With just a few weeks to go in her pregnancy and her little girl, Jordan, vying for her undivided attention, the last thing Kara Tongue of East Longmeadow needs is a back ache.
To lessen the stress on her body, Tongue has enlisted the skills of a physical therapist during both of her pregnancies, and she represents a growing number of women who are finding that pregnancy does not have to be a pain in the neck.
“It has definitely helped me,” said Tongue, who visits physical therapist Catherine D’Agostino, owner of Fisica Physical Therapy in East Longmeadow, once a week. “My big thing was back pain, and I’m so much more comfortable now. I can stand for longer periods of time and get more done … the difference is amazing.”
D’Agostino specializes in physical therapy for women at Fisica – the Italian word for physical – especially those who are pregnant or have recently delivered. She said a number of specific physical problems arise during and after pregnancy, the discomfort of which can be alleviated in many cases through therapy.
“The old school of thought was that a woman had to suffer through the pain until she delivered,” she said, “but the fact is there are options, and the earlier treatment starts, the better.”
A Mother’s Kneads
D’Agostino explained that in addition to low back pain, headaches, and neck pain, pregnant women can also experience pelvic pain, nerve compression in the shoulders, tailbone pain – also called coccydynia – and splits in abdominal muscles, called diastasis recti, a common problem. Joint dysfunction, sciatica, and muscular issues that can lead to incontinence are also not uncommon, she said.
In fact, there are several conditions specific to pregnancy that physical therapy can address, many related to the sheer nature of pregnancy – over nine months, a woman’s body continues to grow and change, placing added stress on muscles, bones, and joints.
“Pregnancy is a very stressful time for the body,” D’Agostino explained.
She added that because of the unique changes and sensitivity pregnancy creates, prenatal physical therapy is a very focused concentration within the field, using largely manual therapy, as well as some suggested exercise and nutrition programs, to treat pain.
“Overall, the treatment makes the pregnancy, as well as the recovery, easier for a woman,” she said, noting that physical therapy during pregnancy includes a variety of specific treatments that are tailored toward keeping a woman and her baby both safe and comfortable.
“It’s hands-on therapy,” she said. “We use manual techniques to facilitate changes in the body … and also a lot of stretches and targeted exercises. Even if there’s no pain, the stretches and exercises are a good idea – they help the body adjust to the changes it’s going through.”
The interventions D’Agostino typically employs differ from woman to woman, but also from trimester to trimester.
“Each trimester presents a new set of challenges,” she said. “First trimester pain is usually due to hormonal changes, and ligaments are at risk for stretch, which causes too much joint motion.”
The second trimester is when most problems present themselves – pain may develop as a woman’s center of gravity shifts, D’Agostino said, as well as due to natural curving of the spine and expansion of the ribs as the baby grows.
“The third trimester is not as bad as some people think,” she continued. “But existing conditions can still be painful, and they can be treated – it is just more difficult to eradicate them.”
And often, the benefits of physical therapy can extend beyond the pregnancy – expediting healing, or protecting a woman against injury during those early months with a newborn. As the due date nears, D’Agostino teaches many of her patients the best way to lift a baby out of a crib or car seat, for instance.
Despite the stage of a woman’s pregnancy, however, D’Agostino said physical therapy can not only alleviate pain, but also help to lessen the chance of problems later in life, or during another pregnancy. She has been an advocate for therapy during pregnancy since the early years of her career, which developed from a combination of degrees and experience in occupational therapy, physical therapy, strength and conditioning, and nutrition, with a long-term focus on prenatal pain.
“I’m still carving a niche for myself,” she said, noting that while more and more physicians accept physical therapy as a valuable health benefit during pregnancy, part of her job has become the ongoing education of the public, to simply explain what she does, how it helps, and why.
“I will not treat a woman unless she’s been cleared by her obstetrician,” D’Agostino said. “An open dialogue between a physical therapist and a physician is critical, and I’m fortunate to have relationships with physicians that make referrals to me.
“I’m also glad that physical therapy during pregnancy isn’t being seen as some sort of alternative medicine, but one part of a woman’s medical treatment. My services require a physicians’ prescription, and I wouldn’t want it any other way.”
That acceptance from the medical community has undoubtedly helped D’Agostino in her professional pursuits, as does the coverage of prenatal therapy by most insurers.
She added that without that support, her practice would not long survive; in part because patients are wary of trying therapies that are not endorsed by their obstetrician.
No Pain, Much Gained
Tongue said she, too, was unsure how much physical therapy would help her during her first pregnancy, but when she became pregnant with her second child, a call to D’Agostino was one of the first she placed.
“This is part of my pregnancy now, and I can’t imagine going through this without it,” she said. “I don’t know why anyone would go through this in pain, when they might not have to.”