Welcome

Welcome to the inaugural issue of Lessons for Health. We at Legacy Physical Therapy hope that you find the information useful. One area that I have a true passion for is working with pregnant women. Therefore, I thought it only fitting that the topics for this first issue all center around pregnancy and post-partum changes to the female body.

Carpe Diem

Brooke Kalisiak DPT

Postural Changes

Many biomechanical and postural changes occur during pregnancy as a result of having to accommodate a growing baby. Discomfort may result as your body adapts to these changes. Your spine will experience a forward pulling as your center of gravity shifts creating increased demand on the muscles of the lower back, upper back, and legs. Increased weight of breasts may cause rounded shoulders and forward head posture that may create pain in the upper back and neck. Because of this forward shift in the center of gravity, a pregnant woman may sit and stand with her shoulders rounded forward, lower back arched and knees hyperextended, all of which can cause discomfort.

A way to counteract this forward pull is to sit, stand, and sleep with proper posture. Concentrate on sitting and standing with your chin tucked to line your ears up with your shoulders and shoulder blades squeezed together, down, and back. When standing, keep your weight distributed equally between both feet, bend your knees slightly, tighten your abdominals and tuck your bottom to decrease the sway in the lower back. You can check out our "Pregnancy Positioning Tips" on our website to get good suggestions for proper posture while sleeping. Practicing good postural habits will help to decrease stress on your back and leg muscles.

Ligament Laxity

During pregnancy, your body releases a hormone called Relaxin. It circulates throughout the body loosening connective tissue, including ligaments, which connect bones and help support our joints. This increased laxity allows for expansion of the rib cage, making room for the growing fetus, as well as allowing the pelvis to expand in order for the baby to be delivered. You may continue to experience ligament laxity after pregnancy if you breast feed due to increased levels of the hormone progesterone.

This increased ligament laxity creates more mobility in the joints, primarily the pelvis. It is not uncommon to feel sharp pain or discomfort in your lower back, near your sacrum/buttocks, in your groin, or over the pubic bone. This problem can be corrected through physical therapy by properly aligning pelvic asymmetries and strengthening the muscles surrounding the pelvis to provide stability to the pelvis and spine.

Pelvic Floor Muscle Strengthening

The pelvic floor muscles are a hammock of several muscles at the base of our pelvis that support our pelvic organs. The pelvic floor muscles surround our vaginal, urethral, and anal openings. Contraction of these muscles causes these openings to close as seen when stopping the flow of urine. Throughout pregnancy the pelvic floor muscles must withstand a greater degree of pressure down onto them due to weight gain and continuous growth of the baby. During childbirth, the pelvic floor muscles are greatly overstretched and weakened. Increased pressure and weakness of the pelvic floor muscles may lead to incontinence. Many women are told that incontinence during pregnancy is normal; however, incontinence during any stage of life is NEVER normal. It is possible to prevent incontinence during pregnancy and after delivery by properly strengthening the pelvic floor muscles. A proper pelvic floor muscle contraction or "kegel" is to tighten and lift the pelvic floor, drawing in around the anal and vaginal openings. You should not hold your breath, squeeze your thighs together, or bear down. Most women have heard of a "kegel" exercise, but research has shown that the majority of women are doing pelvic floor muscle strengthening incorrectly.

Benefits of Pelvic Floor Muscle Strengthening
Helps support your growing uterus and other pelvic organs.
Helps withstand the downward pressure in the abdomen and pelvis during lifting, sneezing, coughing, and laughing.
May allow relaxation of the pelvic floor to become easier during childbirth due to increased control.
Helps improve perineal circulation to help decrease chance of hemorrhoids.
Helps decrease the chance of urinary stress incontinence or prolapse of pelvic organs.
Increases blood flow and may help an episiotomy or laceration heal faster.
May increase pleasure during sexual intercourse.

Pregnancy Exercising

The American College of Obstetrics and Gynecology (ACOG) guidelines in 2002 state that "in the absence of either medical or obstetrical complications, 30 minutes or more of moderate exercise on most, if not all, days of the week is recommended for pregnant women." Expectant mothers also decrease the risk of excessive weight gain, low back pain, varicose veins and water retention if exercise becomes part of their routine. Be sure to modify your exercise routine as you go through your pregnancy to adapt to changes in the body. For example, in the third trimester of pregnancy, your body has change in the center of gravity which may affect your balance. The most important part of exercise is to listen to your body. If you are feeling fatigue, pain or discomfort, stop the activity immediately.

Individualized Exercise Programs

An individualized exercise program can make pregnancy, delivery and recovery easier, safer, and more comfortable. The therapists at Legacy Physical Therapy can help you learn proper body mechanics to prevent back pain and adopt exercises to strengthen pelvic floor muscles. We would be happy to work with you to set up an appropriate exercise program for you during your pregnancy. Please contact us for a complimentary review of your current exercise program.