Physical Therapy Can Help Pregnancy-Related Issues

First of all, congratulations on your pregnancy! This is such a special time of life and an amazing opportunity. Given that you are now responsible not just for yourself, but also for another tiny human, let's talk about strategies to maximize your health.

To start, let's talk about relaxin, a wonderful hormone that helps the pelvis expand during childbirth. Unfortunately, as hormones do, relaxin is circulated throughout the body and is not selective in identifying the joints and ligaments necessary for childbirth. This can lead to increased ligamentous mobility in random joints leading to pain and irritation from the lack of stability.

As you may be noticing, significant musculoskeletal changes occur during pregnancy. With the help of relaxin, the growing fetus in your abdomen accentuates the natural curves in your back called thoracic kyphosis and lumbar lordosis. This new spinal position encourages tightness of the chest, low back, and hip flexor muscles along with lengthening/weakness of the upper back, abdominal, and hip muscles. These changes, among numerous others, contribute to the fact that an estimated 69% of women during pregnancy and 25% of women after pregnancy experience low back pain while 20% of women during pregnancy and 38% of women three months after pregnancy experience pelvic girdle pain.

A physical therapist can help address these musculoskeletal issues with manual therapy and selective exercises. Hands-on techniques specific to the low back and pelvis can be performed gently to reduce stress on the joints and muscles. One such example is a side-lying lumbopelvic mobilization pictured below to relieve low back compression from the excessive lumbar lordosis and thoracic kyphosis.

Certain exercises are better than others during pregnancy. For example, positions such as lying supine and standing in single leg stance later in pregnancy can irritate structures more susceptible to laxity from relaxin. Ensuring proper core and hip strength before attempting prolonged single leg stance positions (hello, tree pose!) will reduce the likelihood of joint pain. If you haven't already, consider making an appointment with a physical therapist for exercise program development and pain-relief techniques (if needed). Monthly wellness check-ups are recommended to ensure proper program progression and execution.

Overall, exercise has been shown to be helpful during pregnancy, especially if that same type and intensity of exercise was performed prior to pregnancy. Research in the 90's exploded regarding the positive benefits of exercising during pregnancy. One particular study suggests exercise works in concert with pregnancy to increase cardiac output, which is the volume of blood pumped by the heart per minute. You may have been instructed to avoid lying on your back after the first trimester. The reason for this is that lying supine temporarily obstructs major blood vessels thereby decreasing cardiac output. See the connection?

Another reason why establishing a regular exercise routine prior to pregnancy is beneficial links to energy uptake levels. If you are comfortable controlling your intake as an active individual, increasing by the recommended 150 calories/day during the first two trimesters and 300 calories/day during the third trimester will be relatively straightforward. Try adding activity and pregnancy at the same time and you will find it very easy to over- or undershoot your caloric needs.

You may have noticed a theme of maintaining your current lifestyle throughout pregnancy. If you are proactively reading about pregnancy, we applaud you! Now is the time to establish these healthy habits to help you feel more confident about your activity levels during your pregnancy. (See my post How Much Should You Be Exercising Each Week? for general exercise guidelines.) With those new to exercise and currently pregnant, please consult your medical team to ensure safety for you and your baby!

**Please remember these are general guidelines. For a program specific to you and your needs, please consult with a medical doctor and/or physical therapist who is familiar with your current health status.

Wang SM et al. Low back pain during pregnancy: prevalence, risk factors and outcomes. Obstet Gynecol 2004;104(1):65-70.

Katonis P et al. Pregnancy-related low back pain. Hippokratia 2011;15(3):205-210.

Pivarnik JM, Lee W, Clark SL, Cotton DB, Spillman HT, Miller JF. Cardiac output responses of primigravid women during exercise determined by the direct Fick technique. Obstet Gynecol 1990;75:954-9. 

Araujo D. Expecting questions about exercise and pregnancy? Phys Sports Med 1997;25(4):85-93.

Van de Pol G. et al. Pregnancy-related pelvic girdle pain in the Netherlands. 2007;86(4):416-422.

Abdulla A. et al. Exercise and pregnancy. Mid East J Fam Med. 2004;2(2).