This is a guest post by a physical therapist who specializes in postpartum issues. It’s perfect timing because I just got back from the Spinning Babies Conference in Minnesota, where I learned all about the pelvis and bodywork! I can’t wait to share some of the things I learned with my birth class clients. For now, Kelsey makes a great point about an often-overlooked aspect of postpartum recovery and experience. You don’t have to be in pain!!
The Importance of Physical Therapy for Postpartum
I’ve been a doctor of physical therapy for 9 years. I couldn’t help but notice a growing trend among my patients with complaints of low back and/or lower extremity pain. A majority of them were women with young children, and they all had similar areas of dysfunction. I know many of these injuries could have been prevented if these patients recieved physical therapy after childbirth.
I started to wonder: why is it that an ankle sprain is commonly treated with a brace and physical therapy, but a recovering postpartum patient with significant orthopedic issues is not?
You might be wondering what those significant orthopedic issues are. To begin, as our bellies expand – our center of gravity shifts forward. We develop an increased curvature in our lumbar spine and an anterior tilt of our pelvis. Our ligaments that stabilize our spine and pelvis stretch out in preparation for childbirth. Our core and abdominal muscles are elongated and sometimes even separated. What exactly does all of this mean? It means that our spine and pelvis are carrying around extra weight in poor alignment and with less support. This makes it very easy for our vertebrae and sacroiliac joints to rotate or shift into a poor position. Mechanically, this can cause problems anywhere from our neck to our feet due to the myofascial and joint connections.
Now let’s consider the additional effects of childbirth. A vaginal delivery will result in straining or tearing of the pelvic floor muscles and can cause significant muscle weakness. This can not only lead to incontinence issues, but also decreased stability of our spine and pelvis. In addition, the coccyx passively extends up to 40 degrees during delivery, and can get stuck extended or rotated as the baby exits the pelvis. This can be a source of tailbone pain and contribute to pelvic floor weakness. With this in mind, our pelvic floor muscles attach to our tailbone. Thus, any alignment or mobility issue of the coccyx will alter the length-tension relationship of the pelvic floor muscles and can be a source of muscle inhibition.
A cesarean section actually cuts through the lower abdominal muscles which only further contributes to core weakness. In addition, scar tissue in the lower abdominal region can actually pull on our lumbar spine and hips, and be a source of mobility restriction. To make matters worse, these patients are now responsible for lifting and carrying their growing babies – often with poor posture and body mechanics. It’s no wonder why many of these patients end up with significant orthopedic injuries in the months to years following pregnancy. In my experience, these issues continue to worsen with each subsequent pregnancy.
Obviously, not every woman who has a baby will end up with an injury. There are many factors that contribute to a healthy recovery – including the strength of our core and pelvic floor muscles prior to pregnancy, no previous back injury, and an uncomplicated delivery. But, research has shown that 43% of women have complaints of low back pain at 6 weeks postpartum, and 42% of women have these same complaints at 6 months postpartum. What does this mean? It means that these issues will not simply resolve themselves or get better with time. In my experience, they only get worse. Women with low back or pelvic pain are also at an increased risk for postpartum depression. For all of these reasons, I think it’s time to change the way our healthcare system treats postpartum recovery.
In an ideal world, every postpartum woman would be set up with at least one physical therapy visit to learn how to effectively contract their core and pelvic floor muscles, self scar massage if needed, and correct body mechanics for lifting and carrying their babies. At a minimum, I think doctors should at least ask their patients at their six week follow-up if they are still experiencing low back or pelvic pain. If so, these patients would significantly benefit from a referral to a physical therapist that specializes in treating spine and pelvic dysfunction. This simple step could have a profound impact on the future health and mobility of these new moms.
Kelsey Vagnoni graduated with her Doctorate of Physical Therapy Degree from the University of Delaware in 2007. Since that time, she has taken over 400 hours of continuing education to further enhance her manual therapy skills. After suffering from her own episode of severe low back pain after the birth of her son in October 2015, and not being able to leave her infant son to get help for herself – she had an idea for a business that offers in-home appointments and flexible scheduling. Thus, Personalized Physical Therapy was created.