All physical therapists (PTs) should have some basic knowledge about women’s health including how to address general musculoskeletal complaints of pregnant women. But some physical therapists are experts in women’s health and are certified as clinical specialists in this area by the American Physical Therapy Association (APTA). In order to become certified they must pass an exam after having completed a clinical residency or 2000 hours of work in women’s health. PTs who are certified in women’s health have skills that most PTs do not. One of these skills is the ability to evaluate and directly treat the pelvic floor.
Much of women’s health is focused on urinary stress incontinence because this a problem that has been shown to respond extremely well to physical therapy treatment. Stress incontinence often develops during late pregnancy or after birth. PTs can use biofeedback to help patients remember how to use their pelvic floor muscles and can give them specific exercises to to improve strength and endurance of those muscles.
But women’s health PTs can help pre- and postnatal patients in many other ways too. If women have pain during pregnancy, PTs can evaluate the source of the pain and may be able to perform techniques such as myofascial stretching and trigger point release that help relieve the pain. They can use gentle techniques to restore pelvic alignment and they can teach patients effective body mechanics to minimize her symptoms. They can also treat postnatal problems such as pudendal nerve injury, incontinence, pelvic pain caused by scar tissue and back pain related to diastasis recti. San Francisco PT, Liz Miracle specializes in pre- and postnatal patients in San Francisco. She states that yoga and aquatic exercise are the most effective forms of exercise to complement the teaching and hands-on work she does in the clinic.
Some women’s health specialists, like Ms. Miracle, run cash-only clinics but physical therapy may be covered by insurance if your doctor refers you for evaluation and treatment of a specific problem. Unfortunately, many doctors are either not aware of the benefits of physical therapy for pregnant women or do not think it is necessary. There is often an attitude of, “You’re pregnant and so it’s normal to have aches and pains. You’ll feel better after your delivery.” Sadly this is an attitude that is all too common in the medical community as well as the general public.
Women’s health physical therapists also offer prevention strategies that minimize or completely prevent problems during pregnancy and childbirth. They can make sure that women are doing pelvic floor strengthening in an appropriate and effective way. This has been shown to decrease the incidence of incontinence.1 They can also teach women to do perineal stretching which has been shown to decrease tearing during childbirth.2Unfortunately these services must be paid for out of pocket. Although it would likely save health care dollars in the long run, insurance does not support such preventative services.
Women who are interested in working with a PT certified in women’s health can find someone in their area by going to the APTA’s “Find a PT”. Ms. Miracle stresses that pregnant or post-partum women should look for a therapist that has training and experience with techniques such as myofascial release and skin rolling and also that they have a strong background in orthopedics in addition to competence in pelvic floor evaluation and treatment.
References:
1 Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Hay-Smith J.; Mørkved S.; Fairbrother K.A.; Herbison G.P.;Editorial Group: Cochrane Incontinence GroupPublished Online: 21 JAN 2009.
2 Preventing Perineal Trauma During Childbirth: A Systematic Review. Eason, E.; Labrecque, M.; Wells, G.; Feldman, P.; Obstetrics & Gynecology: February 2003 - Volume 101 - Issue 2 - p 313-319
