Pain with pregnancy
During pregnancy your body undergoes many changes. Some of these include hormonal changes, postural changes, and endurance changes. The hormone relaxin is present during and after pregnancy increasing the flexibility of muscles and ligaments. With increased weight and up to 40% more blood volume during pregnancy, this new flexibility can lead to laxity in your joints, particularly the pelvis. This laxity can lead to stress on the joints or increased movement in the bones of the pelvis. Postural changes include increased bowing in of the low back from the weight of the baby, shoulders and head coming forward, upper back rounding, and hips rotating outward away from the body. With these bodily changes, you can have pelvic pain, low back pain, sciatica, numbness in the arms & hands, and urinary incontinence to name a few.
How can therapy help? During your pregnancy physical therapy can help with these problems. Therapists provide muscle energy techniques to realign the pelvis and give advice on support belts to help keep it aligned. They provide education regarding exercises to maintain better posture. Therapists are able to outline an exercise program to maximize core strength and stability. Special attention is given to the pelvic floor muscles during the entire pregnancy to support the additional weight of the baby.
What are the pelvic floor muscles? The pelvic floor muscles attach to the bottom of the pelvis forming a sling or hammock of muscle supporting the internal organs. When these muscles are tightened, they help stop the flow of urine and the passage of gas. They assist in normal sexual function. These muscles can be stretched and weakened with carrying the extra weight of pregnancy. During childbirth these muscles are stretched or interrupted with normal vaginal delivery and with episiotomy or forceps delivery.
How can therapy help after childbirth? After your baby is born you may notice some of the same problems you had during your pregnancy, or new problems may develop. Physical therapy helps with back pain, pelvic pain, urinary or fecal incontinence, diastasis recti, neck pain and more. Physical therapists perform a thorough evaluation including joint alignment tests of the pelvis, hips, and lumbar spine; assess muscle length, strength, and coordination; and evaluate internal and external pelvic floor muscles if needed. If you are not comfortable with internal examination, other assessments and treatments can be used. As a new mom suffering from back pain, neck, or shoulder pain you will be educated in better ways to support and position your body while taking care of baby. You will be given postural exercises to help shorten and strengthen the weakened muscles from carrying the baby, and stretch any shortened muscles from pregnancy. Exercises are prescribed to enhance strength of the core and pelvic floor muscles, increase endurance, and flexibility. Just knowing these simple tips can decrease your pain and prevent further problems in the future.
For incontinence, biofeedback is used to help you know when you are using the right muscles of the pelvic floor. Bladder retraining and education regarding healthy bladder habits may be needed to restore normal bathroom habits. You will be given a home exercise program for pelvic floor strengthening. For pain, manual therapy techniques are used to realign the pelvis or spine, mobilize soft tissues, and eliminate internal and external muscle knots that may be causing your pain.
What is diastasis recti? Diastasis recti is the separation of the abdominal muscles at the center of the body where the two halves of the abdominal muscles meet. During pregnancy the abdominal muscles can separate with the increasing size of baby, multiple babies, or even increased amniotic fluid. It will be noticed during pregnancy, with moving from laying down to sitting up, as a raised ridge extending lengthwise from your ribcage through the navel to the pelvis. After delivery it will be seen and felt as a gap in this same area. Physical therapists specializing in prenatal and postpartum issues will be able to give correct exercises both during and after pregnancy that will strengthen the abdominal muscles and help to close the gap. During pregnancy and after delivery is the time to seek help to maximize closure of the diastasis.