A large percentage of changes in a woman’s body occur in the first trimester of pregnancy. A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart & respiratory rates and many other changes that may affect the body in different ways. The fluid volume increase, for example, can make the connective tissues weaker—our tendons can get a little more lax and the nerves and blood vessels a bit softer. This extra fluid and tissue weakening makes a woman more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome or sciatica.
The hormonal changes in pregnancy also play a role in ligamentous laxity. Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows and wrists. The musculoskeletal system is taxed by these changes even before the baby gets very big. Spinal problems can also occur from posture and center of gravity changes. Rib dysfunction can occur as the ribs are forced out and up to make room for the growing belly. Foot pain from falling arches from the sudden weight gain can also be bothersome for many women.
Specific problems in the pelvic girdle that can commonly manifest either during pregnancy or post partum can include:
- Tailbone pain
- Pubic symphysis or sacroiliac (SI) joint pain
- Pain with sexual intercourse
- Groin pain
- Urinary or fecal incontinence
- Pelvic organ prolapse
- Diastasis recti (separation of the rectus abdominis muscle)
Pelvic health physical therapists are specifically trained in women’s health issues and understand the pregnant and post partum body to effectively help pregnant women and new mothers navigate a path to health and strength in a safe way.
After an initial assessment, which often includes a thorough pelvic muscle exam, a treatment program will be developed which can include postural exercises, pelvic floor muscle retraining with biofeedback and bowel and bladder retraining. Soft tissue massage, strengthening and self-care techniques to limit stressors on the body will also be addressed.
Rectus diastasis is a normal separation that occurs between the right and left sides of your rectus abdominis muscle. The linea alba (a fibrous structure that runs down the middle of the rectus abdominis) widens and thins during pregnancy as the abdominal muscles and connective tissues are stretched out from the expanding uterus. This increased inner abdominal pressure from pregnancy and the pushing during delivery causes the rectus abdominis muscles to appear separated from each other. It is normal for this separation to occur, but if it remains too wide or too deep for too long after pregnancy, it can be difficult to use your abdominal muscles to create the core stability you need to lift/care for your children, clean house, do yard work or exercise.
If you are diagnosed with a diastasis recti, it has been shown that visceral mobilization is an effective way to resolve the separation by first loosening the connective tissue of the parietal peritoneum that lies below and is continuous with the linea alba. The parietal peritoneum surrounds your abdominal organs, bunches up together in two places (mesenteric roots) and then fans out around the small intestine. This “fan” is called the mesentery. When the connective tissue gets adhered or stuck to the mesenteric root or mesentery, no amount of abdominal exercises will unstick it. It is like trying to close a hole in pizza dough while someone is holding the crust parts to the edge of the pan. Visceral mobilization can unstick the connective tissue making it easier to bring the muscles together. Once this achieved, your therapist will begin the instruction of safe and effective abdominal/core exercises that will help you engage your core more effectively and pull the two sides of the muscle together. You will also be coached on how to engage your core during your activities of daily living in order to prevent separation.