Postpartum: The Fourth Trimester – When to Consider Physical Therapy

By Catherine Heggie, DPT

After nine months of frequent doctor visits while pregnant, often, all the appointments just stop after delivery. Even though you don’t miss that waiting room, when the focus shifts to your new baby’s health, it can leave you with some questions about your own body. As you heal and recover, here are some reasons to consider postpartum physical therapy:

Before 6 Weeks Postpartum

The time immediately following delivery is about resting and adjusting to the new little one. Because the mix of hormones in your body changes and decreases very slowly, much of what you experience in the first few weeks after delivery will go away on its own. If you had a particularly difficult epidural, you may have some difficulties walking around after delivery; that would be a reason to talk to your OB about physical therapy before your 6-week check-up.

At 6 weeks Postpartum

• Pain and sensitivity at your C-section scar. Do you have difficulty tolerating a waistband against your C-Section scar due to pain?

• Did you have pain in your low back, around your butt, and/or in the lowest part of your abdomen while pregnant? That can be called pelvic girdle pain and if it did not resolve by 6 weeks, you might benefit from physical therapy.

• When you lay on your back and lift your head up (like a mini-crunch) do you see a dome form in the middle of your abdominal muscles? This could be diastasis recti abdominis (DRA). Normally it goes away on its own, postpartum, but if it doesn’t, physical therapy can help it resolve by helping you improve your breathing, coordination, and strength.

Beyond 6 Weeks Postpartum

• If you have leaking from your bowel or bladder that hasn’t resolved by 6 weeks, physical therapy can address that.

• Do you feel a heaviness in your groin when you lift up your baby or a feeling of something falling out? This could be pelvic organ prolapse and physical therapy can help you manage those symptoms through muscle coordination and strengthening.

• Did the low back pain from pregnancy go away only to be replaced by pain in your upper back? This can be related to all of the positions you’re in while trying to feed the little one. If more pillow support for you and under baby doesn’t help, consider physical therapy.

• If your return to sexual activity has been limited by pain, physical therapy can evaluate the muscles that are a part of sexual function.

• Are you counting down the days until you can get back into the gym? If you want to return to high-intensity exercises such as long-distance running, Crossfit, or powerlifting, physical therapy can assess your readiness and guide your return to doing what you love.

About the Author: Catherine Heggie has a Bachelor’s degree in Kinesiology and is a proud graduate of the University of North Dakota’s Doctor of Physical Therapy program. She continued her education with a residency in orthopedic manual physical therapy and courses on pelvic health through the American Physical Therapy Association. Catherine now works in Southern California seeing both general orthopedic patients and pelvic health patients.


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