There is a TON of information available to pregnant people nowadays and there is a big push to educate yourself as much as possible about labor and birth. Hospitals offer classes you can take, doulas, who often also offer educational sessions, are becoming more mainstream, and the technology generation is utilizing the internet to understand pregnancy and birth more than ever.
So how can a pelvic floor PT help you when you are pregnant? Well, education and mental preparation are very important, but physical preparation is perhaps KEY to the preparation process. We are, of course, bias toward the importance of optimizing physical functioning, so let's explain why we feel that way.
There is a buzz word in the orthopedic physical therapy world right now- a term called “pre-habilitation” or "prehab". This refers to the physical therapy provided before surgery.
Decades ago, a person who needed a knee replacement would have the surgery and be provided home exercises by their surgeon. As I’m sure you can imagine, outcomes weren’t always so great. Certainly not like they are now – cue commercial of an older gentleman running or skiing.
In the last several decades, the physical therapy industry has provided surgeons the proper post-surgical rehabilitation required for those new knees. The surgeons rely heavily on a good physical therapist to guide their patient safely back to activity.
Now, we physical therapists, who know the musculoskeletal system inside and out and from top to bottom, knew that post-joint replacement rehabilitation is grueling because we are not just rehabbing the knee. That person spent potentially years walking around on an arthritic knee leading to altered gait mechanics, probable arthritis in other joints on the same leg, an aching hip on the other side, etc. In post-op PT, we have to treat all of those elements – both hips, both ankles, both knees, even the core stabilizers of the pelvis and spine - not to mention the general effects of the surgery and hospitalization itself. (1)
In recent years, PTs and surgeons have joined together to research what would happen if someone went to PT before surgery. And it turns out, research shows, if you begin an exercise program before surgery, then your return to your previous functional level is easier! Patients were returning to activity faster! (1,2) This “prehab” model is being adopted for all types of orthopedic surgeries - ACL repairs, rotator cuff repairs, meniscus surgeries - but also abdominal surgeries, cardiac surgeries, etc.
The chart above demonstrates a typical timeline of function before surgery and after surgery. Line (a) refers to the typical course without prehab. The person is functioning as normally, undergoes surgery, experiences a decline, and slowly works back up to what was their previous functional level. Line (b) refers to a situation where someone might experience a complication during surgery. They might have a longer road to recovery and might not ever reach previous functional level. Line (c) refers to someone who undergoes prehab. They start at a higher functional level, experience a minor decline due to surgery, and rapidly return to their higher functional level. Line (d) demonstrates a person who has undergone prehab AND experienced a complication. They could have a slower return due to the complication, but ultimately, have significantly better return to functional level than if they had not had prehab.
Now, let’s apply the same principles to pregnancy. During pregnancy, your body and your musculosketal system are changing every day – a heavier load on your pelvis, increased pressure in your abdomen, changing dynamics of your diaphragm/breathing, and hormones altering ligamentous stability. Not to mention what’s changing with your digestion, your cardiovascular system, and your lymphatic drainage systems.
Decades ago, post-partum physical therapy was barely advised by OBGYNs. We have been recovering from childbirth for hundreds of thousands of years. But women were quietly suffering from things like pelvic organ prolapse, urine and fecal incontinence, pelvic pain, and sexual dysfunction.
In more recent years, more and more OBGYNs are referring their patients to physical therapy, but still only when problems arise – a very “rehab” oriented approach.
What if we “prehab” before birth? What if we addressed the altered biomechanics and changing movement patterns before problems arise? What if we taught women how their pelvic floor muscles work under normal conditions before the muscles are potentially injured during pregnancy and birth?
Could we improve a person's return to activity? Could we reduce the risk of injury during pregnancy and birth? Could we reduce the incidence of incontinence and prolapse?
The research is ongoing and new(3,4) but anecdotally, physical therapists are seeing GREAT outcomes for those who go to PT before third trimester and before birth.
We, at Pelvio, are trying to change the narrative. Ask your OBGYN for a prescription to physical therapy before things change, before things get tough, before problems arise. This is not only important for postpartum recovery, but also for a successful labor and birth(4). If you knew how to use your muscles for proper pushing, we hypothesize (and are seeing!) that we could shorten pushing times, lessen risk of injury to the perineum and pelvic floor, and ultimately reduce pain and dysfunction.
Stay tuned for our next blog post on Birth Prep to understand more about how your body is changing during pregnancy!
If you are pregnant or looking to be pregnant and want to learn more, email us at contact@pelviopt.com or give us a call at 267-570-3603.
References:
Durrand J, Singh SJ, Danjoux G. Prehabilitation. Clin Med (Lond). 2019 Nov;19(6):458-464. doi: 10.7861/clinmed.2019-0257. PMID: 31732585; PMCID: PMC6899232.
Punnoose A, Weiss O, Khanduja V, Rushton AB. Effectiveness of prehabilitation for patients undergoing orthopaedic surgery: protocol for a systematic review and meta-analysis. BMJ Open. 2019 Nov 19;9(11):e031119. doi: 10.1136/bmjopen-2019-031119. PMID: 31748299; PMCID: PMC6887053.
Weerasinghe K, Rishard M, Brabaharan S, Mohamed A. Effectiveness of face-to-face physiotherapy training and education for women who are undergoing elective caesarean section: a randomized controlled trial. Arch Physiother. 2022 Feb 3;12(1):4. doi: 10.1186/s40945-021-00128-9. PMID: 35109917; PMCID: PMC8812015.
Schreiner L, Crivelatti I, de Oliveira JM, Nygaard CC, Dos Santos TG. Systematic review of pelvic floor interventions during pregnancy. Int J Gynaecol Obstet. 2018 Oct;143(1):10-18. doi: 10.1002/ijgo.12513. Epub 2018 May 18. PMID: 29705985.