Pelvic Girdle Pain: 

This can be in a variety of places, the SI joints and pubic symphysis being the most common.  Stabilization with a brace is recommended to help with the lack of ligamentous stability, which this area depends on a lot!  SI belts and/or pregnancy belly holder type things are commonly prescribed especially in order to exercise without pain (i.e. a means to an end).  Other ways to stabilize include working on strength and endurance of all the muscles that attach to the pelvis (abdominals, outer hips, glutes, multifidus and pelvic floor) as well as avoiding things that pull excessively especially on the symphysis like adductor (inner thigh) work.  Postural support is often helpful for addressing pelvic pain.  Consider researching extra support for your pelvis while working, sitting and sleeping as well as being more mindful of how you’re transitioning from a sitting-to-standing or lying-to-sitting position.  Finally, if one side of your pelvis is more bothersome, it might be the weaker side which you can address by doing single side exercises (e.g. single leg step ups, clamshells, hydrants, single leg bridge, etc.) to ensure extra TLC on the “affected” side.  

Round Ligament Pain:

This is a tough area to manage with physical therapy because there aren’t targeted exercises to reduce pain, release tension or build strength.  It tends to be transient and unpredictable in nature.   The best you can do when it’s acting up is to provide extra support with a belly band or SI belt when you need to be walking.  Then, you want to simply avoid the things that aggravate it (e.g. quick sitting-to-standing movements, walking, transition between positions, etc.).  All of this being said, you can work out with round ligament pain with attention to back and pelvis support and using diaphragmatic breathing as you lift to ensure that the abdominals are bracing on exertion.

Low-to-mid Back Pain: 

This is a big and complex area to manage during pregnancy and postpartum, so let’s break it down to the 6 most important strategies:

• Avoid Excessive Motions: flexion, extension, twisting, side bending – all of them! 

• Massage: Pregnancy and nursing come with ligamentous laxity, leading to “tight” back muscles because they are overworking to stabilize the spine and also combat the anterior weight of the baby.  To decrease overworked back (and booty!) muscles that are causing pain, self-massage or myofascial release with a foam roller, small hard ball or a rolling pin against a wall or on a chair.  If you’ve got a partner, family member or friend to apply some hands-on assistance with this, by all means ask for that support.  

• Warm up + Stretch: Be sure to to warm up and stretch the hamstring, hip flexor and piriformis muscles prior to jumping into your prenatal workouts and postpartum exercises.  A few key stretches to try include: seated forward fold, standing figure 4, half kneeling lunge, standing calf stretch at wall, seated lateral fold, gentle torso rotations and child’s or puppy pose.

• Align: Aim to do things that promote optimal alignment and a neutral spine.  This can be done in any position depending on the trimester: lying on the floor or a foam roller, sitting on a ball or chair, standing against the wall and on all fours.

• Activate the Core, Abductors + Glutes: Focus on isometric abdominal work using diaphragmatic breathing techniques (e.g. planks, side planks, bridges, bird dog, etc.).  Target the abductor and glute muscles with exercises like side leg lifts, clamshells, hydrants and side steps with a theraband around legs.

• Get your Heart Pumping: In general, cardio exercise is very helpful for keeping back pain at bay.  While pregnant and rebuilding after childbirth, swimming and biking are fantastic low impact options if you have access to them.  However you choose to get the heart rate up, make sure you can pass the talk test – especially during pregnancy – and that your core and pelvic muscles are ready for action.  

Carpal Tunnel Syndrome (CTS):

This is very common due to extra fluid in the body during pregnancy that can cause swelling and decrease the space in the “tunnel,” which increases pressure on nerves in the wrists and hands.  The general rule of thumb (no pun intended!) is to simply avoid exercises or movements that put extra pressure on the wrist in flexion for prolonged periods of time (a plank, for example).  Holding very heavy weights or bags with a very strong grip can also make the symptoms of CTS worse.  For chronic swelling and pain, you can try to splint the wrist at night while resting/sleeping and incorporate strength exercises in muscle groups that take the load off the wrist: upper back, shoulders, chest and core.  Finally, stretching the forearm and pectoral muscles can help release pressure on the nerves in the wrist and hands.