Prenatal Posture and Massage Therapy

The aches and pains of postural changes during pregnancy are most often the motivator for clients to seek Prenatal Massage with a Registered Massage Therapist. More than half of all pregnant women are likely to experience backache during pregnancy, often described as generalized fatigue, tightness, and achiness with concentrated areas of pain. Half of pregnant women suffer discomfort in the sacroiliac area, a quarter complain about the lower back, and for another quarter of pregnant women the upper back is most problematic. Many women find months 5 to 9 of pregnancy to be the most uncomfortable, and for many mothers, pregnancy can be the trigger for chronic pelvic and back pain.

During pregnancy, postural changes that lead to low back and pelvic pain may be the result of anterior weight load due to enlarging breasts, uterus and foetus; muscles strain and imbalance; myofascial trigger points; foetal positioning; hormonal effects on ligament; and referred pain from uterine ligaments. The shift in centre of gravity created by the addition of anterior weight in the breast and abdomen challenges a pregnant woman's structural integrity. As pregnancy progresses, her pelvis will continue to rotate forward, tilting the uterus against the abdominal wall. This misalignment increases the lumbar curvature and stretches and weakens all of the abdominal muscles. Pressure against the interior abdominal walls subsequently both separates the rectus abdominus at the linea alba (diastus recti) and incites hyperirritable tender points (myofascial trigger points) in the abdominal muscles that characteristically refer pain both abdominally and posteriorly. In compensation for lumbar and pelvic misalignment, the woman's head and neck jut forward from the optimal vertical line; she leans her upper rib cage more posteriorly; and her pectoral girdle sags into forward rotation.

Increasing weight and misalignment cause the pregnant woman's posterior musculature to become fatigued, tight and full of trigger points. Increases in both abdominal and overall weight encourage external rotation of her hip joints and loss of muscle function when walking. This results in the waddling that so characterizes the pregnant woman's gait. In an effort to prevent falling forward from the increased abdominal weight, she hyperextends her knees, often causing cramping of the calves. She tends to collapse her increased weight onto the inside arches of her weary feet. A foetus with a left or right position preference in the uterus often overburdens that side of the woman's back making it tired and sore. Some women can even develop temporary scoliosis from unbalanced foetal positioning.

Most important are the changes that occur as the pelvic bones and sacrum shift as the belly grows. This causes a rotation in the pelvis that compresses the pelvic joints and sacrum at the sacroiliac joint. As the pelvis rotates, the ligaments of these deep pelvic joints are compressed and strained and can become irritated. Prolonged periods of standing or sitting, walking in high heels, and sitting with poor back support can create additional strain on these joints. Occasionally, hypomobility in one joint will result in excessive mobility in the other. A sharp, stabbing posterior pelvic pain is then often experienced when rolling from a supine position, particularly when on hard surfaces. The lumbosacral junction is similarly affected by increased anterior compression of the lumbosacral joint.

Registered Massage Therapists will use a combination of several techniques to help relieve the aches and pains experienced during pregnancy. These techniques include assisted-resistance stretch, proprioceptive neuromuscular facilitation and muscle energy techniques, CranioSacral Therapy, deep tissue massage, myofascial release, passive movements (including joint mobilizations, rhythmic movements or trepidations, strain counterstrain or positional release, stretching, and traction), Swedish massage and education. Educational activities are also effective methods of intervention for reducing pain and decreasing stress on weight-bearing joints and myofascial structures. The regular practice of correct and safe abdominal strengthening activities for walking, sitting, sleeping, carrying and other daily activities will further reduce strain in the body. More efficient movement patterns enhance and reinforce the effectiveness of hands-on therapy. So, while pregnancy brings with it many physiological changes and some physical discomfort, regular movement, good postural habits, and the skills of a qualified Massage Therapist can help pregnant women get through their pregnancy with less discomfort and greater ease.