Back pain? No core strength? Dr. Amanda Miller of Progress Physical Therapy – Midlothian offers advice to women on how physical therapy can enhance health – especially before, during and after pregnancy.
Q How can women strengthen their cores and prepare their bodies for pregnancy?
A Women planning to become pregnant should maximize deep core function, especially transverse abdominis, pelvic floor muscles and respiratory diaphragm. These muscles help support the back and pelvis, especially important during pregnancy. Weakness or tightness in this muscle group can lead to pain, weakness or urinary incontinence during pregnancy. Research shows women with pelvic floor asymmetry are more likely to have back and/or pelvic pain during pregnancy. I recommend an evaluation prior to pregnancy so exercises can begin before pregnancy makes increasing demands on these muscles.
Q How can physical therapy benefit pregnant mothers?
A Strength gains can be made during pregnancy. The first trimester is different for everybody; many of us feel tired and nauseous and that’s not necessarily the time to increase activity. Except for high-risk pregnancies, women should take the opportunity to feel better during the second trimester and work on gaining strength and mobility in the abdominals. Then in the third trimester, work on strategies to assist in labor and delivery to prevent tearing or long labor.
Q How soon should a mom be evaluated post-partum to detect issues like diastasis recti abdominis (DRA)?
A Usually, six weeks postpartum. If there’s any pelvic discomfort before that, an exam should be done earlier. Everyone gets a DRA during pregnancy. Diastasis is when the rectus abdominis (the six-pack muscles) separates and we lose tension at the linea alba. The linea alba is connective tissue between the muscles that stretch as our belly stretches, causing a diastasis. If this separation doesn’t correct on its own, and the abdominal wall can’t maintain tension with things such as getting out of bed, a physical therapist should evaluate.
Each pregnancy increases the incidence of DRA. I recommend evaluation by six weeks via personal assessment or a physical therapist. This can be corrected through exercise no matter when it’s addressed.
Q What are some common issues women experience that physical therapy helps?
A Urinary incontinence, pelvic organ prolapse, and pain with intercourse. In the U.S., elective hysterectomy is one of the most frequently performed procedures. Many surgeries could be prevented if women address pelvic floor muscles and transverse abdominis through physical therapy.
Q What are the signs of sexual dysfunction post-partum?
A It’s abnormal to experience sexual pain at any point in life. Pelvic floor or other dysfunction can lead to pain, susceptibility of UTI or chronic yeast infections, and cramping, and it can also affect sexual response. These can all be addressed in pelvic PT.
Q Can physical therapy improve back pain related to breastfeeding?
A The back pain common with breastfeeding is related to poor positioning while holding babies. PT can address this. Use pillows during nursing to support back, knees and arms. Try side lying nursing positions and placing a cushion at your low back. Stretch your chest wall and back after nursing
Q How does one get started with physical therapy?
A Consult your physician for a referral to PT to improve your physical health. Check your insurance; most providers cover direct access PT services for 30 days without prescription. Schedule an assessment with a specialized physical therapist such as Dr. Miller to complete a head-to-toe screening.
Dr. Amanda Miller is a Doctor of Physical Therapy, board certified women’s health clinical specialist, and owner of Progress Physical Therapy – Midlothian. She is guest lecturer at Virginia Commonwealth University in the Doctoral Physical Therapy program. She has been a practicing clinician specializing in abdominal and pelvic health for over 10 years. Her practice includes other pelvic health physical therapists and offers services including core wellness, prenatal care, post-partum care, massage therapy, cupping therapy, dry needling, annual wellness check-ups, specialized physical therapy services, biofeedback via ultrasound imaging and surface EMG and more. Although most of their clients are women, their services are open to men and children of all ages with lumbopelvic, urological, and gastrointestinal problems.
