Dr. Samantha DuFlo, PT, DPT,
Owner of Indigo Physiotherapy
Be Well, Do Well, has been our slogan at Indigo Physiotherapy from the moment the idea for Indigo was conceived. Cute tag line aside, what it really means to me is that as a parent, mother, employee, child, friend- whatever your role may be- you can almost always do it better if you, yourself, feel well. Feeling well is often rooted in self-care practices, which although more difficult to find time for in some stages of life, for example new motherhood, is often most needed at those very times.
Self-care can take many forms, from acupuncture to a long walk, meditation to talk therapy. Practicing self-care throughout your pregnancy and into postpartum has been shown through clinically relevant research to have significant health benefits. Not only for yourself, but practicing self-care throughout your stages of pregnancy and postpartum sets the stage for modeling these important practices to your children, and facilitating their intrinsic understanding of the benefits, and need for, self-care. Many of us grew up in generations where acupuncture, chiropractic care, herbalism, yoga and meditation were the “alternatives” to health care, and wouldn’t it be ideal to raise a generation that feasted on a wealth of health care options throughout their lifetimes.
An option for self-care that is often over-looked, lacking recognition, or is misunderstood, is physical therapy. Specifically in this context, pelvic physical therapy. Long gone are the days of our mothers (who can still seek help), who were told that “Oh you leak when you laugh? You had a baby, that’s normal!” Although it is normal to experience pelvic floor weakness and dysfunction after a pregnancy, whether cesarean section or vaginal delivery, it is not normal to continue to experience the weakness leading to incontinence.
Let’s use one of my favorite examples: You come into my office and say, “I can’t hold a coffee cup anymore, my hand feels really weak.” Would a normal response be to ignore it and put your arm in a sling because it can’t do it’s job anymore? Of course not. We would do muscle and strength testing, neural testing, determine why you couldn’t hold the coffee cup any longer, and then proceed to address the dysfunctions with treatment. So why should women have to accept that since they had a baby, they need to wear a pantyliner for the rest of their lives, or run out of exercise classes for fear they will leak? The answer: they shouldn’t (and don’t) have to!
So, you ask, how is pelvic physical therapy relevant during pregnancy and after delivery? Here are some, but definitely not all, examples:
1. Pelvic physical therapists can help address pelvic pain, making penetration tolerable and enjoyable, as well as address your questions regarding sexual function.
2. Learn how to correctly recruit, activate, and contract your different pelvic floor muscles, which happen to be in 3 layers, and coordinate with your core muscles and diaphragm. Learning before pregnancy is important for strengthening, preventing hip and low back pain; internal pelvic floor evaluation during pregnancy is against Maryland PT Practice Act at this time, so the earlier you learn the better.
3. Infertility: Learn to address scar tissue, adhesions, or see a pelvic physical therapist that does visceral mobilization, to facilitate movement and function in your lower abdominal and pelvic region.
1. Continue strengthening your pelvic floor muscles and learn to target very specific intrinsic abdominal muscles. Have an expert in exercise, movement and the body help you develop techniques and a plan to exercise safely throughout your pregnancy.
2. Address pubic symphysis dysfunction (SPD) or pain: often women come to me during their last few weeks of pregnancy or in a second pregnancy, recounting how they have been tortured by pubic symphysis pain for months, which is totally unnecessary. Please go see a pelvic physical therapist that specializes in hands-on treatment and manual therapy techniques.
3. Address hip pain, pain with walking or movement, rolling in bed, pelvic position or alignment.
1.Heal your pelvic floor. For some, this may mean strengthening as a result of incontinence or prolapse, or prevention of either in the future; and for others, just the opposite, it may mean releasing pelvic floor spasms, releasing scar tissue from a tear or episiotomy, and healing pelvic pain that is preventing return to intercourse.
A strong disclaimer: Kegels, or pelvic floor contractions, are not for everyone.
You may experience incontinence because your pelvic floor is actually in spasm, and further
strengthening at this point in your plan of care would be contraindicated. See a pelvic physical
therapist to determine the course of care that is best for your body.
2. Get evaluated for, and treat diastasis recti, or abdominal separation. Abdominal separation can lead to core weakness, low back pain, and difficulty in movement, lifting, and so forth.
3. Address scar tissue and pain: whether adhesions and scarring from a c-section, or a tear or episiotomy during vaginal delivery, both can be very painful and limiting to function, whether it is lifting your baby or having sex.
Pelvic physical therapists are the experts in the musculoskeletal and neuromuscular systems, who are specially trained in continence, sexual function, pregnancy and postpartum topics. One may not traditionally view treatment of these topics as self-care, but physical therapy provides a non-pharmacologic and non-surgical alternative to improving the quality of your life if you suffer from pelvic floor dysfunction. Ultimately, you know your body best- if you suspect you have an issue, please reach out for help. If you have any questions, or are wondering if pelvic physical therapy is right for you, please reach out at www.indigophysio.com or contact your local pelvic pelvic physical therapist.