Over the course of my pregnancies (especially my first), I felt I was not given much concrete advice on safe exercise throughout pregnancy and how to manage aches and pains that popped up along the way. I was told “You can keep doing what you were doing before.” Postpartum, I felt even more lost until I educated myself and took the necessary coursework to become specialized in pregnancy and postpartum exercise and rehab. Pregnancy is so beautiful but can also be a tough time for most women. Some women thankfully experience no pain and are able to perform all their necessary daily activities and exercise without restraint. In my line of work, I mostly see the pregnant and postpartum women who are in pain. Some come to me at 20 weeks, others closer to delivery! Many don’t seek out professional help at all and suffer throughout their pregnancy, thinking there is nothing they can do to relieve pain. I want to make sure all pregnant women understand there is a lot we can do! Even if we do not relieve the pain 100%, we can improve sleep quality, gait and overall strength; help prevent many postpartum issues; and also help prep moms for delivery!
As pregnancy progresses and the baby grows, the body is changing in so many different ways. Besides the basic hormonal changes we love, relaxin is being released to keep ligaments lax enough for the growing baby and for delivery. Keep in mind it affects all ligaments, so there is increased risk of injury with higher-level activities. Anatomically, due to the growing baby, ribs widen and spread out, and the diaphragm is pushed up and cannot expand properly with inhalation. If we cannot use our diaphragm properly, we rely on our accessory muscles of breathing (think neck muscles), causing a lot of neck and shoulder pain. This can worsen postpartum with feeding (whether bottle or nursing) and even just carrying the baby around.
Additionally, the abdominal muscles are stretched out, causing core weakness. The pelvic floor muscles have to handle a lot more pressure coming from the baby, which can cause pelvic floor muscle tightness, weakness and other issues like incontinence and pelvic organ prolapse. Our back muscles now are working overtime to keep us upright and counteract the forward growth of the baby, and to compensate for weak abdominals. This can cause a lot of tightness and pain throughout the back. Additionally, postural changes occur causing tightness and weakness.
A common concern in pregnancy is avoiding diastasis recti (DR). DR occurs when the linea alba (connective tissue between the rectus abdominis (6-pack muscle)) stretches over the course of pregnancy, causing separation between the two sides of the rectus abdominis. It can be seen in pregnancy as a bulge or doming when lifting too much weight, sitting up or with pushing/pulling motions. Almost 100% of pregnant women will have a DR by the end of their pregnancy just due to belly expansion! Some heal on their own postpartum, but others will have varied levels of DR postpartum that need intervention. While it can be an aesthetic concern for most women, it can also affect proper recruitment of abdominal muscles and affect pelvic-floor healing. While DR may not be preventable, PTs can teach proper loading strategies with exercise and everyday activities to minimize the DR during pregnancy. Breathing work and teaching core stabilization without doming of the abdominals is crucial. We can also help teach proper pressure management to decrease force on the pelvic floor. We don’t want to take away activities you enjoy, but we want to make sure we can do them smarter and modified to decrease risk of all of the above issues, which can worsen postpartum.
Another common concern is developing pelvic-organ prolapse (POP). Since our ligaments are lax during pregnancy to prepare for birth, our pelvic-floor muscles are the secondary support system for the pelvic organs. If our pelvic floor muscles are already weak from the increased load from being pregnant, they may not be able to support the organs well. This can cause the pelvic organs to prolapse/descend down. There are different degrees of severity, but in many cases, pelvic-floor PT can help decrease the load on and maintain pelvic-floor muscle strength during pregnancy.
Another very common area of pain is the pelvic girdle. This can be pain in the hips, sacroiliac joint (SIJ) in the low back or the pubic symphysis in the front of the pelvis. These areas are important to support the upper body and provide stability. Pain occurs when the stress placed on these areas increases, and they may not be able to handle the load appropriately. In addition to ligament laxity, this can cause more instability in these areas. Many patients with severe pain in these areas have difficulty walking, which can start early on in pregnancy, and difficulty sleeping. Maintaining movement and sleep is very important for everyone, but especially in pregnancy. Pain in these areas can also make labor and delivery more challenging. PT can help decrease pain in these areas to better tolerate movement, improve sleep quality and teach different techniques for labor and delivery.
So what can we do? The first thing I teach all my pregnant and postpartum clients is proper breathing techniques. This restores proper movement of the diaphragm, which helps recruit abdominal muscles and the pelvic floor. If the pelvic floor and back muscles are tight, breathing can help lengthen and relax these areas as well. Breathing also helps restore rib and spine mobility. While breathing sounds easy, 99% of my clients have difficulty breathing correctly, especially while pregnant or postpartum. While it can take effort to learn, it is 100% worth the effort and can have a big impact on pain and function.
The second thing I teach my clients is proper core and glute recruitment. Maintaining strength in these muscles throughout pregnancy is possible and important! I also teach proper load management with activities the patient wants to continue doing, as well as with daily activities. And, as always, education is key, making sure my patients know when to modify activities, warning signs to look out for and keeping the body and baby safe during pregnancy.
While the above diagnoses have been explained in a general form, the issues can go deeper and vary greatly from person to person. Just know your pain is not in your head. Appreciate all you are going through and what your body can do! But at the same time, know you do not have to suffer. Finding a pregnant/postpartum or pelvic-floor specialist in your area for proper education, evaluation and treatment can be extremely beneficial and have a big impact on pain and function both pre- and postpartum. Most people do not need a prescription from an OB/GYN to see a physical therapist but if you do, do not be afraid to ask for one! Sometimes all you need is a few sessions to get back on track or relieve pain.
Not sure where to start or have any questions? Book a consult with your friendly neighborhood physical therapist.
Jenny is a local, private physical therapist and owner of Next Step PT. She specializes in general orthopedics for adults and teens, is a pelvic-floor specialist, works with pregnancy and postpartum women and is a running gait analyst and more. For a free PT consultation or more information, contact [email protected].
