Hi ya’ll. Some of you may know that I recently began seeking further education in the area of women’s health. I especially have a strong interest in the pregnancy and postpartum population. Since having my two babies I have realized how much change women undergo physically. It’s actually quite amazing what our bodies are capable of. But unfortunately, our postpartum bodies are not perfect. Muscle weaknesses, posture changes, and healing tissues can lead to aches, pains, and impaired function. Luckily physical therapy is available to help women after pregnancy with many of these new and unanticipated challenges.
The need for physical therapy after pregnancy
In my recent postpartum course I discovered some staggering statistics on the number of women struggling with postpartum pain or issues who are not receiving any treatment. Some of the particularly noteworthy statistics include:
Pregnancy related lumbopelvic pain persists in 25-50% of women at 3 months postpartum. And if the pain is there at 3 months postpartum, then it will most likely still be there at one year postpartum.
Sometimes this back pain can become chronic. So what exactly does this mean? This tells us that postpartum women suffering from low back pain need therapeutic intervention. Unfortunately the pain will not just magically go away.
What’s more, only 32% of women who have PLBP (pregnancy low back pain) or PGP (pelvic girdle pain) report it to their care providers. And then of those who report pain to their providers only 25% of these women get a treatment recommendation. This means a huge number of women are not getting any treatment or professional help for their physical problems after having a baby.
Postpartum Care in Other Countries
So why aren’t more women in the U.S. getting physical therapy after pregnancy? I mean their body just went through a huge change, they potentially had surgery, and their physical demands just grew exponentially with a new tiny human on the scene.
Many other countries are leaps and bounds ahead of us in their postpartum care of mothers. In France, the Netherlands, and Australia every woman is automatically given several visits with a pelvic floor physical therapist to address healing issues, muscle imbalances, or any other concerns. Fox News published an article addressing the vast difference between France and the U.S in their care of the postpartum women. In fact, U.S. women are the least likely to get physical therapy treatment after pregnancy (only 24%) compared to Europeans.
Yet, of these women who do get treatment in the U.S. up to 87% reported positive effect, meaning that therapy works. Obviously. Therapy can help your body heal effectively in order to prevent chronic pain symptoms, incontinence, pain with future pregnancies, and safe return to exercise and regular activities.
Common Problems Postpartum
Below are some of the common problems women might experience postpartum.
Abdominal Separation/ Diastasis Recti
When we are pregnant our uterus and stomachs grow as the baby grows. This new growth can place extra pressure on the linea alba which is the tissue that runs down the middle of your 6 pack abs (also known as your rectus abdominis). The added pressure on your linea alba can lead to a separation of your abdominal muscles known as a diastasis recti. A diastasis recti is diagnosed postpartum if the distance between the abs is 2 finger widths or more when measured slightly above and below the belly button, or there is insufficient muscle tension. Around 4 weeks postpartum this separation naturally starts to come back together.
However, about 60% of women still have a diastasis recti 6 weeks after childbirth. In fact, if a diastasis recti is present at 8 weeks postpartum it will likely still be present at 1 year (Coldron, 2008) An untreated diastasis recti can contribute to low back pain, pelvic pain, urinary incontinence, and other pressure system issues in our body.
A physical therapist would be able to assess and provide proper treatment to help heal a diastasis recti. We do not have any specific exercise program supported in the scientific literature to heal a diastasis. What matters is the quality of your exercises and movement which would be assessed by a specially trained PT.
Incontinence
For many women pregnancy and postpartum is the starting point for urinary leakage and other bladder problems. There is no “normal” amount of leakage or pee with activity. A systematic review shows that 33% of women have urinary incontinence at 3 months postpartum. At 4 years postpartum about 29% women reported incontinence. Postpartum incontinence could be from weakness, poor coordination, pelvic floor muscle endurance or from overactivity and muscle trigger points. Again a pelvic floor therapist would be able to evaluate and determine to the best specific and individualized treatment for you.
Cesarean Section Scar Healing
One in three women have a cesarean section according to an article written by The Bump in 2017. A cesarean section is a major surgery in which several layers of the abdomen are cut open. Caesarean sections vary in the layers sutured or not suture as well as the depth and amount of scarring. There are several techniques for scar mobility and massage to help the healing process. A physical therapist can perform and educate a woman on these techniques to aid in optimal recovery.
Perineal Tearing
Tearing is the tissue damage that happens during labor and delivery. Greater than 85% of women have perineal trauma with vaginal birth (about 50% of women have episiotomy). Tissue healing of the pelvic floor is important for proper function and remaining pain free.
Low Back or Pelvic Pain
Pregnancy related low back pain or pelvic girdle pain is common during and after pregnancy. Due to changes in the body’s composition and posture during pregnancy many muscles and ligaments can become stressed out and irritable. And as previously mentioned, the core muscles are often quiet weak so there is a lack of stability which can further contribute to pain in the back and pelvis.
Upper Back and Neck Pain
Similarly upper back and neck pain is often present postpartum. Upper back pain is reported in about 43% of postpartum women. This again is due to muscle imbalances and forward posture preferences when holding baby, feeding baby, and more.
There are numerous other things a physical therapist can assist a new mom with after having a baby. Other impairments that often need to be addressed are posture, gait, breathing patterns, body mechanics, and potentially nerve pain.
How Can Physical Therapy Help New Moms After Pregnancy
No two women, pregnancies, or birth stories are the exact same so there is no one size fits all treatment for new moms. An individualized treatment session with a PT would allow a therapist to look at your specific impairments. There are numerous ways physical therapy could help a woman after pregnancy.
Examples include:
- Help aid appropriate healing of perineal or C-section scars/incisions
- Education on body mechanics and positioning techniques to improve function and prevent pain
- Provide specific techniques and exercises to heal and strengthen the abdominal muscles (often through use of biofeedback, palpation, observation). They can help postpartum moms retrain the deep core muscles to work effectively and appropriately
- Provide specific exercises to heal and strengthen the pelvic floor muscles
- Assess posture, breathing patterns, and gait mechanics for correctness and efficiency
- Evaluate and treat low back pain and pelvic pain. Possible techniques include massage, taping, manipulations, and appropriate exercises.
- Provide an individualized treatment plan for safe return to exercise
What’s Next?
Ok, ok I’ll get off my soap box now. I just recently realized how little education is available to American women regarding their postpartum bodies. To be honest with you there is so much I have learned already that I was not aware of when I had my children. Luckily, I was able to use some of my prior knowledge of the human body to heal and get rid of the little pain and discomfort I did experience after having my babies. But most women do not have a background or education base on body biomechanics and exercise science.
So what can you do? I would love love love if you could share this info with all the mamas or mamas to be out there. I do believe there is a movement happening in the U.S. for postpartum care to be more common place. Do not be afraid to ask your doctor for a referral to a pelvic floor therapist or woman’s health specialist. I think there is a bit of a stigma around woman needing therapy after pregnancy. But you wouldn’t be embarrassed if someone told you your leg muscles were weak. Weakness of the core and pelvic floor shouldn’t be any different.
Keep following along as I embark on this journey of education regarding health and wellness for the pregnancy and postpartum woman. And I do believe the saying, once postpartum, always postpartum. Our bodies are fricken amazing. Let’s give them the love and respect they deserve.
–Monica
