Physical therapy can decrease the strain that pregnancy places on the body as a woman’s body goes through many changes. As the baby grows, her center of gravity changes, which affects her posture. This results in a shift in the workload of her muscles and a relaxing of her ligaments as they prepare for birth. This postural tension increases muscle tightness in the neck, shoulder, mid-back and pelvis that alter the workload on the body, thus increasing fatigue and pain. Therefore, it is important for a pregnant woman to exercise during pregnancy to increase her endurance, strength and the flexibility of her muscles.
Additionally, it is important to include a good home exercise program during pregnancy, because this will improve her prenatal experience as well as ease labor and recovery time. Physical therapy during prenatal and postnatal care can help relieve many associated symptoms, such as back pain, bed rest during pregnancy, carpel tunnel syndrome, thoracic outlet syndrome, transient osteoporosis, diastasis recti, pubic symphysis separation and pain, episiotomy scar tissue, caesarean section scars, pelvic floor-related problems such as incontinence or constipation, and breastfeeding complications.
One of the most frequent conditions associated with carpel tunnel syndrome (CTS) is pregnancy1. CTS can cause pain, numbness, clumsiness, and muscle atrophy. Padua et al. found that edema is present in the tissue of pregnant women in their third trimester, due to an increased fluid retention that causes compression on the nerves in the wrist. Other related factors to CTS are age, weight gain, hand stress, previous pregnancies, abnormal blood pressure, smoking and alcohol consumption. Physical therapy can decrease the edema and the strain on the ligaments, improve joint movement, and reduce the pressure on the nerve at the wrist. This condition is reversible following pregnancy.
Back pain and pelvic pain, which includes sacroiliac dysfunction and pubic symphysis pain, is a complication during pregnancy that can interfere with work function, daily activities and sleep during pregnancy. Sixty-six percent of pregnant women experience back pain and 20% experience pelvic pain2. This can be caused by increased curvature of the lower spine, increased abdominal weight of the baby, relaxing of the ligaments in the pelvis due to the hormone relaxin, and fluid retention in the tissues3. Due to muscle fatigue and increased fluid in the tissues, the pain usually increases at night, making sleeping difficult. In most cases, pubic symphysis pain improves after 6 months postpartum4. Two years postpartum, women who were having anterior and posterior pelvic pain continued to have pain. However, physical therapy will provide strengthening and stretching exercises, as well as functional movement exercises, connective tissue manipulations, and postural and rest support. In a recent research study, Martins and Pinto e Silva found that 61% of the women in the stretching exercise group reported a 100% reduction in pain5. There is a correlation between pregnancy, low back and pelvic pain in women with a high body mass index, excess pre- and post-pregnancy weight, joint hypermobility, amenorrhea, pelvic girdle instability, increased abdominal diameter due to increased fetal weight, and impaired biomechanics6. Without treatment low back pelvic pain can progress to chronic low back pelvic pain following delivery.
Diastasis Recti Abdominus is a condition in which the rectus abdominal muscle separates in the midline at the line alba7. This condition is usually seen in the second trimester of pregnancy, worsening in the third trimester, and without treatment can result in herniation of the abdominal organs. It can affect posture, trunk mobility and stability, respiration, and the delivery of the baby. Physical therapy will give you instructions on special wrapping techniques during transitional movements, such as sitting up in bed and during coughing or sneezing. In addition, you will learn rectus and transverses abdominal muscle exercises, co-contraction pelvic floor exercises, and breathing exercises. These treatments assist your body in healing the diastasis recti abdominus.
Pubic symphysis diastasis is caused by an increase in the hormone relaxin that relaxes the ligaments to promote an efficient delivery. It can cause pubic pain and inner thigh pain when walking, standing, climbing or rolling over in bed. There may be grinding or clicking in the pubic area. The pain is worse at night, preventing a good night’s sleep. During pregnancy the normal amount of gap is 6-8 mm; in a non-pregnant women it is 4-5 mm. At 9 mm gap the joint is unstable, and sacroiliac joint involvement occurs at 20 mm displacement. Physical therapy will recommend a special binder, instruct you in how to move to decrease pain, educate you in movements and positions to avoid, and teach you exercises to support the pelvis.
High Risk Pregnancy is defined as one in which the mother, fetus or newborn may possibly be at risk of mortality before, during, or after delivery8. Medical diagnoses that may place a pregnant woman in a high risk category are preterm labor, premature rupture of membranes, cervical incompetence, placenta previa, hypertensive disorders of pregnancy, multiple births, and gestational diabetes. Your physician will determine your level of bed rest and your physical therapist will educate you on safety during bed movements, positioning and preventing adverse physiological effects due to prolonged bed rest or inactivity.
Exercise during pregnancy is permitted and encouraged. For medical reasons your physician may recommend that you discontinue exercise. The American College of Sports Medicine encourages you to seek medical attention during pregnancy if you have any of these symptoms:
- Bloody discharge or a “gush” from the vagina
- sudden swelling of the ankles, face or hands
- Persistent or severe headaches
- Visual disturbances
- Unexplained dizziness or faintness
- Swelling, pain and redness in the calf of one leg
- Rise in pulse rate or blood pressure that persists after exercise
- Excessive fatigue, palpitations, chest pain
- Persistent contraction of more than 6-8 per hour
- Unexplained abdominal pain
- Weight gain less than 1.0 kg per month during the last two trimesters.
According the the American College of Obstetricians and Gynecologists, contraindications for exercising during pregnancy are:
- Pregnancy-induced hypertension
- Pre-term rupture of membrane
- Pre-term labor during the prior or current pregnancy
- Incompetent cervix
- Persistent second to third trimester bleeding
- Intrauterine growth retardation.
It is healthy for a pregnant woman to exercise 3 times per week. Keep in mind that during aerobic exercise there is a decrease in oxygen that is available, and stop exercising when fatigued, to prevent heart rate increasing beyond 140 bpm.
1. Padua L, Pazzaglia C, Mondelli M, Liotta GA. Symptoms and neurophysiological picture of carpal tunnel syndrome in pregnancy. Clinical Neurophysiology, 2001;112:1946–51.
2. Pennick V, Liddle SD. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database of Systematic Reviews, 2013;8.
3. MacEvilly M, Buggy D. Back pain and pregnancy: a review. Pain 1996;64:405–14.
4. Albert HB, Godskesen M, Westergaard J. Prognosis in four syndromes of pregnancy related pelvic pain. Acta Obstetricia et Gynecologica Scandinavica, 2001;80:505–510.
5. Martins R, Pinto e Silva, JL. An exercise method for the treatment of lumbar and posterior pelvic pain in pregnancy. Revista Brasileira de Ginecologia y Obstetricia, 2005;27(5):275–82.
6. Morgan KL, Rahman MA, Hill RA, Zhou S-M, Bijlsma G, et al. Physical activity and excess weight in pregnancy have independent and unique effects on delivery and perinatal outcomes. PLOS ONE 2014;9(4): e94532.
7. Ponka, JL. Hernias of the Abdominal Wall. Philadelphia: Saunders, 1980.