Physical TheraPT

Pregnancy

Mama Bear Energy

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To wrap up our section on lumbo-pelvic pain, I had a chance to chat with Kathleen about how to manage this from the patient perspective. Kathleen is our unofficial in-house champion of new moms. Her passion for this population is obvious- read more on how she views rehabilitation and fitness as crucial to pre-natal and postpartum health.


SV: For the past month, we’ve been sharing the latest research on lumbo-pelvic pain during pregnancy. As a recap, what are your top three take aways for mom-to-be who's been experiencing back pain?

KM: Sure thing! First, and maybe the most important take away, low back in pregnancy shouldn't be considered just part of the process, something you have to endure. There's no need to be in pain unnecessarily! Next, we have to think outside the box to find an exercise activity that feels right for you during these weird times - whether it’s strength, pre-natal yoga, pilates, or aquatic. Many yoga and pilates studios are offering virtual classes during the shelter-in-place orders. Last, don’t be afraid to speak to your doctor. Advocate for the support you need to help make your pregnancy as comfortable as you can be. Working with a skilled clinician, like a PT or ATC, to address your specific needs can not only reduce pain but also keep you and your baby healthy throughout the pregnancy.

SV:  How does this differ from the type of back pain someone who's not pregnant might experience?

KM: Back pain in pregnancy stems not only from the obvious changes that are occurring in the woman's body from the growing baby, but is also impacted by the hormonal changes that create ligamentous laxity in preparation for childbirth. The pain itself can evolve throughout the pregnancy, shifting in location, intensity and ancillary symptoms. Additionally, lumbo-pelvic pain can coincide with altered balance as the center of mass moves with the growing belly.

SV: According to some, back pain is practically inevitable during pregnancy. What could someone trying to get pregnant do to proactively prepare physically?

KM: Any muscle weakness or joint instability coming into the pregnancy will increase the difficulty of dealing with the demands of pregnancy. Get started now! It’s smart to be proactive, working on strength and overall fitness to prepare for pregnancy!

SV: Pregnancy is NOT easy. Some moms may be feeling overwhelmed just thinking about adding exercise to their day, while others might be eager to feel better and get back to their routine. Can you talk through what a home program might look like?

KM: As we shared, the American College of Obstetricians and Gynecologists recommends 30 minutes of moderate intensity exercise most days of the week throughout pregnancy. This could be a 30 minute walk at a pace in which you can still talk, a 45 minute prenatal yoga or pilates class, or a 30 minute home routine that you could even split up into 15 minutes in the morning and 15 minutes in the evening. Exercises will vary between individuals, but all expecting mothers should include stability, core strength, and proper squat and hinge techniques in their programs. Upper body strength is a great bonus, too!

Postpartum it is important to give your body the time it needs to heal; it is recommended to rest 6 weeks before starting exercise post-childbirth. If feeling unsure where to start, meet with a professional who can guide you through a program to safely get you back to exercising.

SV: At Physical TheraPT, as many of our patients know, we love staying current on the latest innovations in exercise and rehab equipment. What’s your favorite product out there right now for pregnant patients?

KM: There’s been a lot of chatter about abdominal binding postpartum by a certain celebrity. Do your own research on what makes the most sense for your recovery; too much downward pressure following delivery isn’t always safe. Bao Bei Maternity offers physio-designed appropriate support garments for both during pregnancy and postpartum. Check them out at www.baobeimaternity.com or on instagram at @baobeimaternity

SV: Last question- what’s your go-to strategy for pain relief with this type of injury?

KM: Heat can be very helpful - whether a warm bath or a heating pad on the couch with your feet up, this is a great strategy for both pain relief and stress reduction.

Jump Into Prenatal Fitness

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The literature has shown exercise can decrease pain, improve function, and limit time off work due to pregnancy-related back and pelvic pain. In general, strengthening routines should focus on muscles of the back, core and pelvic floor. Bonus circuits can also include upper body strengthening in preparation to lifting and carrying your bundle of joy. Depending on your experience with exercise, you can choose between independent sweat sessions, or working one-on-one with a coach. Prenatal group exercise classes are recommended for individuals who find themselves needing modifications for greater than 50% of the class. But what if you feel too pregnant to exercise?

Enter water aerobics.  While the class may conjure images of senior citizens in shower caps, aquatic therapy is frequently used with patients who are pregnant. Being in the water up to chest level takes off 70% of your body weight. This can be extremely helpful for soon-to-be moms who are having painful back and pelvic girdle issues, allowing for exercise until they can tolerate more land therapy.

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A 2016 systematic review of literature, found strong evidence demonstrating benefit of combined aquatic and resistance for maternal cardiorespiratory fitness and prevention of urinary incontinence. Additionally, a 2011 study found that aquatic therapy is effective in reducing peripheral edema (swelling in the ankles and feet). 

Depending on your community, access to a pool may vary. Some health clubs and specialty physical therapy clinics offer individual and group classes depending on local health regulations. Your OB-GYN can be a great resource for other options. Just be sure to double-check with your primary medical team before jumping in the nearest lake!

Lumbo-Pelvic Pain: Part II

While lumbo-pelvic pain during pregnancy is common, it should not be normalized or ignored. Working with a clinician can help you identify what may be causing your pain, and develop a plan to help you feel better. Dr. Kathleen Melia shares suggestions on what you can start doing today, and how to plan for your recovery.

Lumbo-Pelvic Pain in Pregnancy

Whether you’d consider yourself an athlete or not, pregnancy is physically demanding! From start to finish, rapid changes to the female body can greatly impact biomechanics. Rehabilitative medicine and functional conditioning can have a positive impact on the journey.