Postpartum Recovery Physiotherapy

Reviewed by the Circle Physiotherapy clinical team · 8 min read · Updated 7 August 2026

The postpartum body is doing two things at once: healing from a specific event, and adapting to a job that never pauses. Recovery is not a straight line and it does not finish at six weeks. What almost nobody is told is which symptoms are a normal part of that adaptation, which are signals worth acting on, and how to load a healing body without either wrapping it in cotton wool or running it into the ground. At Circle Physiotherapy in Brampton, Divya Sreejith, certified through all three pelvic health levels, works with people from a few weeks after birth to decades afterwards.

Does the six-week check mean I am cleared for everything?

No — the six-week check confirms that your uterus and any wounds are healing as expected and that contraception and intercourse are reasonable to resume. It is not an assessment of whether your body can tolerate running, lifting or sport, and it rarely tests strength, pelvic floor control or continence.

That gap is why so many people go back to bootcamp at week seven and feel wrecked, or assume that whatever they feel must now be permanent. A postpartum assessment covers what the check does not: how your abdominal wall handles load, how your pelvic floor contracts and relaxes, how scars are healing, and what the next eight weeks should contain.

What does postpartum recovery actually look like month by month?

Healing follows a broadly predictable timeline even though every recovery differs in the details. The first six weeks belong to healing, the next six to rebuilding tolerance, and the months after that to genuine strength. This is a guide, not a schedule you have failed.

A caesarean, twins, a significant tear or very broken sleep all shift that timeline. Some signs need urgent medical care rather than physiotherapy: heavy bleeding that soaks a pad in an hour, foul-smelling discharge or fever, or chest pain. Two more deserve urgent assessment in the weeks after birth rather than a physiotherapy appointment: a severe headache with visual changes, which can signal postpartum pre-eclampsia, and pain, warmth or swelling in one calf, which can signal a clot. If you are pregnant again, reduced fetal movements, fluid leaking from the vagina or regular contractions before term go straight to your obstetrician or midwife.

How do I look after a caesarean scar?

A caesarean is major abdominal surgery, and the scar keeps remodelling for a year or more even though the skin closes within weeks. Once the wound is fully healed and your care provider is happy, commonly around six weeks, scar work can begin: gentle skin mobilisation in every direction so the tissue glides rather than tethering to what sits beneath it.

Desensitisation matters just as much and gets discussed far less. Numbness above the scar, hypersensitive patches, or a scar you cannot bear to touch respond to graded exposure — different textures, light touch progressing to firmer contact, a couple of minutes most days. A scar that tethers or hurts changes how you brace and lift, so none of this is cosmetic. Massage therapy can help alongside it.

What about perineal tears and stitches?

Most perineal tears and episiotomies are well healed by six weeks, but healed does not always mean comfortable, and pain still present at three months is worth assessing rather than accepting. The usual leftovers are a tight, tender band of scar tissue at the vaginal entrance, pain with intercourse, and a pelvic floor that has learned to guard.

All of that responds to treatment. Scar tissue softens with targeted massage you can be taught to do yourself, guarding is unlearned with breath and relaxation work, and returning to comfortable intercourse is a normal thing to have a plan for. Pain that persists is worth investigating for pudendal nerve irritation and other causes of pelvic pain.

When can I go back to running and lifting?

Twelve weeks is the sensible earliest point for returning to running, and it is a floor rather than a finish line — what matters is what you built before it. Running lands roughly two to three times body weight through the pelvic floor with every step, thousands of times a session, so it needs an on-ramp.

A reasonable readiness check is self-administered: walk thirty minutes comfortably, balance on one leg, do repeated single-leg calf raises, bridges and sit-to-stands, then jog on the spot and hop on each leg — all without leaking, heaviness, pain or doming. If that holds, start with short run-walk intervals and build gradually. Lifting follows the same logic: keep the load close and breathe out on effort instead of bracing and holding.

Is leaking or heaviness something I should push through?

No. Leaking urine and a feeling of heaviness, dragging or bulging in the vagina are both common after birth and both signal that today's load exceeds what your system can manage. They are not a verdict, and training through them usually entrenches the symptom, whereas assessment tends to change it quickly.

Leaking with coughing, sneezing, jumping or running is covered on our bladder leakage page, and most people improve with a properly progressed programme rather than random squeezes. Heaviness and pressure, worse late in the day or after carrying, point towards pelvic organ prolapse — more common and more manageable than the name suggests. Our postpartum physiotherapy page covers the clinical detail.

How much do sleep, feeding and mental load matter?

A great deal, and any recovery plan that ignores them will not be followed. Fragmented sleep lowers pain tolerance and slows tissue recovery, feeding positions load the neck, mid-back and wrists for hours a day, and the cognitive weight of keeping a small human alive leaves little capacity for a long home programme.

So the plan has to fit the life: three or four exercises rather than twelve, done where you already stand still — kettle, change table, feeding chair. It means fixing pillow height and forearm support before treating the neck pain that follows. If mood, anxiety or intrusive thoughts are the dominant problem, say so; that belongs with your doctor or midwife.

Is it too late if I gave birth years ago?

It is never too late. The pelvic floor is skeletal muscle, and skeletal muscle responds to progressive training at any age, which is why people ten, twenty or thirty years postpartum routinely improve leaking, heaviness and core function. If symptoms have only appeared recently, that often reflects changes around menopause rather than the birth itself.

An assessment covers your birth history, symptoms and goals, then external testing of movement, breathing, abdominal wall and hip strength, with an optional internal examination in a fully private room with a door. We are at 10725 McLaughlin Rd, Unit #5, Brampton, open seven days a week with direct billing to major insurers, WSIB and motor vehicle accident claims. Call (905) 495-5600, book online, or read our postpartum physiotherapy guide. Still pregnant? See pregnancy physiotherapy.

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