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by Danielle Clark-Fox, DPT

pregnancyPregnancy is a special and exciting time for moms to be, but it’s also a time of great physical change that is not always comfortable and sometimes downright painful. In almost all instances myofascial based physical therapy treatment can be very helpful in alleviating symptoms. The goal of treatment is to preserve the natural changes your body is undergoing to prepare for the birth of a little one, but addressing any changes leading to dysfunction to assist in making your birth experience the best it can be. Physical therapy can also be very helpful post-partum to resolve any lingering symptoms or low back/pelvis dysfunction.

The most common areas for expecting mothers to have pain and dysfunction are the low back, pelvis and hip areas. This is not surprising given that the most significant physical changes center in these areas. By the time labor begins the pelvis will have expanded width wise, tipped forward towards the toes and the curve of the low back will be greatly accentuated. These changes occur not only to accommodate for the baby’s size and assist in birth but to help maintain balance during pregnancy given the shift in mass that occurs.

The hormone relaxin is one of the biggest culprits in pelvis area changes for expectant mothers. Relaxin is primarily responsible for softening the ligaments surrounding the pelvis throughout pregnancy. This softening allows for expansion between the bones in your pelvis to accommodate for a growing baby as well as assist in labor; but can also cause instability and misalignment. This can cause pain while walking, going up and down stairs, lying on one side or another while sleeping and clicking in the pelvis during general movement. It is wonderful your body is naturally accommodating for a little one, but that also puts you more at risk for a small incident leading to misalignment and dysfunction. Normal activities such as biking, prolonged sitting, traveling for prolonged periods in a car or plane or incident such as a fall can move the pelvis or low back in ways other than intended and should be addressed.

Early in pregnancy misalignment can be addressed with myofascial release, but the pelvis should never be any more than gently mobilized. Your body has made changes for a reason, however the more aligned your pelvis is the less traumatic labor and delivery will be for both mother and baby. Later in pregnancy myofascial release can be of great assistance to the sacrum as the baby’s head will be pressing against and moving the sacrum during labor; again the goal being to maximize the experience for both mother and baby rather than achieve perfect alignment. This is particularly important if you will be lying on your back during delivery as the forces are greatly increased compared to standing, squatting or other positions you may have planned with your birthing team.

A physical therapist can also provide gentle stability and stretching exercises for the low back, pelvis and hips. These exercises will change as pregnancy progresses, and should be tailored to stage of pregnancy and to ensure maximum comfort.

Pregnancy is such an exciting time; there is no need to experience unnecessary pain and difficulty with functional activities such as walking. Consult with your birthing team about incorporating the extremely effective techniques of myofascial release based physical therapy if you feel you may benefit. Boston Sports Medicine offers these services for pre and post partum care in our Davis Square location with a John Barnes trained myofascial therapist. We look forward to being a part of this most wondrous life event. 

Dr. Clark-Fox is a Physical Therapist at Boston Sports Medicine