Pregnancy & Physical Therapy pt. 1

For most women and couples, pregnancy is an exciting time. The female body changes at a remarkable speed as it prepares to bring a new life into the world. However, as the body changes nearly every day, pregnancy can begin to tax the musculoskeletal system.

Through different stages of pregnancy, physical therapy can be a tremendous help.

It is not unusual for a woman who is pregnant to experience joint or muscle pain as a result of a few different factors:

1. Increased hormones

  • a. Hormones control various processes through the body. While pregnant, a woman’s hormones steadily rise, which can have a dramatic impact on the musculoskeletal system. A common misconception is that increased mobility during pregnancy is due to an increase in the hormone relaxin. The Hypermobility Syndrome Association explains why that hypothesis is unproven and likely untrue:

“A further group of hormones relevant to hypermobility have a specific function in pregnancy. Relaxin relaxes the ligaments just prior to childbirth so the pelvis can open widely to allow the safe passage of the foetal head. However, although it is observed that joint laxity can increase in pregnancy, studies have not demonstrated a clear relationship between the level of relaxin and the degree of laxity. Other factors must be involved. During pregnancy, oestrogens and progestogens climb in concentration; this might also account for loosening of the joints in pregnancy. This normally remits soon after childbirth but may be prolonged if the mother is breastfeeding.”

2. Rapidly changing overall weight

  • a. Typical weight gain for a pregnant woman can range anywhere from 25-40 pounds. While most of that doesn’t occur until the 2nd and 3rd trimesters, for most women that is a 20-30% gain in overall weight. This can place tremendous stress on the joints, muscles, tendons, and ligaments for the mom-to-be.
  • b. Thanks to this weight gain, a pregnant woman can expect an ever changing center of gravity, especially in the 2nd and 3rd trimesters. She may be more prone to losing her balance, falling, and she may feel overall more clumsy.

3. Increase in overall blood volume

  • a. According to exercise physiologist Amy Dixon from Livestrong.com: “Starting when you are about six weeks pregnant, your blood volume begins to increase and continues to do so until about 32 weeks gestation. This is necessary in order to facilitate the exchange of respiratory gases and nutrients between you and the baby. This increase in blood volume also minimizes the impact of blood loss during delivery.”
  • b. The increase in blood volume can cause increased pressure on peripheral nerves and ultimately lead to numbness and tingling in the extremities.

What are some common symptoms pregnant women experience??

Following are some of the most commonly experienced orthopedic issues experienced during pregnancy
1. Low back pain / sacroiliac joint pain

  • a. According to H. Riahi et al.,

    i. “Isolated low back pain occurs in 24% to 90% of cases. It also occurs approximately twice as often in women who have had back pain before becoming pregnant and more often in women who have previously been
    pregnant.”

  • b. Low back pain can manifest as an ache or as a sharp pain. It may come and go or it may be persistent.
  • c. Pregnant women are particularly susceptible to back pain because of the aforementioned changing hormones, weight gain, and shift in center of gravity.

    i. The sacroiliac joint (also known as the SI joint) is actually made up of 2 joints at the base of the spine where the sacrum (bottom section of the spine) intersects with the two largest pelvic bones. As the pelvis begins to spread to prepare for childbirth, the SI joint may become disrupted.

What can be done?

      • d. Physical therapy, prenatal chiropractic adjustments, and gentle (physician approved) exercise (see “Part 2” of this post coming soon) can be very helpful in managing back pain while pregnant.


2. Pubic symphysis pain

      • a. The pubic symphysis is the area between your two pubic bones and is comprised of soft tissue. This area becomes increasingly more pliable as pregnancy progresses to allow for pelvic growth and stretching to accommodate for growth of the fetus.
      • b. According to whattoexpect.com the incidence of pubic symphysis pain is 1 in 300 pregnancies.
      • c. Pubic symphysis pain usually presents a pain in the region of the pubic bone in the front of your pelvis

What can be done?

      • d. According to whattoexpect.com, the following are suggestions to help manage pubic symphysis pain
      • i. “Wear a pelvic support belt. They’re readily available online and “corset” the pelvic bones back into place during pregnancy.
        ii. Do your Kegels and pelvic tilts. Regular practice helps strengthen the muscles of the pelvis.
        iii. Avoid triggers. Sit down to get dressed, and avoid heavy lifting and pushing (which you should be steering clear of anyway). Avoid standing on one leg when possible.
        iv. Ask for pain relief. If the pain is severe, ask your practitioner about pain relievers that are appropriate for pregnant women”

3. Carpal Tunnel Syndrome

      • a. Carpal tunnel syndrome (CTS) is a condition in which the carpal tunnel (in the wrist) becomes congested
      • b. In pregnancy, the carpal tunnel can become occluded and compress the median nerve primarily because of the increased blood volume, overall swelling, and increase in weight.
      • c. Carpal tunnel syndrome can feel like a numbness in the fingers, or like a weakness in the hand / grip
      • d. According to Today’s Parent: “…because the median nerve runs all the way from the neck, problems further up can manifest in the wrist or hand, says Growse, also a mother of two. “As the breasts get bigger, you get tighter, your shoulders round more, you’re fatigued, maybe you go into that chin-poked-out position.” Carpal tunnel syndrome can happen at any point during the 40-ish weeks of pregnancy, but occurrences are significantly higher after 32 weeks, according to a study done in the Netherlands. (Thirty-four percent of the study’s participants reported CTS symptoms during pregnancy).”

What can be done ?

      • e. For most people. CTS symptoms will dissipate naturally after pregnancy is over.
      • f. In the meantime a physical therapist can help by performing safe and gentle techniques to help give the nerve more room to move. A physical therapist can also prescribe gentle and safe exercises to help alleviate CTS.
      • g. While pregnant some common and safe self treatments include gentle massage, grip strengthening exercises, and a wrist brace while sleeping to avoid compressive positions.

4. Plantar fasciitis / foot pain

      • a. Plantar fasciitis and foot pain are so prevalent in pregnancy, they could have their own blog altogether.
      • b. Plantar fascia pain refers to any pain that involves the fascial band under the bottom of the foot. Typically, the pain presents at the base of the heel, but can span across the whole foot.
      • c. Plantar fasciitis occurs during pregnancy often secondary to weight gain. As weight increases, the bones of the foot splay more to accommodate the extra force, which in turn puts increased pressure through the arch of the foot and the plantar fascia.

What can be done?

        • d. Foot HealthCare Associates suggest the following tips to help reduce the pain of plantar fasciitis while pregnant

          -Wearing orthotics can provide extra support for the feet and help distribute weight evenly
          – Minimize the amount of time spent walking barefoot
          – Wear shoes with good arch support
          – Wear shoes that allow for good circulation to the feet
          – Elevate feet if you experience swelling
          – Get regular, light exercise, such as walking, to promote blood circulation to the feet

        • e. Additionally, physical therapy treatment can help manage symptoms of plantar fascia pain.

5. Upper Abdominal and rib pain:

      • a. According to Dr. Robert Milstein, “This kind of pain can occur on either side and more typically occurs later in the pregnancy when the baby is large enough that it causes pressure on the ribs, while at the same time pulling on the abdominal muscles attached to the ribs. This results in both inflammation and spasm of the muscle at its attachment to the rib.”

What can be done?

        • b. According to EverydayFamily.com, 3 ways to safely self treat rib pain while pregnant include:

          i. Posture
          1. “Hunching” over as your belly grows can cause more compression to the rib cage. Practicing having good (upright) posture allows for smooth digestion, easier breathing, and reduced rib and back pain.
          ii. Support
          1. Proper support (a well fitting bra) for growing breasts can help reduce rib pain.
          iii. Flexibility
          1. Prenatal yoga (more in the next post) and gentle stretching approved by your OBGYN and physical therapist can help loosen tight muscles in your back and ultimately help reduce pain around the ribs.
          iv. Breathing exercises
          1. Seated breathing exercises can allow the diaphragm and rib cage to naturally expand and contract and may help reduce pain felt around the ribs.
          2. For more ideas on breathing exercises check out this post
          3. To read up on patterned breathing for labor, check out this post by the American Pregnancy Association.

Check out this great infographic from GoPhysio for a quick reference and summary of the physiologic changes that occur during pregnancy:

Written by: Jillian Chiappisi PT, DPT, SCS

Posted in: Uncategorized

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