Prenatal PT: Pushing back against pain and preparing for childbirth

Taking Care of Aches and Pains with Prenatal PT 

Carrying a growing fetus, adapting to changing body proportions during pregnancy, and giving birth vaginally or by cesarean section is nothing short of a miracle, but there is no denying it is also one heck of a workout! Just as you probably wouldn’t choose to enter a marathon race without training or pick up the heaviest dumbbells on the rack during your first day at the gym, it’s wise to take steps to prepare the body physically for the demands of pregnancy and childbirth.

Physical therapists with training in prenatal care are an excellent resource to guide you through this preparation and to help address any aches and pains that may develop along the way. This article will address both how physical therapy can improve symptoms of pain or discomfort that might develop during pregnancy and how physical therapists can create an exercise plan to keep you comfortable and prepare your body for childbirth. 

IS EXERCISE SAFE DURING PREGNANCY?

Because every woman and every pregnancy is different, it is important to talk with your obstetrician to get the green light before beginning an exercise program. Generally, however, exercise that includes aerobic activity and specific strength and flexibility training is thought to improve the ease of pregnancy and birth and help with postpartum recovery. 

One study published in 2016 by Di Mascio et al. in the Journal of Obstetrics and Gynecology gathered data from several randomized controlled trials during which women with uncomplicated, singleton pregnancies performed aerobic exercise for 35-90 minutes, 3-4 times per week. Compared to those that did no aerobic training, the aerobic exercise group experienced a significantly higher incidence of vaginal delivery and lower incidence of delivery via cesarean section. They also had significantly lower rates of gestational diabetes and hypertensive episodes while the incidence of pre-term labor did not differ significantly between exercisers and non-exercisers. 

ADDRESSING PRENATAL PAIN

Pain and discomfort in muscles and joints is not uncommon during pregnancy, especially as it progresses. Before, during, and after childbirth a woman’s hormones are fluctuating significantly. Hormones such as progesterone and relaxin cause increased ligament laxity during pregnancy. This has the effect of allowing the pelvis to expand during the birth but also causes laxity in other joints such as the lower spine and hips. Because the ligamentous laxity tends to reach its height during the second trimester as a woman’s uterus is expanding, her belly is getting larger, and her posture is changing, low back, hip, and pelvic pain may develop. 

It is also possible to develop pain or discomfort outside of the lower back and pelvis. Prior lower extremity injuries may be exacerbated by changes in body proportions and aches and pains can even develop in the neck or upper body in response to repetitive activities or moving in new ways. If you are experiencing pain or discomfort, a physical therapist trained in antepartum (before childbirth) physical therapy can assess your symptoms and develop an individualized treatment plan. Also, they can advise you on which exercises are safest and most beneficial to perform during the first, second, and third trimesters. 

WHAT CAN I EXPECT DURING PRENATAL PT?

Prenatal physical therapy should always be individualized to each woman to address her specific needs. Here are some of the treatment techniques a physical therapist may prescribe:

Stretching, mobility and flexibility exercises:  Muscle shortness or tightness can cause discomfort and lead to pain during pregnancy. Flexibility and mobility limitations that may not have bothered you much before pregnancy should be addressed early to limit issues with pain and discomfort. Whether you are seeing your PT because you are already having pain or looking for ways to prevent its onset, your PT can help identify these issues and teach you targeted stretches and mobility exercises. 

Strengthening exercises: Strengthening exercises are key to managing joint or muscle pain during pregnancy and to help prepare the body for childbirth while shortening recovery times. If you are having pain in a certain area, your PT will progress you through a strengthening program targeted to the area of injury. If you are simply looking to develop a program of exercises to prepare your body for giving birth, then you can expect that your program will include exercises to strengthen the abdominals, the back, the pelvic floor and even the legs. 

Pelvic Floor Training: The pelvic floor muscles and tissues are undergoing changes throughout pregnancy and experience trauma during the birthing process. A pelvic health physical therapist can advise you on exercises to strengthen and prepare your pelvic floor for giving birth. There is much more to pelvic floor PT than kegals. These PTs can help address issues of pain, discomfort, or incontinence that might develop during pregnancy and teach you strategies for minimizing these issues after childbirth.  

Soft Tissue Mobilization: Increased muscle tension and decreased soft tissue mobility can exacerbate pain and discomfort during pregnancy. Your PT may choose to apply gentle soft tissue mobilization techniques to address pain and impaired tissue mobility.   

Diastasis rectus abdominus prevention: A diastasis rectus abdominus is a separation of the left and right outermost abdominal muscles known as the rectus abdominus. It most commonly occurs as a result of pregnancy. As the fetus grows, increased pressure is placed on the connective tissue between the two sides of abdominal muscles causing separation. It commonly develops during the second or third trimester and often will resolve on its own in the first few postpartum months. Sometimes, however, it will persist and can cause discomfort, feelings of weakness in the abdominals, low back, hip, or pelvic pain, and feelings of “flabbiness” in the abdominals. 

Physical therapy during the prenatal months can help decrease the likelihood of developing a diastasis rectus abdominus that does not heal quickly on its own. A program of specific abdominal and pelvic floor strength and stabilization exercises performed throughout pregnancy has been shown to be highly effective. 

Just as eating the right foods, getting enough sleep, and managing your stress can help with a healthy pregnancy and delivery, keeping a strong and flexible body should also be a priority. Physical therapy is a great resource for supporting your physical health and reducing pain and discomfort. Whether this is your first pregnancy or fourth, Evolve PT would love to be a part of your journey through a healthy pregnancy and delivery. 

Click here for more information about physical therapy for pregnancy

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

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