Physical Therapists, particularly those specialized in women’s health conditions can play a vital role in helping women progress through pregnancy with less pain and improved function, while also preventing post-partum musculoskeletal issues. Weight gain and the position of the growing baby, while considered normal, can lead to a variety of symptoms that can be implicated in low back pain:

     In addition to excessive anterior weight gain, the hormone relaxin increases ligamentous laxity during pregnancy leading to excessive joint motion and possible micro-injury to ligaments:

Pregnancy-related low back pain often begins in the first trimester of pregnancy and tends to increase with advancing pregnancy and subsequent pregnancies.¹ Women’s Health physical therapists are musculoskeletal experts in providing core-focused training while preventing overstretching of muscles, tendons, and ligaments, which may be contraindicated in pregnancy. The types of exercise programs that have been shown to be the most effective are stability ball exercises and progressive functional core stabilization programs. Yoga by a trained physical therapist or prenatal yoga expert has also been shown to improve low back pain in pregnant patients.¹ Dysfunction of the diaphragm, an essential muscle of breathing, has also been shown to be implicated in low back pain. Pregnancy may inhibit excursion and function of the diaphragm that a physical therapist can retrain through breathing exercises and coordinating appropriate breath with exercise.²³ Women’s health physical therapists are also trained in providing appropriate external bracing for pregnant women if needed, especially in the third trimester. Research has shown the use of pelvic belts have a strong positive effect for the treatment of pregnancy related low back pain.⁴

Diastasis recti, a separation of rectus abominus muscle down the middle can also occur during pregnancy. The presence of a diastasis recti has been found to be significantly related to a support related pelvic floor dysfunction diagnosis and may be implicated in low back pain.⁵ The occurrence and size of a diastasis recti has been shown to be greater in non exercising pregnant women than in exercising pregnant women.⁶ Exercises putting too high of an increase in intra-abdominal pressure such as crunches or involving excessive twisting may worsen separation. The transverse abdominus plays an important role in lumbopelvic stability, by activating prior to sudden movements and providing compression to the sacroiliac joints. Women’s health physical therapists are trained in providing appropriate abdominal strengthening and retraining of the transverse abdominus.⁷ They also can provide temporary taping methods of the diastasis recti to decrease pain during exercise.

The common daily activity of prolonged sitting can lead to a variety of issues. Ergonomic advice on proper workstation set up involving a desk attachment board to support the forearms has been shown to reduce low back pain in a sample of pregnant women.⁸ Easy to do postural exercises throughout the day with or without a band can also help with shoulder, neck and upper back pain from prolonged time spent at the computer. Coccyx or tailbone pain may develop during pregnancy due to hormonal changes, stretch to the pelvic floor muscles, and postpartum due to difficult delivery. Altered sitting postures due to tailbone pain can lead to increased low back pain. Women’s health physical therapists can provide instruction on proper sitting supports and treatment to the appropriate muscles when indicated to improve coccyx pain. ⁹¹⁰

Women should not have to suffer with chronic neck and back pain during pregnancy, and should be advised to see a specialized women’s health physical therapist as soon as possible. The sooner a patient can begin appropriate exercises for pregnancy, the easier it is to retrain muscles and prevent faulty biomechanics during daily activities. New Dimensions Physical Therapy has a team of specially trained women’s health physical therapists to help patients progress through pregnancy comfortably. An evaluation will consist of a musculoskeletal and postural evaluation from head to toe, along with questions about what activities bring on symptoms. Sessions may include pelvic supports, taping, manual therapy as needed, and advice on proper seating and sleeping positions. Methods to activate core muscles appropriately, particularly the transverse abdominus during functional activities and modifications of activities may be taught. Additionally, an exercise program and possible referral to either Pilates or yoga programs should be provided for the patient to independently work towards reducing and keeping symptoms tolerable as pregnancy progresses and to restore your body from the childbirthing process. ⁹

 Lila Abbate PT, DPT, OCS, WCS

Andrea Wood, PT, DPT

References:

1. Belogolovsky I, Katzman W, Christopherson N, et al. The effectiveness of exercise in treatment of pregnancy- related lumbar and pelvic girdle pain: a meta-analysis and evidence based review. J WomensHealth Phys Therap. 2015; 39(2):53-64.

2. Kolar P, Sulc J, Kyncl M, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012; 42(4):352-362.

3. Jassens L, McConnell A, Pijnenburg M et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015;47(1):12-19.

4. Stephenson R, Steiner S, Puniello M. The effect of lumbopelvic support in the third trimester of pregnancy. J Womens Health Phys Therap. 2007; 31(1):25.
5. Spitznagle T, Leong F. The relationship between diastasis recti abdominus and pelvic floor dysfunction diagnosis. J Womens Health Phys Therap. 2007; 31(1):26

6. Chiarello C, Falzone L, McCaslin K, et al. The effects of an exercise program on diastasis recti abdominus in pregnant women. J Womens Health Phys Therap. 2005; 29 (1):11-16.
7. Lee S, Kim T, Lee B, et al. The effect of abdominal bracing in combination with low extremity movement on changes in thickness of abdominal muscles and lumbar strength for low back pain. J Phys Ther Sci. 2014; 26(1):157-160.

8. Dumas G, Upjohn T, Dellisle A. Posture and muscle activity of pregnant women during computer work and effect of an ergonomic desk board attachment. Int J Ind Ergonom. 2009; 39(2):313-325.

9. Tanner H. (2015). Introduction to caring for the pregnant patient [Powerpoint slides]. Retrieved from https://www.medbridgeeducation.com/courses/details/ introduction-to-caring-for-the-pregnant-patient

10. Maigne JY, Rusakiewic F, Diouf M. Postpartum coccydynia: a case series of 57 women. Eur J Phys Rehabil Med. 2012;48(3):387-392.