Physiotherapy can play a vital role in the prevention and management of the physical discomforts and problems that can arise from the way in which the body adapts and changes during pregnancy and after childbirth.

Hormonal changes, altered body shape and weight increase can place abnormal loading stresses on parts of a woman's body, which can lead to significant discomfort and altered function, with even basic tasks such as sitting and walking.

Common physical problems experienced during pregnancy:

• Low back pain – Caused by increased inward curve (lordosis) of the lumbar spine as the body's centre of gravity moves forwards as the weight of the baby increases. Muscular effort in order to support this change can increase in the large muscles either side of the spine leading to muscle tightness and aching. The change to the curve of the lumbar spine can cause aggravation of the joints of the lower back. Hormonal changes (release of relaxin) also mean that ligaments become slightly 'looser' than before, leading to general joint instability which can affect the way in which the spine moves and is supported during activity. As your bump grows, the abdominal muscles and pelvic floor muscles stretch, leading to reduced support of the spinal column which can increase abnormal stresses in the lower back and cause pain.

• Sacroiliac Joint pain and Symphysis Pubis Pain – Widening of the pelvic occurs in order to accommodate the growing baby. This is assisted by the presence of relaxin, one of the hormones released during pregnancy. This hormone affects the ligaments around the pelvis allowing the sacroiliac joints (at the back) and the symphysis pubis (at the front) to effectively loosen to accommodate the widening and to prepare for labour. This can cause a relative instability of these joints leading to pain in these areas. Favouring one leg during activity, leaning on one leg more when standing and crossing your legs when sitting can aggravate this problem.

• Thoracic pain – Pain around the shoulder blades and the mid back can result from the widening of the rib cage as the baby grows, and also from incorrect postures in response to the changing shape and weight of the body.

• Rectus Diastasis – As the abdominal muscle wall stretches throughout pregnancy, the rectus abdominis muscle can separate into right and left halves due to the growing uterus beneath. This can occur to varying degrees and is not usually a painful presentation. Strenuous abdominal exercises during pregnancy can increase the size of the abdominal separation and therefore should be avoided. No treatment is necessary whilst you are pregnant, but specific exercises post pregnancy can help to bring the muscle back together.

• Bladder leakage – Approximately one third of pregnant ladies can experience bladder leakage at any stage during their pregnancy. When you laugh, cough, sneeze or run, the pressure inside your tummy and around your bladder increases. This pressure squeezes your bladder. Normally, your pelvic floor muscles help to close off the bottom of your bladder. If these muscles are weak or can't squeeze fully, they can't do this job, causing leakage or 'stress incontinence'. During pregnancy, hormonal changes and increasing stretching through the pelvic muscles can lead to bladder leakage, and in some cases may continue after childbirth as the muscles remain weak and overstretched. Pelvic floor exercises, if done regularly, can reduce the risk of this happening.

• Carpal Tunnel Problems – Fluid retention and swelling during pregnancy can increase the pressure in the carpal tunnel of the hands causing compression of the medial nerve. Symptoms can include numbness, tingling, pain or a dull ache in the fingers, hand and wrist and even up to the arm or the shoulder. Both hands are often affected and can appear at any time throughout your pregnancy but most common during the second-third trimester when fluid retention is greater. Symptoms usually clear after childbirth.

• Morning Sickness – Nausea and/or vomiting associated with pregnancy can affect more than 50% of pregnant women. Sometimes it is present in the early hours of the morning and can reduce as the day progresses, but it can also persist for much of the day. It can vary between mild feelings of nausea to actual vomiting which may, in the severest of cases cause dehydration, weight loss and metabolic imbalances. Morning sickness can be one of the first signs/symptoms of pregnancy and usually begins around the 6^th week. For most women, it may cease at about week 12 of pregnancy, though may continue after that period. The cause is thought to be linked to changing hormone levels which do not settle until the placenta takes over the job of nourishing your baby at around 12-14 weeks.

Common post-natal physical problems:

Post-natally, back and pelvic problems can continue due to the soft tissue and joint changes that have occurred during pregnancy, and due to the continued presence of relaxin in the body during the post-delivery period and whilst breast feeding. Postures adopted by new mums when picking up their baby, leaning over to change nappies and when breast feeding can contribute to the incidence of joint and muscular pains following childbirth.

Bladder leakage can also persist after childbirth due to the weakening and stretching of the pelvic floor muscles during pregnancy and labour. Both Caesarian section and vaginal deliveries can significantly weaken the pelvic floor muscles and this, coupled with the stretching of this muscle group that occurs during pregnancy can cause the pelvic floor to struggle to 'fire-up' and contract following delivery, leading to persistent lower back pain, sacro-iliac joint dysfunction and urinary stress incontinence.

How can physiotherapy help new mums and mums-to-be?

• Advice and education on issues such as posture, back care, lifting and carrying your baby, and on how the body changes both during and after pregnancy.
• Alleviate joint pains for example, back and pelvic pains associated with pregnancy and following childbirth, using a core stability training programme designed to help support the spine and other joints.
• Massage/soft tissue release for tight and overactive muscles, particularly around the spine, in response to the altered body shape and abdominal weakening.
• Pelvic floor strengthening to help give support to the uterus, help with bladder leakage, and facilitate an easier labour experience (yes, it's true!).
• Alleviate morning sickness using safe and effective acupuncture techniques
• Provide speedier post-labour recovery by assisting with muscle and joint recovery (as described above) but also by facilitating weight loss post-pregnancy and ensuring a safe and timely return to sports and hobbies.

  

The importance of pelvic floor muscles:

What are they?

The pelvic floor is a group of muscles that works like a 'sling', running from the coccyx at the back, between the legs through to the pubic bone at the front of the pelvis. They are deep, internal muscles that sit in the basin of your lower pelvis and support and brace the bladder, bowel and uterus from below. They also work together with the deep abdominal muscles protecting the spine (like a corset).

During pregnancy:

The increasing weight and pressure of the growing baby, along with the release of the hormone relaxin , contribute to the overstretching of these muscles and the result can be reduced pelvic and spinal stability and bladder leakage (urinary stress incontinence).

Post pregnancy:

This muscle group can remain overstretched and inactive and therefore provides little support to the spinal column, pelvic joints or the bladder.

It is important to commence pelvic floor exercises as soon as you discover that you are pregnant in order to maintain as much strength as possible throughout your pregnancy. It has been proven that a stronger pelvic floor reduces the risk of joint pains and stress incontinence, but also facilitates a stronger and speedier labour!

Physiotherapy can help to provide a healthier and more enjoyable pregnancy experience a safe and speedy return to 'normal' so that you can enjoy your baby and your experience as a ne

w mum.

At PEAK Physiotherapy we can teach you how to activate the important pelvic floor muscles and individually design a core stability programme that can improve your pregnancy experience and help you get back to the activities you love following the birth of your child.

We are experienced in educating new mums and mums-to-be about what to expect as their bodies continually change throughout their pregnancy, and can advise how to deal with any physical problems as they arise.

Often, the specifics of ante and post-natal musculoskeletal (MSK) changes are not taught as part of your routine ante and post-natal classes. Physiotherapists are highly trained MSK professionals with in-depth knowledge and skills to address MSK issues as they arise during and after pregnancy.

Call us to enquire about how we can help you to enjoy a more comfortable pregnancy and an active life as a new mum! For further information regarding our ante and post-natal services, please click here or telephone Cathy Preston on 07908 684440 or Sarah Joice on 07908 684441.