Pre and Post-Partum

Low back pain and sacro-iliac joint pain are very common among pregnant women due to hormonal changes, rapid body changes including weight gain and altered weight distribution, as well as joint laxity. Many women think this is a normal part of pregnancy and think it will go away once the baby is delivered, but this is not always the case. Pregnant women may be unsure of which exercises are safe during pregnancy — MTI Physical Therapy can help. A thorough history and evaluation will be done in order to determine the cause of the problem and the tissues involved. The evaluation will help in determining muscle issue and motor control that will be addressed with exercise. Activity modification and patient education will be a focus of treatment and may include self treatment techniques and tips for post-partum including postural alterations and body mechanics tips for carrying, nursing, and lifting your new baby. We will also assess for neurological involvement and any alterations in joint movements that can be addressed through manual therapy. Soft tissue mobilization may be done to allow overworked muscles to recover, and specific exercises can help recruit muscles that aren’t working properly due to your injury.

The Facts
Back and pelvic pain is very common during pregnancy:

  • 60% have low back pain (LBP) (Kristiannson,1996)
  • 22% have pelvic joint pain (Alber, 2000)
  • 49% have both back and pelvic pain (Ostgaard, 1991)

This pain does not necessarily resolve after delivery:

  • 30-43.2% reported LBP 6 months post-partum (Ostgaard, 1992)
  • 37% with low back pain during pregnancy continue to have pain 18 months post-partum (Larsen, 1999)
  • 24.4% have disabling back pain (Bjorklund, 1999)

Urinary accidents during pregnancy and post-partum is common:

  • 21% have accidents three months post delivery (Figeurs, 2004)

Long term consequences to pelvic low back pain include: (Brynhildsen, 1998):

  • 8.6% have pelvic joint pain 2 years post-partum
  • 86% have intermittent LBP post-partum
  • Some will avoid a second pregnancy due to pain

Scapulo-Thoracic Region:

Weakness/pain common with lifting, carrying a child and with nursing

Specific Dysfunctions and Treatment

Diastasis Rectus Abdominus:

  • 37% incidence of a split of the diastasis during the first pregnancy
  • 62.5% chance thereafter with subsequent pregnancies
  • Many do not resolve spontaneously

Pelvic Floor Disorders—is it an epidemic?

  • Affects 3-400,000 women so severely that they require surgery (DeLancey, 2004), (Ashton-Miller, 2001)
  • Benefits of training includes reduced urinary accidents, increased speed for return to sport, ADL’s, and childcare

Pelvic Floor Treatment:

  • Active participation in pelvic floor muscle contraction helps to decrease urinary accidents (Dolan, 2003)
  • Biofeedback is useful for retraining pelvic floor dysfunction
  • EMG studies have found poor muscle function/control in women with pelvic floor dysfunction

Other Treatment for Specific Dysfunctions:

  • Self-mobilization for SI joint dysfunction
  • Self-massage post c-section for desensitization and scar mobilization
  • SI belts for joint hypermobility