Applying My Pilates Principles to Post-Op Laparoscopic Hysterectomy


As a physical therapist (PT) and certified Pilates instructor (CPI) I am routinely giving advice to my clients as to how to prepare and how to recover from surgery.  My expertise has always been very orthopedically centered. So if you have a knee replacement, shoulder surgery, back or neck surgery, or pain in any of these areas I can help.  I can with confidence apply my knowledge of PT and also Pilates training to give you a program or advice on how to manage your situation and your healing.  However, this female abdominal surgery area was totally new to me. You may be having the laparoscopic approach with punctures and small incision or a full open hysterectomy, but in either case, here’s how my fitness knowledge has benefited me along the way with my experience and recovery.

Of course, in my Pilates classes I focus on all the Pilates principles: relaxation, concentration, control, centering, fluidity, precision, breathing and endurance. What I am constantly reminded of is that in just regular activities of daily living  so many of  these Pilates principles can be applied to most any situation, giving you better control and mastery over your body. This applies to pre-op and post- op situations too!

Recently I underwent a supracervical hysterectomy done laproscopically.  I am  very healthy,  I exercise regularly, teach Pilates classes and private training, eat clean, take supplements, meditate etc. but the issues that I suffered from ( large fibroid, heavy periods and to my surprise endometriosis) were not affected by my healthy lifestyle so medical intervention was a MUST.   I am not alone in this, since many women suffer as I did.

What I was surprised to find is that I was able to take what I have been teaching to my clients for so many years and apply them post- operatively.  I hear myself preaching to my clients about how all energy comes from your center and how the abdominals play a role in all movement. This hits home, and fast, once you have an abdominal incision. I was unpleasantly surprised how much discomfort I had with just the smallest of movements- like drying my hair or even reaching for my water bottle.  So with THAT said, how did I apply my Pilates principles to my recovery? Here’s a list.

  1. Breathing:  One of the biggest Pilates principles is the breath.  When you have pain you tend to hold your breath. So first thing I did was to breathe, using my inhale through the nose, exhale through the mouth- Pilates breath.  This helped significantly during simple activities like resting and most importantly when I moved.  By breathing this way you can decrease your intra-abdominal pressure, which can put strain on your incisions, causing increased pain.  So breathe!! Controlled breathing exercises to reduce pain and relax are available on iTunes.
  2. Relaxation: As I mentioned above, I meditate. I NEED to meditate on a regular basis to help keep my thoughts focused and my emotions in check.  Any perimenopausal or menopausal woman can benefit immensely from meditating on a regular basis. But when you have pain, this is one of the BEST pain relieving activities you can do. It calms your nervous system down, which is on high alert at this point, it calms your breathing, decreases blood pressure and heart rate, and decreases the tension you are holding in your muscles due to pain. You can even decrease tension in incision areas with focused meditation.  Healing meditations are my favorite.  You focus your thoughts on blood flow to the area and actual healing of cells.  In my experience with PT I have found that those clients who meditate to help with healing rehab much quicker than those who do not.  Where do you get healing meditations?  ITunes- has a plethora of healing meditations. “The Soul of Healing Mediations” by Deepak Chopra and “Journey into Stillness” by Ramdesh Kaur are two of my favorites.
  3. Concentration and Control: Now we are getting into the more movement part of your healing.  Once you are feeling like getting up and moving around, your pain is managed, and you are off the narcotics you can start this.  Movement heals- we know that. GONE are the days of bed rest when we used to have people lying on their backs for days on end.  Getting up and moving helps with fluid flow, decreases blood clot risk, decreases stiffness in your joints, back etc.  BUT it can still be painful.  Getting up out of bed and going up and down stairs can just plain hurt. This is where your concentration comes in handy.   If you have ever taken a Pilates class, you should hear your instructor reminding you to focus on your moves, coordinate them with your breath, be precise and controlled in your intention to move.  You can do this with early post –op movement too.  Concentrate on your good spinal alignment, that will decrease pressure on incisions, be aware of your surroundings, and placement of limbs. All of this can help with not only safety but with pain control.
  4. Centering:   About  5 day post-op mark is the time to help those deep core muscles reactivate.  All movement stems from your center.  If you have done Pilates you know how long it took you to feel the connection of those deep abdominal muscles.  Well, here you are again taking baby steps. When a muscle is disrupted during a surgery it can be a little sleepy getting started.  Many people have a sleepy bladder after surgery and the pelvic floor exercises can help with that.

So what to do? There are two exercises – 1. Breathing with transversus abdominus contractions and 2. Pelvic floor exercises.  First – set your phone with an alarm to ring a reminder 3 times a day.  Your first exercises will be pelvic floor.  You can sit, lay or stand.  Inhale and as you exhale draw up the pelvic floor muscles (Kegel) and hold for a long count of 10.  Relax. Then perform 10 quick flicks of the pelvic floor as if lifting and lowering it quickly.  Next, you can sit, stand or lay.  Place your hands on your lower waist, near the pelvic crests (hip bones). Inhale and as you exhale, gently draw in your waist, pulling your belly button to your spine.  This may cause a small pulling on your incision but go slowly and only do as tight of a contraction as is comfortable.  As you do these daily you will find those muscles waking up again.  You can also perform this exercise while walking- which is part of your post- op care.  Wait until you get full clearance from your doctor and then return to your Pilates classes or schedule private sessions to gradually get you ramped up to full power. Since you will most definitely have physical activity restrictions for 4-6 weeks post-op, these small isometric exercises are safe and can help you when you do start up with full activity again.

Note on the sleepy bladder:  If you are having problems urinating or getting the flow of urination going here is a technique from PT you can use to help.  This brushing technique we use in PT is to get a muscle stimulated into a better contraction.  Gently (using a pad of toilet paper) swipe the urethra a few times. This can stimulate the muscles and cause urination to start much less hesitantly.

Now I would be remiss as a PT if I did not talk about a few things I think you need to have at home pre-op to make post –op more comfortable.  Here’s my list:

  1. Loose, drawstring pants – to eliminate any pressure on the lower belly. Your Lululemon yoga pants will be too constricting.
  2. A wedge or large propping pillow- Sleeping the first couple of nights on your back slightly propped can help you feel better since rolling or sidelying is not comfortable
  3. A firm pillow or pillow pet ( J) for bracing your incisions when you cough or good grief-sneeze.
  4. Large water bottle for beside- since you will be thirsty from the pain meds and anesthesia.
  5. Heating pad or cold pack- for lower abdominal incision pain. Remember only 20 mins on at a time.
  6. A small basket- now don’t laugh but this was a huge help. With all my electronic devices; phone, iPad, Kindle, earbuds, TV remotes, pill bottles, etc. it was easier to carry my “stuff” around or move it that way, instead of dropping it. Cuz who wants to bend down and pick stuff up? And you know Murphy’s law right?

I hope this helps you after your surgery. I have always found that the best tips I get are from my clients who tell me their war stories. So I hope my war story has helped you.   Most importantly listen to your body, and listen to your doctors.  They know what is best for your specific situation!  Speedy recovery and Pilates on – once you are all healed up.

Want to get started on your Pilates journey?  Visit for more information or contact me with your questions at

By Donna Gambino, Licensed Physical Therapist, Certified Pilates Instructor and fitness author.