Pregnancy Physiotherapy

With the changing shape of your body and the added effects of pregnancy hormones, it is not uncommon to experience aches and pains in pregnancy. These can include:

• Abdominal separation
• Back pain
• Pelvic pain
• Pubic bone pain
• Rip pain
• Carpal tunnel syndrome
• Pelvic floor muscle dysfunction, such as bladder leakage and urgency

Lower back and pelvic pain, including pubic bone pain

It is reported that as many as 50% of pregnant women and around 25% of new mums suffer from pregnancy-related back pain. However, much of this may actually arise from the pelvis and pelvic joints.

Common complaints of the back and pelvic joints in pregnancy include:

• Pain into the buttock, coccyx and pubic bone areas
• Difficulty and pain with activities such as rolling over in bed, stair walking, getting up out of a chair and long periods of sitting, standing and walking.

In pregnancy, pelvic joints become painful and irritable. The changing physique of the spine and pelvis posture with growing bellies and the actions of the pregnancy-related hormone relaxin are the cause. Relaxin softens the soft tissues about the pelvic joints, allowing some give to otherwise very stiff joints in preparation for birth.

The best thing about this pain is that studies have shown that more than 70% (and up to 95% in some studies) of women with these pregnancy-related back pains will have no lasting effects after 2-3 months of their baby being born. As the relaxin hormone leaves the body, the joints return to their pre-pregnancy state.

Physiotherapy management of these pregnancy related pains is very useful. Treatment can vary from gentle joint re-alignment techniques to massage and core stability exercises for the pelvic muscles. There are many other alternatives also to treatment to help you get through these times with less pain, including:

• prescription of sacral or pelvic belt to offer support and compression to the pelvis
• simple supportive taping techniques around the pelvis
• prescription of SRC Pregnancy and Recovery shorts

Recent evidence recommends combining physiotherapy treatment with exercise therapy for the best outcomes for women in both pregnancy and postnatal periods. Safe and appropriate pregnancy and postnatal Pilates can do just that!

Rib Pain

In pregnancy, as your baby grows in your uterus, the space for your other internal organs must be pushed somewhere. Your rib cage and middle back need to spread to allow for this shift. This can cause pain in the following areas:

• Around your ribs
• Your armpits
• In your mid back
• When you breathe
• Sit for prolonged periods then get up

Physiotherapy management of pregnancy-related rib pain can utilise techniques to address the rib and mid back alignment. Massage and exercise therapy such as in pregnancy and postnatal specific Pilates based classes can alleviate pain and discomfort.

Carpal tunnel syndrome

This is a common hand condition reported in pregnancy. After back pain, it is the most common condition involving the skeleton and muscular system in pregnancy. It is most common in the later trimester and is due to the increase in swelling in the body. This swelling can obstruct or narrow the small canal through the wrist, compressing the nerves and the blood vessels to the hand. Tingling and numbness in the hands and fingers are the commonly reported symptoms.

Physiotherapy management aims to assist in minimising swelling in the area with night time resting splints, ice packs and advice.

Like most pregnancy related injuries, carpal tunnel syndrome mostly resolves within a month to year after having your baby. Persistent symptoms may need further help, as some women will continue to experience pins and needles with breastfeeding.

Abdominal separation

Tummy separation is the increased distance between the main abdominal muscles required for the belly to stretch over the growing baby. This is very normal and the body’s way of adapting to your growing belly bump. It is most common in the third trimester of pregnancy and will often remain well into the first full year of being a new mum. For some women, separation will remain for lifetime, and will be mostly present at the level of the navel. Ongoing separation of the belly muscles only becomes significant if there is an adverse effect of these on the support of your back, pelvis, pelvic organs and pelvic floor control.

• advice on managing and preventing further separation with respect to safe exercise, postures and movements
• appropriate strengthening exercises of the lower trunk region, including the pelvic floor and deeper abdominal muscle layers
• prescription and fitting of abdominal support and binders for early post-natal days to encourage healing and good abdominal muscle position
• prescription of SRC recovery shorts

Pelvic floor pain and incontinence

Pelvic floor pain or weakness is very common during both pregnancy and after having your baby. Due to the growing baby and increasing pressure on the pelvic floor muscles, pregnancy is the first time women may experience a loss of good bladder or bowel control. Unfortunately it is often made worse if there has been a previous bladder or bowel problem such as constipation or irritable bowel syndrome. Coughing and obesity can also make it worse.

Most bladder and bowel control problems will resolve themselves six months after childbirth if you perform regular pelvic floor exercises. This is also the case for other pelvic floor problems such as episiotomy and scar healing, sexual pain, sensitivity and pain in the pelvic region.