Pre and Post Natal

At Active Steps Physiotherapy we take a keen interest in treating mum’s and mum-to-be to address the aches and pains that can go with being pregnant and all that comes later!  Having been through two pregnancies Kristen has experienced many of these ‘aches and pains’ and a whole lot more, both pre and post natal.

Pre-Natal

During this period the body is obviously going through some pretty major changes.  Some bodies breeze through with not an
ache or a pain, whilst others can develop back pain, ‘sciatic’ leg pain, pelvic pain, amongst many other things.  Sometimes its a grumble and sometimes it can be debilitating!  Much can be done to help alleviate these symptoms – from manual therapy (joint mobilisation and soft tissue releases), strapping/bracing, education about postural/relieving postures, stretches, gentle exercise, pelvic floor/core stability training. Active Steps Physiotherapy aims to minimise and manage your aches and pains so that you can enjoy your pregnancy and continue to be active and healthy throughout its duration!

Post-Natal

Whether you had a natural delivery or a C-section your post natal recovery is very important, but is often neglected as care of a newborn is often all consuming.  What women present with varies greatly in the post-natal period and this post-natal period can extend well past the first few months of the babies life.  Common presentations include;

Upper back and neck pain can be associated with:
  • poor feeding positions
    prolonged periods of sitting
    prolonged periods of standing holding/rocking/settling a baby
    breast changes (heavier/bigger/sorer) which changes the load through the upper back
    carrying/lifting a toddler (who can be quite heavy and wriggly)
Low back pain is a very common complaint and is often associated with:
  • poor prolonged/repeated sitting postures
    traumatised/neglected pelvic floor muscles which can affect ‘core’ stabilising muscle activation
    poor standing postures carrying/holding a baby (this often becomes even more of a problem over the months/years as the child gets heavier)
    bending into cots, loading baby capsules/wriggling toddlers into cars, lifting prams/bikes/scooter in and out of car boots
Pelvic pain, which can either be anterior or posterior. Accurate assessment is required to diagnose the cause as it could be associated with:
  • pubic symphysis dysfunction
    intra pelvic torsions or rotations
    poor lumbo
    pelvic stability associated with pelvic floor or core muscle weakness
    rectus diastasis
Upper limb pain is also very common because the arms are performing a lot of repeated/new tasks.  Common post natal conditions include:
  • carpal tunnel: is a condition where the median nerve becomes compressed as it passes through the wrist.  It is common during and after pregnancy and may be associated with hormones that result in fluid retention.  It could also be associated with the repeated movements performed by the wrist/hands associated with caring for a young child. Diagnosis, education and sometimes bracing is all part of the management of this condition
  • de Querveins/tenosynovitis: is an overuse injury, and is often associated with repeatedly lifting babies out of cots/prams and lifting their legs to change nappies.  Diagnosis is important as manual therapy and education about changing how tasks are performed are necessary to treat the condition. It is something that is likely to get worse without correct treatment. Sometimes bracing is needed
  • referred arm pain: holding babies for prolonged periods, especially in those who are ‘unsettled’ can mean the shoulder/arm muscles are working very hard over prolonged periods of time.  Like any muscle that works hard they can get tired and sore.  Soft tissue releases, heat, stretches and education can help immensely this is.

The changes the occur within the body during and after pregnancy can be dramatic for some. There can be a ‘lasting legacy’ that needs specific and focused rehab to restore pain free function.  Some people just want to be able to go for a walk without pain, some people want to return to the gym, and others aim to run a marathon! All is possible but if there are undiagnosed/untreated legacies of pregnancy/delivery then these aims may not be achieved.

Common conditions Kristen often sees in the months/years post delivery that impact on a mum’s return to activity include:

  • a rectus diastasis – these vary significantly in presentation and severity.  Its often the depth of the diastasis rather than the length that causes the problems.  A diastasis that affects the full depth of the rectus sheath can greatly impact the capacity of the ‘core’ muscles to generate enough tension to provide the required level of ‘core’ stability to the lumbo-pelvic area. This need specific diagnosis and management to minimise its impact.
  • poor pelvic floor strength – can affect someone’s core strength, or be creating incontinence issues, limiting someones confidence in participating in aerobic activity.  This weakness will not fix itself and needs very specific management.  Without treatment this problem is likely to deteriorate with time and create more issues as the person ages.
  • poor core strength – inappropriate activation or understanding of what core strength means results in ongoing weakness and dysfunction which can have detrimental effects on the body as a whole, but especially the lumbo-pelvic region
  • residual or untreated pelvic torsions/rotations – create create adaptive ‘twists’ throughout the body and vary considerably from person to person.  These are very amenable to manual therapy, strengthening/stretching and movement re-education.

Kristen is passionate about helping Mum’s and mums-to-be through whatever pregnancy or post-natal stage they may be in to achieve their physical goals, minimise their pain, maintain day to day function, and to enjoy their pregnancy/babies.  A lot of the time it is about the mum finally taking some time to focus on their health and their goals and addressing whatever the problem is that is preventing them achieving these goals.

Kristen has recently attended a level 1 Women’s health physiotherapy and continence course with all the latest information on the pre and post natal care of women.