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Ask the PT: Physical Therapy as Part of the Postpartum Process

Posted by on Jul 25, 2017

When I was pregnant with my first child my husband and I took a class. Not a birth class – but a “What do I do with the baby once I get home?” kind of class. I had spent over a decade working with pregnant and postpartum women as my PT clients. I had spent years working with one of the most skilled birth professionals I know. I had read and talked about pregnancy and birth.  Taken pre-natal yoga classes. I felt educated – to some degree – about the “before” part.  But I honestly didn’t really have any experience with kids. Or babies. I was well into my 30s and my son’s diaper was the first I’d ever changed.

In the physical realm, a similar discrepancy exists between a plethora of options for prenatal care but limited knowledge of the options for postpartum issues. There is advice to stay active during pregnancy and many opportunities for prenatal exercise; prenatal versions of pilates, yoga, barre.  But after the baby… Most of the guidance for women is to rest for the first few weeks after the baby is born and at a six week check up she is given the go-ahead to resume exercise and sex provided there are no major issues. And this advice isn’t necessarily wrong.  Or bad.  It is vague. But OBs and midwives aren’t exercise and movement specialists.  It’s not their role to talk about a return to run plan, body mechanics when holding, wearing or feeding a baby, why sex may be painful and what can be done about it. But guess whose role it is? Your physical therapist’s.  

Postpartum PT isn’t just pelvic floor PT. And if you don’t know what pelvic floor PT is – more on that later in this post. (And for more reading see these Evolution blog posts): 

5 Myths About the Pelvic Floor
Ask the PT: The Poop Scoop

Sure, a postpartum PT visit could include both external or internal assessment of the pelvic floor to identify its role in hip, back, or pelvic pain, incontinence, or dyspareunia (pain with intercourse – yeah there’s a name for it!). Postpartum PT can also include posture assessment – assessing how your feed your baby, how you wear your baby in the many variety of baby carriers that exist, how you carry around those non-ergonomically designed car seats – and your therapist can teach you how to do these important activities in a safer way with less pain or discomfort. These activities often lead to neck and upper back pain a common report among new moms and PT can help.

The presence of a diastasis recti is another common postpartum concern. This is the separation of the two sides of the rectus abdominis muscle (a.k.a the “six-pack muscle) that runs from your ribs and sternum down to your pubic symphysis. A diastasis is actually more common than not during pregnancy and,depending on its size, isn’t a major concern when it is still present in the few days and weeks after birth. But there are movements that moms can do that will aggravate or worsen this and many of them are performed with common “Get my abs back” exercise programs. Your PT can assess for a diastasis, give you information, exercises, and techniques for closing it and show you what to avoid.

Between lifting and holding your new baby, fastening tiny snaps and buttons, and carrying car seats around wrist pain is another common report among new moms. Often described incorrectly as “carpal tunnel,” wrist pain is often an irritation of the tendons or muscle strain.  Your PT can assess this area, identify the true cause and help you to manage these aggravating symptoms.

What may be the most important and least talked about postpartum issue is the impact of pregnancy and birth on the pelvic floor. And this includes moms who have had a cesarean birth, especially if it followed a long labor. Pelvic floor symptoms can include incontinence of bladder or bowels, pelvic pain, or a feeling that your vagina or other abdominal organs are falling down.  Pelvic floor issues can also be contributing to hip and back pain. These symptoms are extremely prevalent but are also a bit taboo even in a seemingly open environment. Some moms may have heard horror stories and feel that their little bit of leaking is “no big deal” and not bother seeing a PT. Others may not realize that pelvic health PTs treat this area and that seeing a PT for pain during sex is an option. Your pelvic health PT will be able to assess the area, identify what exercises you should do and teach you how to do them correctly.

Finding the right PT for pelvic health issues is important. Not all PTs have done advanced training on pelvic floor assessment. Why this incredibly important area of the body and set of muscles is glossed over in most PT schools is another topic but for now if you are having specific pelvic floor symptoms, it’s important to find a PT with advanced training in assessment and treatment of the pelvic floor. At Evolution we have four Physical therapists who have completed this training and are actively seeing patients for pelvic health concerns.

The postpartum time is filled with so much newness that seeking help for your concerns is often put on the back burner and unless someone is vocal about their struggles, most providers don’t recommend PT. Talk to your care provider at your first postpartum visit about any issues you may be dealing with. Addressing any issue early on is always better and more effective than waiting until you are in crisis mode. Pregnancy and birth are such dramatic and different experiences – every mom should receive PT postpartum.

– Alison Aiken PT, DPT, CYT

Physical therapy is covered by insurance. Call Evolution to schedule your New Mom Consult:  864-9642.