Motherhood - the joy is overwhelming but the worries can be endless. Luckily, our healthcare system does a great job of preparing you to take care of your newest addition.
From your very first prenatal appointment, a wide variety of brochures and pamphlets are given that tell you what foods to eat and what medications to avoid.
There is a seemingly endless supply of classes you can take and books you can read on topics like infant care and breastfeeding.
AND, you have regularly scheduled pediatric appointments to ensure your baby is healthy and injury-free.
But what about you....the moms?
Unlike the new baby, there is very little emphasis placed on a woman’s physical postpartum recovery.
Typically, there is one brief check up at 6 weeks postpartum to give you the green light to return to all aspects of your previous life
Often, questions like “are you experiencing back or pelvic pain” aren’t even asked.
I guess this isn’t surprising considering we still do not even have paid maternity leave in this country.
But I digress...
Maybe because postpartum orthopedic injuries were not as common when women weren’t rushed back to work or expected to “do it all” with juggling a career and/or multiple children with very little time for sleep...let alone exercise.
Or, maybe there is a higher incidence of postpartum injuries because women are generally having bigger babies, which leads to an increasing number of delivery complications and cesarean sections.
I don’t have all the answers, but here is what I can tell you: I’ve been a physical therapist for almost ten years and the lack of postpartum education and treatment is resulting in an increasing number of new mothers with orthopedic injuries.
Here are the three most commonly overlooked and undertreated issues found in postpartum women that I see...
Alignment/Mobility
Almost every postpartum patient I treat has lumbar spine and/or sacroiliac joint issue.
Why?
HORMONES
The hormones produced during pregnancy (and even longer if a woman is breastfeeding) cause the spine and pelvic ligaments to get very stretchy in preparation for delivery.
This is great for getting the baby out, but it can be disastrous for the structures of our spine and pelvis.
The loss of ligamentous support, in combination with postural changes and weak core muscles due to a growing belly, make it very easy for a vertebrae or sacroiliac joint to move beyond a normal plane of movement and get stuck there.
This results in muscle spasm, joint inflammation, and a loss of mobility at that segment. These types of issues can be especially problematic for any patient who already has a bulging disc or previous back injury.
Have you heard about the 4th Trimester? If not, check out - The One Thing No One Told You About Your Pregnancy…”The Fourth Trimester”)
Diastasis Recti
Most of my patients have an undiagnosed and unresolved diastasis recti - which is a separation of the right and left portions of the large rectus abdominis muscle - your abs.
This separation is normal during pregnancy, but should resolve by 12 weeks postpartum.
If not, you are left with a significant amount of trunk weakness and an increased risk of injury.
What you may not know is that a lack of trunk support will not only contribute to back pain and incontinence issues, but it can even cause shoulder, hip, and knee injuries.
Sadly, most doctors do not even check for this condition. The ones that do will usually tell you that you have it (which is a great first step) but not what to do about it.
(womp womp)
Not to mention, the muscle and joint issues mentioned previously can cause an incomplete closure of a diastasis recti because those abdominal muscles attach on the pelvis.
Cesarean Scar Tissue
Lastly, the biggest contributor to back injury and back surgery that I see is excessive scar tissue from a cesarean section.
For most people, the abdominal region creates a lot of scar tissue.
This will not only restrict your trunk movements (especially rotation and extension), but it can actually pull on the structures of your spine and pelvis.
Furthermore, the deeper core muscles get cut during this procedure and usually do not magically start working again.
(surprise, surprise)
As with any surgery that affects muscles, they need to be properly trained in order to return to optimal functioning.
To make matters worse, these new mothers go home and start lifting and carrying their growing babies (and those heavy car seats) with poor body mechanics.
(You might want to check out...Babywearing or Car Seat…How Should You Carry Your Baby?)
They spend several hours per day nursing their babies in poor posture.
AND they aren’t getting very much sleep.
FACT: Your body’s repairs injured tissues during your deepest sleep cycle - and I don’t know many new moms who are getting much of that.
Thus, the inflammatory phase of an injury persists.
With all of these things in mind, it is no wonder these women are ending up with disc herniations and back surgery.
Obviously, not every woman who has a baby is going to end up with an orthopedic injury. An uncomplicated delivery, no history of back pain, and good core strength prior to delivery can help significantly reduce the risk.
However, if a woman does have some of these physical issues after pregnancy or delivery - they do not usually resolve on their own and often get worse with subsequent pregnancies.
I look forward to the day when postpartum physical therapy is a routine part of the recovery process, as it already is in other parts of the world.
Until then - I urge healthcare professionals who work in the birth space to start screening for these issues and referring these patients appropriately.
And I want postpartum women to know that prolonged back/pelvic pain or cesarean scar tightness is not a “normal” part of their recovery, and you should be an advocate for your own health and wellness.
Kelsey earned her Doctorate of Physical Therapy from the University of Delaware in 2007. She worked in out-patient orthopedics for nearly 10 years and specialized in treating spine/pelvis injuries. She noticed a growing trend among her patients - they were mostly all moms. She realized this population had a unique set of physical issues with minimal options for diagnosis and treatment. In June 2016 - she started Personalized Physical Therapy which offers in-home appointments, hands-on treatment, and flexible scheduling to busy moms.