Postpartum Physical Therapy

Postpartum Physical Therapy

Written by Lisa Nerem

Have you ever thought about utilizing physical therapy before or after giving birth? A lot of people don’t! This is one thing I would recommend to prepare you for labor and delivery and all of the things that happen afterwards.

I am not an expert, but do know that our bodies go through significant physical changes while preparing for birth. These changes can be postural, hormonal and weight gain. Postural changes can be increased curvature of the spine or forward shifts of your head and neck. This, along with increased belly size, can cause strain in your muscles. Hormonal changes cause laxity of the ligaments to allow for widening of the pelvis to prepare for delivery. Weight gain puts stress on the spine and extremities and can cause fluid retention. It is also very common for the muscles of the abdomen to separate, which is called diastasis recti.

Physical therapists can assist women before and after delivery for a number of different treatments. They can provide assessments of muscular and joint dysfunction on all areas of the body, depending on their specialty. Therapists provide exercises and manual techniques to assist these dysfunctions.

In preparation for your delivery, they can assist in proper positions for labor and delivery, they can use biofeedback machines to find relaxing positions for your pelvic floor muscles, they can educate you in proper pelvic floor exercises to assist you during delivery and they can help you with proper breathing techniques.

Following delivery, when cleared by your doctor, you can visit a physical therapist to assist you in a variety of ways. Whether you had a vaginal delivery or a cesarean, your pelvic floor muscles can be stretched or sometimes damaged. This can lead to issues such as urinary or fecal incontinence, urinary frequency or urgency, pelvic organ prolapse, pelvic pain, pain with sexual activity, low back pain, scar pain (from cesarean or from a vaginal tear) or diastasis recti.

I am someone who already had poor posture so it did not help to add all the extra weight and large belly. I noticed my pelvic alignment was off quite often due to the laxity of my ligaments. This caused symptoms of symphysis pubis dysfunction. I had pain when trying to stand on one leg to put pants on, walking and especially when trying to roll over in bed. I had had chiropractic adjustments but of course, I kept getting out of alignment.

During both of my pregnancies, I worked out a fair amount and ate fairly healthy and still gained 50 pounds. I had a moderate amount of swelling in both of my legs. Thankfully I am taller so although my belly was still large, I seemed to have more room for my babies to spread out with my longer torso. Thankfully, I never experienced diastasis recti, or abdominal separation.

My first delivery was a vaginal delivery and my epidural was so strong I was unable to tell when to push. When my doctor told me to push, I didn’t know how. If I would have known how to fully activate my pelvic floor muscles with proper breathing techniques, which weren’t properly taught during my delivery class, I may have had less issues during my vaginal delivery.

My second delivery I chose to have my baby via cesarean due to complications with my first. After delivery, once I was cleared by my doctor, I started physical therapy. Being a physical therapist assistant myself, I knew a lot of what I needed to do. I wanted to go to a fellow professional and have them assess me to see what they thought I needed to work on. I sought treatment to address my scar which was very sensitive and work on decreasing scar tissue as well as guidance on proper exercises.

Despite teaching these exercises to people over the past 10 years, having someone teach me how to properly work my deep core muscles and pelvic floor muscles in coordination with proper breathing was shockingly hard! Working your deep core muscles is more than trying crunches or sit ups. You will be surprised at how challenging it is but even just a visit or two can get you going in the right direction to assist you before and/or after delivery and help you avoid any issues that you think are just “normal” issues that go along with having a baby!


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