During pregnancy, your body goes through a lot of changes to help grow and deliver the baby. While many of these changes are temporary, they may cause pain or limit how well you can move. The good news is, physiotherapists are well trained to help reduce pain and improve your movement. Here's some information on common problems during pregnancy and tips on how to manage them.

Lower Back Pain

Many women experience lower back pain at some point during their pregnancy. This can happen because of:

• The extra weight of your growing baby puts more strain on your spine.
• Changes to your posture and the way you move as you progress through pregnancy. 
• A decrease in physical activity and muscle strength.

Even though you might still have some back pain during your pregnancy, there are lots of ways physiotherapy can help reduce your pain and improve your movement and daily life.

Education and Exercise

Research shows that combining exercise with learning how to manage pain is very helpful in reducing back pain during pregnancy. It's important to talk to your physiotherapist about what exercises are safe for you. Some examples might include:

• Hydrotherapy (water exercises)
• Strengthening exercises
• Stretching
• Aerobic exercise
• Pelvic floor exercises
• Clinical Pilates

Your physiotherapist can also teach you pain management strategies, movement and activity modifications, positions of ease and physical activity recommendations.

Manual Therapy

Physiotherapists can also use hands-on techniques to help reduce your pain. These might include spinal mobilisations, muscle relaxation techniques, TENS (a machine that uses electrical impulses to reduce pain) or kinesio taping to help support your lower back.

Support Wear Recommendations

There’s strong evidence to suggest that wearing special support garments can help with pregnancy-related lower back pain. Your physiotherapist can recommend what types of support wear might work best for you, such as tubigrip (a type of stretchy bandage), compression shorts/tights to support your belly and pelvic area as well as SIJ belts or belly bands for your lower back.

Pelvic Girdle Pain (PGP)

You may experience pain in certain areas of your pelvis during pregnancy and occasionally for a period after birth. 

Why might this happen?

During pregnancy your body undergoes many changes to allow for your baby to grow. These may include: 

• Changes to your joint structure, including widening of your pelvis to support your growing baby.
• An increase in pressure on your pelvis due to the growth of your baby.   
• Changes to your posture and movement patterns as you progress through pregnancy. 

Where might you feel pain?

PGP can present differently in different people. You may experience pain in your: 

• Pubic bone
• Sacroiliac joints
• Groin/glutes and surrounding structures

What is likely to aggravate the pain?

• Prolonged periods of standing and/or walking 
• Movements that involve separating the legs (ie. getting in and out of the car, going up and down stairs, rolling in bed)
• Single leg activities (putting pants on) 
• Shearing exercise (cycling, running, walking)

Strategies to manage PGP

• Avoid movements which involve separating your legs. It may help to imagine you are wearing a mini skirt, always try to keep your legs together when hopping in and out of bed or the car.  
• Apply ice packs every 2-3 hours for up to 20 minutes to sore areas as needed, on your joints to reduce pain and inflammation.
• Wearing support wear can help to reduce some of the load on your pelvis during pregnancy, speak to your physiotherapist to find which works best for you. 
• It is important that you are still achieving some form of daily physical activity unless instructed otherwise from your doctor. You may wish to seek guidance from your physiotherapist for safe and effective activity modifications. These may include clinical pilates and/or hydrotherapy. 
• If you are struggling to manage your pain, seek advice from your doctor. 

Carpal Tunnel Syndrome

The carpal tunnel is a structural opening in the wrist which nerves and tendons pass from your arm into your hand and fingers. Increased fluid retention during pregnancy will often cause compression of the median nerve, leading to carpal tunnel syndrome. 

Symptoms of Carpal Tunnel Syndrome

You may experience the following: 

• Numbness/tingling/pins and needles sensations in parts of your hand, wrist and forearm
• Nerve-like pain in your wrist and hand which may radiate up your arm.
• Night pain and difficulty sleeping
• Wrist and hand weakness 
• Difficulty using your hands and fingers 

Management of Carpal Tunnel Syndrome

• Try to avoid heavy lifting where possible
• Limit bending of your wrist (see image below); wearing a wrist splint can help to maintain a neutral position. 
• Apply ice to reduce swelling and help with pain management, every 2-3 hours for up to 20 minutes. Ensure ice does not directly contact the skin. 
• Wear a compression bandage (ie. tubigrip or wrist compression sleeve)
• Elevate your arms above the level of your heart when able
• Lymphatic drainage techniques (perform a sweeping motion from the fingertips towards your shoulder with your arm elevated above heart level) 
• Avoid activities that aggravate your symptoms

Managing Carpal Tunnel Syndrome with a Newborn

Often it can take at least 3-4 days after birth for the swelling in your body to start to reduce or show signs of improvement. While caring for your baby, it is important to try keep your wrist as neutral as possible. Especially when breastfeeding and or/carrying your baby to avoid aggravating your symptoms. You may continue to wear a wrist splint until your symptoms resolve. Use pillows for extra support while breastfeeding and discuss with your midwives’ alternate positions that feel right for you. If your symptoms show no signs of improvement with these strategies, it is important to seek guidance from a physiotherapist for the next steps in treating your carpal tunnel. 

Diastasis Rectus Abdominis Muscle (DRAM)

DRAM (also known as abdominal muscle separation) is the stretching of your connective tissue in your abdominal region as a result of your growing baby during pregnancy.

Causes of DRAM

DRAM can occur due to multiple factors throughout your pregnancy (9). These may include: 

• Hormonal changes 
• Stretching and/or weakening of your abdominal muscles as your baby grows 
• Genetics 
• Multiple pregnancies 
• Twins or large babies

Can DRAM be avoided?

There is evidence to suggest that low impact exercise (walking, cycling, Pilates) throughout pregnancy can reduce the severity of DRAM, though everyone will experience some degree of abdominal muscle separation likely in the third trimester. 

Importance of addressing DRAM

Our abdominal muscles are important as they provide support for our back and work together with our pelvic floor to support our pelvic organs after birth. While your abdominal wall can heal naturally in the months following birth, it is important to be mindful and continue to monitor it over time with your physiotherapist.

Preventing DRAM

1. Wearing abdominal support wear can help to promote tissue healing and provide comfort to you as you start to gradually increase your activity. Choose whichever support wear feels right for you, you want to feel comfortable and supported. 
2. Avoid lifting anything heavier than your baby for the first 6 weeks. 
3. Try to avoid full sit ups in the early stages post-birth by using rolling to your side to assist getting in and out of the bed. (see image) 
4. Exercises to strengthen the deep abdominal muscles (use description from still birth recovery handout). These exercises can be progressed by your physiotherapist. Remember to use your deep abdominal muscles functionally in all of your daily activities ie. lifting your baby, standing up from a chair etc.

Pelvic Floor Dysfunction

The pelvic floor is a group of muscles that work together to support your pelvic organs and help control your bladder and bowel. During pregnancy, these muscles can weaken due to the increased intra-abdominal pressure from the growing baby and other changes in the body. This can lead to the development of pelvic floor disorders, such as pelvic organ prolapse (POP), urinary incontinence (UI) and/or faecal incontinence (FI). 

How can Physiotherapy help?

Research shows that training your pelvic floor muscles can help reduce or even stop problems like leaking urine and pelvic organ prolapse during pregnancy and after birth. Strengthening these muscles can make a big difference in both the amount and frequency of urine leakage, meaning you might not need long-term treatment. It is strongly recommended that pregnant women regularly do pelvic floor exercises with help from a health professional.