What physiological and musculoskeletal changes occur in a women's body during pregnancy?

HORMONES: First of all, due to increased hormonal levels (relaxin and progesterone) the connective tissues in the body become more lax. Where there was previously stability in certain joints around the pelvis and spine, they become more mobile to allow for the baby to grow in the abdomen and ultimately to be delivered. This ligamentous laxity affects joints all over the body. The hormonal changes also cause fluid retention. Thus, pooling can occur in the lower legs as well as the lower arms. This can cause cramping and varicose veins in the calves and carpal tunnel syndrome in the wrist and hand.

How can physical therapy help? Performing lymphatic drainage to reduce swelling and congestion, educating patients to minimize water retention through movements and positioning, mobilizing restricted nerves and training them how to maintain mobility in a healthy way to prevent inflammation and how to move and function in a safe way to adapt to the laxity of the joints and prevent injury.

POSTURE: As the fetus enlarges, postural changes will also occur. The center of gravity in the mother becomes higher and more forward, which forces her to compensate to stay balanced. There are accentuated curves in the spine, placing more pressure on the low back and pelvis. Her head will sit further forward as a result causing the muscles in the neck and front of the shoulders to become tighter. The hip musculature will generally become shortened by the extra weight and postural changes, which can lead to compression of the sciatic nerve causing the common condition of sciatica.

How can physical therapy help? Using soft tissue and joint mobilization combined with stretching techniques, maintain optimal muscular length combined with core stability to optimize posture during standing, walking, lifting and carrying, and even sleeping. (Did you know you should sleep on your left side later in the pregnancy to avoid putting pressure on your vena cava?) Use of visceral manipulation techniques to help balance abdominal structures that may also be impairing postural control. Also, teaching patients how to bring their baby into their center of gravity in ways that place less stress on the low back and less pressure on sensitive nerves.

WEAKNESS: Finally, as some musculature will tighten during the pregnancy, other muscles will become overstretched and then weak. The abdominals can become so overstretched that a condition called diastasis recti often occurs. With diastasis recti, the connective tissue in the center of the abdomen between the rectus abdomini gets overstretched allowing the organs around the belly button to protrude outward. This can lead to low back pain and a possible hernia.  Also, pregnancy will often lead to an overstretched and weak pelvic floor which can lead to incontinence.

How can physical therapy help? To prevent or correct diastasis recti, giving gentle but very specific exercises can be given to facilitate a stronger abdominal wall and pelvic floor. And NOT through crunches. Splinting around the waist to maintain closure or draw back together the separated abdominal muscles. Learning specific breathing techniques to build core stability while promoting relaxation. Manual facilitation using PNF (proprioceptive neuromuscular facilitation) to train the deep core musculature to become and remain strong during the pregnancy, allowing for a faster and stronger recovery post-partum.

When should I consider seeing a physical therapist. if I'm pregnant?  Right away! It's important be educated as soon as possible on what to expect during your pregnancy in terms of musculoskeletal changes. The P.T. will evaluate the strength, mobility, posture, balance, and overall function of YOUR specific body and provide you with the tools to minimize physical complications through out your pregnancy and after childbirth. This will include manual therapy to address any dysfunctions that may put you at risk for injury or pain, as well as a carefully designed exercise program to help maintain your physical health during / after the pregnancy. During the 1st trimester, there will be no mobilization of structures around your uterus.

How often should I come to physical therapy. if I'm not having problems?  We recommend at least once or twice during each trimester to ensure you are adapting well to the changes that are occurring and to guide you on how to best manage the next phase of your pregnancy from a physical perspective.

What about after I've delivered? When can I come in?  You should wait for your doctor to clear you to begin physical therapy for medical reasons. It will usually be between 4-6 weeks post-partum.

What kind of things would physical therapy do for me after I have my baby?  If you underwent vaginal delivery, chances are you will have weak pelvic floor musculature. Manual Physical Therapy will help to facilitate the muscles that control your bladder to help prevent or tackle incontinence issues, while retraining - in a safe way - your core strength. If you have incontinence, you are also at risk for a prolapse (where one of your pelvic organs may begin to slip out of position toward the vagina). Thus retraining that pelvic floor to prevent this risk is very important.

If you underwent a C-section, it is critical that you seek physical therapy to at least begin the scar mobilization process. Many women will suffer from low back pain, sacroiliac problems, sciatica, digestive issues, or hip pain months or even years after a C-section that is often the result of adherences caused by the scar tissue that developed. Scar tissue is like an iceberg. What you see on the surface is only about 10%. That said, even if it's been years since your C-section, coming in for P.T. can make a huge difference.

Regardless of your delivery method, you should be evaluated for diastasis recti. If you have it, tackling it early will help prevent  possible problems later on, especially if you plan on having another child.

Here is a list of common problems associated with pregnancy that physical therapy can address:  Low back pain, headaches, neck pain, carpal tunnel syndrome, sacro-iliac (SI) pain, sciatica, lower leg swelling/pain, incontinence, pain with intercourse, constipation, difficulty with lifting / carrying mechanics (such as holding another child), abdominal pain/weakness, diastasis recti, fatigue, shortness of breath.