Pre-Natal/Post-Partum Care

Pregnancy does impose normal physiologic changes on a female. The question is, will she adapt to these changes without pathology? If not, physical therapy is the most appropriate course of action. Normal gestation is 38-42 weeks with an average of 40 weeks. This gestational time is divided into trimesters and during each trimester a woman will undergo various physiological changes. These changes will often result in anatomical changes which may lead to dysfunction. The hormone Relaxin begins to increase at conception and usually peaks at 16-20 weeks. This hormone is responsible for "relaxation" of all the connective tissue (ligaments, fascia etc...) in the body including the pelvic region and is necessary to allow passage of the baby through the birth canal. Unfortunately, this relaxation of connective tissue predisposes the pregnant female to musculoskeletal problems which may affect the spine, pelvis or other joints. The most common complaint during pregnancy is related to some form of low back pain.

Common Complaints Low back pain Neck pain Thoracic pain Numbness and tingling in the arms and hands Abdominal pain Pubic pain Stress incontinence Sacroiliac pain/Hip pain Knee and foot pain Rib pain Swelling of hands and feet Constipation Fatigue Pre-natal Low Back Pain: At Advanced Physical Therapy, our motto is "back pain during pregnancy is common, but not normal." 80% of expectant women experience low back pain at some time during their pregnancy. Often, these same women are told that low back pain is a "normal" part of pregnancy and will be alleviated after delivery. This is a common misconception. Back pain may manifest in the lumbar spine, sacroiliac joints, or lumbosacral joint. Commonly, the pubic symphysis (pubic bone) is also affected. Many factors contribute to back pain during pregnancy, including the effects of the hormone Relaxin which causes relaxation of the supporting structures of the spine and pelvis. This relaxation may lead to overstretching of the ligamentous support and lead to instability of the pelvis. Not only does the hormone Relaxin affect the pelvic structures, but can affect other joints in the body. Postural imbalances are another causative factor for low back pain during pregnancy. Women experience significant changes in center of gravity, balance, and in body alignment. These postural changes include increased sway in the low back and increased forward head and rounded shoulder posturing. These conditions are further complicated by muscle weakness in the abdomen and weakness of muscles surrounding the spine. At Advanced Physical Therapy, you will receive a thorough evaluation of your spine, bony pelvis, posture, muscle strength, and muscle imbalance. We will evaluate each patient's ability to perform normal daily tasks and will make recommendations regarding changes in workplace environment, home activities, recreational activities, and in other daily activities as needed. We will tailor a specific program based on examination findings which will include: manual (hands-on) therapy, specific exercises based on areas of weakness, postural education, bracing (as needed), and other treatments to control inflammation and pain. Each patient is given a specific home exercise program in order to enhance the rehabilitation process. "YOU DO NOT HAVE TO SUFFER WITH PAIN DURING PREGNANCY. THERE ARE TREATMENTS AVAILABLE TO IMPROVE YOUR PREGNANCY EXPERIENCE AND QUALITY OF LIFE!!!" Diastasis Recti: A separation of the rectus abdominis muscle at the mid-line; above, at, or below the umbilicus (belly button). A separation of 2 cm (2 finger widths) and more is considered significant. Predisposing factors may include weak abdominal tone or hormonal influence (Relaxin) in pregnant women. The diastasis may occur any time during a pregnancy and often appear during the second trimester. This separation can contribute to low back pain. A diastasis will cause weakening of abdominal support, and may result in herniation of abdominal contents through the separation. Treatment includes the use of support belts and exercise. Postpartum Low Back Pain: Women who experience low back pain during pregnancy are often surprised that the pain continues even after the delivery of their child. It is a common misconception that low back pain during pregnancy will be alleviated after childbirth. Many factors contribute to back pain during and after pregnancy, including the effects of the hormone Relaxin which causes relaxation of the support structure of the spine and pelvis. This may lead to overstretching of the ligamentous support and instability of the pelvis. Not only does the hormone Relaxin affect the pelvic structures, but can affect other joints in the body. Relaxin levels will slowly return to normal over a 3 month period for a mother who does not breastfeed and even longer if the child is breastfeeding. Postural imbalances are another causative factor in low back pain during and after pregnancy. Other women may notice low back pain after the birthing process which may be related to positioning during the labor and delivery process. At Advanced Physical Therapy, you will receive a thorough evaluation of your spine, bony pelvis, posture, muscle strength, and muscle imbalance. We will evaluate each patient's ability to perform normal daily tasks and will make recommendations regarding changes in workplace environment, home activities, recreational activities, and in other daily activities as needed. We will tailor a specific program based on examination findings which will include: manual (hands-on) therapy, specific exercises based on areas of weakness, postural education, bracing (as needed), and other treatments to control inflammation and pain. Each patient is given a specific home exercise program in order to enhance the rehabilitation process. "LOW BACK PAIN SHOULD NOT INTERFERE WITH THE ENJOYMENT OF YOUR NEW PARENTING EXPERIENCE!!" After childbirth, women should have a consultation with a Women's Health physical therapist in order to evaluate their ability to return to normal activities including exercise in order to prevent injury or re-injury. Instruction regarding strengthening of the pelvic floor muscles through Kegel exercises should also be addressed. If a woman is unable to contract the muscles in the pelvic floor, then treatment should begin to reeducate these muscles to prevent future incontinence or supportive dysfunctions (pelvic organ prolapse). Common Postpartum Conditions Low back, mid-back and/or neck pain Diastasis recti Scarring C-Section, episiotomy, or perineal tear Pelvic floor weakness Pelvic organ prolapse Urinary or fecal incontinence Pelvic pain Dyspareunia Physical Therapy Treatment May Include: Soft tissue mobilization, myofascial release, deep tissue massage Muscle energy techniques/Joint mobilization Medical exercise Pelvic floor exercise/retraining Postural reeducation Instruction for activities of daily living including lifting techniques and body mechanics Home exercise program Instruction on transition to an independent gym program

I appreciate all you did to help my pregnancy be more enjoyable. I was even able to work up until the day my son was born, and I truly believe it was because of your help. Next pregnancy, I hope to avoid any aches and pains but if they do resurface, I will know who to call. AB

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