Physical Therapy Support During Pregnancy and Postpartum

For expecting moms, pregnancy can be a joyous time. Yet, pregnancy is not without challenges. From morning sickness to an aching back, there are multiple symptoms that accompany one’s pregnancy experience.

Plus, the postpartum period presents a number of issues as well.

“It's very scary to be pregnant, and sometimes any ache or pain that we feel can make us hesitate to do a movement,” said Franciscan Health physical therapist Sarah Randolph-Kaminski, PT, DHSc. “But what we know and what research shows is that staying active and staying mobile helps us not only have a better pregnancy, but a better delivery and a faster rehab postpartum.”

Physical therapy can help with issues that occur during pregnancy such as low back pain, pelvic pain, incontinence, education on positioning and reducing tearing and prolapse during labor. Physical therapy after pregnancy is important to address continued problems with pain, incontinence, C-section scars, return to sex if painful, diastasis recti or prolapse.

With concerns related to pelvic health, physical therapy during pregnancy and post-delivery can be quite effective. Whether it’s incontinence or pain, a physical therapist can guide women in implementing solutions.

Your First Physical Therapy Visit

When someone goes to physical therapy for the first time, no matter the issue, therapists perform a full, head-to-toe musculoskeletal assessment and take a thorough medical history. The pelvic floor is no different than any other skeletal muscle, so it gets a similar analysis.

“We have all sorts of fibers down there we assess. If you are pregnant, we would not be doing any kind of invasive exam as you would receive at an OB/GYN, for example. But, there's plenty to be addressed, like postural training, lifting, if you have children already in the household, if you need to do repetitive tasks with your work up until your day of delivery—all are things we address,” said Milka Thoresen, Doctor of Physical Therapy with specialties in pelvic health.

Physical Therapy In Pregnancy

Physical therapists can teach women many techniques to mitigate pregnancy-related issues. For example, pelvic floor strengthening exercises help with incontinence. Pregnancy is the most common cause of injury to the pelvic floor because the uterus can compress various muscles and nerve groups, straining them as they are relied upon for more support.  

Additional tactics that help make the third trimester more bearable include core strengthening and stabilization techniques or even using stability belts at the pelvic joints to lift the belly a bit.

“It's typically during the second and third trimester that, because of body changes and shape changes that start occurring, a different center of gravity,” Thorensen said. “We see a good number of people start coming into us with back pain, something also called sacroiliac joint pain, which is basically where your pelvis and your spine join together on two sides to form a pretty significant joint that sometimes can displace. Or pelvic girdle pain, pubic pain, anything around the pelvic region, both in the abdomen and towards the back and front side are very common issues that come through our doors.

“And it's not a surprise. Hormonal changes, body fluxes, things are a lot more lax, so displacements of joints are very common during this time.”

Physical Therapy After Pregnancy

“For moms who've had any trauma during their delivery or having any aches or pains that aren't resolving, they can absolutely benefit from referring themselves postpartum. “They do have the strength and the capability of rehabbing these muscles, just like from any other injury, or just like from any other trauma. We can teach them how to strengthen both their pelvic floor, their abdominal wall, and get them back to their pre-partum habits and exercise.

“If we want to begin to wake up some of the muscles that were most impacted by delivery, there are two key areas that we want to focus on.”

Pelvic Floor Strengthening

“Our pelvic floor muscles, which are the muscles that run from our front pelvic bone back to our tailbone, serve like a bowl or a hammock and provide a lot of stability and support to our bladder,” Randolph-Kaminski said. “So that's where we want to talk about doing a little bit of pelvic floor strengthening. You might have heard this called Kegel exercises.

“When we're talking with moms about how to best connect with these muscles, imagining as though you are going to stop your urine flow midstream, and feeling those muscles draw up and in, and connecting with that feeling and then releasing.”

Abdominal Wall Strengthening

“We can think about beginning to tighten our abdominal wall muscles,” Randolph-Kaminski said. “This is the second muscle group that's really important to begin to wake up post-delivery. And how you might connect with those muscles is we imagine as though we're zipping up tight pants and we're drawing our abdominal muscles in, or almost drawing our navel towards our spine and hollowing out that space in between our hip bones.

“When we first start doing this postpartum, those muscles are going to feel like they don't want to work at all, but I promise you a little bit of work every day and within a few weeks, you'll find yourself connecting with those muscles so much better.”

“It's just nice to see our clients over a period of time, sometimes six to eight weeks long, which is the beauty of it because you see natural tissue healing. If given the right prescription and it's done the right way, things retract back the way they need to and issues often dissipate and are very manageable,” notes Thoresen.

When Pregnant Or New Moms Should Seek Physical Therapy

Thoresen urges women to visit with their OB or primary care physician if pain or other pregnancy-related problems persist for more than two weeks. Something as simple as an over-the-counter pain medicine could do the trick. However, she also encourages women to ask for a prescription for physical therapy.

“Pregnancy is a very natural process, and we want to normalize it as much as possible—even though issues can creep up," she said. "My message out there is to not worry. We can help with a number of things and hopefully make that transition and your new newborn lifestyle all the more pleasant.”

Listen Now: Physical Therapy For Pregnancy Support

With concerns related to pelvic health, physical therapy during pregnancy and post-delivery can be quite effective. Whether it’s incontinence or pain, a physical therapist can guide women in implementing solutions.