Physical Therapy for the Pregnant and Postpartum
Written by Missy Gallow, DPT
Do you have pain and are pregnant or recently had a baby? Do you have pain with intercourse, low back pain or experience leaking now that you’ve had a baby? Do you still have the “mummy tummy” that you wish you could get rid of?
Physical therapists can help! The #1 reason women don’t seek physical therapy for pregnancy and postpartum pain is because they don’t know they can or their OBGYN/midwife doesn’t know either. Unfortunately, a common misconception is that pain during pregnancy will go away on its own once the baby is born. Recent research from The International Journal of Obstetrics and Gynecology shows that 80% of women who have pain or urinary incontinence that hasn’t resolved within 3 months postpartum, will continue to have chronic pain for years. While the pelvic floor muscles are stretched from having a baby and some leaking is normal the first 3-4 weeks post baby, beyond that leaking is not normal.
Urinary incontinence can start during pregnancy as the baby is essentially pushing on your bladder. Training the pelvic floor muscles during pregnancy is a great way to maintain continence. But don’t worry, if you have developed incontinence due to child birth, it’s not too late! A women’s health physical therapist can help you retrain your pelvic floor muscles and connect those muscles back to your brain. Once the brain and muscles are working together again, the therapist can help you incorporate using these muscles in your daily life (ie squatting, lunging, picking up baby, getting up from the floor or carrying a car seat).
YOUR CHANGING BODY
Think of your body as your house (I mean you do live in it!) and your pelvis is your foundation. Now, pregnancy is the biggest house renovation you will ever undergo! One of the most important systems your body has is it’s “anticipatory system” comprised of the diaphragm, core and pelvic floor. Unfortunately this system gets stretched, pushed and redistributed as you go through pregnancy and you are left with an unbalanced system postpartum.
Hormonal changes in your body cause ligamentous laxity as well as your changing center of gravity as baby grows, putting more pressure on your low back and pelvic girdle. BUT, you don’t have to go through your pregnancy in pain! Any pain pre-pregnancy will only intensify during and likely after. A skilled physical therapist can teach you how to deal with these body changes in a safe way without harming you or the baby.
Women are STRONG (that’s why we carry the babies) and we often just deal with pain, but
literature shows that 30% of women experiencing pelvic pain early in their pregnancy, when left untreated, go on to have chronic pelvic girdle pain. You may say “I have a baby now, I don’t have time for physical therapy”. Now, having just had two babies myself, what I don’t have time for is chronic pain! A physical therapist is just a guide, giving YOU the tools to manage your pain throughout your (busy) daily life. Who doesn’t want POWER over their body?!
THE POSTPARTUM BODY
“I need to do sit-ups to get my core back!”
First off, let’s define “postpartum”, whether you’ve had a baby 5 months ago or 10 years ago YOU ARE POSTPARTUM
A common “injury” postpartum is diastasis recti, which is a fancy term for your abdominal muscles being separated, which is even more common after having multiple births. If left untreated, or if improper exercises are performed too early it can lead to chronic issues like low back pain and abdominal hernias, not to mention the “mummy tummy” where you continue to look pregnant even years after having your baby. A Physical Therapist can help teach you what exercises can close the abdominal wall and what exercises to avoid that may worsen the condition. They can also teach women who have had c-sections proper scar mobilizations to prevent scar adhesions. Believe it or not, your c-section scar can adhere to your bladder, causing bladder pain and chronic pelvic pain or pain with intercourse.
This is by no means an ultimate guide to “what to do during pregnancy and postpartum” but the goal here is to empower women to have control over their bodies. If you are a Mom or soon-to-be, you are a superhero and deserve to be able to go through life without chronic pain related to pregnancy and childbirth! As physical therapists, we need to spread the word that there is help out there for you.
Click on the link below to see how to check for diastisis recti
*Please note that each individual has different needs, and a physical therapist would evaluate your body and create a program specific to your needs
Contact Missy at Active Physical Therapy for additional information or with questions on Pregnancy and Postpartum Physical Therapy
MacArthur C, Wilson D, Herbison P, et al. Urinary incontinence persisting after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology. 2016
Michele Wojciechowski. What to Expect When They’re Expecting: PT’s Who Treat Patients During and After Pregnancy. PT in Motion. December 2017-January 2018.
Juile Wiebe. http://www.juliewiebept.com/
Personal referance: Anne Guist. Women’s health Physical Therapist.