Selected Podcast
Physical Therapy Support During Pregnancy and Postpartum
You do not have to live with pain or leakage during pregnancy. Therapy can help with issues that occur during pregnancy, low back pain, pelvic pain, incontinence, education on positioning and reducing tearing and prolapse during labor. Therapy after pregnancy is important to address continued problems with pain, incontinence, c-section scars, return to sex if painful, diastasis rectus, or prolapse.
Featuring:
Milka Thoresen, DPT
Milka Thoresen DPT received her DPT from MGH-Institute of Health Professions in Boston. She is a pelvic health and lymphedema specialist. She has been with Franciscan Health for 10 years and a practicing PT for 15 years. Transcription:
Scott Webb: You don't have to live with pain or leakage during pregnancy. Therapy can help with issues that occur during pregnancy, low back pain, pelvic pain, incontinence, education on positioning and reducing tearing and prolapse during labor. Therapy after pregnancy is important to address continued problems with pain, incontinence, C-section scars, return to sex if painful, diastasis recti or prolapse.
And joining me today to discuss all of this and more is Milka Thoresen. She's a doctor of physical therapy with specialties in pelvic health. This is the Franciscan Health Doc Pod. I'm Scott Webb. So Milka, thanks so much for joining me today. We're going to talk about physical therapy, but in the context or through the lens of pregnancy, during pregnancy, post-pregnancy and so on. But before we get rolling and get to that, I want to have you tell folks about yourself and the work that you do.
Milka Thoresen, DPT: My name is Malka Thoresen, and I'm a physical therapist that works through our Franciscan Hospital System, and I get the extra special privilege of specializing in pelvic floor. So we get to see both men and women basically breaking the silence and coming to see us to deal with issues that affect their very personal quality of life.
Pelvic floor media, I think, exposure has been around for quite some time, but not always the right kind. And I think all the resources can be overwhelming. And I feel like my job is to help identify and simplify an individualize program based on what each of you guys come in to see us for. And, being a pelvic floor therapist, we do see a good number of prenatal clients, patients who are pregnant, who end up developing some issues along the way. And they're not necessarily issues, they're just body changes that need addressing. Just a brief summary and I could go a little bit more in depth later on is back pain, just postural dysfunction, voiding issues, both urinary and bowel issues, and just tissue weakness and other things that we cover.
Scott Webb: Yeah, you definitely cover a wide range of things. So let's get started here. Let's drill down more specifically into the physical issues that women may have during pregnancy and how you help them.
Milka Thoresen, DPT: It's typically during the second and third trimester that, because of body changes and shape changes that start occurring, a different center of gravity, we see a good number of people start coming into us with back pain, something also called sacroiliac joint pain, which is basically where your pelvis and your spine join together on two sides to form a pretty significant joint that sometimes can displace. Or pelvic girdle pain, pubic pain, anything around the pelvic region, both in the abdomen and towards the back and front side are very common issues that come through our doors. And it's not a surprise. Hormonal changes, body fluxes, things are a lot more lax, so displacements of joints are very common during this time.
Scott Webb: Yeah. I'm certain that they are. So specifically, how do you help folks? I don't know if you want to get into specific exercises and things like that, but in general, what could women expect, you know, if they're working with you during their pregnancy?
Milka Thoresen, DPT: I'm not the first one to say this, but I really feel like as a physical therapist, we are privileged to really empower changes that we all encounter, especially during pregnancy and just basically to humanize healthcare. So, you know, back pain and the pelvic girdle pain, they were one of the top things that I would see people for. Incontinence is also a common issue that happens too, that we could also assist people with both urinary or bowel incontinence and, as I said earlier, tissue weakness.
What would a typical pelvic floor therapist who specializes in this help you with, you come to me first day and it is very much like a PT musculoskeletal assessment. So pretty much head to toe, getting a full medical background. Just making sure that other systems are not a potential source before we start delving into the mechanics of things. And then, just assessing what the primary areas. If it's pain, we're going to probably do a complete assessment of the spine, making sure that we get a good rap on what muscles might be overly tight, what muscles might be on the other hand overly stretched and weakened. Often the two come hand in hand and they're very reflective of the body, meaning one side of the body is weak, the other side is overly strong and overworked.
The same is true with the pelvic floor, no different than any other skeletal muscle. We have all sorts of fibers down there that we assess. If you are pregnant, we would not be doing any kind of invasive exam as you would at an OB-GYN, for example. That would be something that would be done after six weeks, at least after postpartum. But there's plenty to be addressed, postural training, lifting, if you have children already in the household and you need to repetitive tasks with work up until your day of delivery, all those things are things that we address.
Scott Webb: Yeah, it sounds really comprehensive and thorough, and you can see that a lot of benefits for women. So let's assume that you help them during pregnancy and things go well. And then there's a whole multitude of things that they could need help with after pregnancy, right? So let's go through that laundry list and, again, how you can help women?
Milka Thoresen, DPT: So this is, too, where incontinence, as you progress through the third trimester, body weight gain and volume are greatest. So you may see things like incontinence, leaking happening with coughing and sneezing and lifting. There are some techniques to teach the body neuromuscularly how to inhibit the bladder without doing anything invasive, which is kind of neat. Teaching pelvic floor strengthening muscles as well too. Those are not just doing the Kegels as I think all of the world refers to them as, but they're pelvic floor squeezes. And there are different categories for the different fibers. Teaching another phenomenon that can happen as belly grows, the big rectus, the six-pack muscle, for example, can weaken in the center and beginning some core strengthening and stabilization techniques. Even recommending some tools, belts, stability belts both at the pelvic joints and even some to help lift the belly are also some tools that we may recommend that may just make that last trimester a lot more bearable. And then some of that gets used after as well.
So all those things that I just mentioned are pertinent both the latter part of pregnancy and very much postpartum when some of these symptoms-- You think you delivered the child, "All right," now we've got the tough work ahead of us of raising the kid, but on top of that, we've got all these body changes that are still here with us, and why aren't they retracting back fast enough? It's just nice to reassure and to see our clients over a period of time, sometimes six to eight weeks long, which is the beauty of it because you see natural tissue healing. And if it's given the right prescription and it's done the right way, things retract back the way they need to and often these issues do dissipate and they are very manageable relative to the high statistic rate of 40% to 50%, sometimes even 90% of back pain statistics that are out there that have been done in the recent year studies.
Scott Webb: Yeah. And it's great to hear that it is manageable. As you say, you've had the child and you think, "Okay, I'm on easy street now," but obviously that is just not the case. And I'm sure it's very gratifying for you to work with women and couples over a long period of time and see those smiles on their faces and know that there's been natural healing and that you've contributed to that, which is really awesome.
And I know you help, folks besides doing the podcast here, you help folks by doing some webinars as well. So maybe you can tell us about the webinars, some of the areas and topics that you cover. I know you've got a couple of dates coming up.
Milka Thoresen, DPT: So, yeah, Franciscan has done a wonderful job. Our prenatal assistance program that's located throughout at least two or three of our Indiana Metropolitan areas here, I believe in our Munster area, I believe in Indy as well. And I'm not sure if Michigan City also does or has same program, but we do these webinars and present to our prenatal population that is interested in topics like breastfeeding, baby care. We've got, I believe, something called Baby Let's Move that incorporates both you postpartum, family members and baby in some exercise strategies. There's a class devoted, I think, on breathing and on mindful parenting. And then I've participated with Beth Leonard also at our clinic that speaks of everything we just talked about today in a little bit more detail from the anatomy, to the incidence, statistics, and how PT can help.
Scott Webb: This has been really great, Milka. As we wrap up, what are your final takeaways and thoughts on the role that physical therapy can play in helping women, prenatal, during pregnancy and after pregnancy and all the many benefits that they can get from this?
Milka Thoresen, DPT: Pregnancy is a very natural process and we want to normalize it as much as possible, even though some of these things that we talked about can creep up. And my message out there is to not worry. If symptoms are persisting for more than just a couple of weeks and you're trying all your own strategies, please go see your OB or even your primary care physician and see if they can help.
If it's something that might be as simple as their own recommendations or maybe some pregnancy-safe over-the-counter or prescription medications, that might be all you need temporarily. But if things are still ongoing for weeks after that, I really recommend just going back the doc and saying, "Hey, give me a pelvic floor PT order" and go see one of us. I'm sure we could probably attack a number of things and hopefully make that transition and your new newborn lifestyle all the more pleasant.
Scott Webb: Yeah, that sounds awesome. And that's a perfect way to end. You know, speak with your primary, speak with your OB-GYN. Try to get to see someone like yourself to help during and after pregnancy. And just really educational stuff today. This has been really fun. Thank you so much and you stay well.
Milka Thoresen, DPT: Thank you, Scott. I appreciate you guys.
Scott Webb: And to register for one of the webinars, visit franciscanhealth.org/events and select the category pregnancy and infant care.
Host: And if you found this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: You don't have to live with pain or leakage during pregnancy. Therapy can help with issues that occur during pregnancy, low back pain, pelvic pain, incontinence, education on positioning and reducing tearing and prolapse during labor. Therapy after pregnancy is important to address continued problems with pain, incontinence, C-section scars, return to sex if painful, diastasis recti or prolapse.
And joining me today to discuss all of this and more is Milka Thoresen. She's a doctor of physical therapy with specialties in pelvic health. This is the Franciscan Health Doc Pod. I'm Scott Webb. So Milka, thanks so much for joining me today. We're going to talk about physical therapy, but in the context or through the lens of pregnancy, during pregnancy, post-pregnancy and so on. But before we get rolling and get to that, I want to have you tell folks about yourself and the work that you do.
Milka Thoresen, DPT: My name is Malka Thoresen, and I'm a physical therapist that works through our Franciscan Hospital System, and I get the extra special privilege of specializing in pelvic floor. So we get to see both men and women basically breaking the silence and coming to see us to deal with issues that affect their very personal quality of life.
Pelvic floor media, I think, exposure has been around for quite some time, but not always the right kind. And I think all the resources can be overwhelming. And I feel like my job is to help identify and simplify an individualize program based on what each of you guys come in to see us for. And, being a pelvic floor therapist, we do see a good number of prenatal clients, patients who are pregnant, who end up developing some issues along the way. And they're not necessarily issues, they're just body changes that need addressing. Just a brief summary and I could go a little bit more in depth later on is back pain, just postural dysfunction, voiding issues, both urinary and bowel issues, and just tissue weakness and other things that we cover.
Scott Webb: Yeah, you definitely cover a wide range of things. So let's get started here. Let's drill down more specifically into the physical issues that women may have during pregnancy and how you help them.
Milka Thoresen, DPT: It's typically during the second and third trimester that, because of body changes and shape changes that start occurring, a different center of gravity, we see a good number of people start coming into us with back pain, something also called sacroiliac joint pain, which is basically where your pelvis and your spine join together on two sides to form a pretty significant joint that sometimes can displace. Or pelvic girdle pain, pubic pain, anything around the pelvic region, both in the abdomen and towards the back and front side are very common issues that come through our doors. And it's not a surprise. Hormonal changes, body fluxes, things are a lot more lax, so displacements of joints are very common during this time.
Scott Webb: Yeah. I'm certain that they are. So specifically, how do you help folks? I don't know if you want to get into specific exercises and things like that, but in general, what could women expect, you know, if they're working with you during their pregnancy?
Milka Thoresen, DPT: I'm not the first one to say this, but I really feel like as a physical therapist, we are privileged to really empower changes that we all encounter, especially during pregnancy and just basically to humanize healthcare. So, you know, back pain and the pelvic girdle pain, they were one of the top things that I would see people for. Incontinence is also a common issue that happens too, that we could also assist people with both urinary or bowel incontinence and, as I said earlier, tissue weakness.
What would a typical pelvic floor therapist who specializes in this help you with, you come to me first day and it is very much like a PT musculoskeletal assessment. So pretty much head to toe, getting a full medical background. Just making sure that other systems are not a potential source before we start delving into the mechanics of things. And then, just assessing what the primary areas. If it's pain, we're going to probably do a complete assessment of the spine, making sure that we get a good rap on what muscles might be overly tight, what muscles might be on the other hand overly stretched and weakened. Often the two come hand in hand and they're very reflective of the body, meaning one side of the body is weak, the other side is overly strong and overworked.
The same is true with the pelvic floor, no different than any other skeletal muscle. We have all sorts of fibers down there that we assess. If you are pregnant, we would not be doing any kind of invasive exam as you would at an OB-GYN, for example. That would be something that would be done after six weeks, at least after postpartum. But there's plenty to be addressed, postural training, lifting, if you have children already in the household and you need to repetitive tasks with work up until your day of delivery, all those things are things that we address.
Scott Webb: Yeah, it sounds really comprehensive and thorough, and you can see that a lot of benefits for women. So let's assume that you help them during pregnancy and things go well. And then there's a whole multitude of things that they could need help with after pregnancy, right? So let's go through that laundry list and, again, how you can help women?
Milka Thoresen, DPT: So this is, too, where incontinence, as you progress through the third trimester, body weight gain and volume are greatest. So you may see things like incontinence, leaking happening with coughing and sneezing and lifting. There are some techniques to teach the body neuromuscularly how to inhibit the bladder without doing anything invasive, which is kind of neat. Teaching pelvic floor strengthening muscles as well too. Those are not just doing the Kegels as I think all of the world refers to them as, but they're pelvic floor squeezes. And there are different categories for the different fibers. Teaching another phenomenon that can happen as belly grows, the big rectus, the six-pack muscle, for example, can weaken in the center and beginning some core strengthening and stabilization techniques. Even recommending some tools, belts, stability belts both at the pelvic joints and even some to help lift the belly are also some tools that we may recommend that may just make that last trimester a lot more bearable. And then some of that gets used after as well.
So all those things that I just mentioned are pertinent both the latter part of pregnancy and very much postpartum when some of these symptoms-- You think you delivered the child, "All right," now we've got the tough work ahead of us of raising the kid, but on top of that, we've got all these body changes that are still here with us, and why aren't they retracting back fast enough? It's just nice to reassure and to see our clients over a period of time, sometimes six to eight weeks long, which is the beauty of it because you see natural tissue healing. And if it's given the right prescription and it's done the right way, things retract back the way they need to and often these issues do dissipate and they are very manageable relative to the high statistic rate of 40% to 50%, sometimes even 90% of back pain statistics that are out there that have been done in the recent year studies.
Scott Webb: Yeah. And it's great to hear that it is manageable. As you say, you've had the child and you think, "Okay, I'm on easy street now," but obviously that is just not the case. And I'm sure it's very gratifying for you to work with women and couples over a long period of time and see those smiles on their faces and know that there's been natural healing and that you've contributed to that, which is really awesome.
And I know you help, folks besides doing the podcast here, you help folks by doing some webinars as well. So maybe you can tell us about the webinars, some of the areas and topics that you cover. I know you've got a couple of dates coming up.
Milka Thoresen, DPT: So, yeah, Franciscan has done a wonderful job. Our prenatal assistance program that's located throughout at least two or three of our Indiana Metropolitan areas here, I believe in our Munster area, I believe in Indy as well. And I'm not sure if Michigan City also does or has same program, but we do these webinars and present to our prenatal population that is interested in topics like breastfeeding, baby care. We've got, I believe, something called Baby Let's Move that incorporates both you postpartum, family members and baby in some exercise strategies. There's a class devoted, I think, on breathing and on mindful parenting. And then I've participated with Beth Leonard also at our clinic that speaks of everything we just talked about today in a little bit more detail from the anatomy, to the incidence, statistics, and how PT can help.
Scott Webb: This has been really great, Milka. As we wrap up, what are your final takeaways and thoughts on the role that physical therapy can play in helping women, prenatal, during pregnancy and after pregnancy and all the many benefits that they can get from this?
Milka Thoresen, DPT: Pregnancy is a very natural process and we want to normalize it as much as possible, even though some of these things that we talked about can creep up. And my message out there is to not worry. If symptoms are persisting for more than just a couple of weeks and you're trying all your own strategies, please go see your OB or even your primary care physician and see if they can help.
If it's something that might be as simple as their own recommendations or maybe some pregnancy-safe over-the-counter or prescription medications, that might be all you need temporarily. But if things are still ongoing for weeks after that, I really recommend just going back the doc and saying, "Hey, give me a pelvic floor PT order" and go see one of us. I'm sure we could probably attack a number of things and hopefully make that transition and your new newborn lifestyle all the more pleasant.
Scott Webb: Yeah, that sounds awesome. And that's a perfect way to end. You know, speak with your primary, speak with your OB-GYN. Try to get to see someone like yourself to help during and after pregnancy. And just really educational stuff today. This has been really fun. Thank you so much and you stay well.
Milka Thoresen, DPT: Thank you, Scott. I appreciate you guys.
Scott Webb: And to register for one of the webinars, visit franciscanhealth.org/events and select the category pregnancy and infant care.
Host: And if you found this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.