Postpartum

The Unspoken Necessity of Physical Therapy During Postpartum

7 min read

Key Points

  • Physiological and psychological influences on a woman's body during pregnancy can make Physical Therapy a top option for recovery
  • Pelvic floor dysfunction signs can point to long term concerns
  • Diastasis Recti affects up to 59% of postpartum women
  • Physical therapy helps reduce using opioids postpartum

 

The role of physical therapy in postpartum recovery

Pregnancy is one of the most challenging times for every woman. Carrying a child has many physiological and psychological influences on the mother’s body. Women will inevitably experience hormonal changes during pregnancy and postpartum that may cause postpartum depression. The postpartum period is as crucial as pregnancy because the body returns to its pre-pregnancy state. Many women may not know that physical therapy has a vital role in postpartum recovery by alleviating the mother’s pain. In this guide, you will understand how physical therapy can help in the postpartum period. 

 

Physiological changes that occur during pregnancy

Pregnant women experience many physiological changes to adapt to the baby being carried. The following are some of those changes:

 

Weight gain

Pregnant women experience gradual weight gain over the nine months of pregnancy. Weight gain occurs due to the development of the child, the presence of the placenta, and gestational fluids supporting the baby. 

According to the CDC, weight gain should depend on your BMI before pregnancy. This table shows the recommended weight gain for women carrying one baby. But many studies and real women with real bodies and different compositions have challenged the uses of the BMI chart as an accurate source as it is a one-size-fits-all rubric that doesn’t consider multiple factors. Take a look at the chart:

Pre-pregnancy BMIThe recommended weight gain
Underweight 28-40 pounds
Normal weight25-35 pounds
Overweight15-25 pounds
Obese11- 20 pounds

 

Pelvic issues

Because the uterus is present in the pelvis, the baby's weight puts pressure on the mother's pelvis, resulting in significant trauma. Furthermore, the baby's head and torso must pass through a relatively small anatomical space during vaginal birth.

 

Ligaments changing

During pregnancy, the body produces the relactin hormone, which causes the ligaments to become loose and stretchy in order to accommodate the growing baby and prepare the mother for delivery.

 

Common Postpartum Conditions:

Some of the most common postpartum issues that physical therapy can help with are as follows:

 

Pelvic floor dysfunction

The pelvic floor consists of several muscles in the bottom of a woman’s pelvis. These muscles help support the bowels, bladder, and uterus. During pregnancy or postpartum, tearing or laxity usually occurs to pelvic floor muscles due to the pressure of the baby’s weight and the childbirth strain. 

 

The pelvic floor dysfunction signs include:

  • Pelvic pain
  • Sexual dysfunction
  • Pain during sex
  • Separation of the pubic symphysis bone
  • Prolapse of the pelvic organs through the vagina.

Diastasis Recti

Diastasis Recti is a common postpartum condition. It develops as a result of the abdominal muscles stretching to accommodate the expanding baby. This muscle stretching creates a gap between the left and right abdominal muscles, resulting in a protruding belly. Diastasis Recti is characterized by low back pain and a bulging tummy below the navel in women. Diastasis Recti affects up to 59 percent of postpartum women, according to this study.

 

Women who are at risk of developing Diastasis Recti:

  • Women who have had multiple pregnancies
  • Women who give birth to twins or triplets
  • Women with poor muscle tone pre-pregnancy
  • Women who are pregnant in a late stage of life
  • Petite women

Urinary incontinence

Urinary incontinence is when you leak some urine unintentionally. The inability to control the bladder is due to the weakness of the pelvic floor muscles during pregnancy and postpartum. 

 

Low back pain

During pregnancy, the baby grows up and stretches the abdomen muscles that become less effective. Moreover, this stretching causes the spinal lordosis to be more pronounced, causing low back pain during pregnancy and after delivery. 

Furthermore, this study stated that women who received epidural anesthesia during C-section delivery are at high risk of developing chronic low back pain.

 

Abdominal pain

The uterus returns to its pre-pregnancy form after birth, causing lower abdomen pain. This abdominal ache is caused by the release of oxytocin hormones and can last 6 weeks or more after birth.

 

Pelvic, hip, and tailbone pain

Pelvic, hip, and tailbone are common areas where women suffer from pain and discomfort during pregnancy and postpartum. The pressure of the baby and muscles weakness cause this pain. 

 

How can physical therapy help in postpartum recovery?

Physical therapy aims to relieve the mother’s pain and strengthen her muscles, thus, avoiding pain and uncomfortable sleep that lasts beyond pregnancy and the onset of mental health conditions such as postpartum depression. Additionally, physical therapy helps reduce using opioids postpartum. According to this study, in the United States, more than 25% of women who went through vaginal delivery and 75% of women with cesarean deliveries received opioid prescriptions. These drugs can be highly addictive and affect the body’s recovery and breastfeeding journey. Because of pain, many women continue using opioids for months following birth. 

 

The following points describe the role of physical therapy for postpartum women in detail

  • Strengthen pelvic floor muscles
  • Correct and strengthen mother’s posture
  • Realign the pelvic girdle joints and lumbar spine through muscle energy techniques
  • Strengthen core muscles
  • Mobilization of joints
  • Improve sleep pattern
  • Release stress
  • Help lose the gained weight during pregnancy

What to expect in your first physical therapy session?

Your therapist will ask you about your symptoms and where you are experiencing discomfort or pain during the first session. Your therapist will then conduct a physical examination to assess your case. Finally, your therapist will design a specific workout program for you to follow. Furthermore, your therapist will utilize several techniques throughout the treatments in each subsequent session, such as manual, electrical stimulation, ultrasound, cold therapy, or moist heat.

 

Frequent exercises help in postpartum recovery:

Physical therapy exercises will help restore your muscles’ strength and function.

 

Pelvic floor muscle contractions (Kegels exercise)

This exercise improves the pelvic floor muscles, which helps to relieve low back pain and incontinence. Kegels are performed by contracting the pelvic floor muscles, holding them for one to three seconds, and then relaxing. For a few minutes, alternate between multiple contractions and relaxation. For best outcomes, remember to breathe through the contractions.

 

Balance exercises

Balance exercises help strengthen core muscles to restore your body balance and posture. Additionally, they improve stability and reduce back pain and the gap between abdominal muscles in the diastasis recti. Your therapist may recommend performing balance exercises using a Bosu ball or yoga ball to avoid unnecessary strain. Examples of such practices are:

  • Tai chi
  • Standing with weight on one leg
  • Perturbation-based balance training
  • The Otago Exercise Program

Abdominal exercises

Low-intensity abdominal exercises are recommended to strengthen your abdominal and pelvic floor muscles. Your therapist will inform you of the suitable activities that fit your case.

 

Diaphragmatic breathing

Diaphragmatic breathing is a simple technique that helps you relax and improve your core muscles. You can do it by breathing in for two or three seconds then slowly exhaling. Repeat for two or three minutes. 

 

Physical Therapy improvement timeline 

It is determined by the severity of your case and symptoms. Typically, it takes at least five weeks of treatment to notice a reduction in pelvic pain. Other disorders, such as pelvic floor prolapse or incontinence, may take months to resolve.

 

Women go through several physiological and hormonal changes throughout pregnancy in order to accommodate bearing the baby. If you are nursing and experiencing pain or discomfort, consult with a therapist to develop a personalized treatment plan for you. Physical therapy can aid in postpartum recovery by strengthening muscles and ligaments and alleviating pelvic and low back pain. 

 

 

 

References:

  1. (Chia et al., 2016) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845853/
  2. (Peahl et al., 2019) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2739048?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072619
  3. (Benjamin et al., 2014) https://www.physiotherapyjournal.com/article/S0031-9406(13)00083-7/fulltext
  4. Lindberg, Sara. “The Best Postpartum Exercises to Do Right Now.” Healthline, 27 January 2020, https://www.healthline.com/health/exercise-fitness/postnatal-exercises
  5. “Pregnancy Care and Postpartum Physical Therapy.” ATI, https://www.atipt.com/pregnancypostpartum-care
  6. “Physical Therapy for Postpartum Recovery – Information, Exercises, and More.” In Motion O.C, https://www.inmotionoc.com/ailments-we-treat/sacroiliac-joint/postpartum-physical-therapy/
  7. Petrie, Tim. “Postpartum Physical Therapy.” Very well health, 25 June 2021, https://www.verywellhealth.com/postpartum-physical-therapy-5187995
  8. “Postpartum Relief with Physical Therapy.” Results physiotherapy, 24 July 2020, https://www.resultspt.com/blog/posts/postpartum-relief-with-physical-therapy
  9. “Weight Gain During Pregnancy.” Centers for Disease Control and Prevention, 26 May 2021, https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm
  10. “Balance Training.” Physiopedia, https://www.physio-pedia.com/Balance_Training
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