Postpartum physical therapy treats the muscular, fascial and nervous system changes that happen during pregnancy and birth. It addresses core weakness, diastasis recti, pelvic floor dysfunction, back and hip pain, scar tissue, and safe return to exercise. Most women benefit from it, and almost none are offered it.
Here is the part nobody explains properly. Your six-week postpartum appointment is a medical clearance visit. It confirms that your uterus has contracted, your incision or tear is healing, and you are not bleeding abnormally. It takes about ten minutes.
It is not a functional assessment. It never was. Nobody checks whether your abdominal wall is generating tension, whether your pelvic floor is coordinating with your breath, whether your hips have returned to a position that lets you run without leaking, or whether the scar tissue from your delivery is pulling on structures three inches away. Those things are the actual work of recovery, and they get skipped.
That is the gap postpartum physical therapy fills.
What postpartum PT actually treats
Most women arrive at our clinic thinking postpartum PT means Kegels. It is considerably broader than that.
- Core and abdominal wall dysfunction. Pregnancy stretches the abdominal wall and the connective tissue running down the midline. Roughly 60 percent of women still have measurable separation at six weeks postpartum. Some resolve on their own. Many do not, and the ones that do not tend to produce back pain, a persistent belly pooch that has nothing to do with body fat, and difficulty generating pressure through the trunk.
- Pelvic floor dysfunction. Leaking, urgency, heaviness, pressure, pain with intercourse, difficulty emptying. Around one in three women experiences urinary incontinence in the year after giving birth. It is common. It is not normal, and it is not something you have to live with because you had a baby.
- Back, hip and pelvic girdle pain. Your center of gravity shifted forward for months, then shifted back overnight while you started carrying a growing weight on one hip. The compensations are real and they persist unless someone addresses them.
- Scar tissue restrictions. Whether from a cesarean, an episiotomy, or a natural tear, scar tissue adheres to surrounding fascia and can pull on structures well beyond the incision itself.
- Return to exercise. Running, lifting, high impact classes. The question is not whether you are cleared. It is whether your system can currently manage the load without leaking, bulging or hurting.
What recovery actually looks like
Recovery is not linear and it does not conclude at twelve weeks. A more realistic map:
Weeks 0 to 6 are for healing and rest. Gentle breathing work, walking as tolerated, scar care once your incision or tear has closed. No loaded exercise. This is the only part of the timeline conventional care handles well.
Weeks 6 to 12 are when PT should begin, and almost never does. This is the window for assessment, for addressing any pain, tightness and heaviness, restoring coordination between breath, core and pelvic floor, for beginning progressive loading. Starting here dramatically shortens everything that follows.
Months 3 to 6 are for rebuilding capacity. Strength work, return to sport progressions, addressing whatever compensations have set in. Most women are functionally ready for impact somewhere in this window, though it varies widely.
Months 6 to 12 and beyond are still fair game. Tissue remodelling continues for at least a year. Hormonal shifts during breastfeeding affect tissue quality throughout. And plenty of women arrive at our clinic five or ten years postpartum with problems that started here. Those are still treatable.
Something worth knowing: in France, every woman receives state-funded pelvic floor rehabilitation after birth as standard care. It is not considered optional or elective. The American College of Obstetricians and Gynecologists has moved in this direction too, revising its guidance to recommend ongoing postpartum care rather than a single six-week visit. Practice has been slower to catch up than policy.
What happens at your first appointment
Mostly conversation. We ask about your birth, your recovery so far, what you are struggling with, what you want to get back to. Some women want to run a half marathon. Some want to pick up their toddler without their back seizing. Both are legitimate goals and they need different plans.
The physical assessment looks at breathing mechanics, abdominal wall function, posture and alignment, hip and back mobility, and how you move under load. An internal pelvic floor assessment is usually the most informative piece, but it is never required at a first visit and never happens without your explicit consent. You can bring your baby. Most of our postpartum patients do.
Hina Sheth, founder of Rebalance PT, puts it plainly to new mothers: “You were seen constantly for nine months and then handed a baby and told good luck. The system checks that you survived the birth. It does not check whether you can live in your body afterwards. That’s the part we do.”
Signs you should book an appointment
Any leaking, at any volume, at any point after birth. Pain, heaviness, dragging or bulging in the vaginal area. Pain with intercourse. A gap or doming along your midline when you sit up. Back or hip pain that started during pregnancy and has not resolved. Difficulty with bowel movements. A cesarean or perineal scar that feels tight, numb or tethered. Or simply wanting to return to running and not knowing whether your body is ready.
Two of the most common presentations, diastasis recti and pelvic organ prolapse, both respond well to physical therapy and both are frequently dismissed as things women simply have to accept.
You do not have to accept them.
Getting started
We see postpartum patients at our Center City Philadelphia and Narberth clinics, from six weeks postpartum through to a decade out. If you are not sure whether what you are experiencing warrants an appointment, it almost certainly does.
Book a free 15-minute phone consultation. It is a straightforward conversation about what you are dealing with and whether we can help, with no obligation to book anything further.
