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Physical Therapy for Pregnancy, Postpartum and Beyond

Melissa H.
MELISSA H.
Physical Therapist
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Join physical therapist, Melissa Hines, for a Q&A focused on physical well-being during pregnancy, postpartum and beyond. Melissa is here to answer questions about physical health including pelvic pain, c-section recovery, returning to exercise after delivering, and more.

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MELISSA ADDED A NEW COMMENT!
Pelvic pain and hand numbness postpartum
JILL

Hello! I've been experiencing two issues since my daughter's birth on 2/26 (8 weeks ago) and I'm wondering if I should expect them to go away or do I need to see a doctor.

First issue is that I've been having pelvic pain whenever I lay on my side in bed. I had a lot of pelvic pain towards the end of my pregnancy as well, any time I stood up and often when walking. My baby was only 7lbs 15oz so not huge.

Second issue started after delivery. It started as pins and needles feeling in my right hand fingers. It changed to be numbness in the whole hand and a feeling inside like an elastic band getting stuck and then snapping when I rotate my wrist. I get the numbness in both hands now. It's worst at night, nursing the baby, showering and doing my hair.

Thanks for any info or advice!

Melissa
MELISSA

Hi Jill!

Pelvic pain is often the result of pelvic floor muscle dysfunction or tight muscles that lead to pelvic pain. It is VERY common for the pelvic floor muscles to become tight during pregnancy because they play a major role in supporting the baby, however, when they become too tight, they cause pain. The good news, is that pain can be decreased and eliminated with pelvic floor muscle release. I would definitely get an evaluation or treatment with a pelvic floor specialist who can release these muscles and give you some stabilization work. It is important to address the issues now to prevent any other issues from coming up specifically with bladder leakage, etc.

Sounds like the pins and needles in the right hand and fingers could be a carpal tunnel issue. You could try a wrist flexor stretch (google wrist flexor stretch) and hold for 30 seconds on both hands. Breastfeeding and holding your baby create a lot of tension throughout these muscles and causes them to become tight and compress the nerve that runs down your arm. A massage would also be SUPER helpful into your neck and shoulders.

Let me know if you have any questions!

Melissa
MELISSA

Also, make sure you are drinking plenty of water and staying hydrated. This can help with nerve pain. Magnesium cream is often helpful in calming down numbness and can be found at whole foods. Just apply it to the affected area. I can be reach at melissa@wellesthealth.com if you have any other information or would like a consultation.

JILL

Thank you so much Melissa! How would i find a pelvic floor specialist? Would I look for physical therapy?

Melissa
MELISSA

Yes a pelvic floor physical therapist. Are you located in Boston? I am located at 364 Boylston Street. Marathon Physical Therapy in Newton also has a couple of pelvic floor physical therapists. If you let me know what area you are in, I can send you some names!

Melissa
MELISSA

Here is a directory to help find a pelvic floor physical therapist in your area...https://hermanwallace.com/practitioner-directory

JILL

I'm in Southeastern CT, close to Norwich. New London is a half hour away also.

How to find a pelvic floor physical therapist in your area!
MELISSA

If you are looking for a pelvic floor physical therapist in your area, this is a great resource...https://hermanwallace.com/practitioner-directory
If you are in the Boston/New England area, please feel free to reach out to me at Wellest Integrative Health if you have any more questions about what you should be doing to prepare your body for delivery and post delivery recovery. It is a wonderful idea to see a pelvic floor PT who can evaluate you and give you the proper exercises/stretches needed.

MELISSA ADDED A NEW COMMENT!
Lower back pain post-partum
ROSANNA, PARENT OF 3 YEAR OLD

My son is has always been a heavy baby (currently 28lbs, 13months), making it difficult to carry him as well as pick up and put down (he still has to be rocked to sleep as he will not be put down in the crib awake). Even though I'm mindful of not straining my back, I often feel as if my posture is twisted and I get lower back pain frequently. It's especially bad if I have to partially bend down or if I'm sitting for a while or lying flat on my back. Is this something that physiotherapy could help me with? Are there any particular exercises I could do to help with this?

Melissa
MELISSA

Lifting 28 pounds is a lot of stress on your back and because of the position of carrying your son, it puts a lot of stress through the spine in a rotational way making it difficult to engage your abdominal muscles. Your core stabilizers are really important in stabilizing your back and are often on "sleep" mode after having a baby. Also, carrying your son involves hiking one hip up toward your ribcage which causes compression through your lower and mid back. Physical therapy targeted at your pelvis and stabilizing your pelvic floor through core stabilization will help to prevent these compressions on your spine. Proper body mechanics are making sure you are bending your knees, keeping your spine long, and engaging your abdominals by drawing your belly button to your spine like you are putting tight pants on. I would definitely evaluate your back with a pelvic floor PT as there are many things to do about this. Let me know if you have any further questions!

ROSANNA

Thank you! I will look into it.

MELISSA ADDED A NEW COMMENT!
Pilates & best excercise to burn baby fat
JESSICA

Hi! Is it ok if I do Pilates on a reformer? I'm 4 months pregnant.. until when? Is Crossfit recommended? Cycling?
Also, whats the best exercise to burn baby fat? How soon after giving birth can I start? Any other recommendations during and after to staying fit?

Melissa
MELISSA

Yes pilates reformer is great to do throughout pregnancy and also great for recovery after delivering. You can do it up to your due date as long as you are not having pain or any other issues. Cycling is okay as well but it may be helpful to monitor your heart rate. It can also be a lot of stress on your perineum/vaginal area when you get bigger. I would be cautious with cross fit unless you have an instructor who is very knowledgable about pregnancy. Most importantly, listen to your body and if something does not feel good, don't do it! Sounds like you are doing all the right things to stay fit.

MELISSA ADDED A NEW COMMENT!
Sciatica during pregnancy
MONIQUE

Hi Melissa, I'm 35 weeks pregnant. I had sciatica due to a workers comp related fall in 2015. My Saccral illiac joint puts pressure on my sciatic nerve. Plus I have pain due to L3 & L5. I've tried prenatal massage, chiropractic treatment, swimming, the normal hip/ lower back exercise(hip tilts, ball exercises, pelvic raises, stretches, heat (is excrutiating), cold (leaves me stiff), Tylenol only reduces it but not enough. I also use a body pillow to ease the hip/ lower back pain. Also I have acid reflux. Its super hard laying on my left side all the time to aid digestion as well as ease my right hip sciatic pain. I know the extra baby weight doesn't help but its becoming unbearable to sleep. On top of my little ones strong kicks. It feels like she is about to drop out of my... any minute ! Camomile knocks me out but only for a few hours. I'm in pain and don't sleep well because of it. Are there any other pregnancy approved therapy for sciatic pain and pelvic pain so I can gain more mobility, sleep better and not be so miserable?

Melissa
MELISSA

I would look for a pelvic floor physical therapist in your area that can address any instability in your pelvis. There is a muscle in your pelvic floor that can become compressed and reproduce symptoms similar to sciatic nerve pain. With pregnancy that area definitely gets stressed because of the added weight and the widening of your pelvis to make room for the baby. I pelvic floor physical therapist would be able to give you some ideas for sleep positioning, etc. Here is a good place to look for a practitioner...https://hermanwallace.com/practitioner-directory

MELISSA ADDED A NEW COMMENT!
Postpartum Pain
DANIELLE

I had a rather rough after delivery. I am 5.5 months postpartum and still have pain. I had a really bad tear - it was in a hard place to repair and I had 1.5-2 hours of stitches after birth, followed by a blood transfusion and things just haven't been the same. I have pain off and on and I know it takes the body time to heal but I wonder if I could be doing exercises to help heal? I am a runner and do weight lift three times a week. I also run three times a week. I push thru the pain. And advice?

Melissa
MELISSA

This is a really common complaint after any perineal tearing and stitches. The only way to work into that area is with direct pressure. I would definitely have a further consult to help address the scar tissue that the tear has caused. The sooner you get the scar tissue worked on, the better it will heal. Unfortunately, there really are no exercises that you can do to help it, the scar tissue simply needs to be broken up. Ideally, stitches take about 6 weeks to fully heal and it's more than likely the density of the scar tissue that is causing the pain. Good news, is a pelvic floor PT can help with addressing this issue. Please email me if you would like more info or consultation at melissa@wellesthealth.com

MELISSA ADDED A NEW COMMENT!
Sciatica
PAULA, PARENT OF 5 YEAR OLD

What types of physical activities can someone with sciatica perform without risking a flare up?

Melissa
MELISSA

It is tough to answer that question without evaluating you further. It really depends on where the sciatic nerve is getting impinged on what exercises will be helpful/detrimental. I would definitely use a tennis ball into your buttock area in order to help release the muscle. Find an area of tightness and use the tennis ball as direct pressure to help release it. Please email me if you have any questions or want a more in depth evaluation at melissa@wellesthealth.com.

MELISSA ADDED A NEW COMMENT!
Exercises for Diastasis Recti and Pelvic Floor
SAFIYYAH, PARENT OF 3 YEAR OLD

Hi! I would love to know if any exercises that are easy to describe here for strengthening abdominal muscles and pelvic floor. I gave birth 11 months ago. Thank you!

Melissa
MELISSA

It is hard to go over the diastasis recti corrections not in person to make sure you are doing them correctly, but below is a great link to some of the exercises that you can look at. One thing to note about a diastasis is you do not want to do any sit ups or core exercises where you are bending at your spine. This puts a lot of stress on the abdominal muscles and creates more of a diastasis. You want to start with the more basic exercises that you will see in the blog post below and then transition to more extension based exercises (planks/side planks, etc).

http://www.pelvicpainrehab.com/diastasis-recti/2306/fix-diastasis-recti/

MELISSA ADDED A NEW COMMENT!
Longterm postpartum SPD
SARAH, PARENT OF 3 YEAR OLD, 2 MONTH OLD

Hi there! I had SPD during my pregnancy and after delivery. I was extensively treated, including by a specialist physical therapist, and completed treatment about five months ago, when my daughter was 14 months. Do you have any recommendations for physical activities are are especially friendly to a still-somewhat-touchy pelvis?

Melissa
MELISSA

Hi Sarah,

For any pubic symphysis dysfunction, it is important to do exercises that are more symmetrical or linear in nature. I would check out gyrotonic or pilates reformer for more strength based work. I would stay away from any yoga or exercises where you are over stretching because it sounds like you have hypermobility (too much mobility) in your pelvis, causing the SPD. As for aerobic exercises, I would work on more symmetrical or linear exercises ie rowing on a rowing machine or recumbent bike because your pelvis is a little more stable. There are some stabilization exercises that you can do prior to exercising that help to make sure your pelvis is in proper alignment. This are inner and outer thigh squeezes which you are probably familiar with. Let me know if this helps answer your question!

MELISSA ADDED A NEW COMMENT!
Physical exercise
ALIN

Hi Melissa! How do I know if I can start doing exercise?

Melissa
MELISSA

Hi Alin! It is good to wait at least 6 weeks after delivery (vaginal/c-section) before starting exercise to allow your body to heal. If everything is feeling okay and you have been cleared, it is okay to start exercising. I would recommend starting with walking for aerobic exercise to ease into any exercise. It really depends on what your issues are after delivery that would prevent you from doing certain exercises. Hope this helps!