Pelvic Floor Physical Therapy During Pregnancy

It’s truly amazing what bodies endure during and following pregnancy. We praise all the new parents that come into the clinic for their resilience not only physically but mentally, taking care of themselves as well as being a caretaker 24/7 whether it’s one child or three children, it really is a super power.

It’s so easy to neglect ourselves when you become a new parent; however, this is the time that you can really use our help as rehab therapists. Physical therapy can help women tremendously throughout pregnancy and during the postpartum period.

In this article I will be going through a few of the common diagnoses the therapists see at our clinic during and following pregnancy; however, to understand these common diagnoses it would be better to explain the physical changes that occur and then contribute to patients’ symptoms.

Issues Commonly Experienced During Pregnancy

• One of the most common complaints reported during pregnancy is Low Back Pain, pain that occurs anywhere between the 12th rib and gluteal fold.
• 45% of pregnant women report some level of LBP during their pregnancy (33% were considered pregnancy-related low back pain and 50% were pelvic girdle pain).
• Pelvic Girdle pain, this is defined as pain located below the PSIS (posterior superior iliac spine), in gluteal region, posterior thigh and the groin.
• Pregnancy-related low back pain is defined as pain along anywhere of the lumbar spine region and above the sacrum.

Physical Changes

Imagine your Uterus growing from the size of your fist to large enough to hold a 10 lb baby. That’s like 0 to 100 in just nine months, and then imagine if you’re having twins! The body is an amazing complex system that allows this process; however, doesn’t mean that these changes feel all happy and dandy. On the contrary, many of the physical changes that occur can result in low back pain, hip pain, pelvic pain, pubic symphysis dysfunction, diastasis recti, and sacroiliac joint pain just to name a few. And these aches and pains can then carry over postpartum, which is why it is so important to be aware of how to help the symptoms when they start to prevent them from getting worse or even persist way beyond following pregnancy. Because let’s be real, following pregnancy the heavy lifting that was all centralized in your stomach is now crawling, running or climbing all over the place. Physical therapy can teach you tools to help reduce or eliminate your symptoms and get you back to doing the activities you care about whether it’s with child care, daily chores, activities of daily life or your occupation.

Common pregnancy posture consists of: a tucked tailbone, flattening and inhibition of the glutes, rounded shoulders, a forward thrusting pelvis and rib cage sitting behind the pelvis, otherwise known as a sway back posture. A pregnancy posture takes you out of optimal alignment, plus having increased load from the baby there is increased strain on the abdominal wall and your back muscles. With Physical therapy you can create a treatment plan with your therapist to help minimize or avoid these postural deficits to prevent aches and pains from occurring.

Low Back Pain and Pelvic Girdle Pain during Pregnancy

In a 2019 study by Varveris, more than 45% of pregnant women reported some level of low back pain, of which were either classified as pregnancy-related low back pain or pelvic girdle pain. Pelvic girdle pain is considered pain below the posterior superior iliac spine, in gluteal region, the groin and posterior thigh, where as, pregnancy-related LBP is pain along anywhere of the lumbar spine and above sacrum region.

Check out this article written by Heather Jeffcoat, DPT which features some exercises for low back pain during pregnancy.

How Physical therapy Can Help During Pregnancy

The therapists at Femina Physical Therapy are experts in helping pregnant individuals gain the strength and skills they need to be as independent as possible with all the things they need to be doing throughout their pregnancy. Our therapists will perform a thorough intake including a medical history check, systems review, and special therapy tests in order to help therapists determine what problems are affecting you. With that information, therapists will work with you to create a unique treatment plan that will address your functional limitations, goals and quality of life.

Physical therapy for the Postpartum Period

Labor and delivery are no joke! Although there is a tremendous range in birth stories, and post-partum experiences, one thing is certain: you are at a higher risk for certain diagnoses (i.e. pelvic pain, scar pain, low back pain, SI joint dysfunction, pain with sex, postural pain from childcare and breastfeeding, diastasis rectus abdominis, pelvic organ prolapse, urinary incontinence, pubic symphysis dysfunction). This is true whether you delivered your baby via C-section or vaginal delivery.

Layered with the physical toll that labor and delivery can take on the body, are all of the physical challenges of new parenthood: lifting a baby in and out of cribs and car seats, schlepping car seats, diaper bags, groceries, and everything else in and out of the house, holding a baby during multiple feedings, neck aches from your loving gaze down at your new babe, and overall muscle pain from a lack of sleep. Lucky for you, we are here to help!

Checking in with a physical therapist specializing in pelvic floor issues (like everyone at Femina PT) will help you with any symptoms you might be experiencing, as well as give you the information and skills you need to keep any problems from getting worse. Also check out this article written by Heather Jeffcoat, DPT about early postpartum recovery, featuring some great exercises you can do as you begin your postpartum period.

What does Physical therapy look like when you’re pregnant and post-partum?

Treatment will consist of:

• Myofascial/connective tissue release
• Postural training
• Gait and body mechanic training
• Ergonomics (i.e. workstation, office desk set-up)
• Activity modifications to assist with pain provoking tasks and to prevent injury or repetitive stress on muscles and joints
• Strengthening and stabilization training (this would be tailored to the individual and based upon what stage of gestation you are)
• Stretches to address myofascial restrictions due to bodily changes during pregnancy
• Abdominal strengthening and neuro-muscular awareness of pelvic bracing during functional activities
• Pelvic floor muscle awareness and training to help stabilize pelvis and support
• Pelvic floor downtraining to help with pelvic pain, hip pain, constipation, and pain with sex

Check out these articles on the Femina PT website about pregnancy

• Early Postpartum Recovery, by Heather Jeffcoat, DPT
• Exercises for Low Back Pain in Pregnancy, by Heather Jeffcoat, DPT
• Carpal Tunnel in Pregnancy, by Heather Jeffcoat, DPT
• Help for Pubic Symphysis Pain, by Heather Jeffcoat, DPT
• Post Partum Urinary Incontnence, by Heather Jeffcoat, DPT
• Help for Postural Pain After Breastfeeding, by Heather Jeffcoat, DPT

Resources Cited

Varveris, N. K. (2019). Differential Diagnosis and Physical Therapy Management of Lumbar Instability in a Patient With Pregnancy-Related Low Back Pain. Journal of Womenʼs Health Physical Therapy, 43(2), 98–108. https://doi.org/10.1097/jwh.0000000000000132

Simonds, A. H., Abraham, K., Hill, C., Spitznagle, T., Cheng, M. S., & Parrott, J. S. (2018). Disability, Pelvic Girdle Pain, and Depressive Symptoms in the First 3 Months Postpartum. Journal of Womenʼs Health Physical Therapy, 42(3), 139–147. https://doi.org/10.1097/jwh.0000000000000105