The American Council of Obstetrics and Gynecology recommends pregnant women perform 30 minutes or more of moderate exercise a day on most, if not all, days of the week in the absence of either medical or obstetric complications.

While traditional or group exercise classes may be beneficial in prevention of pain in pregnant women and new mothers, instructors are often untrained. Alternatively, prenatal physical therapists specialize in treating this population, and can perform evaluations and offer diagnoses, on top of creating a healthy exercise routine.

ADVANCE spoke with Martina Fogt, MPT, CAPP, co-owner and senior physical therapist at Bebe PT, Los Angeles, CA. Bebe PT is the only physical therapy facility in Los Angeles that provides and specializes solely in pre- and postnatal services to mothers and mothers-to-be.

Prenatal PT Vs. Exercise

Studies have shown that individualized treatment programs with specifically designed stabilization exercises are more beneficial than traditional exercise or group exercise classes.

Fogt noted the difference between prenatal physical therapy and traditional exercise is significant.

"A prenatal physical therapist will conduct a thorough postural and musculoskeletal examination in addition to gait analysis and a physical examination of the lumbar spine and pelvic girdle, in order to identify impairments and differentially diagnose the culprit of symptoms," she explained.

Traditional exercise instructors, on the other hand, are typically inexperienced and do not diagnose patient's problems.

Prenatal physical therapy can help prepare a woman for labor and delivery in multiple ways. Though there is conflicting evidence in the literature, some studies report that women who exercise during pregnancy experience shorter second stages of labor, and deliver babies with higher Apgar scores and shorter recovery times.

"In my personal experience, women receiving regular physical therapy interventions, including specific core, abdominal and pelvic floor muscle training, had significantly faster recovery times, stronger transversus abdominus and pelvic floor muscle recovery, and an overall easier delivery, unless fetal positioning or other obstetric challenges were present," said Fogt.

Bebe PT provides physical therapy treatments, including postural evaluation, gait analysis and musculoskeletal examinations, to mothers and mothers-to-be. Based on findings, patients are provided with an independent home exercise program, postural modifications for nursing, lifting or carrying infants, ergonomic workplace adjustments, and weekly individualized treatment programs. "The majority of my patients report notable improvements in back and hip pain and an increase in stamina and strength after treatments," noted Fogt.

Pre- and Postnatal Pain

During pregnancy, many women present with low-back and posterior pelvic pain (often referred to as sacroiliac joint dysfunction). Posterior pelvic pain is one of the most commonly seen diagnoses and is often misdiagnosed as sciatica.

"Pelvic obliquity or pregnancy-induced laxity often leads to pelvic girdle dysfunctions, which can greatly limit functional mobility and gait," said Fogt. "Pelvic floor dysfunction and urinary incontinence are also common [in pregnant women] and can be easily addressed with specific pelvic floor strengthening, functional retraining and biofeedback to the pelvic floor."

Other symptoms in this population include neck and thoracic strains (due to poor posture), and increased myofascial strain, carpal tunnel syndrome, sciatica and round ligament pain (due to the expanding uterus).

Postnatal pain syndromes often include low- and mid-back pain, as well as interscapular muscle discomfort and cervical strain due to lifting, carrying and nursing the infant. De Quervain's tenosynovitis and carpal tunnel syndrome can result from overused wrist and thumb tendons when picking up the infant. Headaches, urinary incontinence, scar pain after Caesarean section and dyspareunia are common as well.

"Bebe PT has been set up to be a one-stop-shop for the physical wellbeing of a woman's body during and after pregnancy," explained Fogt.

The facility provides pain relief with individualized strengthening and stabilization exercises. Prenatal physical therapists also offer advice to new mothers regarding carriers and support devices to prevent myofascial tightness during the first month of meeting the demands of motherhood.

"One other important factor is that pregnancy-related pain is very much ignored by the mother as well as some physicians," noted Fogt. "Therefore, symptoms may develop undiagnosed for a long time. Educating expecting mothers and OBGYNs is key in terms of early intervention and prevention of pain."

Preventing Pain in New Mothers

New mothers should learn proper posture and how to correctly lift and carry their baby, stressed Fogt.

"Incorrect lifting and carrying mechanics lead to overuse injuries and can become a significant problem when pain prevents mothers from picking up their children," she noted.

Pain is often associated with poor lifting and bending techniques, which poses significant strain on the structures of the low back, thoracic spine and shoulder elevator musculature. Poor abdominal, core and pelvic floor muscle strength or neural inhibition post-surgically (C-section) often contribute to the mothers' increased low back pain and can be addressed early.

Wrist and thumb tendons can also become inflamed when mothers use poor wrist positioning to burp, nurse and hold their baby.

"We educate patients on correct lifting and carrying positions before the newborn arrives in an effort to establish good habits from the beginning and to avoid pain all together," stated Fogt.

Bebe PT plans to expand in the future as Fogt sees a growing need to offer PT services to this population. She offered this advice to therapists who wish to incorporate these same services into their practice: "I find it valuable to have at least one clinician in your team of physical therapists who is trained in women's health issues, pelvic floor dysfunction, incontinence and/or pre- and postnatal physical therapy care in order to provide adequate knowledge and skills to address these issues."

Beth Puliti is senior associate editor and web editor of ADVANCE and can be reached at epuliti@advanceweb.com

Workout For Two

Martina Fogt, MPT, CAPP, co-owner and senior physical therapist at Bebe PT, Los Angeles, CA, listed 10 ways exercise can benefit mothers and mothers-to-be.

1. Controls weight and maintains fitness;

2. Improves sense of well-being, enhances ­confidence;

3. Increases energy and reduces stress;

4. Improves sleep and relaxation;

5. Facilitates adjustments of posture and strengthens muscles required for optimal posture;

6. Provides pain relief;

7. Helps to prevent pelvic floor dysfunction;

8. Reduces risk of preeclampsia;

9. Greatly reduces the risk of gestational diabetes;

10. Exercise in early- to mid-pregnancy stimulates placental growth.