• Physical preparations for childbirth
• Pain relief measures during labor and post-partum
• Physical rehabilitation post-partum
• Proper endurance, muscle tone, and posture during the childbearing year

Prior to getting pregnant, it is important to exercise regularly, get fit, and maintain a healthy weight. A physical therapist can assist in finding appropriate exercises to target specific problems and treat nagging injuries before the added stress and weight of pregnancy. Two-thirds of pregnant women will experience back pain, which can worsen if you have a previous history. Addressing flexibility and strength deficits prior to pregnancy can make the experience much more comfortable.

Significant Physical Changes

After becoming pregnant, the body will undergo significant physical changes affecting the musculoskeletal system. These can include postural and hormonal changes and weight gain.

Posture changes include an increase in the lordosis, or curvature of your lumbar spine, and a forward shift of your head and neck. This shift of posture, combined with the weight of your belly, can lead to overuse of the muscles that extend your spine and hips and can strain the muscles that flex your ankles.

Hormonal changes that are integral to allow for widening of the pelvis during delivery can cause ligamentous laxity. This can make some positions uncomfortable, such as sitting or standing for an extended amount of time or rolling over in bed.

Weight gain puts increased stress on the spine and lower extremities and causes fluid retention that can compromise the space where nerves typically move freely. Both of these latter deficits, hormonal shifts and weight gain, contribute to a stress at the midline of the abdominal muscles called a diastasis recti. This separation, if not corrected, can lead to increased strain on the lower spine.

Physical therapists can provide patient education, exercise instruction, and hands-on manual therapy to address each of these concerns. Education focuses on proper posture and positioning to ease the stress or strain on ligaments and joints. PTs are the experts at proper fit and use of maternal supports that allow women to remain comfortable in both activity and rest. Finally, a physical therapist can provide hands-on treatment to address joint and muscular dysfunction during all stages of pregnancy.

Before and After Delivery

In preparation for delivery day, physical therapists can assist with appropriate labor and delivery positions that are specific to your dysfunctions. They can also assist through the use of biofeedback machines in finding relaxing positions for your pelvic floor that may provide an increased sense of comfort and control during delivery. Prior to delivery, physical therapists can provide instruction on correct pelvic floor contractions to minimize pain and maximize outcomes during this stage of recovery.

Following delivery, the focus shifts to healing the pelvic floor. Learning how to correctly identify and contract the pelvic floor prior to or soon after delivery can have positive effects in the early stages of healing. Even if you have had some tearing or an episiotomy, early contraction of the pelvic floor promotes quicker healing. It can also relieve congestion of the area and help alleviate tailbone pain. Most importantly, early return to exercise of the pelvic floor can reduce the risk of both urinary and fecal incontinence for years to come.

Pregnancy and childbirth is a magical time! Don't let your aches and pains get in the way. See a local physical therapist and find out what he or she can do to help you. Our PTs at Therapeutic Associates provide one-on-one evaluations and treatments designed specifically to fit your needs.

The reasons for back pain vary from person to person, but the majority of back pain concerns can be accounted for by one of the following reasons:

• an increase in hormones
• a change in the body's center of gravity
• gaining additional weight
• a decline in posture
• added stress

Over the last 40 years, the average age of women having their first child has risen from 21.4 to 25 years of age. Due to the fact that many women are juggling both the demands of pursuing higher education and the competitive nature of today's workforce, more women are having their first child after the age of thirty five.

As a result, many women becoming pregnant are less physically active in their daily lives. This decreased activity leaves an alarming number of women under-prepared for the strenuous journey of carrying and delivering a baby.

Physical Therapy for Relieving Pain

Women searching for ways to cope with this reality may be surprised to know that four of the above factors can be directly addressed with a proper physical therapy program. Physical therapy is a medically based profession specializing in pain relief. Physical therapists (PTs) work with individuals to develop a treatment plan to decrease pain by identifying and addressing its causes.

Though it varies from state to state, many don't require a doctor's referral or prescription to see a physical therapist. PT's can begin treating your pain on the first visit, so you walk out the door feeling better than when you walked in. Additionally, since physical therapy is a medically based profession, the services are covered by most medical insurance plans with limited out of pocket cost.

Treatment plans take a comprehensive approach by working on pain's typical triggers:

• posture
• joint alignment
• muscle strength
• flexibility
• nerve involvement

Additional weight, poor posture, stress and control of the center of gravity are not independent from one another. A change in your center of gravity affects your posture, which causes the muscles to work harder. Increased exertion creates fatigue, which leads to a decreased motivation to be active. The absence of an athletic release often results in increased stress.

Though it is difficult, this domino effect can be slowed greatly with the help of physical therapy.

Lower back pain is an all too common reality for many expecting mothers. As the uterus and baby grow, the mother's center of gravity moves forward. This shift increases the amount of force the muscles must generate for everyday support causing women to slump forward. Over time this poor alignment creates muscle tightness in the pectoral muscles, rolling the shoulders forward and creating increased stress on the muscles of the neck, shoulders and mid-back.

If these muscular factors are not addressed, these forces will ultimately be translated down to the low back, an area which is already under a great deal of stress because it is supporting the increased center of gravity.

Additionally, exercise increases physical endurance and muscle strength, especially in the hips, back and abdomen. Improving these areas can prepare the body for the physically demanding event of delivering a baby. Finally, therapeutic exercise during pregnancy can assist the recovery after the delivery.

It tones muscle which will improve metabolism, decrease the severity of fatigue, and assist in reclaiming your pre-pregnancy weight.

I thought physical therapy was limited to recovery after surgery?

There is a general impression that physical therapists are similar to personal trainers or only work with people after surgery or catastrophic injury. While that is a component of what physical therapists do, it does not entirely encompass the scope of the profession. As stated previously, physical therapy is a medically based profession specializing in pain relief by identifying and treating the causes of pain in each individual.

A good program will take both an active, exercise based approach, as well as a passive one. The ultimate goal is to educate the client so that they can be independent in their program and continue to treat themselves at their own convenience.

Home Exercises During Pregnancy

There are no guarantees, but it is fair to expect your pregnancy and labor to be easier and possibly even go quicker following any strength and flexibility enhancements. Although a few visits with your physical therapist is a good start, it is essential to incorporate home exercises into your physical therapy program.

Your physical therapist is going to provide you with specific exercises that target what you need to make your pregnancy easier and even healthier. You can also rest assured that your physical therapist will guide you through proper usage of these exercises so that you can reap the most benefits.

Tips for Choosing the Right Program

Today's expectant mothers have a wide variety of options to consider for prenatal care. The key is finding the appropriate program. Be wary of treatment programs that are passive, place increased stress on the joints and do not address muscle strength and flexibility with exercise.

Here is what you should look for in a physical therapy program:

• Managed by a certified professional
• Focused on building strength, increasing flexibility and improving posture
• Encompasses home based elements for you to do yourself
• Proactively looks for any weakness, which may become a problem later

Pregnancy is the ultimate strain on one's body. Physical therapy can intervene to lessen this strain. A proactive strength, flexibility and stabilization program can be beneficial in preventing or decreasing the intensity of painful symptoms, thus making your pregnancy experience a more positive one.