Direct Access

Do you have a musculoskeletal injury or pain, posture or balance problem? All of these can restrain your recreational activities or affect your everyday routine. It is likely a visit to your physician will result in a referral to physical therapy.

Many don't know that in the state of California consumers have direct access to physical therapy. This means that you can see a physical therapist without a referral from the doctor. Click Here to Read More

Physical Therapy & Pregnancy (by Charles Alexander, DPT)

by jessicag, November 7, 2018

 

Hello everyone, my name is Charles Alexander and I am a new Physical Therapist at Burch
Physical Therapy. I am thankful for the opportunity to participate in blog post today. Just a little
background on myself: I received my undergraduate degree at Sacramento State University where I
received my Bachelors of Science in Kinesiology with an emphasis in Exercise Science. I then went to
Azusa Pacific University to receive my Doctorate of Physical Therapy.

For the blog discussion today I will be talking about some of the misconceptions with pregnancy
and how Physical Therapy can assist with the issues associated with pre and post pregnancy. The primary
reason I wanted to share this information is the fact that my wife and I recently found out that we will be
having twins soon and the relevance it plays in my life currently. Here are the top three:

1) You cannot exercise while you are pregnant:
One of the most common misunderstandings with pregnancy is that you cannot exercise. Such thought
process is that exercises will induce an early labor or preterm birth. Though this may be the case for some
women who are considered to have a high-risk pregnancy or to have a sedentary lifestyle prior to
pregnancy, regular exercise during pregnancy provides health benefits for the mother and the child. Most
notably it lowers the risk of conditions associated with pregnancy such as induced high blood pressure
and gestational diabetes. In addition it lowers the risk of having a baby of a low birth weight, which
increases the risk of the infant for perinatal complications and developmental problems. So what are the
current recommendations for exercises while pregnant? Current research suggests that you should work
out 3-4 days a week with a moderate intensity starting at 15 minutes and slowly increasing to 30 minutes
for a total of 120 minutes a week. This does not include a 10-15 minute warm up and cool down resulting
in 150 minutes or 2.5 hours a week. If you have been sedentary or your have a BMI >25 it is
recommended to do light intensity exercises starting at 25 minutes and adding 2 minutes a day until 40
minutes is reached for 3-4 days per week. The optimal time to progress exercises is after the first trimester
or around 13 weeks due to risks during pregnancy are lowest at that time.

(2) Back/hip pain should be expected and normal when pregnant:
Another common misinterpretation is that during pregnancy back and hip pain is normal. Although you
natural body mechanics change due change hormonal changes, increase metabolic demand, and a shift of
your center of gravity; it is treatable with physical therapy. The prevalence of pain is high, more
specifically: sacroiliac (low back and tailbone) pain is seen in 15% of the pregnant population and about
50% of females experience pubic symphysis being to loose after conceiving. Of those affected 30% can
result in chronic pain. With knowing that every individual has differences, common approaches include
core stability, pelvic floor exercises, and movement science to help address the issues seen with back and
hip pain so that you can get back to what you desire without having the pain that is “normal”.

3) A small amount of urine leakage is normal:
The final misconception that is common is that urine leakage is normal during and after pregnancy. This
however is never normal and should be concerning. In fact current research shows that 80% of women
who experience urinary incontinence that does not resolve in 3 months after pregnancy is not going to.
The primary goals with treatment of incontinence with physical therapy is two fold. The first is to educate
the patient on techniques for bladder and or bowel retraining education with behavioral management. The
second is to strengthen and improve awareness of pelvic floor musculature to minimize incontinent
episodes and prevent future episodes. Education should include: bladder diary, bladder irritant list, use of
pelvic floor contractions to postpone leakage, and proper diaphragmatic breathing. Initial exercises should
include appropriate relaxation techniques with breathing exercises, awareness of pelvic floor musculature,
short and quick muscle contractions of the pelvic floor with development to longer and sustained
contractions, coordinated contractions of the pelvic floor with specific activities that cause leakage, and
appropriate hip/core/lower extremity exercises according to the patient being treated. Best results with
urinary incontinence occur with 3 months or more of physical therapy treatment.

References:
1: https://www.apta.org/PTinMotion/2017/12/Feature/WhatToExpect/
2: ACSM Guidelines for Exercise Testing and Prescription
3: Pelvic Health Module by Daniel J. Kirages, DPT, OCS, FAAOMPT
4: Pocket Orthopedic: Evidence-Based Survival Guide Michael Wong, DPT, OCS,FAAOMPT
5: Orthopedic Rehabilitation: Clinical Advisor: Derrick Sueki and Jaclyn Rechter
6: Exercise Physiology: Nutrition, Energy, and Human Performance.