Is Physical Therapy safe during pregnancy?

As long as you are not on bed rest, you can still receive treatment.  If you are in pain, your physical therapist can determine if this is from the musculoskeletal system.   Many women experience pregnancy related low back pain or pelvic girdle pain or incontinence, and may benefit from physical therapy.

What is the difference between Pregnancy Related Low Back Pain and Pelvic Girdle pain?

During pregnancy, low back pain, pelvic pain, or a combination of both can occur.  Low back pain typically occurs in the second trimester (due to weight and postural changes) and pelvic girdle pain typically occurs in the first trimester (due to hormonal changes).  To ensure appropriate diagnosis, your therapist will perform a cluster of orthopedic tests during your evaluation. 

It is it safe to have an internal exam?

Even without an internal pelvic floor muscle exam, you can still be seen and participate in effective treatment. As the risk of miscarriage is highest during the first trimester, some facilitates do not offer them during this time-frame. However, there is no evidence linking internal pelvic floor muscle exams to miscarriage. If you are cleared and safe to have intercourse, you may opt to have an internal pelvic floor muscle exam if your therapist thinks it may provide useful information to inform your treatment.

What are some safety guidelines for exercise?

Each pregnancy varies and everyone responds differently. The safest way to exercise involves listening to your own body. Because your vital signs can be altered during pregnancy, rate your difficulty based off of your perceived rate of exertion: 0 to 10 how difficult was it for you to complete this activity.  Research shows that moderate activities (<8/10 effort) are safe to continue doing.  Strength training is still encouraged, although you may opt for a wider stance or to change your mechanics and routine as your body changes.  Confidently set yourself up for success to lift a baby and a carrier!

Can you help with birthing preparation?

Your therapist and doula can help come up with a birthing plan with you.  For instance, if you have orthopedic injuries such as hip pain, your therapist can help instruct your team on how make you feel most comfortable. At 36 weeks gestation, you can start perineal massage to improve the elasticity and prepare the muscle for stretch during delivery. You can also discuss crib and lactation ergonomics to plan for optimal posture and improve comfort after the delivery of your baby.  It is recommend to have at least 3 sessions prior to delivery.

When do I start physical therapy after delivery?

Most people are cleared for internal assessment and gentle exercise at 6 weeks post-partum.  At this time, they are usually cleared for internal assessment.  However, we recommend you have 1 follow up at 2-3 weeks postpartum to ensure appropriate healing and success with gentle core activation.  Some research even recommends very gentle scar massage (above or below the incision) can be started as early as 2 weeks postpartum.

When should I expect "return to normal"?

Everyone has a different end goal in mind, and a different experience giving birth.  The American College of Obstetricians and Gynecologists (ACOG) recommends that you have your last follow up with your OB/Gyn at 12 weeks.  At this time, you will typically see a gradual return to activities or be recommend to start physical therapy.

Remember, it takes time for tissue healing to occur.  For instance, if you have a grade 1-2 muscle tear, recovery can take up to 3 months.  If you have a grade 3 muscle tear, recovery can take up to 6 months.  Laceration to tendons also take 6 months to heal, and ligaments can take up to 1 year to completely heal.  

Comfortable return to running or impact activities may take 6-9 months, while your initial focus will be on core and strength training. It depends on where you were before pregnancy, before delivery, and how your body has recovered. This can be a frustrating time with so many factors out of your control, but getting back to exercise comfortably and at your body’s own pace is important.

If incontinence, low back pain, or other symptoms have not resolved, you should consider physical therapy services to reach your goals.