Pregnancy and Postnatal Physiotherapy
Reasons for aches and pains in the Childbearing Year
In the child bearing year many musculoskeletal changes occur within the women’s body. It is important to respect these changes during pregnancy, post-delivery and into the postnatal period. The pregnancy softening hormones continue to have an effect on joint tissues for some months postnatally.
Pregnant and post-natal women commonly experience fatigue. When you feel tired, muscle systems do not provide the usual support of joints and soft tissues. This results in movement patterns being often poorly performed and posture becomes sloppy. Repetitive movements of bending, lifting and carrying an increasing weight is also a daily challenge. These physical changes and challenges may place strain on tissues, leading to pain, tightness and movement difficulties.
Common Pain Complaints in the Pregnancy/Postnatal Period
Skilled physiotherapist’s, who have a special interest in women’s health, are trained in treating common pregnancy and postnatal complaints.
These may include:
- Back pain and sciatica
- Pelvic girdle pain, sacroiliac joint, pubic symphysis, coccyx pain)
- Buttock muscle/piriformis pain
- Headaches and neck pain/stiffness
- Shoulder and mid back pain
- Movement difficulties (walking, sit to stand, turning in bed)
- Carpal tunnel syndrome, wrist pain
- Pelvic floor weakness (poor bladder/bowel control/prolapse)
- Abdominal muscle separation and bulging (rectus abdominis diastasis)
- Post caesarean pain (after healing)
- Postural problems and pain
- Thumb/wrist pain (De Quervain’s tenosynovitis)
- Breast engorgement and mastitis
Physiotherapy Treatment Options
At Physiotherapy for Women our physiotherapist’s listen, assess, treat and educate pregnant and postnatal women. Having provided Pregnancy and Postnatal Physiotherapy Services to Adelaide women for over twenty years, we have the knowledge and skills to select the physiotherapy treatment option appropriate for each presenting condition.
The aim of physiotherapy is to gently restore balance, strength and flexibility to your body, selecting techniques that are right for you. Some of the treatment options we may use include:
- Joint and spinal mobilisation
- Massage techniques
- Exercise prescription
- Corrective taping and strapping
- Core and pelvic floor muscle training
- Clinical Pilates
- Heat and cold therapy
- Patient education
- SRC shorts/leggings
- Splints and support
Physiotherapy is a great way to reduce painful symptoms, feel more mobile, be flexible and comfortable in your movements, strengthen your body and minimise the reoccurrence of injuries. This means you can stay active during your pregnancy as well as optimise labour and your postnatal recovery.
Healthy Breathing and Physiotherapy
Healthy Breathing and Physiotherapy
Breathing is our life force, but how often do we spend any time thinking about this vital process. Do we know how poor breathing can create pain that may eventually require physiotherapy?
A good breathing pattern uses the diaphragm, which is the muscle that separates your chest cavity from your abdominal cavity. The diaphragm is also a core stabilising muscle of the trunk.
Healthy breathing has depth, fullness and freedom. The cycle of in and out breaths are not controlled. They happen naturally. The abdominal muscles relax with a diaphragmatic in breath, allowing the belly to become round. On the breath out, the diaphragm relaxes and the belly flattens.
Unhealthy breathing is shallow, where upper chest movement takes over from diaphragmatic movement.
Ineffective breathing patterns have become a part of our busy, modern life styles. Constant demands and daily stresses encourage our primitive fight-flight mechanism to be permanently switched on.
This mechanism is necessary when we are exposed to a threat or perceive danger. Our human body responds to the stress with:
- Shallower breathing
- Breath holding
- Faster breathing pace
Living with ineffective breathing patterns is energy sapping. Upper chest breathing and breath holding encourage the wrong muscle systems to be working. This leads to musculoskeletal changes in the neck, ribcage, shoulders, mid back, low back, and pelvis.
Over time the musculoskeletal changes to muscles, joints and nerves of the upper trunk, spine and pelvis promote poor posture and this leads to weakness and pain in different parts of the body.
Therefore, many conditions presenting for physiotherapy, may have unhealthy breathing patterns being one of the causes creating or adding to the problem.
Physiotherapists working in women’s health often need to include breathing awareness into their treatment program for some of the following conditions:
- Headache, neck and shoulder pain
- Pelvic floor muscle weakness, urinary stress incontinence and prolapse
- Rib and mid back pain
- Back and sacroiliac joint pain
- Hip and buttock pain
- Pelvic pain
A Physiotherapist can provide you with proactive treatment, strategies and advice where healthier breathing patterns may be an important option for you.
What does Tennis Elbow mean?
Tennis elbow is a painful condition affecting the outside part of the elbow. This area is called the lateral epicondyle and so the medical term is lateral epicondylitis. Tennis elbow is usually caused by overuse of the forearm. The outer elbow tissues become inflamed. This involves wrist and elbow extensor muscles being overused in repetitive movement and/or sustained postures. Many forearm muscles attach at or around the lateral epicondyle so when they are overused they pull too much on the elbow and make it sore. Patients typically develop this condition in association with activities involving repeated wrist extension against resistance or from activities involving repetitive or forceful gripping of the hand. This includes sporting activities such as tennis and squash, manual work such as gardening, painting, cleaning, sewing and knitting or working at a computer.
What are the symptoms of Tennis Elbow?
Common symptoms of pain, stiffness and inflammation occur at the outer elbow. Pain can be constant or it just comes and goes with particular wrist and elbow movements. The elbow and forearm pain is often aggravated with grip, lift and twist activities. Even a simple activity of holding a pen and trying to write or turning a door handle can be uncomfortable.
Pain and tenderness is usually felt on the outside of your dominant elbow and into the upper forearm. The pain is often aggravated by wrist movements such as gripping, where the use of inflamed forearm muscles and tendon tissues near the outer elbow hurts. Knocking the outer elbow against furniture may produce sharp, intense pain.
Most cases of tennis elbow settle well with appropriate physiotherapy. This requires careful assessment by the treating physiotherapist to determine which factors have contributed to the development of the condition. The assessment findings determine a treatment plan which will focus on correction of the factors causing the pain. When simple, everyday tasks or sporting activity continues to be painful then elbow condition can be very frustrating.
Physiotherapy Treatment for Tennis Elbow
Physiotherapy treatment for lateral epicondylitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Physiotherapy treatment may be a selection of the following:
- Soft tissue massage and myofascial release
- Joint mobilization
- Dry needling
- Ice or heat treatment
- Progressive exercises to improve flexibility and strength
- Activity modification advice
- Technique correction
- Anti-inflammatory advice
- Devising and monitoring an appropriate return to sport or activity plan
How long will my tennis elbow last?
With appropriate management, most minor cases of tennis elbow that have not been present for long can usually recover within a few weeks. In more severe and chronic cases recovery can be lengthy process and may take up to 6 months in those who have had their condition for a long period of time. For women experiencing tennis elbow symptoms, family and work activities can become quite difficult. Early physiotherapy intervention is therefore vital to hasten recovery and enable you to use your arm in everyday activity with comfort.
When do I use Heat and when do I use Cold
This is a question frequently asked by our clients in both consultations and exercise classes at Physiotherapy for Women. Hot and cold therapies have been used for centuries as healing modalities to promote health and well-being. Our physiotherapists will help you in your choice of thermal energy (hot or cold) with the following answers.
Cold Therapy Applications
When is an ice pack best used?
During the early acute phase of injury (first 24 to 48 hours) cold therapy or cryotherapy is a common choice. At this time of tissue trauma, cold can be applied in the form of ice packs, cold towels, ice compresses and iced water baths. Inflammation, swelling and muscle spasm are features of acute trauma.
What effect does cold have on tissue?
Cold therapy assists in reducing swelling by narrowing the blood vessels and decreasing blood flow to the injured tissues. As skin temperature is reduced, large diameter nerve fibres are stimulated. This leads to a local analgesia or numbing of tissues, which helps in pain control.
How long is an ice pack applied for best effect?
Apply the ice pack or cold compress to injured tissue for 15 to 30 minutes maximum. Do not apply again for a minimum of 2 hours. Usually, 3 to 4 applications of cold in a 24-hour period are advised.
What are the safety issues with cold therapy?
Avoiding “ice-burns” to skin is essential. It is always necessary to place a damp cloth between the skin and the ice pack. Never place a cold pack directly on the skin.
Do not use cold therapy in the following situations: open or infected wounds; cardiac issues; skin numbness; poor circulation; Raynaud’s disease; dermatitis or eczema flare-up; hypersensitivity to cold temperatures.
Heat Therapy Applications
When is a hot pack used?
The application of heat can be beneficial when the acute phase of injury (after 48 hours) is over, or when chronic soft tissue and joint pain and tightness are being treated. Heat can also be used before stretching, physical activity, soft tissue treatment or massage.
Heat can be applied in the form of heated gel, grain or heat-bead packs, electric blankets and pads, a warm bath, spa or sauna.
What effect does heat have on tissue?
Heat therapy assists in promoting healing, reducing long standing inflammation, decreasing muscle spasm and pain, enhancing blood flow, muscle flexibility and joint motion.
Heat increases blood flow to tissues by dilating blood vessels. This assists in delivering oxygen and nutrients to the tissue cells, removing cell waste products and promoting tissue healing.
Relaxation of muscles and the nervous system is enhanced in most people when warmth or heat is applied.
What are the safety issues with heat therapy?
Always protect skin from heat burns by placing several layers of towelling between the skin and hot pack.
Never lie down or fall asleep on a hot pack as both situations increase the chance of skin burn.
Application of a hot pack should be for 15 to 20 minutes.
Discontinue heat treatment if there is an increase in discomfort.
Maintain hydration by drinking water before and after immersion in baths, spas or saunas.
Pregnant women need to avoid immersion in hot baths, spas and saunas.
Very young and people who are elderly or frail need to be monitored for the entire time of heat therapy. Avoid warm water and saunas with these age groups.
Avoid heating in the following situations: acute injury or tissue trauma; open or infected wounds; swelling; severe bruising; areas of skin numbness; peripheral vascular disease; diabetes; poor circulation; poor thermal regulation; abnormal tissue and tumours.
Common Clinical Examples Using Heat or Cold
Pregnant women experiencing pubic symphysis pain often feel relief with a small ice pack placed on a moist flannel over the pubic bone.
Gluteal or buttock / hip muscle pain can be soothed with a hot pack and protective cloth placed over the top buttock muscle area in side lying.
Strained ankle or knee joints which are swollen and painful, will benefit from an ice pack application with protective moist cloth.
Tight shoulder and neck muscles related to holding and feeding a baby will benefit from a hot pack applied to the top shoulder and neck muscle area.
Our well-trained Physiotherapists can assist you if you still feel unsure as to what to do. Phone our friendly receptionist on 84433355 and make an appointment in our women’s health physiotherapy clinic.
Think Santa this Christmas!
Let’s spell it out loud and clear: SANTA (Straighten up, Active, Neck long, Take breaks, Action)
Take the S for Straighten up:
Good posture decreases our susceptibility to back pain.
Call on the A for Active:
Eating so much over the festive period requires us to be more active. Get outdoors, go for a walk, take a beach or park run with family and friends.
Sound out the N for Neck long:
Constantly looking down at our phones puts enormous strain on our necks and spines. Create ‘no phone’ policy during the festive period, allowing festive gatherings to be true social occasions. When using your phone bring it to eye level, so your neck is long.
Sing out T for Take breaks:
Christmas is always a busy time putting up decorations, wrapping presents and cooking up Christmas feasts. Our spine often feels the constant strain that we place on our bodies. Ask for help so that you are not doing all the tasks at once or on your own. Allow yourself to take frequent breaks.
Finally move the A into place for Action:
Do some simple movements outside of your repetitive movement zone as demonstrated by Santa. The action of arms out or arms up and a knee lift to the bent elbow is so easy.
Thank you, SANTA