The prenatal period is a time of great change
for a woman, physically, emotionally, and hormonally.
As the fetus grows, the overall musculoskeletal
system is challenged by altered posture, shortened
muscles, potential muscle imbalances, and changes
in spinal mobility. These changes may cause pain
and dysfunction. In the postpartum phase, fluctuating
hormone levels combined with additional physical
changes as a result of delivery may also result
in musculoskeletal problems such as excessive joint
mobility, weakness of the core stabilizers, and
altered spinal mobility and function.
What causes dysfunction in the prenatal
and postpartum periods?
Fluctuating hormone levels in both the prenatal
and postpartum phases may cause excessive joint
mobility which can cause pain and dysfunction.
Because of the postural changes associated with
pregnancy, some muscles become tight to support
the changing posture, while others are stretched
and become weak. This results in muscle imbalance
and a potential for decreased stabilization. Mobility
of the spine can be affected in both the prenatal
and the postpartum periods as the spine adjusts
to the changing posture as the baby grows.
What are symptoms of musculoskeletal
dysfunction during the prenatal and postpartum
Symptoms of dysfunction may include pain in the
joints of the pelvis or spine, muscular pain in
the hips and L/E's, or numbness into the extremities.
Weakness may be present in the abdominals, resulting
in pain with transitional movements or lifting.
Weakness may also be manifested as urinary incontinence
in the postpartum period. Muscle imbalance may
also cause pain or contribute to urinary issues
in the postpartum phase.
How can physical therapy help?
Physical therapists are skilled in evaluating
and providing patient centered treatment of musculoskeletal
problems. Physical therapists trained in the area
of women's health have further knowledge about
issues directly related to women as they move through
different stages of life, from childbearing years
to the post menopausal period. Physical therapists
can provide hands on treatment to address spinal
and pelvic joint dysfunction, instruct in exercises
to address muscle weakness and imbalance, and provide
guidance and instruction related to modifications
of activities of daily living that may be difficult
during the prenatal and postpartum phases.
Who should be referred to a Women's Health
- Back, sacral, hip, pelvic, rib pain
- Pain in
the neck or upper back
- Sciatica, carpal tunnel, thoracic
outlet or other nerve symptoms
- Decreased ability
to do normal daily activities
- Weak or tight
- Pelvic pain with sexual intercourse,
use of tampons or gynecologic exam
- Desire to
start or continue an exercise program
Have you recently had a baby? Are you beginning
to think about returning to exercise? Many women
begin to think about exercise about 6 weeks after
delivering their baby. Although they are still
getting to know their new bundle of joy and are
still nursing, the new Mom may begin to think about
returning to an exercise routine. Questions new
mothers have include: How will exercise affect
breast milk quality? , When can I begin an exercise
routine? How do I get started? and What exercises
are good for my weak tummy muscles? A physical
therapist trained to work with post-partum women
can help to answer some of these questions for
Returning to exercise must be done gradually.
It is necessary for the new Mom to check with her
obstetrician or midwife before resuming an exercise
program. Generally, women are given the o.k. to
resume an exercise program at their 6 week post-partum
visit. If you have experienced a caesarian section,
traumatic vaginal birth, large losses of urine,
pelvic pressure, heavy bleeding, pain or breast
infections please consult with your M.D. before
resuming your exercise routine.
It can take a woman many months, a year or more before she
feels like she has returned to her pre-pregnant self. Some
women may never return to their pre-pregnant level of strength.
Women who do not regain full abdominal, pelvic floor and back
strength are at potential risk for future injuries.
Your exercise program needs to make you feel good. While exercising,
continually monitor how you are feeling. Listen to what your
body is telling you. Stop when you are fatigued and do not
exercise to the point of exhaustion. It is essential to maintain
an adequate fluid intake. This is especially important for
breastfeeding moms. Keep a water bottle with you before, during
and after you exercise. Also, allow time for adequate rest.
A new mom’s exercise routine must include" Kegels" (pelvic
floor muscle strengthening exercises), abdominal
strengthening and a cardiovascular component. It
is especially important for the new Mom to pay
strict attention to correct posture while exercising
and while caring for her baby. The loose abdominal
wall and increased breast weight during the postpartum
period creates abnormal stresses and strains on
the postural muscles. A physical therapist can
assist you to improve your posture and instruct
you in exercises to strengthen your postural muscles.
Many women have concerns that exercise will affect
the quality of their breast milk. A number of studies
have been conducted on the effects of exercise
on breast milk. One study completed by nutritionists
in California found frequent, sustained, moderate
to high intensity running during lactation did
not impair the quantity or the quality of human
breast milk. However, extremely intense anaerobic
exercise (interval workouts) occasionally altered
the taste of breast milk.
When the new Mother begins to exercise, she will
find increased endurance, postural strength and
improved flexibility. To prevent future risk of
injury, it is important to regain your pre-pregnant
level of strength and endurance. The Regional and
State Representatives from the Section of Women’s
Health are able to assist you in finding a qualified
therapist in your area – just
click on this link (list link for state and
From the Women's Health Section
of the APTA Written By: Susan
is a separation of the abdominal muscles, specifically
the rectus abdominal muscle, during pregnancy.
Any separation larger than 2 cm or 2 finger widths
apart is considered significant. It can occur above,
below or at the level of the belly button. It is
thought to be the result of hormonal effects on
the connective tissue and the biomechanical changes
that occur during pregnancy. Studies have reported
the incidence of diastasis recti to be approximately
27% in the second trimester, 66% in the third trimester,
and 62.5% of postpartum women within 92 hours of
Symptoms such as low back pain, due to the lack
of abdominal support that helps to control the
pelvis and low back, or difficulty performing tasks
such as going from a laying down to sitting may
result from a diastasis recti. A simple test may
be completed to check for diastasis recti. The
woman should be lying down on her back with her
knees bent, feet flat on floor. (Remember, this
position should only be maintained for a short
period of time while checking for a separation
if after the 4 th month.) The woman will slowly
raise her head and shoulders off the floor reaching
her hands towards her feet. The tester will place
fingers of one hand horizontally across the midline
of the abdomen at the belly button level. If a
separation exists, the fingers will sink into the
gap. Make sure to check above, below, and at the
level of the belly button since it may occur at
all three areas.
This condition can be reversed. It is important
to perform corrective exercises specific for diastasis
recti until there is a separation of 2 cm/finger
widths or less. Once this condition has been corrected,
the woman may resume regular abdominal exercises,
however, should still monitor the abdominal area.
Many women may not even be aware they have a diastasis,
but need help to ensure a strong and healthy life
as well as preventing future injuries. For more
information on diastasis recti and the correction
of this condition, contact a physical therapist
in your area.
From the Women's Health Section of the APTA Written
by : Janet