Physical therapy can be a great asset to the care and well-being of the pregnant client.  Education, exercise instruction, treatment of orthopedic conditions/pelvic floor dysfunction, and prevention of injury through postural and movement re-education are all areas where physical therapy can help.

It is sometimes difficult to assess when to send patients to physical therapy, as some complaints are common during pregnancy, and, often, symptoms seen to resolve on their own.  These symptoms, however, can point to dysfunction in the musculoskeletal system, which is exacerbated by the added stresses of pregnancy.  With a physical therapy evaluation, these areas can be quickly addressed, and the patient educated as to how to take better care of their bodies during and after pregnancy.  Early intervention can reduce the possibility of greater difficulties arising later in pregnancy, when treatment options are more limited.  Early intervention can also reduce difficulties during delivery and postpartum.

When to refer:
1.    Consistent complaints of low back pain with or without radiculopathy, sacroiliac pain, and/or pubic pain.  If symptoms occur in the first trimester, it may relate to increased ligamentous laxity, which will only become more problematic in the last trimester, and more difficult to treat.

2.    Complaints of orthopedic pain, related to old pathology.  This definitely points towards unresolved dysfunction in the musculoskeletal system, which should be addresses as early as possible.

3.    Previous history of pelvic floor muscle tension, vulvar pain syndromes, interstitial cystitis, pelvic floor trauma, incontinence, and prolapsed.  Physical therapy can help to reduce worsening of symptoms during pregnancy, and avoidance of further trauma during delivery.

4.    Significant DRAM (Diastis Rectus Abdominis Muscle).  Physical therapy can help to prevent worsening of DRAM during pregnancy.  Prevention of further stress in this area can reduce secondary stresses on the pubic symphysis and pelvic floor.  Good abdominal     strength and control is important during the second stage of labor, and will be compromised if there is no education or treatment of the client with significant separation.

5.    Nerve compartment syndromes such as carpal tunnel or thoracic outlet syndrome.  This is due to edema, and patients can be helped with management and manual therapy to create more space around nerve structures.

6.    Coccyx pain or significant previous coccyx injury.  This could result from decreased mobility of the sacroccygeal joint which could create decreased space for passage of baby during delivery or increased risk of further injury to area during delivery.

7.    Significant deconditioning.

8.    TENS for labor and delivery.

9.    TENS for pain relief post delivery i.e. pubic pain, c-section scar, coccyx injury, afterbirth cramps, and episiotomy pain.  TENS can reduce the need for pain medication.

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