Pregnancy is a complicated time for women, as weight gain and associated postural changes are often expected and accepted for the first time. During pregnancy and childbirth, soft tissues such as muscles, fascia, ligaments, tendons, and others undergo significant changes that can affect posture and soft tissue dysfunction (1). The biggest problem is the changes and adhesions of the fascial structure. They lead to dysfunction and overload of the entire body and thus to pain.
Urogynecological physiotherapy is largely based on working with the myofascial or joint system, but also on working with the internal organs and vascular system of the abdomen and pelvis. A holistic approach to working with a patient should be characterised by therapy on many different levels. Especially if the patient has a problem that may be caused not only by muscle dysfunction, but also by faulty drainage, such as of the pelvis. An experienced urogynecologic physical therapist will perform a comprehensive examination of the patient’s functioning and, based on that, determine where additional work needs to be done to finally achieve balance at the pelvic level. The presence of old and new postoperative scars resulting from a caesarean section or episiotomy can also affect myofascial imbalance. It is necessary to pay attention to such scars and treat them so that they become neutral to the function of the soft tissues through which they pass (2).
The psychological or emotional aspect can be connected with the fascial system. Very often our body reacts with postural changes to problems and mood swings in our mind. Emotions such as anxiety or fear can often cause a defensive/closed posture. Clenching the teeth, closing the chest, tensing the buttocks or pulling back the shoulders are characteristic of this posture. Women who have become young mothers are not always smiling and full of joy, and their emotional state before birth and pregnancy may already be very unstable. Hormonal changes resulting from the course of pregnancy and childbirth can perpetuate or trigger postural changes that have their root in the psyche and affect the perception of your body. Women who experience changes in the perception of their bodies feel social and cultural pressures regarding their appearance, especially in the context of returning to their pre-pregnancy shape (3,4).
Therefore, it is important that postpartum women are aware of these changes and that they have access to appropriate medical and psychological care. It is also recommended that women focus on the recovery process rather than the social pressures associated with their appearance. Taking care of your mental and physical health can improve your posture and body image.
Grzegorz Jędrzejewski
References:
- Sarkar PK, Singh P, Dhillon MS, Bhattacharya S, Singh A. Postural deviation in pregnancy: A significant debilitating balance problem which can be rectified by physiotherapeutic intervention. Journal of Family Medicine and Primary Care. lipiec 2022;11(7):3717.
- Dischiavi SL, Wright AA, Hegedus EJ, Bleakley CM. Biotensegrity and myofascial chains: A global approach to an integrated kinetic chain. Med Hypotheses. styczeń 2018;110:90–6.
- Goossens N, Geraerts I, Vandenplas L, Van Veldhoven Z, Asnong A, Janssens L. Body perception disturbances in women with pregnancy-related lumbopelvic pain and their role in the persistence of pain postpartum. BMC Pregnancy and Childbirth. 18 marzec 2021;21(1):219.
- Hall H, Cramer H, Sundberg T, Ward L, Adams J, Moore C, i in. The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain: A systematic review with meta-analysis. Medicine. wrzesień 2016;95(38):e4723.
