Pregnancy, labor and delivery are life-altering experiences, and they have significant effects on a patient’s body. Many people who give birth experience a wide range of postpartum symptoms, such as pelvic girdle pain, low back pain and urinary incontinence. These symptoms cause significant discomfort, and thus effective physical therapy is an important part of improving quality of life after pregnancy.
A 2013 systematic review explored how effective physical therapy is in treating patients with postpartum pelvic girdle pain.1 Many people experience both low back pain and pelvic girdle pain during pregnancy, and typically these complaints resolve within 6 months after.1 However, for a percentage of patients, the pain persists for many years, and prior to this review there was a knowledge gap in how this type of pain after pregnancy runs its course.1 This review specifically looked at physical therapy that used stabilizing exercises, which theoretically help improve pelvic girdle and low back pain by strengthening spinal muscles.1 They found that stabilizing exercises had the most positive effect on patients with pelvic girdle pain over lower back pain, particularly with individualized programs and one-on-one guidance, both by direct strengthening as well as indirectly by increasing adherence to a treatment program.1 A similar study looked at how pelvic floor PT improved outcomes for patients with low back pain and/or pain in the SI joints.3 They used biofeedback with a pelvic floor stability rehabilitation program for -for patients with lumbopelvic pain after pregnancy, and they found that these patients had better outcomes in pain intensity, functional performance, and quality of life when compared to the control group.3 They particularly found that strengthening of the transverse rectus abdominis reduced strain on the ligaments in the pelvic ring, resulting in decreased pain.3 However, one thing to note is that many people have anatomic variations in these muscles, and so several factors can affect how much benefit patients receive.3
Another common complaint that causes a significant detriment to quality of life in patients after pregnancy is urinary incontinence, which may also be improved through physical therapy. A 2020 study looked at how pelvic floor PT, guided by a physical therapist, improved incontinence for first-time mothers.2 The experimental group began a 12-week program at 9 weeks postpartum and were assessed at 6 months and 12 months after completing treatment.2 When compared to the control group, who received no pelvic floor PT guidance after the initial evaluation, the patients who underwent pelvic floor PT had significantly lower rates of urinary incontinence and related bothersome symptoms.2 These improvements were still seen a year out from completing PT, and pelvic floor strength and endurance were also improved.2 This study shows that patients experiencing postpartum urinary incontinence can benefit from pelvic floor physical therapy in both the short and the long term.2
Many changes occur postpartum, both in terms of lifestyle and to the body, and it is important to have evidence-based treatments to improve quality of life during this time. Physical therapy, particularly stabilizing and pelvic floor therapy, has been shown to help with pain and other related symptoms after pregnancy.
References
- Ferreira CWS and Alburquerque-Sendi F. Effectiveness of physical therapy for pregnancy-related low back pain and/or pelvic pain after delivery: a systematic review. An International Journal of Physical Therapy, 2013; 6: 419-431. DOI: 10.3109/09593985.2012.748114
- Sigurdardottir T, Steingrimsdottir T, Geirsson R, Halldorsson TI, Aspelund T, Bo K. Can postpartum pelvic floor muscle training reduce urinary and anal incontinence? An assessor-blinded randomized control trial. American Journal of Obstetrics and Gynecology, 2020; 222(3): 247-255. PMID: 31526791
- Wang H, Feng X, Liu Z, Xiong R. A rehabilitation programme focusing on pelvic floor muscle training for persistent lumbopelvic pain after childbirth: A randomized controlled trial. Journal of Rehabilitative Medicine, 2021; 53(4). DOI: 10.2340/16501977-2812