Another, perhaps more suitable, option for many women is water immersion.  Immersing oneself in water provides a uniform compression that does not vary over time and produces a natural pressure gradient.  It has been shown (Journal of Women’s Health Physical Therapy, Vol 34, Number 2, May/August 2011) that pregnant women with peripheral edema who immersed themselves in water up to their chest for 20 minutes significantly reduced the swelling  in their feet. This was compared to women who sat in a chair with their feet elevated on a chair with a pillow on it. In this study, 86% of the women who were in the water significantly reduced their edema. None of the women in the water increased their edema and the remaining subjects did not experience a change in edema.  Of the “land” women, only 38% of the women experienced a reduction in swelling.

Methods for edema reduction that were not explored with this study, but have potential to be effective as well, include exercise during immersion in water and increasing the amount of time in the water. Lower extremity exercise during immersion is expected to create muscle pumping action that may assist in the removal of fluid from the legs.

Further research is needed to determine how long the edema reduction persists, how frequently pregnant women may require immersion to retain the effect, and whether other interventions such as exercise during immersion produce even greater edema reduction.

–Mia Ramsey, DPT

Prenatal yoga is a great way to achieve all of these benefits. In addition, yoga can decrease stress levels, decrease mom’s resting heart rate, increase gestational age at delivery (fewer preterm births), and decrease incidence of IUGR (intrauterine growth retardation) (Narendran 2005). Many women who have never taken a yoga class before or are not frequent exercisers feel comfortable having their first yoga class be a prenatal yoga class because they know it will be lead by a instructor specifically trained in a pregnant woman’s special needs.  Women who have a regular yoga practice prior to pregnancy can enjoy continuing their practice in a class offered specifically for pregnant women that includes modifications they may need as they progress in their pregnancy.

Come join us at C.O.R.E. PT for prenatal yoga and experience all these benefits for yourself! Call 970-223-8293  or visit OmMamaPrenatalYoga.com for details.

For some reason, the changes that occur during pregnancy are enough to make a previously non-problematic, problematic. Lower back pain during pregnancy can be caused by many of the same factors that cause lower back pain with non-pregnant individuals. Often, women experiencing increased back pain during pregnancy have had minor episodes of back pain prior to pregnancy-episodes that were possibly not even bad enough to seek help for. The pregnancy may just be, for these people, the proverbial “Straw that broke the camel’s back”. Pre-pregnancy causes of back pain for these people can be postural, activity dependent (overuse) or traumatic injury, putting undue stress on the spinal components: the intravertebral discs, the nerve roots as they exit the spine, the facet joints or in some cases, muscle and ligament. For these people, pregnancy aggravates dysfunction that is already present.

As we all know, there are significant hormonal changes during pregnancy that effect not only the mother’s mood and appetite (or lack thereof, due to nausea), but also how her muscles and ligaments respond to stress. The pregnant woman begins to produce a hormone called Relaxin in her first trimester. This hormone peaks at about 12 weeks of gestation. The purpose of this hormone is to prepare the mother’s body for the growth it will experience and to allow for safe passage of the baby through the pelvis during delivery. The hormone works, as its name implies, by “relaxing” ligaments and connective tissue throughout the body, causing an increase in joint laxity.

This is all well and good for the pregnancy and delivery, but what about Relaxin’s effects on an already weak and/or unstable spine or pelvis? The good news is that the baby won’t fall out because of this increased laxity; however, it can add a whole new dimension to what was an only mildly bothersome pain (or no pain) prior to pregnancy. The increased laxity (or mobility) can cause increased strain on the ligaments that run between the joints in the spine and pelvis and can also cause increased strain on muscles that are trying to stabilize the region, and all this can add up to pain or discomfort.

In addition to increased laxity in a pregnant woman’s body, there is the additional weight in a localized area (right in front of the lumbar spine and inside the pelvis) that stresses the spinal and pelvic structures. The weight of the baby can pull the woman’s spine into an increased lordosis (or arch), which can compress the facet joints in the spine and cause muscle spasm or fatigue. The weight of the baby sitting in the bowl-like pelvis can also stress the pelvic floor muscles, which are crucial for urinary and bowel function as well as controlling motion between the pelvic bones.

Following delivery, one of those two previously mentioned factors is removed- the baby. And Relaxin remains in the body for only about 3 days postpartum. So why does the back pain sometimes just not “go away”? One of the reasons is that the mother now has this solid bundle that she is always carrying, nursing, changing, pushing in a stroller or pulling in and out of a car seat. These activities often cause the mother to get into positions that are straining on the healthiest of backs. In addition, many of the stabilizing muscles and ligaments that control movement of the spine and pelvis and protect them while the mother may be in those positions are still stretched and may be weak. The weakness is partially due to reduced activity during the pregnancy and continued relative inactivity after the pregnancy due to fatigue and mom’s time being occupied by the new addition.

Physical therapy can help both during the pregnancy and after. There are many treatment options for the pregnant patient such as retraining and strengthening of weakened muscles, soft tissue and joint mobilization for muscle and joint dysfunction, Kinesio Taping to correct muscle and joint dysfunction and promote tissue healing and ergonomic training to learn how to do all these new activities in the best possible position to minimize spinal stress. Following pregnancy, all these treatment options are available in addition to modalities such as ultrasound and electrical stimulation.

I welcome comments and questions on this or any other subject related to pregnancy and physical therapy. Please feel free to leave comments or questions here or email me at mia@coreptfc.com. Don’t hesitate to leave questions on the blog as there are most likely many others out there with the same question!

Pregnant women experience many changes in their bodies that make them more susceptible to injury. Due to postural changes caused by a shift in the mother’s center of gravity as well as stretching of abdominal muscles and pelvic ligaments, pregnant woman can experience low back pain, Sacral Iliac pain, neck pain, headaches and upper back pain. Other common issues are: tightness and pain in lower legs and feet, arm pain or tingling/numbness and rib pain. Woman also experience pain following delivery due to continued joint laxity and weakness of muscles that have been stretched.

In addition to problems that occur as a result of pregnancy related changes, we can provide safe and affective treatment options for any orthopedic problem. Physical therapy is a natural and conservative way to address these issues without putting the mother or baby at risk.

Mia Ramsey is a Physical Therapist at C.O.R.E. Physical Therapy who has developed a special interest in treating pregnant patients. She is currently pursuing a certification through the American Physical Therapy Association that highly qualifies her in the orthopedic treatment of pregnant patients. She has two young children of her own and understands the stresses, anxieties and pressures, as well as the joy of pregnancy and motherhood.

Mia is passionate about helping pregnant women feel better so they can enjoy this remarkable and unique time in their lives. Addressing these painful issues when they occur during pregnancy can help prevent future problems after pregnancy. Studies show that Low Back Pain during pregnancy is more likely to occur if it has occurred with previous pregnancies. Studies also show that almost 40% of women who experience Low Back Pain during pregnancy are still experiencing pain 18 months post partum.

There is something you can DO! Call us today at (970) 223-8293.

** Larsen EC. Wilken-Jensen C, Hansen A, Jensen DV, Johansen S, Minck H et al. Symptom-giving pelvic girdle relaxation in pregnancy. I: Prevalence and risk factors. Acta Obstet Gynecol Scand. 1999;78