The Role of Osteopathic Care in Pregnancy

Often we think about the new bundle of joy that we are about to have, but we often forget the significant physiological changes that pregnancy brings. The body has to adapt to carry up to a 4kg baby that sits within the pelvis, as well as experience the hormonal changes that allow our body to take on the task. No wonder the pregnant body screams out for help.
As Osteopaths, we can assist those going through pregnancy at any stage; prenatal and postnatal. Here are just a few common musculoskeletal complaints that may occur during pregnancy:

Low Back Pain:
One of the most prevalent musculoskeletal complaints during pregnancy is low back pain. As the uterus expands, it shifts the center of gravity forward, putting additional stress on the lower back. Hormonal changes (such as relaxin) loosen ligaments and joints also contribute to back pain.

Pelvic Girdle Pain (PGP):
PGP involves pain in the pelvic area, often radiating to the back, buttocks, and thighs. It can be attributed to the relaxation of ligaments due to hormonal changes and increased pressure on the pelvic joints as the baby grows.

Pelvic Floor Discomfort
The pelvic floor is affected both during pregnancy and during the birth. It is important to address this post birth, to regain normal strength and support for the pelvic contents and to help with continence. Pelvic floor training should start during the pregnancy and continue after the birth, until normal function is achieved

The sciatic nerve, which runs from the lower back down the back of each leg, can be compressed during pregnancy, leading to pain, tingling, or numbness. This can result from the growing uterus putting pressure on the nerve.

Carpal Tunnel Syndrome:
Swelling and fluid retention during pregnancy can compress the median nerve in the wrist, leading to carpal tunnel syndrome. This may cause pain, numbness, or tingling in the hands and fingers.
Neck and Shoulder Pain:
Changes in posture, often due to the forward shift in the center of gravity, can lead to strain in the neck and shoulders. Breast enlargement and hormonal changes can also contribute to discomfort in this area.

Edema (Swelling):
Fluid retention is common during pregnancy and can lead to swelling, particularly in the feet and ankles. While not exclusively a musculoskeletal complaint, edema can contribute to discomfort and affect mobility.

Postural Changes:
The changing shape and weight distribution of the body during pregnancy can result in altered posture. This may lead to muscle imbalances and discomfort, especially in the lower back and pelvic region.
Osteopaths can provide guidance and management for those suffering from their musculoskeletal pain during and post pregnancy. They can recommend appropriate interventions or strategies, including exercises, clinical pilates and osteopathic treatment to help mums-to-be with their pain.

**These complaints can vary in severity and duration, and it’s important for pregnant individuals to communicate any concerns with their healthcare providers.

Pre/Post-natal Pilates

What is it?

Modified Pilates exercises, shifting the focus to what your body needs during this time. Classes are designed to help your body through all stages of your pregnancy and post-partum experience.

Key differences to general Pilates classes:

A focus on spinal mobility continues throughout pre/post-natal Pilates classes.

Where it differs are:

  • modified positions, for example, during second and third trimesters no exercises lying on your back or tummy,
  • focus shifts from exercises strengthening the core to exercises for postural awareness and pelvic strength, and
  • exercises to assist with post-partum recovery.

Key goals of Pilates exercises during pregnancy and post-partum:

To improve or maintain:

  • Pelvic floor muscle activation
  • Pelvic strength and support
  • Postural awareness/training

What if I have pelvic or back pain?

Modified pregnancy Pilates classes aim to assist with pelvic strength and spinal mobility to help prevent pregnancy-related pain but they can also be modified for women with pain to assist them through their pregnancy and to recover post-partum.

What does a pre/post-natal Pilates class at Peninsula Osteopathy and Allied Health look like?

Small class sizes so exercises can be easily modified and individualised to your stage in pregnancy, level of Pilates experience and how you are feeling on the day.

Participants may complete an individual assessment with an Osteopath before their first class. This will include discussing health/fitness goals and any injury or health concerns.

Pregnancy- What Is Happening?

Pregnancy is such an important and happy time for most families. Maybe you are pregnant or thinking about having a baby?

Here we look to discuss some of the common changes that occur during pregnancy and how this may manifest in your body.

First Trimester

Months 1-3

Here we see early fetal or baby development. Whilst the baby is still small at this stage the body is preparing for further growth.

This can often be a difficult time for women who still have to work or look after other children.

With the changes occurring to the body we commonly see women presenting with

* upper back and neck pain which is often made worse by tiredness, vomiting and a heavier chest as the breasts enlarge.

* low back pain or pain around the pelvis as hormones start to soften this area preparing for growth or exacerbated by constipation which is also common at this stage of pregnancy.

* headaches which can be aggravated by vomiting and also the changing posture as the pregnancy progresses

Second Trimester

Months 4-6

As the baby continues to grow and the uterus enlarges we see pelvic changes occur to allow for this. During this phase of the pregnancy the mothers belly usually becomes more prominent. This can change how our spine moves as the mothers centre of gravity is changing. Often pregnant women will present to the clinic with

* upper back, neck and shoulder strain as the belly and breast grow and the body’s mechanics change to accommodate the growth these area’s can be under strain.

* tingling in the hands especially at night which can be the result of increased fluid in the body related to the pregnancy and also increased tension and restriction in the neck and shoulder region.

Third Trimester

Months 7-9

This trimester is often associated with significant growth of the baby. As the baby grows the uterus continues to enlarge as the baby gets ready to enter the world.
Pregnant women will often seek help for
* low back or pelvic pain as the uterus is growing this can lead to increased stress on the tissues in the spine and pelvic regions. Hormones are also working to allow flexibility in the pelvis for deliver which can make muscle is this region have to work harder to help move and control the pelvis and lower back.
* sore ankles and feet, which is often exacerbated by heat and the increased fluid in the pregnant body. The feet are also now carrying a heavier load and are adjusting to the changes in the joint movements further up the body e.g hips and pelvis.
* sleep difficulties due to pain and lots of going to the toilet. As the baby starts to take up more space in the pelvis this can often lead to having to go to the toilet more. The pelvis being more subtle can also lead to difficulties turning in bed and getting comfortable as women often have to change their sleeping posture.

What can be done to help?

It’s really important to continue to visit your health professional such as GP, midwife or obstetrician through out your pregnancy to monitor your progress and check up on your baby. These health professionals are specially trained and play an important part in your pregnancy care.
With all these changes going on to the body, it’s important to make sure that the body has the capacity to adapt as best as possible to allow the baby space to grow. We do this by looking at how the different areas of your body are moving, review your current strategies and help you to prepare for the deliver of your baby.
Treatment would include hands on treatment to improve muscle tension, encouraging joint movement, appropriate stretching and strengthening exercises and advice to help making work and home duties easier through your pregnancy. We will also discuss strategies for birth and for when you come home to help you manage these important changes to your body.
We will work with your other health care providers to work out the best exercise and treatment plan for your pregnancy, and then to assist you recover from the birth and transitioning to parenthood!

If you have any questions about how Peninsula Osteopathy + Allied Health can help with your pregnancy we would love to hear from you!