PREHAB
“PREHAB”
Treating patients during their pregnancy has always been a passion of mine. I came from a clinic that was an orthopedic outpatient physical therapy clinic and anytime a patient came in that was pregnant was put on my schedule. Even if they had a toe injury. All of the therapists were scared to touch anyone who was pregnant. But I had not had a ton of exposure to working with patients during their pregnancy at that point in my career. I had already done my foundational courses for pelvic health but even in those specialized courses, there wasn’t a lot of emphasis on the pregnant patient. Most of the emphasis was on postpartum rehab or elderly patients with bladder, bowel, or a pain dysfunction. Then as I began to work with more patients that were pregnant, I realized that these are just like any pelvic health patient that I had seen before. They had similar bladder, bowel, pain, movement dysfunctions as well.
I can’t tell you how many times that I’ve seen patients who are postpartum, whether they were two weeks postpartum or two years postpartum, telling me, “Well I had these issues during my pregnancy but I just thought I had to wait until after I had the baby to come in to see you”. I wanted to change that. Which is why we talk to so many women about “prehab” before the baby is here. Pregnancy is such a vulnerable time for a woman’s body and it is also the most amazing time. The reason I say vulnerable is because your body is changing on a daily basis during pregnancy out of your control.
There is a big difference in postpartum recovery outcomes between the patients that I saw during their pregnancies and the patients who did not seek out a pelvic floor PT during their pregnancy. I do not have a research article on this but I am speaking from clinical experience and treating thousands of women who are/have been pregnant. For example, I would have to see a patient anywhere from 4 to 12 times postpartum if I’ve never seen them during their pregnancy. However, when I have seen them during their pregnancy, I would say that 4 to 12 average goes down to about 2 to 6. The reason for this is they’ve already understood the basics about their pelvic health, have an individualized plan care, and they have prepared their body to potentially dodge some of those unwanted postpartum symptoms.
In a perfect world, all providers (doctors, chiros, doulas, etc.) who see a patient during their prenatal period would teach them about pelvic floor rehab. We should all be working as a team for the patient and baby. In my opinion, I look at a woman’s prenatal journey in regards to a pelvic floor PT and a midwife/OBGYN like I do a principal and a math teacher at a school. Think of the pelvic floor PT as the math teacher and think of the midwife/OBGYN as the principal. Yes, the principal is the boss of the math teacher and is in charge of the day to day well being of the school. But the principal would not be able to just jump into the math teacher’s class and teach the subject seamlessly. This is the same thing as the midwife/OBGYN are like the “principal” of the patient during their pregnancy and the pelvic floor PT is the specialist when it comes to the musculoskeletal system. They both have to work together to help the patient achieve the best pre and postnatal outcomes.
Back to the “prehab” thing. Many of us realize that delivering a baby is a pretty big deal. It changes your life in so many ways and especially your body. Physical therapists are in charge of getting your body ready for the big event a.k.a. childbirth. Seeing a pelvic floor PT during your pregnancy is so important because they are going to talk to you about bladder health, bowel health, safe exercise progression, posture, positioning, breath work, and more. Since your body is changing so rapidly during those nine months, it’s important to be continually assessed so that you know that you are doing the right things to protect both your body and baby.
My hope is that for anyone who is reading this will understand the importance of pelvic floor PT during pregnancy. I want this to become the “norm” because I have seen the benefits with my own eyes time and time again.