March is Women’s History Month, and what better way to celebrate than focusing on our Mamas and Mamas-to-be. As a pelvic floor physical therapist, I have the pleasure of helping women through their pregnancy, as well as helping them recover in the postpartum period. Most women aren’t told how beneficial physical therapy can be during pregnancy and postpartum recovery. Many women don’t even know it exists! But I’m here to spread the word.
If you are pregnant, looking to get pregnant, or if you’re a new mom, physical therapy can be invaluable in making this exciting time of your life as easy and pain-free as possible. Here’s a few reasons why.
Physical Therapy During Pregnancy
Pregnancy causes a woman’s body to go through a host of changes, affecting the cardiovascular, endocrine, renal, and musculoskeletal systems. These changes often lead to pain or discomfort. However, physical therapy can be a safe an effective way to help manage the physical challenges that accompany pregnancy. Advances in PFPT have shown effectiveness in decreasing pain while improving posture, alignment, improved bowel and bladder function. Physical therapy while pregnant can also proactively improve strength, flexibility and stabilization to help make your pregnancy a more positive experience.
Here are some of the most common conditions I see in pregnant women:
Low Back Pain
Low back pain (LBP) affects 50-75% of pregnant women, and a large percentage of these women continue to experience LBP after childbirth and beyond the postpartum period. The reason for this may be due to physiological and hormonal changes that occur during pregnancy, as well as an increase in body mass that places mechanical stress on the spine.
As the uterus grows in size, the curve of the lumbar (low back) spine increases, and the center of gravity of a woman’s body shifts. These changes can increase strain on bones, muscles, and ligaments of the low back. Additionally, the abdominal muscles are significantly stretched and unable to efficiently maintain posture, which causes the back muscles to take over adding additional strain. These back muscles become fatigued, which can lead to LBP.
Pelvic Girdle Pain
About 20% of women experience pelvic girdle pain (PGP) during pregnancy. The pelvic girdle is a ring of bones around your body at the base of your spine. The three joints of the pelvis work together and normally only move slightly. PGP is usually caused by the joints moving unevenly, which can lead to the pelvic girdle becoming less stable and more painful. As your baby grows, the extra weight can change in the way you sit or stand, putting more strain on your pelvis.
Symptoms of PGP include:
- Pain in pubic region, low back, hips, groin, thighs, knees
- Clicking or grinding in pelvic area
- Pain with walking on uneven surfaces
- Pain with moving your knees apart, like getting in/out of a car
- Pain with standing on one leg (climbing stairs, dressing)
- Pain with rolling over in bed
- Pain during sexual intercourse
Constipation
Bowel changes are very common in pregnancy, especially in later stages and can even occur after delivery. This can be caused by the baby getting bigger or hormonal influences slowing down digestion. Constipation may be a problem if you regularly have to strain with bowel movements, have hard or lumpy stools, feel as though you are not emptying completely, and/or have less than three bowel movements per week.
Urinary Incontinence
Similar to bowel conditions, changes in bladder health are also very common. Some of these changes include increased frequency, urgency, or leakage, especially when coughing, sneezing, or laughing. Urinary incontinence may be the result of the physiological changes that occur during pregnancy such as increased abdominal pressure and hormonal changes.
Some signs of urge incontinence include leaking when you feel the urge to urinate, leaking on your way to the bathroom, or leaking when you hear running water. Pregnant women may also experience stress incontinence. Signs of stress incontinence may include leaking when you cough or sneeze, leaking when you go from sitting to standing, or leaking with intercourse.
Is Physical Therapy Safe During Pregnancy?
The short answer is yes! Physical therapy can be a safe and effective treatment for pregnant women experiencing pain or discomfort, however there are certain safety considerations that are important to remember.
1. Consult with your healthcare provider. Before starting PT, it is important to know whether your healthcare provider has advised any activity restrictions that should be followed. Make sure to speak with your OBGYN before starting physical therapy.
2. Find an Experienced and Knowledgeable Physical Therapist. Choose a PT that specializes in prenatal care and is knowledgeable about the physiological changes during pregnancy so that they can tailor their approach accordingly.
3. Customized Treatment Plans. Physical therapy sessions should be tailored to your individual needs and adjusted as your pregnancy progresses. Exercises and treatments should be safe and appropriate for each stage of pregnancy.
4. Avoid Certain Techniques and Positions. Certain positions, such as lying flat on your back, should be utilized with caution, especially in the later stages of pregnancy. A physical therapist who specializes in pregnancy care will be able to guide you on suitable positions and modifications.
5. Monitoring and Communication. During the therapy sessions, constant monitoring of your progress and communication with your physical therapist are important. If you experience any discomfort or have concerns, it’s essential to speak up and collaborate with your therapist to adjust the treatment plan.
Physical Therapy in the Postpartum Period
After the 40-week journey of carrying a baby and giving birth, women may still be experiencing aches and pains from pregnancy due to their altered mechanics, posture, changes in their center or gravity, or even injury from labor.
Physical therapy can play a role in supporting a swifter postpartum recovery by addressing postural strengthening, core strengthening and correction, and pelvic floor muscular coordination and strengthening, and more.
Here are a few of the most common conditions seen in new moms.
Diastasis Recti
Diastasis Rectus Abdominis (DRA), or separation of abdominal muscles, occurs in many women during the third trimester. For some people, the muscles can automatically come back together, but sometimes they need some instruction or re-training from a physical therapist to heal.
Bowel and Bladder Changes
Even if not experienced during pregnancy, bowel and bladder changes can also be very common after giving birth. Many postpartum women report urinary leakage with things like coughing, sneezing, picking up their baby, exercising, or with sexual intercourse. It is not uncommon to leak gas or fecal matter from your anus, especially if there was pelvic floor tearing during delivery or an episiotomy.
Prolapse
Pelvic organ prolapse (POP) is the pelvic floor disorder or injury most strongly associated with vaginal birth. It is also a large contributor to urinary incontinence. It refers to loss of support to the uterus, bladder and bowel leading to their descent from the normal anatomic position towards or through the vaginal opening. Some common symptoms include a feeling of pressure or fullness in the pelvic area, low back pain, painful intercourse, leaking of urine or chronic urge to urinate, constipation, spotting or bleeding from the vagina. When you go to Physical Therapy for prolapse, your PT will focus on retraining and strengthening the pelvic floor muscles to help support the organs and reduce symptoms, as well as advise behavior modifications.
C-Section Recovery
Women who gave birth via c-section can also benefit from PT. As the tissues around the c-section scar in the abdomen heal after surgery, they may become stuck to each other or to other structures in the pelvis. These scar tissue adhesions can cause issues with the bladder or low back pain. Pelvic Floor Physical Therapists can help patients decrease adhesions around the scar.
Birth Recovery
Overall, postpartum physical therapy has tremendous benefits for a new mom. Postpartum PT can teach you the best way to carry, lift, and feed your baby to help prevent back pain and keep your back in the best shape possible. Most activities associated with taking care of a new baby, such as feeding or holding an infant, are done in a forward leaning position. As a result of this, combined with potentially overstretched abdominal or pelvic floor muscles from pregnancy and delivery, low back pain or fatigue can occur.
We are Here for You!
Once you have attended your postpartum check-up, usually at six/eight weeks, your doctor may give you clearance to begin physical therapy. Depending on the severity of your symptoms, it may take some time before your postpartum condition begins to improve. After a thorough evaluation, your PT will be able to provide you with a more accurate timeline.
Being pregnant can be a beautiful and emotionally fulfilling time, but it can also be physically daunting as many women are left with one or several musculoskeletal conditions as a result of pregnancy or the birthing process. Fortunately, these conditions can be successfully managed or treated with the help of a physical therapist and their evidence-based techniques. It is not something you have to face alone; we are here to help you every step of the way.
Schedule with Trudy by requesting an appointment here.
Meet the Expert
Trudy Roth, PT, DPT
Montvale Physical Therapist
Trudy has worked with a variety of patient populations, including oncological, post-surgical, trauma, orthopedic and pelvic floor patients. She enjoys treating orthopedic conditions, but also has a special interest in women’s health physical therapy. Trudy is currently completing a pelvic health residency through Ivy Rehab. Her goal is to earn her pelvic rehabilitation practitioner certification. Learn more about Trudy here.
References
Kesikburun S, Güzelküçük Ü, Fidan U, Demir Y, Ergün A, Tan AK. Musculoskeletal pain and symptoms in pregnancy: a descriptive study. Ther Adv Musculoskelet Dis. 2018 Nov 19;10(12):229-234. doi: 10.1177/1759720X18812449. PMID: 30515249; PMCID: PMC6262502.