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Physical Therapy in the Perinatal Time

Author, Aimee Lake, DPT, Women’s Health Lead at GPT

Physical therapy can be very helpful for maintaining a healthy level of physical activity during pregnancy. It can assist with managing and solving some of the physical challenges of pregnancy, and can also be a great resource for preparing for birth and postpartum recovery.

People often think of physical therapy in terms of getting rid of pain or the rehab that’s needed after a surgery. But as a Women’s Health physical therapist, I like to think of my role as helping my clients move better in their bodies so that they can be comfortable and achieve the goals that are important to them.

So how can physical therapy be helpful during pregnancy?

First Trimester:

Designing an exercise routine:

“Can I keep doing planks? What kinds of cardio activities are safe? Can I still ride my bike? I want to keep my abdominal muscles as strong as I can.”

A physical therapist can help you establish a safe and healthy exercise routine to pursue during your pregnancy. They can consult with you on whether the exercise routine you are currently doing is safe to continue. They can help you know how to modify your activity as your pregnancy progresses. They can help you figure out what abdominal exercises are safe at different stages of your pregnancy.

Decreasing impact of chronic injuries:

“I’m pregnant and I’ve always had back pain and now I’m worried.”

“I’ve always leaked a little urine when I run. Is this going to get worse now that I’m pregnant?”

“My knee is OK now but I’ve never been able to squat. Is that going to be a problem in labor?”

Pregnancy lasts a long time (or at least if feels that way). There is plenty of time to address and improve chronic injuries. Just because you’ve had back pain, knee problems or urinary incontinence during your life doesn’t mean you can’t make positive changes to those issues while you are pregnant. A physical therapist can help you with the rehab process for all of these, and other concerns.

Second Trimester:

Resolving pelvic girdle pain:

“I’m 17 weeks pregnant and I suddenly feel like I can’t walk because my pelvis hurts.”

Pelvic girdle pain, which is pain around your tailbone, at the sides of your hips, or in front at your pubic symphysis can increase any time your baby has a growth spurt. Physical therapy can offer relief and the ability to stay more active throughout your pregnancy with a combination of hands-on muscle release, gentle guided movement/exercises, and education on ways of moving to minimize symptoms.

Addressing pelvic floor problems:

“I’ve had vaginismus or chronic pelvic floor pain for a long time and I’m worried about my ability to birth my baby.”

“I’ve leaked urine when I cough ever since I was a teenager. Can I improve that at all before my baby comes?”

There are many helpful treatment options for decreasing pelvic muscle tension and pain during pregnancy. There is also progress that can be made in strengthening the pelvic floor muscles prior to birth. These include hands on techniques to reduce tension through the pelvic floor and tailbone area, gentle movements and exercises to increase hip mobility, and education on resolving and managing symptoms.

Third Trimester:

Encouraging optimal fetal positioning:

“I had terrible ‘back labor’ with my first birth and I would really like to avoid that this time.”

Because baby is subject to gravity on the inside just as we are on the outside there are many musculoskeletal-based things that can be done to encourage good fetal position prior to labor. Having good hip mobility is key and physical therapy can be helpful for increasing hip mobility, stretching tight hip muscles, and educating you on helpful positions to encourage your baby to settle in the best position prior to labor. Because these things take some time, in my experience it is best to start working on encouraging good fetal positioning between 30 and 35 weeks.

Biofeedback for birth preparation:

“I’m afraid of what labor will be like.”

As a women’s health physical therapist, I often use biofeedback, which uses small sensors on the pelvic floor muscles, to help clients find the positions in which their pelvic floor muscles tend to be most relaxed. This can be very helpful for giving women an idea of what positions might be most helpful for them in labor, especially for the push phase. They can pass this information on to their OB or midwife so that they can utilize those positions during labor as needed.

Education for good abdominal and pelvic floor care in labor and afterwards:

“Is perineal massage effective for preventing tearing in labor? What is a sitz bath? Should I start doing Kegels right away after I have the baby?”

Women’s Health physical therapists can be very helpful for education on the effectiveness of perineal massage prior to labor. They can offer advice for good postpartum care of the perineum. They can also offer guidance for what gentle movements might be appropriate and what may not be immediately postpartum. They can advise on whether or not to use an abdominal binder postpartum.

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Physical therapy can also be very helpful postpartum. Here are some of the ways that it can be useful:

Postpartum:

Minimizing and alleviating upper back pain associated with newborn feeding and carrying:

“I’m two weeks postpartum and my upper back and neck are killing me from nursing.”

Physical therapists can help alleviate muscle tension and improve positioning to decrease discomfort with early infant care.

Addressing diastasis recti and restoring abdominal function:

I have a two finger-width separation in my abdominal muscles and I Googled it and now I’m scared.”

As a Women’s Health physical therapist, I work with many women to help them reduce their abdominal muscle separation and restore their abdominal muscle strength. Even in women who do not have separations, I often find that the balance of their upper abdominal strength vs. lower abdominal strength does not automatically return to normal after delivery. Even one session of education on this important topic postpartum can be so helpful for setting you up to be successful in your recovery and return to physical activities.

Resolving incontinence and prolapse issues 

“I’m 12 weeks postpartum and I’m still leaking urine.”

This is not normal or ideal and a Women’s Health physical therapist can offer valuable treatment including releasing tight pelvic floor muscles, retraining weak pelvic floor muscles, and helping you re-establish good bladder and bowel emptying habits.

Providing release to tight scar tissue postpartum

“I had a 3rd degree tear with a lot of stitching and now at 12 weeks postpartum it’s still painful to sit for long periods or attempt to have sex.”

“I had a c-section and I feel like I have sharp jabbing sensations along my incision at times.”

When perineal tears and c-section incisions heal, the tissue heals up tighter then it was initially. This can be quite painful but is easily treated with some hands-on scar tissue mobilizations to the areas to loosen up the scar tissue and restore normal tissue movement.

Returning to higher level physical activities

“I’m 6 months postpartum and I want to know about safely returning to yoga/marathon training/kickboxing/Pilates/etc.”

A physical therapist can help design a program specifically for you to help you return to your sport or activity safely and strongly.

Throughout pregnancy and for many years postpartum, physical therapists can help you live stronger, be more comfortable in your body, and achieve your movement goals.