During pregnancy the female body undergoes significant musculoskeletal, hormonal and physiological changes to both nurture and house a growing baby. These changes affect every organ in the female body and include changes to the cardiovascular system, gastrointestinal system, urinary system and musculoskeletal system.
Increased ligament laxity due to a changing hormonal status and changes to posture due to a growing uterus and baby can put new loads on the body and it is common for women to experience musculoskeletal pain during pregnancy. Common areas of pain include:
Women can also experience pelvic floor symptoms including:
At Fit and Flow Physiotherapy we have over a decade of experience in assessing and treating pregnancy-related pains. We love working with women during their pregnancies, helping to reduce pain and increase function, so they can continue to enjoy their work, sport and leisure activities.
Pelvic girdle pain describes pain in and around the pelvic area, including pain in the lower back, hips and front of the pelvis. Pelvic girdle pain is often aggravated by tasks like rolling in bed, walking, climbing stairs, lunges, getting in and out of the car and even prolonged standing.
The good news is that for the majority of women (>90%) this pain will resolve in the postpartum period. However, women shouldn’t feel that they need to suffer through their pregnancy or after their pregnancy with this pain. A recent study revealed that only 25% of Australian women are offered treatment for this pain and current recommendations support physiotherapy treatment for pelvic girdle and low back pain. At Fit and Flow Physiotherapy our treatment approach often includes a combination of hands-on-treatment like massage, acupuncture and/or gentle mobilisation, we might use taping and bracing to help reduce pain when you leave the clinic and specific exercises to help with strength and pain-relief at home!
The carpal tunnel is a small passage in the wrist, bordered by the wrist bones on one side and strong connective tissue on the other side. Nerves and tendons pass from the arm through the carpal tunnel to the hand. During pregnancy, hormonal changes and fluid retention can cause swelling in the hands which reduces the available space for the nerves and tendons in the carpal tunnel. With these nerves being pushed or compressed in the carpal tunnel, women will often experience pins and needles, numbness, pain, burning or weakness in the hand. These symptoms can be quite distressing and uncomfortable, but the good news is again many women experience relief of symptoms with physiotherapy treatment. Our treatment may include gentle drainage massage, exercises to reduce symptoms at home, provision of compression bandages or wrist guards and advice about positions to avoid that will aggravate symptoms.
By the third trimester of pregnancy, around 60-100% of women experience a stretching or widening in the connective tissue between their abdominal muscles, this is called rectus abdominus diastasis (abdominal separation). Women will often notice a gap or a bulging in the centre of their stomach when sitting up from lying or doing other tasks that load the abdominal wall. This is a normal process to make room for a growing baby and for many women there will be normal recovery that happens after they give birth. Some women will continue to notice this “gap” in the centre of their stomach in the post-natal period. These women often benefit from support garments and an individualised physiotherapy assessment. At Fit and Flow we will assess your “abdominal separation” and the ability of your abdominal wall to transfer loads between the upper body and lower body. We will often provide you with stretches and/or strengthening exercises to improve the function and strength of your abdominal wall.
Up to 67% of women experience “leaking” (incontinence) of urine when pregnant. With a growing baby there is increased weight and pressure downwards on the pelvic floor, so many women find that they “leak” when coughing, sneezing or exercising, especially by the third trimester of pregnancy. Women who carry out pelvic floor muscle exercises under a physiotherapist’s direction, are less likely to leak in their late pregnancy and in the postpartum period. During a pelvic floor assessment with a Women’s Health physio, you will learn how to correctly activate your pelvic floor muscles, how many squeezes you should complete and how to relax your pelvic floor between each squeeze!
Around 50% of women who have been pregnant will experience some kind of prolapse. Prolapse refers to the symptomatic bulging of the uterus, front and/or back wall of the vagina. Pregnancy and the birth process are the biggest cause of prolapse, particularly if you have had more than one baby, if your baby had a bigger birth weight or if your pushing phase was prolonged or very short. Family history, lifestyle factors and other medical conditions can also increase your likelihood of prolapse too. Treatment options include lifestyle modifications, pelvic floor muscle training with a physiotherapist, the fitting of a pessary or even surgery. Pelvic floor muscle training has been shown to significantly reduce the symptoms of prolapse when compared to people who only received lifestyle modification advice and didn’t complete pelvic floor muscle training.
In the post-partum period, women are recovering from the significant changes that occurred in their body during pregnancy, the trauma or changes that occur as a result of the labour/birth and the new (and repetitive) loads on the body with duties as a mother.
For some women, musculoskeletal complaints experienced during pregnancy will resolve in the early postpartum period. However, for those who continue to experience pelvic girdle pain, lower back pain, abdominal separation, carpal tunnel syndrome and pelvic floor disorders, physiotherapy rehabilitation may be required to help improve function and reduce pain or dysfunction postpartum.
At Fit and Flow Physiotherapy we recommend a post-natal check with your physiotherapist in the first 4-6 weeks after birth. Our post-natal assessment takes into account your status during pregnancy, your labour and birth.
We then work with you to help address pain, improve strength and function and create an individualised rehabilitation program to help you return to the activities that you love!
For more information on post-natal pelvic floor conditions please see Women’s Health page.
Extensive experience in musculoskeletal and sports injuries, adolescent injuries, pre and post-natal physiotherapy, women's health and surgical rehabilitation provided from expert Physiotherapists in Caringbah.
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