Having lived through the pregnancies resultant in my two sons, it's easy to conclude that the human body is amazing. But you'd be wrong to make such a claim, at least on such specific grounds, because: A. humans are not the only species that gestate young, and: B. the males of the species certainly can't do this. So really, it's that the female body is capable of amazing things.
For a woman, I imagine that this period of amazement is often met with equal amounts of confusion. We the males bear witness to the visible changes and first hand accounts only. The females, however, get to experience all of the feelings associated with this 41.5 week adventure, both emotional and physical, and straight answers may not always be easy to find when things become strange or unfamiliar.
My name is Dr. Allan Buccola, physical therapist and owner of Impetus Physical Therapy in Greensboro, NC. In this blog post, I wanted to discuss some common problems women may experience either during pregnancy or postpartum, particularly in regards to things that physical therapy can address. I know so many mommies who accept these issues as par for the course, unaware that there are places to go to find solutions. Women's health issues need a louder voice, because help is right around the corner.
As a side note, this blog is intended to serve educational purposes only. Unless I have examined you personally, I am in no position to make medical recommendations to any individual. If you suspect you are experiencing one of the aforementioned problems below, please consult a healthcare professional who can assist you.
Pregnancy and back Pain
Let's just start out with the most obvious. As many people know, pregnancy can come standard with a more than fair share of back pain. For some women, this is experienced early on in the pregnancy as the hormone Relaxin peaks in the first trimester. Relaxin serves to soften the strong ligaments that hold the pelvis together, which puts greater load on postural muscles for support. For some women, this may cause no problems, but for others, mobility of the pelvic bones may become too great, causing painful sensations as joints shift into positions that are novel or unstable. Pelvic pain is often difficult to pinpoint, but often is experienced as deep aching in the pubic region or buttocks.
Other women may experience a different kind of back pain that comes later into the third trimester. This back pain is often more similar to back pain experienced in the general population, and often times is mediated by prolonged positioning of the thoracic and lumbar spine into excessive curvatures resultant from changes to the female body. As the baby grows and shifts moms center of mass forward, the lower back curvature increases, allowing the upper trunk to shift backward and provide counter balance. This posturing of the spine can be provocative, especially under chronic loading circumstances, but each person has their own tolerance.
Both of these types of back pain can respond well to conservative treatments offered by physical therapists. Often times, the goal is to retrain the muscular system to better respond to increased demand. This is a serious necessity as many joints in the body rely on strong ligamentous systems for innate stability, meaning that under normal circumstances muscular involvement is more critical for movement than stabilization. With sudden changes in joint mobility, muscles will need to work longer and harder to maintain joints in a stable, comfortable range.
A 2016 study surveying postpartum women about back and leg pain revealed that 1 in 5 experienced sciatica, however only about 80% of these women sought medical care. Their data also revealed that women with a college education were less likely to seek care for their back pain when compared to less educated women. Another interesting study from 2015 showed that women who regularly participated in high impact sports such as running, jogging, or ball sports, were 14% less likely to develop pelvic pain during their first pregnancy.
abdominal wall dysfunction
This category seems like a no-brainer, but I think this category covers a much wider variety of problems than you might imagine. As the fetus continues to grow and push mommy's belly out, the inner and outer abdominal muscle layers also expand which may manifest in a few different problems. The first one that comes to mind is a condition called diastasis recti.
If you can picture the quintessential 'six-pack' abs that you see at every grocery store check out, the one thing you often don't see is the linea alba. This thin line of connective tissue is what keeps those two vertical columns of the 'six pack' abs muscles help tightly together from left to right. In diastasis recti, the linea alba stretches or splits and these two columns of the abdominal begin to separate. This compromise of the abdominal wall can create core weakness that lingers far after parturition, and can lead to low back pain or limited functional strength.
Women at increased risk for diastasis recti are those who have multiple births, aged greater than 35, or have high birth weight babies. A 2015 study in the Journal of Orthopedic and Sports Physical Therapy revealed that different types of abdominal strengthening postpartum had opposite effects on this condition, so it is important to address it with a healthcare professional if suspected.
Changes to the pelvic floor muscle also fit into this category. If the human 'core' was a soda can, the pelvic floor would be the bottom of the can. As the abdomen moves in and out with breathing, the pelvic floor also moves to accommodate these volume changes. These muscles are also responsible for stabilization of the pelvis, lower back, and control of bladder and bowel function. When these muscles become out of balance during pregnancy, they can become a trigger for pelvic pain or urinary incontinence.
Postpartum urinary incontinence has been an embarrassing topic for many women and one difficult to broach with their health care providers. Equally so, dysfunction of these muscles postpartum can also result in bowel distress with increased straining. Fortunately, word continues to spread that this is a very common problem after pregnancy, and one that pelvic health specialist physical therapists are able to address through retraining of these muscle systems.
No, your feet are not growing during pregnancy, but many women will attest to changes in shoe size from beginning to end. As with changes in ligament laxity in the pelvis, the foot is another anatomical area that is held together especially tightly with ligaments. One study revealed that the hormonal effects and additional loading of pregnancy cause permanent collapse of the arches of the feet, resulting in perceived increase in foot length. Another study revealed that this effect is almost 50% higher in obese women than in non-obese women.
For some women, changes to the transverse arch of the forefoot also means wider feet. For many women this translates into moving up one to two shoe sizes. The evidence isn't clear as to whether increasing arch support would provide any prophylaxis, but it certainly could be an easy measure to potentially alleviate foot pain during pregnancy. Another option is also focusing on foot strengthening, but again there is insufficient evidence to say how effective this will be.
Regardless, be aware that this is a real phenomenon for many women and be sure to find shoes that fit well after these changes occur to prevent additional changes to the feet resultant of ill fitting shoes, such a bunions or hammer toes. This is especially important for women who expect to remain physically active in an athletic context. It might mean that your favorite running shoe is no longer 'cutting it' as you return to running with a new foot shape.
Likely a lesser known phenomenon is the increased prevalence for expecting mothers to experience high rates of certain types of hand and wrist pain. One 2014 study shows that as much as 67% of pregnant women exhibit sign of hand and wrist dysfunction such as tendinitis or carpal tunnel syndrome. This study found this high rate to be the same among women regardless of age, BMI, occupation, or number of previous pregnancies. These changes may persist after parturition and can detract from quality of life for new or expectant mothers.
I hope this post has helped to shed light on some commonly tolerated maladies than occur during and after pregnancy. The message I hope to send is that while your OB or midwife may or may not be fully aware of treatments for these issues, Physical Therapy can offer resolution and rehabilitation. No matter where you live, there is likely a specialist near you who is able to address your concerns and instill hope in the form of a solution. If you have any questions about any problems you might be experiencing or need a referral to a specialist, please contact me today for more information or for a free phone consultation.
Never stop moving!
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