By Motion Physical Therapist: Dr. Alyssa George, PT, DPT, OCS
A 2015 study looked at the incidence of injury from childbirth and found that in a group of women at risk for pelvic muscle injury, 91% of them experienced some form of musculoskeletal injury involving the pubic bone or levator ani muscle when assessed at 7 weeks post-partum.1 All participants in the group had at least one risk factor for pelvic floor muscle injury, as established by previous research: a long second stage, anal sphincter tear, or older maternal age. Many of these injuries seen on MRI were similar to injuries experienced by runners and other extreme athletes such as severe muscle strains, tears, and stress fractures. Here it is, proof that childbirth is an extreme sport! Though many women are given the go ahead to return to normal activities at their 6 week post-partum check-up, it is not uncommon to feel ongoing soreness in the pelvic muscles and bones and a certain hesitancy to return to activities like exercise or sex. Injuries such as stress fractures and muscle tears or strains can take much longer than 6 weeks to completely heal so it is important to listen to your body and return to activity gradually. And if you feel like things are just not healing like they should, it may be worth talking to your physician for further investigation. Similar to training an athlete for competition, it would be ideal if women were better educated in things they can do during pregnancy to better prepare their bodies for delivery in hopes of preventing these injuries from occurring in the first place. These preventative measures may involve stretching, massage, focused relaxation, and building awareness of the pelvic floor muscles. A physical therapist with special training in pregnancy and post-partum issues can be very helpful in addressing concerns related to preparing the body for delivery.
The Following Are a Few Things You Can Do to Prepare:
When: throughout pregnancy (as long as they do not cause increased pain)
Purpose: lengthen the pelvic floor muscles
Frequency: 1-2 times daily
- Child’s pose/Prayer stretch
- Kneel on the floor and sit back on your heels, reach both arms forward on the floor until you feel a stretch. Breathe deeply and visualize your pelvis opening up and relaxing. As your belly grows, you may need to move your knees wider.
- Deep squat
- Stand with feet wider than hips and sit down into a squat as far as you can comfortably go. Breathe deeply and visualize your pelvis opening up and relaxing.
2. Perineal Massage2
When: You can start this 6 weeks prior to delivery (week 35 until the end).
Purpose: to prepare the tissues for the stretch required for delivery
Frequency: Once daily for 10 minutes.
- Use gentle pressure to avoid bruising or swelling
- Do not perform in the presence of an active infection or herpes lesions, preterm labor, vaginal bleeding during pregnancy, premature rupture of membranes, or incompetent cervix.
You can take a warm bath or apply a warm compress to the perineum (the area between the vagina and rectum) for 10 minutes before performing the massage. You and/or your partner can gently massage the perineum to soften the tissues and prepare it for delivery:
- Sit or lean back in a comfortable position
- Use a water-soluble or oil-based lubricant on your thumbs and perineum
- Place your thumbs 1-1.5 inches inside vagina and press downward towards the rectum and towards the sides until you feel slight burning or tingling.
- Hold the pressure for 2 minutes until you feel the area go numb. Breathe deeply and slowly into the abdomen while visualizing the muscles relaxing with the pressure.
- Continue to press down and massage slowly and gently over the sides of the vaginal opening in a “u” shaped motion for 3 minutes.
Rest and repeat once.
3. Pelvic Floor Bulging
When: You can start this during the last 3 weeks of pregnancy.
Purpose: to build awareness and train your muscles in the proper way to push without holding your breath. Many women do this incorrectly and it may be necessary to have a women’s health PT check to make sure you are doing it correctly. You want to be able to tense your abdomen while lengthening your pelvic floor.
Frequency: 5 repetitions, once daily.
4. Birthing Positions
It may be helpful for you to practice getting in and out of various birthing positions. If you have had any history of orthopedic injuries such as hip, knee, or back pain, some birthing positions may not be ideal. Having a PT help you try different positions to reduce strain on certain joints can help to reduce stress and pain during delivery.
Dr. Alyssa George, PT, DPT, OCS
Alyssa wants to get you back to doing what you love, whether that be sports/recreational activities, your career, or caring for your family. Specializing in treating pelvic and orthopedic conditions, Alyssa develops individualized treatment plans because she understands that no two bodies are alike. She has been involved in research projects to help advance the field of physical therapy. Most recently she has written a case series detailing the benefits of dry needling for chronic pelvic pain and presented on the function of breathing muscles in pelvic pain at the American Physical Therapy Association’s Combined Sections Meeting. She has over nine years of experience as a physical therapist and has started and led pelvic health programs at clinics in Texas, Ohio, and now Minnesota, her home state.
Alyssa earned a Bachelor of Arts degree in biology from Gustavus Adolphus College, a Master of Physical Therapy degree from the University of Wisconsin-Madison, and continued her education at the University of Montana, earning her Doctorate in Physical Therapy. She is a board-certified clinical specialist in orthopedics and earned her certification in pelvic physical therapy from the American Physical Therapy Association Section on Women’s Health. She has been a lecturer and faculty mentor of both orthopedic residency and manual therapy fellowship programs at The Ohio State University and is a credentialed clinical instructor for physical therapy students. Alyssa has been certified in dry needling and utilizes other various manual therapy techniques in her management of abdominopelvic disorders (including incontinence, constipation, lumbopelvic pain, and pregnancy-related musculoskeletal disorders) and orthopedic conditions of the neck, back, shoulder, hip, knee, and foot/ankle.
- Miller JM, Low LK, Zielinski R, Smith AR, DeLancey JO, Brandon C. Evaluating maternal recovery from labor and delivery: bone and levator ani injuries 2015. Am J Obstet Gynecol. 213(2):188.
- PERL (Promoting Effective Recover from Labor) Project. “Perineal Massage,” University of Michigan School of Nursing. Updated February 12, 2001. http://umich.edu/~umperl/massage.htm Accessed 12/6/2017.