The challenges of pregnancy on a women are unique to her and often come with minimal understanding. In a recent study of 569 women, it was estimated that 42% of women will have low back pain and 34% will have some type health d pelvic girdle pain.

That alone points to the need for physical therapy interventions at an early time frame. Evidence also suggested however that these physical changes will most likely begin to occur by week 15 during pregnancy.

Knowing the signs to look for and understanding that early intervention is highly successful is key to a women’s long-term health. Prevention is paramount to attaining and maintaining your physical health during and after baby.

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These are some of the most common physical signs and changes that need your attention and intervention before and after baby. It doesn’t matter how long it’s been since your baby, check to see if you have any of them.

1. Low back pain

It is the most common pain women describe during pregnancy and after her baby is born. The increased structural load to the system disrupts normal upright posture and this strains the back. Also due to so many hormonal changes a women becomes exhausted and fatigued as she is often not sleeping well at night either, especially if she is breast feeding.

A Coccyx strain with resulting pain can often occur as well during pregnancy due to the heavy load in the floor, but it is esp common during labor and delivery when prolonged pushing occurs, especially with bigger babies and can occur also with fast childbirth experiences where the transition happens quickly. Often when this occurs, women are unable to sit very well, go from a sit to stand position without pain or they are unable to do prolonged standing due to pain there. This can occur acutely after delivery or can last for years if the coccyx had a severe trauma to it.

2. Pelvic girdle or pelvic floor pain

This is the second most common complaint. The pubic symphysis is at the front of the pelvic girdle snd it separates due to the hormone relaxin to make room for the growing baby and to prepare for delivery.

The Sacro-iliac joint in the back of the pelvis has large ligaments that will often soften as well due to increased hormones and the sacrum and ilium will often become unstable esp during walking, rolling over in bed and with sit to stand. Often during pregnancy a pelvic girdle belt is needed if the instability is interrupting your normal lifestyle at home and work. Tight hip muscles can also be the culprit as well so these need to be addressed as well.

3. Abdominal weakness

The abdominal muscles are one of the 4 pillars of the “core” muscles ans without them functioning well we are unselect I love well. It is possible that a diastasis Rectus can occur due to the hormone changes as these hormones create laxity of the abdominal tissue.

There is also the possibility of an abdominal hernia due to weakening of the tissue. This can look like a vine shaped structure or a pooching of tissue that occurs with movement.
A C-section scar line can disrupt abdominal function as well, creating a downward pull on abdominal muscles, instead of upward lift. Scar tissue needs to be addressed and mobilized after labor and delivery to restore normal movement patterns in the core trunk especially.

4. Diaphragmatic breathing issues

As the baby is growing the ability to do deep breathing due is limited due to the abdominal and pelvic cavity space constraints. We need our ability to breath deeply even during pregnancy as the the diaphragm and the pelvic floor work together in the core. If the diaphragm dies not work properly neither will the pelvic floor.

They are directly related if one is strong they both are strong if one is weak they both are weak.
Often as baby grows we tend to breath up high only in the chest and neck region. This tends to create tightness in our neck and chest wall. Learn to breath down into your lower lateral ribs and use your hand over this area of your ribs to feel the air expanding your ribs there with your breath.

5. Pelvic Floor Trauma during pregnancy and or during labor and delivery

If you have had to have an episiotomy, forcep and/or vacuum assisted labor and delivery it is evidenced that this alone can disrupt the floors neural and muscular integrity. Please have your pelvic floor checked to ensure that it’s muscles are functioning properly.

Large babies, excessive hormones that cause decreased peristalsis and straining during bowel movements along with excessive pushing during labor and delivery can cause external and internal hemorrhoids and bowel constipation. During pregnancy drink more water and eat more soluble fiber to help. Exercise increases blood flow and decreases constipation.

Pudendal nerve irritation or damage can occur as well during pregnancy or following baby due to pressure and compression on the nerve directly, tightening of muscles and/or fascial tissue in the region due to body changes, decreased blood flow to region due to baby size and sustained pressure or trauma during labor and delivery on the nerve itself. Numbness and tingling or poor sensation in the pelvic floor itself can occur. This needs to be addressed quickly to avoid long term damage.

6. Urinary incontinence

This happens often as the baby is growing during pregnancy because the pressure is increasing in the abdominal cavity. Leaking is the most common with activities where there in a quick change of position. This means the front part of the floor is weak and not communicating with the abdominal and other “core” muscles correctly. This should be addressed quickly during pregnancy and afterwards to mitigate long-term health issues.

7. Hip and knee pain

Due to the increased structural load to the hips and knees during pregnancy, along with the increase in hormones, the ligaments and cartilage of the hips and knees soften and are more lax overall. This causes pain with squatting, stooping, descending stairs, kneeling and athletic activities. Often the hip flexors and piriformis are too tight along with the IT band and the antagonist muscles are too weak and need to be strengthened.

8. Pelvic Organ Prolapse

This occurs when the pelvic floor muscles and the surrounding fascial and connective tissue become weakened during pregnancy and then can become damaged during labor and delivery if there is sustained pushing that occurs. The Pelvic organs will fall down inferiorly and begin to push into the vaginal canal. The bladder and the rectum due this most commonly, but there can be vaginal or urethral tube dropping as well. Your OB/ GYN most often will use Grades 1-4 to describe these changes and physical therapy intervention is needed immediately if you are a Grade 1 and 2. Often if you are a three or higher surgical intervention is necessary.

9. Emotional changes

The flood of hormones for a women can cause many feelings during pregnancy and particularly afterwards. The brains system is being rewired and this is the time to ask for help from your loved ones. Please do not do this time alone. Enlist family, friends and care givers such as doulas etc to be part of your tribe. Depression, anxiety and the “baby blues” are real things and need to be addressed, quickly. Please ask for help! We are here for you as a Support in motherhood.

10. Neck, upper back and shoulder pain along with carpal tunnel

During pregnancy the physical changes in the abdomen and pelvic region directly affect the rest of the spine. Due to the instability that often occurs in the low back and pelvic girdle, the upper back, neck and shoulders often become stiff and the muscles tighten in response. The neck, upper back and shoulders muscles will need daily stretching. Cat and cow, neck rotation with chin nods and child pose with side bending and rotation reach can help.
Excess fluid retention can cause swelling around the carpal nerve and compress it in the tunnel thereby increasing numbness and tingling. Often this occurs at night while sleeping, but some women will have it t/o the day as well. Stretching these areas is important t/o these time frames, as well as strengthening the core postural muscles.

11. Abdominal bloating, swelling in the legs and arms and varicose veins

Changes in the vascular system is immense during pregnancy and the system then has to adapt after baby as well. Make sure to exercise daily, walking is esp beneficial to keep the system working correctly and to minimize the likelihood of excess swelling t/o the body. Also daily strengthening exercises activates the muscle pump around the blood vessels and this facilitates vascular health.

12. Breast Mastitis

This can occur whether you breast feed or not. It’s most common during breast feeding when a milk duct becomes clogged. Infection can then set in in the breast and it will become red, hot and swollen and lumps will often occur. See your MD immediately as you will need antibiotics if you have a fever.

Please come see us during pregnancy and afterwards as we specialize in women’s health.

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Sheree DiBiase, PT is the owner of Lake City Physical Therapy and she and her incredible staff look forward to taking care of you during and after baby. It’s never to late to make a change. Please come see us at our Hayden (208)762-2100, Cda (208)667-1988, Post Falls (208) 457-3435, Spokane Valley (509)891-2623.