Physiotherapy in Pregnancy – Relieve Pain and Prep for Birth

Did you know that 50% of pregnant women experience low back pain during their pregnancy? However, we’ve found that physiotherapy for pregnant women offers a natural, drug-free solution to this and many other pregnancy-related discomforts.

Research shows that women who participate in physiotherapy during pregnancy experience remarkable benefits. They’re 80% less likely to face urinary incontinence after labour and can reduce their gestational weight gain by up to 3 kilograms compared to those who don’t exercise regularly. Additionally, physiotherapy helps with faster postpartum recovery and decreases the likelihood of cesarean births.

We’ve created this comprehensive guide to help you understand how physiotherapy can support you throughout your pregnancy journey, from managing common discomforts to preparing for a smoother delivery. Whether you’re dealing with sciatica, pelvic pain, or simply want to stay active safely during pregnancy, we’ll show you exactly how physiotherapy can help.

Understanding Physiotherapy’s Role in Pregnancy

Pregnancy creates unique physical demands that regular physiotherapy doesn’t typically address. Understanding the specialised approach to physiotherapy during this transformative time can make all the difference in your pregnancy journey.

What makes pregnancy physiotherapy different

Pregnancy physiotherapy stands apart from standard treatment because it focuses primarily on helping your body manage the distinct physical challenges of pregnancy. Unlike general physiotherapy, prenatal care takes a comprehensive approach that considers physical, emotional, and social aspects through different stages—from pre-conception to one year post-birth.

The main goal of pregnancy physiotherapy is to assist your body in dealing with musculature, mobility, circulation, and respiration issues that emerge as your pregnancy progresses. A specialised physiotherapist creates individualised care plans that adapt to your changing needs throughout each trimester.

Pregnancy physiotherapists are specifically trained to understand the hormonal and physical changes affecting your body. Consequently, they can safely guide you through exercises that strengthen without strain and provide relief without risk.

The science behind prenatal physical therapy

Your body undergoes remarkable changes throughout pregnancy. Cardiac output increases by 30-50% above baseline, peaking in the third trimester. The diaphragm elevates approximately 4cm due to your enlarged uterus, while respiratory changes accommodate the demands of both you and your baby.

Furthermore, the hormone relaxin increases during pregnancy, particularly in the second trimester. This hormone loosens the birth canal to prepare for childbirth, but also affects other ligaments throughout your body, often resulting in lower back pain.

Physical therapy works by addressing these scientific realities through targeted interventions. Research strongly supports its effectiveness—a systematic review conducted by the Journal of Orthopaedic & Sports Physical Therapy concluded that physiotherapist-developed exercise regimens can reduce low back pain and decrease the likelihood of symptoms persisting after delivery.

Another important scientific aspect is the increased pressure on your pelvic floor muscles due to the growing uterus. Physiotherapy helps strengthen these muscles, with studies showing that women who receive pelvic floor physiotherapy are 80% less likely to experience urinary incontinence after labour.

When to start physiotherapy during pregnancy

The ideal time to begin pregnancy physiotherapy is as soon as possible—ideally in the early stages of your first trimester. Starting early offers several advantages:

• • Proactively addresses existing pelvic floor dysfunction before pregnancy compounds it
  • Establishes proper movement patterns before your centre of gravity shifts
  • Builds strength gradually rather than attempting to correct problems later

• Many pregnant women, especially those who are more active or athletic, seek physiotherapy earlier in their pregnancies. Nonetheless, the general recommendation is to listen to your body and begin when you start feeling discomfort associated with pregnancy.

Each trimester requires different physiotherapy approaches. First-trimester sessions typically focus on posture correction and addressing pre-existing musculoskeletal issues. Second trimester work emphasises stretching techniques for flexibility, mobility, and strengthening exercises for the abdomen and spine. By the third trimester, your physiotherapist will concentrate on labour coping strategies, including breathing exercises and positioning techniques to facilitate delivery.

According to research, the frequency of sessions varies based on individual needs and circumstances, with your physiotherapist creating a tailored treatment plan specific to your pregnancy stage and health goals.

First Trimester Physiotherapy: Building a Foundation

The first trimester sets the foundation for a healthy pregnancy journey. I’ve discovered that starting physiotherapy early offers significant advantages, allowing you to establish proper movement patterns before your body undergoes major changes.

Posture correction techniques

Proper posture during early pregnancy prevents back pain and reduces strain on your changing body. Initially, many women don’t realise how quickly pregnancy affects their alignment. Good posture involves training your body to stand, walk, sit, and lie in positions that place minimal strain on your back.

For standing correctly:

• • Hold your head straight with your chin in and ears aligned with the middle of your shoulders
  • Keep your shoulder blades back and chest forward
  • Maintain straight knees without locking them
  • Tighten your stomach by pulling it in and up when possible
  • Avoid standing in the same position for longer than 30 minutes

• For sitting properly, sit up with your back straight and shoulders back, using a small rolled towel or lumbar support at the curve of your back. Distribute your weight evenly on both hips and keep your knees at a 90-degree angle. Throughout your day, make a conscious effort to correct your posture by lifting your chest and pulling your shoulder blades back and down.

Core stability without strain

First trimester core work creates a foundation that supports your growing belly. Unless your doctor advises otherwise, most abdominal exercises are safe early in pregnancy.

Strengthening your core offers numerous benefits:

• • Reduces the risk of back pain
  • May contribute to faster labour
  • Supports pelvic organs as your pregnancy progresses
  • Alleviates pressure on your back

• Safe first-trimester core exercises include pelvic tilts, bridging, and gentle transverse abdominal contractions. For bridging, lie on your back with your hands by your side, knees hip-width apart. Squeeze your buttocks, lift your pelvis, hold for 10-20 seconds while breathing regularly, then slowly return to the starting position.

First and foremost, always listen to your body—if an exercise doesn’t feel right or causes pain, stop immediately. Remember that during the first trimester, exercises may be performed while lying on your back, yet after the first trimester, avoid this position as it puts pressure on a major vein.

Managing early pregnancy discomforts

Physiotherapy offers effective strategies for handling common first-trimester challenges. Morning sickness, contrary to its name, can occur at any time of day and even persist throughout pregnancy for some women.

Physical activity generally helps overcome first-trimester changes like morning sickness, fatigue, and low energy levels. Specific exercises that may help reduce nausea include:

• • Gentle neck stretches to relieve tension that can exacerbate nausea
  • Upper body stretches targeting arms, shoulders, and back
  • Low-impact aerobic activities like walking or swimming
  • Breathing techniques incorporated into your daily routine

• Beyond morning sickness, physiotherapy addresses other early pregnancy discomforts. Approximately 62% of pregnant women experience carpal tunnel syndrome, which causes pins and needles or numbness in the wrist and fingers. Your physiotherapist can provide specific exercises and suggest ergonomic modifications to alleviate these symptoms.

For optimal results, aim for about 150 minutes of moderate-intensity exercise weekly (20-30 minutes daily). Just remember that all exercises should ideally be performed under supervision, staying well-hydrated, and following proper warm-up and cool-down procedures.

Second Trimester Physiotherapy: Adapting to Changes

The second trimester brings significant physical transformations that require specific physiotherapy adaptations. As your baby grows, your body faces new challenges that need targeted support through proper exercise and movement techniques.

Addressing growing weight distribution challenges

Your uterus expands substantially throughout the second trimester to accommodate your growing baby. Subsequently, this expansion shifts your centre of gravity forward, causing postural changes and increased pressure on your lower back. This shift contributes to the characteristic lumbar spine curvature that frequently leads to lower back pain.

One hormone in particular—relaxin—increases dramatically in the second trimester, primarily to loosen the birth canal for childbirth. Nevertheless, relaxin affects all ligaments in your body, creating joint instability and increasing injury risk. This hormonal shift explains why many women experience looser ligaments and the resulting discomfort during this period.

Round ligament pain typically appears during the second trimester (weeks 14-27). As these ligaments stretch to support your growing uterus, sudden movements often trigger sharp pain. Indeed, common triggers include changing positions quickly, rolling over in bed, sneezing, coughing, or exercising.

To manage weight distribution challenges, consider these physiotherapy-recommended solutions:

• • Wear an elastic belly band for additional support without restricting breathing
  • Move slowly when changing positions to minimise round ligament strain
  • Bend and flex your hips throughout the day to reduce tension
  • Hold your belly when sneezing or coughing to provide extra support

Safe strengthening exercises as your body changes

The second trimester requires modifying your exercise routine. First and foremost, stop any exercises requiring you to lie on your back or stomach. Floor exercises done while lying on your side are a much safer alternative.

Regular physical activity during pregnancy can reduce gestational weight gain by an average of 6.8 pounds compared to inactive women. For appropriate weight management, women starting pregnancy at a normal weight should aim to gain between 11.5-16kg total, while those overweight should target 7-11.5kg.

For safe second-trimester strengthening, focus on exercises that support your changing body without straining the round ligaments. Walking remains excellent for building strength—aim for thirty minutes daily, three to five times weekly. Moreover, water exercises provide excellent low-impact options with minimal fall risk.

Gentle prenatal yoga helps stretch muscles, reduce lower back pain, and decrease blood pressure. Practice thirty minutes of yoga three to five times weekly, avoiding twisting your abdomen, inverted poses, or hot yoga environments.

Pelvic floor training fundamentals

The second trimester is crucial for pelvic floor strengthening. The hormonal changes and a growing baby put extra pressure on these important muscles. Above all, pelvic floor exercises during pregnancy can prevent bladder and bowel problems both during pregnancy and after birth.

Approximately one in three women develops some form of incontinence after childbirth, yet research shows women with strong pelvic floor muscles are less likely to experience these issues.

To perform effective pelvic floor exercises:

1. 1. Sit or lie down comfortably with your knees bent
   2. Tighten the muscles around your back passage as if preventing urination
   3. Breathe normally throughout the exercise
   4. Perform quick contractions followed by slow holds (counting to 10)
   5. Aim for three sets of eight contractions daily

1.  Pelvic physical therapists can design personalised exercise programs that strengthen core and pelvic muscles, reducing strain on the round ligaments. For instance, specific hip stretches can reduce tension and help improve the position of the baby and uterus.

Remember that listening to your body is essential—stop exercising if you experience any queasy feelings, overheating, dehydration, vaginal discharge, bleeding, or abdominal/pelvic pain.

Third Trimester Physiotherapy: Preparing for Birth

As the final countdown to birth begins, third-trimester physiotherapy takes on a crucial role in preparing your body for the birthing process. The exercises and techniques learned now directly impact your labour experience and delivery outcomes.

Optimal positioning exercises for baby alignment

In the third trimester, specific exercises help create balance in your pelvis, encouraging your baby to find the best position for birth. The most beneficial position is typically head-down with the baby facing your spine (occipito-anterior position).

Forward-leaning positions provide more available space in your pelvis for your baby to manoeuvre. Try these alignment exercises:

• • Hip circles – Increase flexibility in your hips and encourage the baby into an optimal position
  • Cat-cow pose – Helps loosen your spine, improve posture, and create more room in the pelvis
  • Deep squats – Help relax and lengthen pelvic floor muscles, stretching the perineum

• For best results, start these exercises from 32 weeks if your baby is in the head-down position, always checking with your doctor first.

Breathing techniques for labour management

Proper breathing remains fundamental to labour management. Steady breathing increases focus and delivers oxygen to both you and your baby. Certain breathing techniques even reduce tearing risk.

Different stages of labour require varying breathing patterns:

First stage contractions: Use an organising breath (deep cleansing breath) before and after each contraction, followed by slow breathing through intense contractions.

As labour intensifies, Light, accelerated breathing at one breath per second helps manage pain.

Transition phase: Variable “hee-hee-hoo” breathing works well for overwhelming contractions.

Mobility exercises for easier delivery

Throughout the third trimester, mobility exercises prepare your body for the physical demands of childbirth. Walking remains excellent—its back-and-forth hip motion helps your baby descend through gravity.

Exercises like supported lunges stretch your hips and open your pelvis, helping the baby move into the ideal birthing position. Likewise, pelvic tilts train you to push effectively.

Partner-assisted physiotherapy techniques

Having your partner attend a prenatal physiotherapy visit (ideally around 34 weeks) significantly enhances birth preparation. Together you can learn:

• • Labour positioning recommendations to practice before delivery
  • Visualisation strategies that help relax your pelvic floor
  • Hands-on massage and counter-pressure techniques between contractions

• Slow dancing with your partner helps open the pelvis through sideways hip movements. Besides physical benefits, exercising with someone you love releases oxytocin, helping you stay calm and better manage pain.

Remember that scheduling a 34-week “prep” appointment with a pelvic specialist proves extremely helpful even after an easy, pain-free pregnancy.

Specialised Physiotherapy for Pregnancy Complications

Pregnancy complications require specialised physiotherapy interventions tailored to address specific conditions that can emerge as your baby develops. These targeted approaches provide relief when standard prenatal care isn’t enough.

Relief for sciatica and lower back pain

Sciatica during pregnancy occurs when the sciatic nerve becomes irritated, causing pain from your lower back down to your buttocks and legs. Thankfully, physiotherapy offers several effective interventions. Soft-tissue massage applied to your lumbar spine and gluteal muscles reduces muscle spasms and tightness around the sciatic nerve. For optimal results, your physiotherapist might recommend:

• • Specific stretches to reduce tension around the nerve
  • Strengthening exercises for your lower back, glutes, and hamstrings
  • Proper posture guidance to minimise nerve irritation

• These approaches help because the extra weight from your growing baby often puts pressure on areas connected to the sciatic nerve when supporting muscles lack adequate strength.

Managing pelvic girdle pain effectively

Pelvic girdle pain (PGP) affects 1 in 5 pregnant women and can significantly impact your mobility and quality of life. PGP manifests as pain in the front or back of your pelvis, potentially affecting your hips or thighs.

Early diagnosis and treatment are crucial—PGP isn’t something you simply have to endure until delivery. Your physiotherapist will likely recommend exercises that strengthen your abdominal and pelvic floor muscles to improve balance, posture, and spine stability. Additionally, manual therapy gently mobilises joints to restore normal movement without causing pain.

Techniques for reducing pregnancy-related swelling

Although most pregnant women experience swelling in their lower legs and feet, several physiotherapy techniques can provide relief. Wearing 15- 20 mmHg compression socks that end at your knee helps alleviate achiness by gradually increasing pressure in your legs and moving excess fluid back into your blood vessels.

Furthermore, immersing your feet and ankles in cool water for 20 minutes several times weekly minimises swelling. Even simple foot exercises improve circulation: bend and stretch your foot up and down 30 times, then rotate each foot in a circle 8 times in each direction.

Carpal tunnel syndrome interventions

Remarkably, 31% to 62% of pregnant patients experience carpal tunnel syndrome, compared to just 4% of the general population. This condition occurs when pregnancy-related fluid increases pressure in the wrist’s carpal tunnel, compressing the median nerve.

The most effective first-line treatment involves immobilising your wrist in a neutral position using a splint, particularly while sleeping. Hand and wrist therapy, incorporating range of motion exercises, strengthening movements, massage, and nerve gliding techniques, can provide significant relief.

Conclusion

Physiotherapy stands as a powerful ally throughout pregnancy, backed by compelling research and proven results. Scientific evidence clearly shows its effectiveness, from reducing back pain to preparing for smoother deliveries. Women who engage in prenatal physiotherapy experience remarkable benefits, including better posture, stronger pelvic floors, and faster postpartum recovery.

Each trimester brings unique challenges, yet physiotherapy offers tailored solutions that adapt as pregnancy progresses. Starting early helps build a strong foundation, while continuing through later stages ensures optimal preparation for birth. Though pregnancy might feel overwhelming at times, remember that most discomforts respond well to proper physiotherapy techniques.

Based on extensive research and clinical experience, we’ve found that consistent physiotherapy practice throughout pregnancy significantly improves overall comfort and delivery outcomes. Whether dealing with common issues like sciatica or preparing for labour, physiotherapy provides essential tools and techniques for a healthier pregnancy journey.

FAQs

Q1. How can physiotherapy benefit pregnant women?

A1. Physiotherapy during pregnancy offers numerous benefits, including reduced risk of postnatal depression, increased strength and stamina, preparation for labour and delivery, and relief from common pregnancy discomforts such as pelvic or back pain.

Q2. What role does physical therapy play in childbirth preparation?

A2. Physical therapy equips expectant mothers with essential tools for labour and delivery. It focuses on techniques like breathing exercises, core strengthening, and pelvic floor exercises, which can facilitate an easier labour and faster postpartum recovery.

Q3. Why is maintaining mobility important during pregnancy?

A3. Mobility exercises are crucial during pregnancy as they help create optimal space for the baby to move into a better position for delivery. Improved mobility can reduce resistance in the uterus and surrounding tissues, allowing the baby to find their ideal position for birth.

Q4. What physiotherapy techniques are recommended before labour?

A4. Before labour, pelvic floor muscle training (both tightening and properly releasing the muscles) is recommended to make labour more efficient. Perineal massage is also beneficial as it can reduce the likelihood of severe perineal tears, shorten the second stage of labour, and decrease post-natal perineal pain.

Q5. When should a pregnant woman start physiotherapy?

A5. It’s ideal to start physiotherapy as early as possible, preferably in the first trimester. Beginning early allows you to address existing issues, establish proper movement patterns, and build strength gradually. However, it’s never too late to start – listen to your body and begin when you start experiencing pregnancy-related discomforts.

About the Doctor

Dr. Aayushi is one of the Best Physiotherapists in Mohali, renowned for her expertise in prenatal and postnatal care. With years of experience, she has helped countless women manage pregnancy-related discomforts and prepare for smoother deliveries. Her clinic, recognised as the Best Physiotherapy Clinic in Mohali, offers personalised treatment plans tailored to each stage of pregnancy. Whether you’re seeking relief from back pain, pelvic girdle discomfort, or preparing for childbirth, Dr. Aayushi provides compassionate, evidence-based care at her Physiotherapy Clinic in Mohali. Trusted as Mohali’s Top Physiotherapist, she is dedicated to ensuring a healthy, active, and comfortable pregnancy journey for every patient.