Pregnancy is an amazing time in a woman’s life, but not always without its challenges. As the fetus grows within the uterus, the body is releasing hormones to relax the connective tissue, the woman’s center of gravity is shifting, and the pelvis is widening to accommodate the new baby. At the same time, the baby and mother are adding weight which puts pressure on all load bearing joints. This can leave the woman with pain and discomfort, especially in the low back, hip, and pubic region. A pregnant woman may also complain of foot pain due to a flattening of the arch or even carpal tunnel syndrome due to an increase in fluid retention in her joints.
Overall low back pain is the most common complaint amongst expectant mothers. LBP is reported in 50-75% of pregnant women at some stage of their pregnancy. Specifically, pregnancy can cause a lot of discomfort in the sacroiliac joint. This area is the joining of the sacrum (the triangular bone at the end of the spine) and the two halves of the pelvis, named the ilia. This joint becomes more lax or loose in pregnancy and shifts as the pelvis widens and spreads. When this joint is a source of pain, women may complain of buttock or sciatic type pain that can radiate down the leg and cause a feeling of instability or weakness.
Physical Therapy can help during this stage of a woman’s life! By using manual techniques, the physical therapist can help to relieve tension and spasm in the muscles that are working overtime to help support mother and baby. A PT may also teach a woman how to move and lift safely and efficiently so as to limit irritation of lax joints, especially the SI joint discussed earlier. The therapist can offer advice on pelvic and foot orthoses and can apply kinesiotape to help provide stability to painful areas.
The fun doesn’t stop when the baby is born! The Post-partum period can have its own specific challenges. Whether the woman has a vaginal delivery or cesarean section, she can have lingering pain, orthopedic issues, and even experience urinary incontinence or urgency/frequency. The pelvic floor undergoes a great deal of trauma during labor and delivery.
During a vaginal delivery, the pelvic floor musculature and connective tissue stretches and deforms to accommodate for the passage of the baby through the birth canal. In this process, there can be tearing of the tissues. Once birth is complete and the injuries have healed, there can be lingering muscle spasm, scar tissue, and sometimes nerve damage. The vaginal opening can be scarred or the surrounding muscles can have recurrent spasms which results in pelvic pain that is exacerbated by general activity or sexual intercourse. During a c-section, the abdominal wall is cut in order to deliver the baby. Once the incision is closed and healed, scar tissue forms. This can adhere to the tissues below the surface and be a source of pain that radiates into the abdominal wall or pelvis. C-section also results in a weakened abdominal wall and poor core activation which may make some activities difficult for the new mom and set her up for lasting low back pain.
Physical Therapists can help a new mother navigate through the array of post-partum issues. For pain relief, the PT can provide manual treatment or apply modalities in order to relax the muscles and return them to normal tone. Then, the PT will teach the patient appropriate exercises to help stabilize the joints so that she can start to return to her previous level of activity. For cases of urinary incontinence or urinary urgency, the PT can apply specific pelvic floor rehabilitation techniques to identify the areas of weakness or dysfunction. The patient will be given tailored exercises to return the normal function to the pelvic floor to eliminate her urinary symptoms. Physical therapy can help the patient so she can return to her most important job, being a new mommy!