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Why PT after Pregnancy is Important

The physiologic and morphologic changes that occur during pregnancy continue for 4-6 weeks postpartum. As soon as her clinician deems return to physical activity medically safe, she may gradually return to her pre-pregnancy exercise routine. Because of the de-training that occurs during recovery from delivery, activities must be resumed gradually, and women may benefit from the knowledge and guidance of a physical therapist to assist with this return as well as direction on optimal completion of activities of daily living, including caring for her newborn, housework, and caring for herself. Furthermore, many of the symptoms she experienced during pregnancy, including low back and pelvic pain, may still be present or new symptoms, including hip or shoulder pain, may have begun as she started caring for her newborn and her house once again.

Physical therapy for women postpartum consists of training for optimal completion of activities related to caring for a newborn, lifting, and carrying; modifications are also recommended as needed to increase her comfort with these activities. The physical therapist will demonstrate proper positioning for mother and baby when standing at a changing table or changing the baby on the floor. Because of the frequency of which a newborn must be fed, optimal positioning for the mother is imperative to reduce the instances of low back, middle back, and shoulder or arm pain during and after feedings. Reaching into the crib or bassinet is another activity a new mother completes often, and demonstration of proper positioning of her back, legs, and arms will increase her comfort with this task and prevent injury. Caring for children also comes with a lot of gear, such as diaper bags, carseat carriers, and toys. Therefore, ways to prevent injury when lifting and carrying these items as well as the baby himself or herself are provided.

Often times, new mothers come to therapy because they are already experiencing pain or have injured themselves, the physical therapist will use such treatments as manual therapy and therapeutic exercise to reduce their symptoms and prevent recurrence. Manual therapy techniques include soft tissue (muscles, ligaments, and tendons) mobilization, neural mobilization, and joint mobilization. Tendinitis in such body regions as her shoulder or hip often occur with overuse of weak muscles and responds well to soft tissue mobilization, including friction massage. The development of myofascial trigger points can occur in overused muscles as well, and they will become less tight and painful with trigger point release techniques. Mobilization of the nerves that run in between and underneath soft tissue structures benefits these patients when the muscle tightness is tensioning or compressing a nerve, leading to symptoms of numbness, tingling, or pain. Unlike muscles, nerves do not stretch, and the mobilization techniques aim to restore their ability to glide between soft tissue surfaces. Joint mobilization techniques aim to restore optimal position and movement of joints affected by faulty posturing during pregnancy and post-partum; this time of increased laxity makes them more susceptible to injury. Because of the forward flexed posture many women attain when feeding, lifting, and carrying their newborns, mobilization of the spine to promote extension through the middle back can reduce the discomfort they feel in this region. Furthermore, the pelvic malalignment common during pregnancy can persist after delivery unless corrected with physical therapy through such joint mobilization as muscle energy techniques.

When therapeutic exercise complements manual therapy techniques, they become more effective in treating the patient’s symptoms3. Research shows more than 1/3 of women continue with low back or pelvic region pain 1 year after giving birth (1). A risk factor for chronic pain after delivery is asymmetric laxity of the SI joints; retraining of the transverse abdominal muscle group can significantly reduce the laxity at these joints(2). Special considerations must be taken with abdominal stabilization training if the woman has diastasis recti, a separation of the abdominal wall, from pregnancy. A treatment program consisting of stabilization exercises effectively reduces pain, improves function, and improves heal-related quality of life(2).

Strength training of the woman’s upper body and lower body are important as well to allow her to regain her functional activity level prior to pregnancy. Special considerations of the physical therapist while assisting with her return to strength training include proper progression of intensity, promotion of optimal form to avoid injury during this time of continued laxity, and how to fit her home exercise program into her newly busier schedule. Stretching to regain flexibility must also be performed properly to avoid injury to the muscles and ligaments surrounding lax joints. Since the buoyancy property of water provides support to these joints when submerged, aquatic therapy should be considered as she resumes physical activity. Often, aquatic therapy allows her to resume strengthening and stretching for which her body is not yet ready to complete on dry land. Once she gains the strength and stability necessary to safely exercise outside the water, her therapy sessions can transition to land-based treatments. Compliance with therapy and exercise after pregnancy increases when women can exercise without provoking pain, when resistance is gradually and appropriately increased, and when muscle control and activation during functional tasks is incorporated(2). Proper instruction and supervision of the exercise program ensures proper form(2).

Written By: Abby Kurylo, DPT

References
1. VanBenten E, Pool J, Mens J, Pool-Goudzwaard A. Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy; a systematic review. J Orthop Sports Phys Ther 2014; 44(7):464-473.
2. Stuge B, Lareum E, Kirkesola G, Vollestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. Spine 2004; 29(4):351-359.
3. Whitman JM. Pregnancy, low back pain, and manual physical therapy interventions. J Orthop Sports Phys2002;32(7):314-317.

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