Why You Need a Physical Therapist During Pregnancy and Postpartum

Physical Therapist During Pregnancy and Postpartum

There is nothing more powerful than being able to create and nurture a human being inside your womb, and usher it into the world by the forces of nature. But as that warm little baby in your belly grows and moves about, it makes demands on your body that are distorting, uncomfortable, and sometimes downright painful.

A physical therapist who specializes in women’s health can help you mitigate and manage the physical changes and challenges brought on by pregnancy and childbirth, from your first trimester, all the way through the postpartum period.

Physical Changes of Pregnancy


Even before your baby is the size of a peanut, your body is already undergoing profound changes. Shifting hormones put a halt to your monthly periods and cause your breasts to swell and become tender. You may feel sleepy and lethargic, and your emotions may become more volatile than normal. And for many pregnant moms, nausea and a heightened sense of taste and smell make the first trimester seem like a bout of the flu.

As the baby grows and begins to take up more space in your body, more pronounced physical changes set in.

  • Weight gain coupled with crowding from your growing baby can cause pain and discomfort in your low back and pelvic floor.
  • Relaxed ligaments may cause symphysis pubis dysfunction (SPD), where your pelvic joint becomes misaligned and unstable, causing pelvic pain.
  • Pressure against your abdominal wall can cause diastasis recti, where the two sides of your “six-pack” separate down the middle.
  • Pressure on your nerves can send pains shooting through your pelvis and lower extremities.
  • A stretched and weakened pelvic floor can cause urinary and fecal incontinence, and pelvic organ prolapse.

While all these changes are common and normal, the pain and discomfort can become difficult to manage. A physical therapist can work with you to find strategies that relieve pain and pressure, maintain optimal health and fitness, and reduce any long-term damage.

Postpartum Issues


Pregnancy and childbirth can be difficult, but the aftermath has its own unique challenges that may make you wish you could put that baby back in your belly. The postpartum period is often referred to as the “fourth trimester” because it is a time of healing for you, and a critical developmental stage for your baby.

Sadly, modern culture does not recognize the postpartum period as an ongoing part of the pregnancy and childbirth experience. Women are expected to pick up where they left off before they became pregnant, with no time to recover from the trauma of childbirth. Yet many women have lingering issues that need attention.

  • Pelvic misalignment and pelvic floor weakness can create ongoing problems that interfere with sexual function, cause urinary and fecal incontinence, and lead to other issues that cause pain and diminish your quality of life.
  • Trauma during childbirth can cause pelvic floor muscle injuries like perineal tearing, rupture of pelvic floor muscles, pelvic organ prolapse and other damage from prolonged labor, pushing and traumatic hospital birthing methods.
  • Diastasis recti can leave you with a misshaped and dysfunctional abdomen, causing a shift in the position of your vital organs and hampering your efforts to get back in shape.

Physical therapists that specialize in women’s health understand how to treat postpartum issues, and are dedicated to helping you restore optimal form and function.

How a Physical Therapist Can Help

Pregnant and postpartum mothers are often more concerned about the cosmetic changes of childbirth than any underlying structural damage. In trying to maintain and restore your pre-pregnancy appearance, you may be tempted to work out harder or seek the help of a personal trainer. But many of the exercises you did to keep in shape before your pregnancy can actually worsen the damage done by childbirth.

A women’s health physical therapist is trained in both orthopedic and pelvic floor physiology. They can help you maintain your muscle and joint integrity during pregnancy, and help you heal and restore function after you give birth. They can also design a progressive exercise program to help you get safely back in shape.

In addition to addressing issues related to pelvic floor and abdominal muscle function, a physical therapist can recommend lifestyle strategies for breast feeding positions, lifting and carrying your baby, using a car seat and stroller, and other practical advice to protect your body while it heals, so you can return to your pre-pregnancy fitness level without ongoing problems.

Women’s Health Physical Therapy in NYC

The women’s health physical therapy team at NYDNRehab understands how important it is for new moms to heal and get back in shape. We go beyond superficial cosmetic interventions, to treat and restore your pelvic floor, improve the integrity of your abdominal wall, and help you heal from the traumas of pregnancy and childbirth.

Even if you have no lingering symptoms during your postpartum period, your body is still healing inside. It is recommended that all postpartum moms have at least a few physical therapy sessions during the “fourth trimester.”

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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