right side and a left side, or a top half and a bottom half. Have the woman move her pelvis through the arc on the one side and back through the middle of the clock, and then move the pelvis through the opposite side and back through the middle. Initially, the woman may notice asymmetry when comparing the halves; this will improve with time.

• Once the patient understands and is able to perform the clockwise pattern have her do counterclockwise motions with all of the above activities, and then progress the exercises to the sitting position.

Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

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