Dr. Sanjivni Khanna

How physiotherapy can help through pregnancy and after pregnancy:

Pregnancy and childbirth throw a woman's daily routine out for a toss. During and after pregnancy is the time when her body undergoes a number of hormonal and physical changes. Mundane tasks like sitting, standing, walking, and working become a challenge.

Research suggests that almost all pregnant women experience musculoskeletal discomfort but around 25% become temporarily disabled because of it. All these occur due to the incredible changes taking place in the body during a normal pregnancy.

Pregnancy discomfort has been accepted as a part of the normal process of pregnancy for years now. But just because you are pregnant does not necessarily mean that you have to accept problems like a backache and pelvic girdle pain as unmanageable. Doctors of today have realized that physiotherapy is the key to enhancing a woman's health during pregnancy. The main aim of physiotherapy is to reduce discomfort, to prepare the body for delivery and to speed-up recovery after childbirth.

Physiotherapy through pregnancy

The basic aim of physiotherapy during pregnancy is to help the body deal with issues related to mobility, musculature, circulation and respiration. Prior to starting an effective antenatal (before birth) program, a thorough evaluation is done to recognize which exercises would be best suited to the woman's needs. These exercises are aimed at strengthening muscles,
decreasing joint pain, correcting muscle imbalances, and increasing the overall range of motion of the body. Therapists may also advise you about correct sleeping positions as your normal sleeping routine may be disturbed during pregnancy.

Here's how physiotherapy deals with some common complaints experienced by women during pregnancy.

Lower back pain: almost all pregnant women experience low back pain, though it tends to become severe after third trimester begins because the woman's centre-of-gravity shifts due to the increase in the stomach size. Lower back pain is treated with manual and passive physiotherapy, back support, postural education, and some pilates exercises. Home exercises are also taught which the women are encouraged to continue at home.

Pain in the sacroiliac joints: sacroiliac joints are present in the lowest region of the lower back. This pain is usually concentrated in the buttock region. During pregnancy, due to excessive hormone release, the body's connective tissues tend to relax so that the muscles can stretch to aid in delivery. This may cause the sacroiliac muscles and ligaments to become excessively mobile, causing extreme joint movements. Due to this, the woman may experience difficulty in lifting the leg, swelling in the joints, pain in the hips, and difficulty while standing and sitting. Strengthening exercises are provided by the physiotherapist to stabilize the joints and hands-on therapy is given to reduce the pain by realigning the pelvis.

Urinary incontinence (due to pelvic floor weakness): progesterone, which is known as the pregnancy hormone, relaxes the muscles of the pelvic floor in order for it to be supple and ready for delivery. Therefore, these muscles can weaken and strain during pregnancy and childbirth, which leads to urinary incontinence (unable to contain or retain urine) and pelvic floor dysfunction. Physiotherapists will teach you strengthening exercises to strengthen the pelvic floor muscles. They may also provide you with a pilates based exercise program to help reduce the muscle weakness that may occur after childbirth.

Sciatica: sciatica is a problem that a lot of pregnant women experience. Continuous pressure or strain on the sciatic nerve can lead to backache, and weakness, numbness and tingling in the leg or associated areas. Physiotherapy uses stretching exercises and manual therapy to relieve you of these symptoms.

Carpal tunnel syndrome: this condition is caused due to build-up of excessive fluid resulting in swelling in the carpal tunnel in the wrist. You may experience symptoms like pain, numbness, tingling, and loss of coordination in your hands and fingers. Physiotherapy techniques such as mobilization, strengthening exercises, stretching, and soft tissue techniques help to reduce these symptoms. In severe cases, a wrist brace may be provided to put on during specific activities to minimize inflammation.

Physiotherapy after pregnancy

Physiotherapy does not stop once your baby is born. It is very much part of post-natal care too. Gentle physiotherapy exercises must be started two days after the baby's birth. However, this must only be done after consulting with your doctor. Most hospitals have physiotherapists who will offer their services before you are discharged. For the first six weeks after childbirth, your body is still in the recovery phase and walking is the best exercise for you. Start with short walks, and then slowly increase time, distance, and speed of your walks, according to your comfort. Swimming is another good exercise, but you can only start with this after you have recovered properly. If you experience any pain and discomfort, discontinue the activity immediately and consult your doctor. After six weeks, with the go-ahead from your doctor, you can start with sports and exercise classes.

Women also experience certain post-natal complications. Here is how physiotherapy helps you recover from them.

Low back pain: physiotherapy techniques such mobilization, stretching, strengthening, soft tissue techniques, and hydrotherapy are very beneficial in reliving post-natal backache. Certain pilates exercises are also helpful.

Weakness of pelvic floor muscles: immediately after childbirth, the pelvic floor muscles are weakened. These muscles can be strengthened by pilates based exercise program and other exercises specific to pelvic floor muscle strengthening, which the physiotherapist will teach you.

Sacroiliac joint pain: this pain can continue after pregnancy too. Strengthening exercises and hydrotherapy can help in regaining normal muscle tone.

Diastasis recti or abdominal separation: generally this condition occurs in women who have undergone multiple pregnancies. A physiotherapist will provide you strengthening exercises to strengthen the abdominal muscles.

A woman's body undergoes incredible strain during pregnancy, and physiotherapy is something that can make the entire process so much easier. It aims not only at your recovery but enhances your body's ability to have a smooth and easy delivery. Physiotherapy makes the experience of pregnancy positive and joyful, just as it should be.

Sleep disorders are problems in the pattern of sleep of an individual, often leading to a serious mental, physical and psychological strain. The most common types of sleep disorders are:

1. Insomnia: People suffering from insomnia usually display symptoms like difficulty in falling asleep, waking up in the middle of the night and being unable to get back to sleep or waking up feeling tired.
2. Sleepwalking: People suffering from this disorder get up and walk around, being asleep all this time.
3. Narcolepsy: People suffering from narcolepsy usually complain of overwhelming drowsiness after waking up and the drowsiness persists throughout the day.
4. Obstructive sleep apnea: Patients suffering from this, generally experience a state where their breathing pauses for a while and resumes after few seconds. This usually happens when throat muscles block the airway and create problems.

Homeopathy offers several treatments for these disorders and they are:

1. Using Nux Vomica: This is especially helpful in case of insomnia; it can help in recovering from a general state of sleeplessness.
2. Using Coffea cruda: Sleep disturbance and waking up in the middle of the night are symptoms for which this medicine proves to be beneficial.
3. Belladonna: Bad dreams of deep-lying insecurities that don't let the patient sleep are most common symptoms that can be treated by this. Belladonna helps in case of problems of consistent sleep.
4. Stramomium: It is beneficial for sleepwalking and also proves to be helpful to an extent in case of sleep apnea.
5. Aconite: Especially, helpful for patients suffering from narcolepsy as it reduces the onset of tiredness brought about by lack of sleep and thus, helps in recovering from the drowsiness and lack of activity that narcolepsy brings.
6. Phosphorus: Helps in case of sleepwalking and is often beneficial in cases of insomnia too.
7. Pulsatilla: Beneficial for obstructive sleep apnea by reducing the muscle constriction and for people suffering from acute cases of narcolepsy.
8. Arsenicum: It helps with better sleep for people suffering from sleeplessness due to anxiety, fear or worry. Acute thirst of water coupled with lack of sleep past midnight and general drowsiness are the symptoms that you need Arsenicum. This works well for sleepwalking patients too.
9. Valerianna: Especially, beneficial for sleepwalking patients. Patients who are only able to sleep towards the morning are the ones on whom this works well and this can be taken in herbal capsule form as well.