Postpartum Low Back and Pelvic Pain

About Postpartum Pain

During pregnancy, your pelvic floor muscles work overtime to support the weight of your baby and amniotic fluid. At the same time, special hormones are released to make your ligaments more pliable and elastic, to allow your baby to travel through the birth canal. For some women, the combination of extra weight and loose ligaments can lead to low back and pelvic pain after the baby is born.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

Dr. Lev Kalika, Pelvic Floor Physical Therapist

Dr. Lev Kalika has been an active member of the International Society of Medical Shockwave (ISMST ) since 2007, and has performed over three thousand ESWT procedures. He is a world renowned expert in ultrasound guided dry needling and has published multiple peer-reviewed articles about ultrasound guided procedures. He uses ultrasound guidance to perform dry needling and ESWT for pelvic floor dysfunction treatment. Dr. Kalika has developed his own unique approach to pelvic pain, which is cardinally different from conventional pelvic pain physical therapy.

Dr. Kalika’s expertise makes NYDNRehab the clinic of choice for pelvic floor physical therapy in NYC.

Why Postpartum Treatment at NYDNRehab is Better than Conventional Physical Therapy

Over the past 20 years of practicing postpartum physical therapy, numerous patients have turned to us after other practitioners have failed to resolve their postpartum pain and dysfunction. Our trained and certified pelvic pain specialists understand women’s bodies, and we know how to meet the needs of our pelvic pain patients.

We use diagnostic and rehabilitative ultrasonography to visualize the structures of the pelvis and retrain the pelvic floor and core muscles. Our research-grade high resolution ultrasound equipment provides the most advanced technology for detailed imaging of the pelvic structures. Our technological tools enable us to diagnose and quantify core and intrinsic spinal stability deficits, so we can design personalized treatment programs to meet the individual needs of every patient.

Why Postpartum Treatment at NYDNRehab is Better than Conventional Physical Therapy

Symptoms, Causes and Risk Factors for Postpartum Complications


  • Urinary incontinence

  • Constipation

  • Diastasis recti

  • Pain during intercourse

  • Persistent pelvic pain

  • Low back and Hip pain


  • Pelvic instability

  • Torn and damaged perineum

  • Pelvic organ prolapse

  • Stretched and weakened pelvic floor

  • Ruptured linea alba

  • Nerve damage or compression

Risk Factors

  • Obesity

  • Being out of shape

  • Multiple pregnancies

  • Prolonged or complicated labor

  • SI joint dysfunction

  • Symphysis Pubis Dysfunction

Accurate Diagnosis Means Successful Treatment

As postpartum physical therapy specialists, our primary goal is to identify which ligaments and muscles have been overly stretched and damaged during pregnancy, and which muscles need to be retrained to restore pelvic stability.

We use diagnostic musculoskeletal ultrasonography to visualize the structures of the pelvis, combined with a thorough clinical exam to assess spinal and pelvic stability. Once we arrive at an accurate diagnosis, we design a personalized treatment plan to address the specific needs of the individual patient.

Accurate Diagnosis Means Successful Treatment

Our High-Tech Equipment Yields Optimal Results

Technological tools have been a game-changer for postpartum physical therapy, allowing us to visualize, quantify and treat postpartum pelvic dysfunction, and measure our results. Technology enables us to assess the effectiveness of our treatment interventions and make adjustments accordingly.

Our postpartum tech toolbox includes:

High resolution musculoskeletal ultrasonography

High resolution musculoskeletal ultrasonography

For diagnosis and rehabilitation via real-time feedback muscle retraining

Extra corporeal shock wave therapy (ESWT)

Extra corporeal shock wave therapy (ESWT)

To relieve pain, reduce inflammation and promote healing of muscles and ligaments

Electromagnetic transduction therapy (EMTT)

Electromagnetic transduction therapy (EMTT)

To augment and enhance the regenerative effects of ESWT

Restoring Pelvic Stability

Restoring Pelvic Stability

Pregnancy can destabilize the pelvic region, contributing to pelvic pain and dysfunction. Using rehabilitative ultrasonography, dynamic neuromuscular stabilization (DNS) and other innovative methods, we work with our patients to optimize pelvic and spinal stability, to eliminate pain and dysfunction, and restore fluid pain-free movement.

Injection Therapies for Postpartum Pain

In addition to diagnosis and feedback training, we use ultrasound to guide our needling procedures:

Ultrasound Guided Dry Needling

Ultrasound Guided Dry Needling

Pelvic pain and dysfunction are often caused by trigger points located deep within the pelvis. Under ultrasound guidance, we are able to visualize and accurately target trigger points, to cause a twitch response that releases taut tissue, immediately relieving pain.

Ultrasound Guided Injection Therapies

Regenerative Injection Therapy

Prolotherapy is a procedure where a dextrose solution is injected into damaged and overstretched ligaments, under ultrasound guidance. The solution irritates the tissues, to evoke a regenerative reaction and restores the integrity of overly lax ligaments.

Preventing Postpartum Pain and Dysfunction

If you are planning to become pregnant, starting a regular exercise program that includes walking, swimming, water exercises, yoga and/or light resistance training can help prepare your body for the rigors of pregnancy.

If you are already physically active, making modifications as your pregnancy advances can help you to have a successful labor and delivery, and mitigate the risk of postpartum complications. Working with a physical therapist throughout your pregnancy can help ensure that your exercise routine is effective, without placing excessive stress on your muscles, ligaments and joints.

Preventing Postpartum Pain and Dysfunction Image 1
Preventing Postpartum Pain and Dysfunction Image 2

Maintaining proper posture throughout the day can help alleviate postpartum back pain. You may also benefit from a maternity belt, to help support your abdomen and stabilize your hip and pelvic joints in your third trimester. After your postpartum recovery period, pelvic floor physical therapy can help to restore the integrity of your abdominal and pelvic floor muscles.

Get Pain-Free Postpartum Treatment that Really Works!

Once your pain is gone and your function has improved, we transition our patients into our postpartum lower back and pelvic pain prevention program. We blend Pilates, yoga and other pelvic-specific physical therapy into a personalized exercise program you can do at home.

Our goal is to educate our patients on how to maintain muscle tone for pelvic stability and optimal pelvic function. We help our new moms to get back to their pre=pregnancy fitness levels, so they can continue to remain physically active and care for their babies.

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Get Personalized Postpartum Physical Therapy
Designed Just for You

The women’s health specialists at NYDNRehab understand that every pregnancy is different, and every patient has unique needs during pregnancy and throughout the postpartum period. We design personalized programs and work one-on-one with our patients, to ensure your needs are fully met and your pelvic pain and dysfunction are completely resolved.

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    Dr. Lev Kalika
    Dr. Lev Kalika

    Clinical director & DC RMSK

    Research at NYDNRehab

    Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018) At: Paris, France DRY NEEDLING UNDER ULTRASOUND GUIDANCE DECREASE NEUROPATHIC COMPONENT AND INCREASE LEVEL OF MOTION IN PATIENT WITH LOW BACK PAIN

    Our Specialists

    Dr. Mikhail Bernshteyn MD (Internist)
    Dr. Michael Goynatsky DPT
    Dr. Daniela Escudero DPT
    Dr. Michelle Agyakwah DC
    Dr. Tatyana Kapustina L. Ac.

    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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