Physical Therapy During Pregnancy: Safe Or Not?

Pregnancy is a physically demanding process that can cause back pain, hip pain, and pelvic girdle pain due to weight gain and hormonal changes. Physical therapy is an effective way to manage and prevent pain during pregnancy. It can also help with the recovery process after giving birth. While some treatments used by physical therapists, such as ultrasound or electric stimulation, are not suitable for pregnant women, other treatments such as stabilization exercises, posture correction, and manual therapy can help alleviate pain and discomfort. According to the American College of Obstetricians and Gynecologists (ACOG), pregnant women should exercise at least three times a week for 15 minutes per session, with a heart rate of 140 beats per minute.

Safe exercises for pregnant women

Staying active during pregnancy is highly beneficial for both mother and baby. It can help you maintain physical fitness, reduce back pain, manage symptoms of depression and anxiety, and improve postpartum recovery.

If you exercised before you became pregnant, it is usually safe to continue your activities during pregnancy, although you may need to modify or reduce the intensity of your workouts. If you are new to exercise, you can start with light-intensity physical activity.

Walking

Walking is a great low-impact workout that doesn't strain your joints and muscles. It is an excellent way to get the recommended amount of aerobic activity, which is at least 2.5 hours of moderate-intensity aerobic activity each week.

Swimming and Water Workouts

The water supports the weight of your growing baby, and moving against it helps keep your heart rate up. Swimming is also easy on your joints and muscles and is a good alternative if you experience lower back pain with other activities.

Riding a Stationary Bike

Riding a stationary bike is safer than riding a regular bicycle during pregnancy as you are less likely to fall.

Yoga and Pilates

Yoga and Pilates can help you improve flexibility, strength, and balance. Make sure to inform your instructor that you are pregnant so they can help you modify or avoid certain poses, such as lying on your belly or flat on your back after the first trimester. Some studios offer prenatal yoga and Pilates classes specifically designed for pregnant women.

Low-Impact Aerobics

Low-impact aerobics include activities such as walking, riding a stationary bike, and using an elliptical machine. They are safer than high-impact aerobics, where both feet leave the ground at the same time, such as running or jumping rope.

Strength Training

Strength training helps build muscle and strengthen bones. It is safe to work out with weights as long as they are not too heavy. Consult your healthcare provider about the appropriate weight for you.

Pelvic Floor Exercises

Pelvic floor exercises strengthen the muscles that come under great strain during pregnancy and childbirth. These exercises can help reduce or prevent stress incontinence, which is common during and after pregnancy.

Stomach-Strengthening Exercises

These exercises can help ease backache, a common issue during pregnancy. One example is the pelvic curl, which involves lying on your back with your knees bent and feet flat on the ground. You then tuck your pelvis and roll your spine off the floor, lifting it one vertebra at a time until you reach your shoulder blades.

Squats

Squats strengthen the muscles in your lower body, including the quads, glutes, and hamstrings. They can help protect your back by encouraging you to use your legs instead of your back when lifting.

Bicep Curls

Bicep curls with light weights can help you prepare your arms for lifting and holding your baby.

It is important to listen to your body and not overexert yourself. Consult your healthcare provider before starting any exercise program during pregnancy to ensure it is safe for you and your specific circumstances.

Benefits of physical therapy during pregnancy

Pregnancy is a time of great change for the body, with hormonal changes, structural adjustments, and increased physical demands. These changes can lead to pain and discomfort, and in some cases, even injuries. Physical therapy is a safe, natural way to relieve these aches and pains and improve bodily function. It can also help prepare the body for labour and delivery, and speed up postpartum recovery.

Pain Reduction

Physical therapy can help the body's muscles, tendons, ligaments, and other components function as they should, reducing pain sensations. It can be particularly effective in addressing back pain, which is experienced by 50-70% of pregnant women. This can be caused by a number of factors, including increased hormones, changes in the body's centre of gravity, weight gain, and a decline in posture.

Regain Muscle Strength

Physical therapy can help to strengthen abdominal muscles, which separate during pregnancy due to the pressure exerted on them. This condition is called Diastasis recti and can lead to symptoms such as a bulging or soft feeling near the belly button, visible coning of abdominal muscles, and difficulty with lifting objects or walking.

Easier Labor and Delivery

Physical therapy can increase strength and flexibility, making the process of labour and delivery smoother. It can also help prepare the body for the physically demanding event of delivering a baby, and certain exercises can assist with recovery after delivery.

Shortened Postpartum Recovery

Pregnant women who are breastfeeding undergo physical intensity similar to that experienced by marathon runners during a race. Physical therapy can support women during and after pregnancy, with muscle-training exercises, spinal realignment, and mobility and flexibility training to potentially shorten recovery time.

Reduce Pelvic Floor Dysfunction

Pelvic floor muscles support the bladder and reproductive organs, and during pregnancy, they stretch and weaken. Physical therapy can help tone these muscles, helping to regain function and reduce symptoms of dysfunction, such as problems fully emptying the bladder, discomfort in the tailbone, abdomen or pelvis, and pain during intercourse.

Enhance Sleep

Spinal alignments can help pregnant people rest in a more comfortable position, and exercise can also help relax the body and improve sleep quality.

Physical therapy for pain management

Pregnancy can be a painful experience for many women. The American Pregnancy Association reports that as many as 70% of women experience back pain during pregnancy. This is due to a variety of factors, including the effect of additional weight on the body's center of gravity, hormonal changes, and changes to the body's posture.

Physical therapy can be an effective way to help manage this pain and make pregnancy more comfortable. Physical therapists can help with back pain and other pregnancy-related pains by implementing treatment plans that address strength, flexibility, alignment, and posture. They will work with you on exercises during sessions and also send you home with exercises to do on your own.

Exercise During Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) recommends that women should exercise at least 3 times per week for 15 minutes per session, getting their heart rate up to 140 beats per minute. Suitable exercises include brisk walking, yoga, and swimming.

Women who exercised regularly before becoming pregnant may continue their current exercise regimen, as long as it does not include any contraindicated activities. It is recommended that women who perform high-intensity exercise regularly before pregnancy gradually decrease the activity intensity as the pregnancy progresses to reduce the chance of injury.

Manual/Passive Therapy

Joint mobilization or massage can ease a pregnant woman's discomfort. A physical therapist may recommend a sacroiliac (SI) belt to stabilize the lower back and provide back support.

Safety Guidelines for Exercise During Pregnancy

• Avoid the supine position for more than 3 minutes after the first trimester.
• If laying on the side, only lay on the left to avoid compression of the inferior vena cava.
• Avoid positions in which the buttocks are higher than the chest.
• Avoid strong abdominal compression/strain during the second and third trimesters.
• Avoid rapid bouncing or swinging.
• Avoid vigorous stretching of the adductors.
• Do not use deep heat/electro modalities.
• Avoid internal vaginal manual treatment.
• Do not overheat and make sure to drink plenty of fluids.
• Allow more time for warm-up and cool-down activities.
• Exercise in a temperature-controlled room (be careful with outdoor activities unless the weather is mild).
• Avoid contact sports or activities with a high risk of falling.

Physical therapy for urinary incontinence

Physical therapy is a safe and effective way to manage pain during pregnancy. It can also help to enhance your body's ability to have a smoother pregnancy and birth. It is a medically based profession specialising in pain relief by identifying and treating the causes of pain in each individual.

Pregnancy physical therapy can be useful for remedying common discomforts like back pain, pelvic pain, or nerve compression syndromes such as carpal tunnel, tendonitis, circulatory problems, spinal problems, and sacroiliac pain. It can also help to prevent long-term impairments in bowel and bladder function.

Pregnancy is the greatest risk factor for the future development of pelvic organ prolapse. 40% of women who have cesarean births report urinary incontinence. Urinary incontinence (UI) is a condition that often goes untreated due to embarrassment or the assumption that it is a normal part of postpartum or aging. UI affects up to 50% of women and up to 10% of men, yet less than half seek treatment.

UI is the involuntary leaking of urine. The most common symptom of UI is the involuntary leakage of urine, but other symptoms may include:

• Urgency (a strong need to urinate that cannot be delayed)
• Waking up at night to urinate
• Leakage with physical activity
• Leakage when coughing, laughing, or sneezing
• A feeling of pressure in the lower abdomen (which could be due to an organ prolapse)

The two primary types of UI are:

• Stress incontinence: Urine leaks when abdominal pressure increases, such as with coughing, sneezing, laughing, or exercising.
• Urge incontinence: Urine leaks due to an involuntary contraction of the bladder muscles.

UI can also be caused by a combination of both stress and urge incontinence.

The goal of physical therapy for urinary incontinence is to improve symptoms and quality of life by optimising the function of the pelvic floor. Treatment will be individualised based on specific needs and may include:

• Pelvic floor muscle exercises: These exercises help to strengthen the pelvic floor muscles and improve bladder control. Core and hip exercises will also be prescribed to encourage optimal muscle synergy.
• Bladder training: This involves gradually increasing the time between bathroom visits to help retrain the bladder muscles.
• Biofeedback: This is a type of pelvic floor muscle training that uses sensors to help you better understand and control your pelvic floor muscles.
• Education: You will be taught about UI, how to manage your symptoms, and what you can do to prevent issues in the future.
• Manual therapy: This may be used to release any tightness in the pelvic floor muscles or connective tissue.
• Functional training: This involves learning how to do everyday activities, such as lifting and coughing, without triggering UI symptoms.

Contraindications to physical therapy during pregnancy

Physical activity is considered safe and beneficial for pregnant women without contraindications to exercise. Contraindications to physical therapy during pregnancy are conditions where exercise is not recommended or where the risks of exercise may exceed the benefits. These contraindications can be divided into absolute and relative contraindications.

Absolute Contraindications

Absolute contraindications refer to conditions where exercise is not recommended. These include:

• Hemodynamically significant heart disease
• Restrictive lung disease
• Incompetent cervix or cerclage
• Multiple gestations at risk of premature labor
• Persistent second or third-trimester bleeding
• Placenta praevia after 26-28 weeks gestation
• Premature labor during the current pregnancy
• Preeclampsia or pregnancy-induced hypertension

Relative Contraindications

Relative contraindications refer to conditions where the risks of exercise may exceed the benefits. These include:

• Unevaluated maternal cardiac arrhythmia
• Poorly controlled type 1 diabetes mellitus
• Extreme morbid obesity
• Extreme underweight (BMI <12 kg/m²)
• History of an extremely sedentary lifestyle
• Intrauterine growth restriction during the current pregnancy
• Poorly controlled hypertension
• Orthopedic limitations
• Poorly controlled seizure disorder
• Poorly controlled hyperthyroidism

Frequently asked questions