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  • JenDion

The Importance of Physical Therapy Shortly After Childbirth

How exciting! Not only is your pregnancy almost over and you get to meet your child - but all of those aches and pains that you have been experiencing in your low back and pelvis should disappear too - right?! I have experienced these exact thoughts twice now - my son AJ is three years old and my daughter Aria is 18 months. The picture to the left is after the delivery of my daughter :)

Luckily, with my physical therapy background, I was able to self treat and alleviate a lot of the secondary impairments that come during and after pregnancy. What I think is unfair is that not all women know that Physical Therapy is an option - both during pregnancy and afterwards - to help with many aches and pains that you experience.

Pregnancy and delivery is really tough on the body and most women need help to safely address all of the effects this time period has on your body. In my experience over the past decade, many women are told "Back pain/sciatica is normal during pregnancy and it will go away once you have your baby" - well that could potentially be a very long 10 months without any help! Another common one I hear is "Most women will pee while exercising after pregnancy, its just something we need to accept to have children" - also untrue!

When you are pregnant, your body starts to change soon after conception. Your pelvic floor and abdominal muscles begin to stretch. These structures are highly vital supports for your joints. At the same time, our body begins to release a hormone called Relaxin, which helps ready your body for labor and delivery by loosening joints and ligaments. Unfortunately, this also makes you more vulnerable to low back and pelvic pain because you no longer have the stability that your body needs. This is why we often see pregnant women "waddling".

This is where simple exercises are recommended for you to engage in. The goal of these exercises is to strengthen your muscles to reduce pain and also prepare you for labor and delivery. Vaginal delivery can be incredibly traumatic to the muscles of the pelvic floor. These are the muscles that also work to control the flow of urine. So often women experience varying levels of incontinence after giving birth. Most women in Europe and other parts of the world are usually mandated to go to physical therapy - both during and after pregnancy. Why is this not a normal referral in the US? Most OBGYN's will gladly make the referral, but unfortunately, you will need to ask for it.

Another common postpartum condition is diastasis recti - see picture to the right. Diastasis recti occurs because the rectus abdominis muscles in your abdomen have widened during pregnancy causing a gap in the middle. Not only is this an issue for aesthetics, but it can also lead to low back pain and SI joint instability due to the reduction in support that this area is supposed to give you while lifting. Many women will try to get back in shape after delivery and tighten this area with crunches - This is the worst thing you can do if you have a diastasis recti because it will widen the gap and make your abs look worse! How frustrating!

One of the most effective ways of overcoming these postpartum conditions is to undergo physical therapy. A physical therapist will be able to safely assess your diastasis and instruct you on exercises that will close the gap and strengthen your core. Visiting a physical therapist can also help you treat additional problems such as: Urinary leakage, Prolapse, Low back pain, constipation, pelvic pain, SI joint instability, postural issues and neck/shoulder pain from breast feeding, etc. Physical Therapy can also reduce the need for medication and surgical intervention.

As stated before - with great frustration - in the United States, physical therapy has not been fully incorporated as part of routine care for new moms. Six weeks after childbirth, ob-gyns assess the cervix and uterus but usually ignore the pelvic floor muscles and evaluation of diastasis recti. This can be disastrous in the long run, as the pelvic floor and core muscles continue to weaken over the years.

Concerned you may have a diastasis recti? Want to return to activity but not sure how to do this safely? Having back pain that is preventing you from enjoying your baby or life? I offer free screens to all mothers - call or email today to ask your questions and get the help you need! Remember, Physical Therapy is covered by insurance. I look forward to hearing from you - and also seeing pictures of that new baby that is so worth all this frustration :)

Jennifer Dion, PT, DPT, CSCS

(774) 955-5830

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