During these times of the Covid-19 pandemic, all non-coronavirus health issues seem to fade into the background. And yet nothing has changed. People continue to get sick, hurt, and bring children into the world. Life goes on at its regular pace, burdened by a pandemic, while especially expecting mothers and postpartum mothers are obliged to fall into step with the demands dictated by their condition.
During pregnancy and childbirth, there are three profound changes to a woman’s musculoskeletal system:
* Change in posture: As the pregnancy progresses and the abdominal region is weighed down, the woman’s center of gravity gradually shifts, thus affecting her posture. This new posture can be characterized by increased kyphosis in the upper back and lordosis in the lower back. This shifted posture slowly develops over the nine months of pregnancy and “follows” the mother even after childbirth.
* Change in the abdominal region: The presentation of the abdomen changes during pregnancy and retains this differentiation even after childbirth. The constant “stretching” of the abdominal region during childbirth creates an “opening” along the linea alba (the vertical line between the bottom of the sternum and the pubic region). This opening is a separation (or diastasis) in the abdominal muscles, that is, the rectus abdominis. This separation is the reason why the abdomen does not return to its pre-natal state.
* Change in the pelvic floor: The most significant change in the body of a woman who has just given birth is the only one that is invisible and this is the weakening of the pelvic floor. At the base of the pelvis there is an elastic web of muscles that stretches from the coccyx – the tip of the spine – to the pubic bone – the pelvic bone located in front of the pelvic girdle. The pelvic floor is what supports the bladder, uterus and bowel and controls sphincter movement, protecting from incontinence and prolapse, that is, the collapse of the pelvic organs. It is hence highly important that the pelvic floor is strengthened after childbirth to ensure continence and that the vital pelvic organs remain in place.
In the postpartum period, every woman needs to take the time to start exercising in order to re-educate her body and restore correct posture, decrease the separation of the abdominal muscle, and strengthen her pelvic floor.
Physiotherapists specializing in female healthcare have designed comprehensive programs aimed at restoring the body and the functions that have been affected by pregnancy. In Greece, the MAMA (Principles of Motherly Hugs) program targets women who have just given birth, focusing on fully reversing the three abovementioned changes.
The MAMA Scientific Therapeutic Exercise for Pregnancy and Childbirth program focuses on:
* Posture (assessing current posture, alleviating musculoskeletal pain and restoring correct posture).
* Diastasis of the rectus abdominis: Training women during pregnancy and after childbirth to do the necessary exercises to prevent the separation (diastasis) of the abdominal muscle and protect it (and avoid the exercises that may exacerbate the condition), assessing the diastasis of the rectus abdominis, reducing the diastasis with targeted exercises.
* Dysfunctions of the pelvic floor: Assessing the condition of the pelvic floor muscles and treating any pelvic floor dysfunctions regarding the bladder, the bowel, pelvic organ prolapse, sexual activity and pelvic pain.
* Core stability: Assessing the core stability of the body, training in the Do’s & Don’ts of postpartum exercise, and providing specialized therapy for core stability.
Women in the postpartum period can choose one, two, or all three programs based on how they have been assessed and their specialized needs.
Mimi Marcellou, PT, MSc. Praxis Physical Therapy.