Prenatal Physical Therapy Care

Pregnancy is a time when our bodies are going through many changes. We have to listen to our bodies during this time. Most people don’t realize how physical therapy can assist with keeping your body feel well through these changes. Physical Therapy can assist with sacroiliac joint pain (SI joint pain), pubic symphysis dysfunction, low back pain, round ligament pain, diastasis recti, and decreased rib cage mobility. Learning how to take care and manage these issues can be very helpful.

Exercise can be a great way to support your babies growth and support your own body in process. Despite misconceptions, it is completely safe to exercise during pregnancy as well. It can help prevent gestational diabetes and manage weight gain. Exercise produces greater red cell volume which leads to increase in oxygen to the mom and fetus. My advice as a Physical Therapist would be not to embark on a new and very unfamiliar form of exercise, but that it is favorable to begin a new exercise routine such as walking, weight lifting, barre, or yoga. Just to suggest a few. Beginning more extreme forms of exercising during pregnancy may not be advisable such as wake boarding or contact sports etc. How do you know if your exercise is too intense? Well, wearable heart rate monitor can be helpful but also simply “The Talk Test”. Yep! You heard me right! Can you speak or talk to someone while performing the exercise? If you can hold a conversation or sing a short song like happy birthday, then you are probably exercising right on track at a moderate level! Some mothers may not be able to lay on their back for exercise or lay on their back in general towards the end of pregnancy. The baby weight can compress inferior vena cava and lead to decrease fetal blood supply. If you are able to tolerate doing exercises laying down, I would consider laying on your side in between sets to minimize the decrease in blood flow. If you can’t tolerate fully laying down on your back that a reclined position is also a great option. Physical Therapist can also help adjust exercises as necessary to accommodate changing bodies with new aches, pains, or restrictions.

Keep in mind that some cannot tolerate exercise which is okay too. Extreme exercise is not recommended especially is hot temperatures since it can increase the fetus temperature too greatly. In some, it can also lead to early contractions and in this case may not be recommended by your doctor. In the very least, keep moving, performing breathing exercises, and stretching as much as tolerated during this time.

Informing soon to be mothers of the birthing process can be be empowering. It can be especially helpful when trying to understand what needs to happen in order to assist with a smoother delivery. Being able to practice keeping your pelvic floor relaxed during birth may decrease the likelihood of tearing your pelvic floor. Although, truthfully the evidenced based research on this topic is limited. What I can tell you is that it is not harmful to begin tuning into this area of your body in order to prepare! Check out my posts below on some positions to practice relaxing your pelvic floor! Finding a comfortable position for your body where you don’t feel any aches and pains and are able to connect with pelvic floor is optimal for labor and delivery. Sometimes laying on one side may be more comfortable than the other. Try the different positions and see for yourself. Perinatal care can be just as important as the aftercare in order to support Moms to be! Physical Therapy while pregnant can also manage painful conditions such round ligament pain, pubic symphysis pain, sacroiliac joint pain, low back pain, sciatica etc. Incontinence, constipation, pelvic floor heaviness, diastasis recti may also begin to be a problem while pregnant as well. Some of these issues can also be addressed in Physical Therapy while pregnant! Why not work on things prior to the postpartum period! It may make you more comfortable during your pregnancy and make you recovery postpartum quicker.

Investing in services such as chiropractic care, prenatal massage, support groups, and physical therapy can give guidance, comfort, confidence during this unpredictable time!

Here are the links to some of the tips on Pregnancy and Delivery I have discussed through social media.

Low Down on Pelvic Organ Prolapse

Pelvic Organ Prolapse is condition in which the pelvic organ are descending or have descended down into the vaginal wall or the rectum. It is typically abbreviated as POPS. This condition is typically diagnosed and graded for severity by your Obstetrician or Midwife. Pelvic floor therapists can screen for these issues as well. Let’s go into more detail about some of the different types of vaginal prolapse.

Prolapse is typically graded from 1-4. One being the least severe and grade four being the worst. Cystocele is when the bladder drops down into the vaginal wall. Rectocele is when the rectum descends down and forward in to the posterior vaginal canal. Uterine prolapse is when the uterus and cervix descends. Less commonly seen is enterocele, when the small intestine descends into the vaginal wall. Additionally there is vaginal vault prolapse is when the vaginal canal folds in on itself.

Some forms of prolapse are manageable with pelvic floor physical therapy using pressure management strategies. An additional strategy that can be helpful in some cases includes the use a pessary fitted by your obstetrician. Grade three or four prolapse is in some cases are a surgical procedure. Strengthening and mobility of the legs, hips, trunk, and coordination of these structures can assist with mitigation of some symptoms as well.

Prolapse can happen with or without previous birthing history. Commonly prolapse symptoms can begin during pregnancy which is why it is so important to begin addressing symptoms as early as possible. Symptoms can included but are not limited to urinary incontinence, decreased ability to hold in gas or stool, in complete emptying of stool or urine, and pelvic floor heaviness. In severe cases, you may feel sometimes coming out of vaginal wall.

Managing how you are pressurizing the system can assist with symptom modification. Re-training these things does take work and commitment re-learn how you are going about some of your daily tasks and exercises. If you are having any of the symptoms or struggling with anything discussed in the videos, please don't hesitate to reach out to your local pelvic floor therapist to get assessed and get some help!

References:

Carvalhais, A., Natal, J.R. , & Bo, K. (2017) Performing high-level sport is strongly associated with urinary incontinence in elite athletes: a comparative study of 372 elite female athletes and 372 controls. Br J Sports Med, bjsports-2017

de Mattos Lourenco, T.R., Matsuoka, P.K., Baracat, E. C., & Hadad, J.M. (2018). Urinary Incontience in female atheltes: a systematic review. International urogynecology journal, 1-7

Matthews, et al (1991) “Prevalence, Incidence and Correlates of urianry Incontinence in Healthy, Middle-aged Women” Journal of Urology 146: 1255-1259

McKenzi, S., Watson, T., Thompson, J., & Briffa, K. (2016). Stress urinary incontience is highly prevalent in recreationally active women attending gyms or exercises classes. International urogynecology journal, 27 (8), 1175-1184

Whitehead, W.E. (2017, 07). Symptoms & Causes of Fecal Incontinence. National Institute of DIabetes, Digestive, and Kidney Health. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/symptoms-causes

What is Diastasis Recti?

When the the Linea Alba thins and stretches, which is the connection between the rectus abdominis or six pack muscles, it can create what is called a Diastasis Recti. This is a completely normal occurrence with pregnancy to accommodate room for a growing baby. A diastasis can sometimes close on its own or linger. Sperstad et al in 2016 followed 300 first time pregnant women. The prevalence of diastasis rectus abdominus was 33.1% at 21 weeks gestation. They followed these women into their post partum period as well showing 60% prevalence at 6 weeks post partum; 45.4% at six months post partum; and 32.6% at twelve months post partum.

Here is a video series I posted about Diastasis Recti!

If you have any questions, feel free to contact us! We are happy to help with all of your women's health needs!

References:

Sperstad. J..B.; Tennfjord, M. K.; Hilde, G.; Ellstrom-engh, M,; Bo, Kl; (2016), Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50 (17): 1092-1096.