Using Physical Therapy to Help Relieve Pain and Ailments Following a Pregnancy

Using Physical Therapy to Help Relieve Pain and Ailments Following a Pregnancy:

How my Own Personal Experiences Guide my Perspective

By Pamela G.Guevarra, PT, DPT

My husband and I waited patiently for years to have a baby.  When our doctor told us we were pregnant with twins, like most families of multiples, we were surprised, yet felt extremely blessed.  However, I had a difficult pregnancy.  A herniated disc in my cervical (neck) spine, which existed prior to my pregnancy, worsened.  The pain I felt in my ribs from the extreme amount of pressure is something I cannot soon forget.  I had carpal tunnel syndrome that started on one wrist and eventually both.  Not to mention the pain in my lower back, which actually increased after my pregnancy, creating a radiating numbness on my right thigh, lower leg, and foot.

While physical therapy treats a wide range of physical ailments and conditions for men and women of all ages, many women are not aware of the benefits of physical therapy following their pregnancy.  During a pregnancy, women and physicians often utilize physical therapy to help relieve ailments and symptoms.  However, most women experience residual, or even new, ailments or symptoms after their pregnancy, yet many never even seek professional assistance.

Following the delivery of my twins, I became very ill.  My primary care physician explained I had an infection, my entire body was inflamed, and I was not recovering fast enough following my C-section.  Yet I still had to care for my newborn, premature twins.  I was so ill that I was not allowed to exercise.  I was so weak that standing up took time.  Sleepless nights led to constant fatigue.  I felt and looked like a frail, old lady stooped over from severe weakness.  After two months, I started to feel better, but was still experience neck pain, a stiff thoracic spine (upper back), pain and stiffness in my lower back, and numbness in my right leg and foot.  It is not normal to have symptoms like lower back pain and leg numbness.

Common symptoms that women experience after giving birth include pain in their back, pelvis, neck, legs, and/or arms along with weakness, stiffness, and headaches.  These symptoms, as well as other musculoskeletal conditions, can be intensified during or after birth, and may last for months to a year after delivery.  During pregnancy, the body's ligaments (tissues that connect bones together) become lax from a hormone called relaxin, which is released to allow the body to adapt with the growth of the baby.  This hormone predisposes pregnant women to injuries or can aggravate already existing conditions.  In addition, other reasons why women have musculoskeletal problems after pregnancy include postural changes, symptoms before and/or during pregnancy, a complicated vaginal delivery, C-section, a complication or illness after delivery, and giving birth to multiples.

Throughout a pregnancy, women experience an altered posture to compensate for the baby bump.  Nine months of pregnancy is more than enough time to stress joints and cause women to continue this altered posture after pregnancy.  An altered posture places unnecessary force on the body’s joints causing increased pain and decreased comfort while caring for the child and performing daily activities.  Another cause of symptoms arises from a complicated vaginal delivery.  A lengthy labor adds stress on top of stress to the pelvic floor muscles, leading to pain in the pelvis and incontinence issues. 

Women who choose to have a C-section, or require one following a lengthy labor, may experience weakness in the abdominal and pelvic muscles causing trunk weakness and low back pain.  A C-Section is now the recommended delivery option for women pregnant with twins (triplets, etc.) because it is safer for the babies and the mother.  However, not all women/couples are aware that a C-section is a major abdominal surgery; risks that are not adequately discussed in a birthing class.  The negative result of a C-section can cause emotional changes to some mothers who feel their body has failed in addition to the weakness and pain.

Physical therapy can treat these musculoskeletal conditions and reduce any residual symptoms.  Unfortunately, very few women seek the assistance of a licensed physical therapist because they assume nothing will help or they ignore their symptoms.  Most moms place themselves second, third, or even last after the demands of their family, their job, and other responsibilities despite the pain that they experience.  However, for a woman to give 100% to the demands of her role as a homemaker, mother, and/or a full-time employee, a woman must take care of her body and remove any and all obstacles or ailments preventing her from physically functioning at 100%.

A licensed physical therapist will be able to evaluate and treat the symptoms by addressing the specific problems individually and setting future health goals.  Treatments may include pain relief with manual therapy and modalities like cold pack, hot pack, and electrical stimulation.  Physical therapy will work to strengthen specific muscle groups, improve stability in specific muscle groups, increase endurance levels to avoid fatigue, improve posture through manual therapy and exercises, and relieve joint stiffness with manual therapy and stretching. 

I am a physical therapist, but I definitely needed another physical therapist to help me get back in shape for my husband, my twins, and to be able to return to work.  I was treated for my neck, my lower back, and thoracic spine.  Manual therapy loosened my spine to correct my posture and relieve pain and stiffness.  A home-exercise program was designed to improve my strength (especially in my core) flexibility, and endurance level.  Despite my daily demands, I had to create the time to complete these exercises at home, not only for my family, but for myself.

While every woman’s symptoms and speed of recovery are different, a licensed physical therapist will be able to frequently modify the treatment plan based on goals and improvement.  Some women, especially those who have an infection or other complication(s) during and after delivery, may need to see their physician prior to seeing a physical therapist.  New mothers must take special care of their bodies after giving birth to help regain energy and strength.  The better a woman takes care of herself, the more she will be able to provide the best care for her child.

Questions or comments?  Leave Pamela a comment below or contact AZOPT at (623) 242-6908 to find out how you can benefit from physical therapy.  Pamela will respond directly to your questions/comments within 24 hours.

Pregnancy and Back Pain: What You Can Do To Help

Pregnancy and Back Pain: What You Can Do To Help

By: Tyler Guymon, DPT

I am very blessed to be the father of four beautiful children.  But, as most people know, I would not have accomplished this great achievement without my wonderful wife.  Confidently I will say that while my wife would not change anything about our kids or what they have added to our family, she would happily change how she felt during the nine months prior to each of their births.  

Unfortunately, 50 to 70 percent of pregnant women experience back pain throughout their pregnancy.  While the reason for back pain varies from person to person, the majority of back pain concerns can be traced to one or more of the following factors:

• Increases in hormones
• Change’s to the body’s center of gravity
• Weight gain
• Poor posture
• Added stress

Over the last 40 years, the average age of women when they conceive their first child has risen from 21.4 to 25 years of age.  Furthermore, with women juggling the demands of pursuing a higher education and a competitive workforce, more and more women are conceiving their first child after the age of 35.  As a result, many women becoming pregnant are less physically active in their daily lives.  This decreased activity, along with the increasing national prevalence of a sedentary lifestyle, leaves an alarming number of women less prepared for the strenuous journey of carrying and delivering a baby.

You may be surprised to learn that the previously mentioned factors that cause back pain can be address by a physical therapist through a personalized program.  Through a detailed evaluation and a review of systems, a physical therapist will develop a plan of care that addresses:

• Back pain
• Decreased flexibility
• Muscle weakness
• Poor posture
• Nerve irritation/involvement
• Problems with joint alignment

Although it would be difficult to prescribe a generic exercise/stretching program that is appropriate for every woman, here are a few exercises that I feel would benefit all pregnant woman experiencing back pain:

Wall Push-Ups

Start your pregnancy exercises with wall push-ups, which work the pectoral muscles in the front of your chest and the triceps muscles in the back of your upper arm.

• Standing and facing a wall, lean forward and place your hands on the wall at shoulder height, slightly wider than shoulder-width apart.
• Keep your knees comfortably apart.  
• Slowly bend your elbows and lower your chest until your chin reaches the wall. 
• Remember to keep your back straight. 
• Then return to the starting position. 
• Gradually work up to 15 repetitions.

Squats With a Fitness Ball

Squatting during labor — even for short amounts of time — help open your pelvic outlet and allows more room for your baby to descend.  Practicing squats now will make it easier to squat during labor. Try squats with a fitness ball.

• Stand up straight with a fitness ball behind your back and against the wall, your feet about shoulder-width apart. 
• Be sure to have feet far enough from the wall that your knees do not pass the toes at the bottom of your squat.
• Slide down the wall until your knees reach a 90-degree angle, being careful to keep your heels flat on the floor. 
• Maintain upright posture - do not lean back over ball or bend forward as you descend.
• If you can't bend your knees to a 90-degree angle, simply go as low as you can — then return to the starting position. 
• Gradually work up to 10 repetitions.

Leg lifts

To strengthen your back and abdominal muscles, try leg lifts. 

• Start on your hands and knees, keeping your arms straight and your hands directly beneath your shoulders.
• Lift your right knee, straightening your leg behind you — ending with the raised leg parallel to the floor.
• Maintain level hips - do not roll to the side, and be sure to tighten
  your stomach.
• Repeat on the other side. 
• Gradually work up to 10 repetitions on both sides.

Side planks

The side plank challenges your stability and works the muscles along the side of your body.

• Lie on your left side and raise yourself onto your left forearm. 
• Place your left shoulder directly above your left elbow, keeping your shoulders, hips and knees in alignment.
• Again, do not roll to the side or lean back/forward
• Rest your right arm along the side of your body. 
• Hold for several seconds, and then lower yourself to the floor. 
• Gradually work up to 10 repetitions. 
• Repeat on the other side.

Step ups

To do a step-up, you'll need a small step stool — or you can stand in front of the stairs. 

• Position yourself near a wall or railing for extra balance or support, if needed. 
• Pushing primarily through your lead foot, lift your body up onto the step. 
• Then step backward to the starting position. 
• Alternate your lead foot each time you step up.
• Remember to keep your back straight and plant your foot entirely on the step. 
• Do as many repetitions as you can, depending on your fitness level. 
• Stop when you're fatigued or your form begins to suffer.

If you are new to exercise and fitness, or just don't know what to do, please first check with your doctor or a licensed physical therapist prior to starting an exercise program to reduce the risk of injury or increased pain.  

Call AZOPT at (623) 242-6908 to schedule an evaluation today if you feel you can benefit from a licensed physical therapist through your pregnancy.