Pre- and Postnatal Physical Therapy: Why is it important?

tgibsonBy Tara Gibson, PT, DPT, CFMT
Whether you’re planning on getting pregnant, in the middle of your pregnancy, or recently delivered, there are a number of reasons why you may want to see a physical therapist who specializes in Women’s Health at EHS. Pregnancy is a wonderful and normal physiological process through which many women have no problems during or afterwards. That said, many women encounter problems that are often preventable or treatable through physical therapy. Symptoms that PT can address may include the following: low back pain, pelvic pain, incontinence, sexual dysfunction, extreme fatigue, varicose veins, swelling of hands or legs, sciatica, carpal tunnel syndrome, and other manifestations of pain related to postural and hormonal changes. Many of these issues can be addressed with some simple postural changes and gentle stretching and strengthening exercises. Others may be a bit more complex requiring some manual techniques and more specified education to help resolve the problem. Either way, we are here to help! Read on to see why pre- or postnatal physical therapy can make your life a LOT easier….

Immediately upon becoming pregnant, your hormones will change. Increases in both relaxin and progesterone will cause the connective tissues in the body to become more lax. This is to allow space for your baby to grow and when it’s time, be delivered. Where there was previous stability in certain joints around the pelvis and spine, they become more mobile. This normal phenomenon is called ligamentous laxity and will affect joints all over the body. The hormonal changes also cause fluid retention. Thus, pooling can occur in the lower legs as well as the lower arms. This can cause cramping in the thighs, varicose veins in the calves, and carpal tunnel syndrome in the wrist and hand.

How could physical therapy help?
• Lymphatic drainage – Performing techniques such as lymphatic drainage will reduce swelling in your hands or legs by reducing congestion in your abdomen. These techniques are very gently and safe and often offer immediate relief and decreased fluid retention.
• Gentle movement techniques – We will educate you on how to minimize water retention and protect your joints through movements and positioning. We will also teach you how to self-mobilize restricted muscles and nerves to eliminate problems like carpal tunnel syndrome.

As the fetus enlarges, postural changes will also occur. Your center of gravity will become higher and more forward forcing you to compensate to stay balanced. There will be accentuated curves in the spine, placing more pressure on your low back and pelvis. Your head will tend to sit further forward as a result, causing the muscles in the neck and front of the shoulders to become tighter. The hip musculature will generally become shortened by the extra weight and postural changes; this can lead to compression of the sciatic nerve causing symptoms of sciatica (low back pain that extends into the buttock and sometimes down the leg). Breathing can become labored as the diaphragm becomes restricted by the growing fetus. The vena cava, a very important blood vessel in your abdomen that transports blood from your legs to your heart, can be compressed when you lie down.

How could physical therapy help?
• Manual techniques – Using soft tissue and joint mobilization, combined with stretching and strengthening techniques, you will be helped to maintain optimal muscle length and core stability to optimize posture during standing, walking, lifting and carrying, and even sleeping.
• Exercises – We will teach you how to strengthen the muscles that get weak from being overstretched and stretch the muscles that get tight.
• Sleep position – We will teach you how to position yourself using pillows when sleeping to minimize pressure on important vessels in your abdomen and still be comfortable.
• Postural education – We will teach you how to adapt your posture to bring your baby into your center of gravity. This will place less stress on your low back and on sensitive areas like the sciatic nerve.
• Breathing techniques – We will train you on how to position yourself and how to consciously control your diaphragm to allow for more optimal breathing patterns.

Finally, as some musculature will tighten during the pregnancy, other muscles will become overstretched and then weak. During the 2nd trimester a condition called diastasis recti usually occurs. With diastasis recti, the connective tissue in the center of the abdomen between the abdominal muscles gets overstretched and weakened allowing the organs around the belly button to protrude outward. This can lead to low back pain and a possible hernia (tearing of the tissue that allows the organs to actually protrude out). Also, pregnancy often leads to an overstretched and weak pelvic floor causing pelvic pain, low back pain, and incontinence.

How could physical therapy help?
• Diastasis recti – We will help you prevent or correct diastasis recti, giving gentle but very specific manual techniques and exercises to facilitate a stronger abdominal wall and pelvic floor. This is NOT through crunches, which put excessive pressure on the abdominal wall.
• Splinting – Splinting with a soft but supportive SI belt around the low abdomen can help maintain closure or draw together the separated abdominal muscles.
• Manual techniques – Gentle manual facilitation using PNF (proprioceptive neuromuscular facilitation) to train the deep core musculature to engage during the pregnancy will allow for a faster and stronger recovery post-partum. Intra-vaginal techniques may also be utilized to help decrease muscular tightness/pain and facilitate a better pelvic floor contraction.
• Exercises – Personalized core exercise home program, depending on whether you did abdominal training before getting pregnant or not, will be prescribed. If you did not actively exercise your core before getting pregnant, you should not start doing anything intensive during your pregnancy. The exercises should be carefully prescribed.

When should I consider seeing a P.T. if I’m pregnant?
Right away! It’s important be educated as soon as possible on what to expect during your pregnancy in terms of musculoskeletal changes. We will evaluate the strength, mobility, posture, balance, and overall function of YOUR specific body and provide you with the tools to minimize physical complications through out your pregnancy and after childbirth.

How often should I come to P.T. if I’m NOT having problems?
We recommend at least once or twice during each trimester to ensure you are adapting well to the changes that are occurring and to guide you on how to best manage the next phase of your pregnancy from a physical perspective.

What about after I’ve delivered? When can I come in?
You should wait for your doctor to clear you to begin therapy for medical reasons. It will usually be between 4-6 weeks post-partum.

What kind of things would physical therapy do for me AFTER I have my baby?
• Pelvic floor weakness – If you underwent vaginal delivery, chances are you will have weak pelvic floor musculature. P.T. will help to facilitate the muscles that control your pelvic floor musculature to help prevent or tackle incontinence issues and pelvic pain during sex or otherwise. If you have incontinence, you are also at risk for a prolapse (where one of your pelvic organs may begin to slip out of position toward the vagina). We will help you recover your pelvic floor strength in ways that extend beyond simple Kegels.
• Scarring – If you underwent C-section, it is critical that you seek physical therapy to at least begin the scar mobilization process. Many women will suffer from low back pain, SI problems, sciatica, digestive issues, or hip pain months or even years after a C-section that is often the result of adherences to other structures by the scar tissue. Scar tissue is like an iceberg. What you see on the surface is only about 10%. That said, even if it’s been years since your C-section, coming in for P.T. can make a huge difference.
• Diastasis recti – Regardless of your delivery method, you should be evaluated for diastasis recti. If you have it, tackling it earlier rather than later will help prevent a sea of possible problems later on, especially if you plan on having another child. We will teach you how to restabilize your core in a way that does not place direct pressure on the diastasis, allowing it to close and heal.


Elite Health Services, located in Old Greenwich, (and now Westport!) CT is a world-class provider of certified functional manual physical therapy, personal fitness, golf & triathlon performance training, massage therapy and wellness related services. Our team of highly skilled and dedicated professionals take a no-excuses approach to providing exceptional care and delivering exceptional results. To learn more visit www.EliteHealthServices.

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