Common Postpartum Issues (Part 1)

Written By Sarah Cline

Hi, Bestie! If you were here last time, you’ll remember that we talked about common issues during pregnancy, including diastasis rectus abdominis (DRA), stress urinary incontinence (SUI), and more. Today, I thought we could piggy-back off of our last chat and dig into some of the common issues folks face in the postpartum period. Some of them are similar to the issues faced in pregnancy, and some of them might surprise you! If you’re expecting or you are currently postpartum, this is for you. Pro-tip: share this with your non-birthing partner if you’d like them to gain some insight into a few of the physical challenges of postpartum. Let’s get right into it! 

What does the “postpartum period” actually refer to? 

For many, the term “postpartum” refers to the first 6-8 weeks after childbirth. However, the body takes a long time to recover following childbirth–much longer than the typically-assumed 6-8 weeks. The body continues changing and adapting long after delivery, especially when breastfeeding and caring for an entire brand-new human come into play. For our purposes, let’s think of the postpartum period as the first 12 months after childbirth, give or take!

Common Postpartum Issues:

  • Shoulder/Neck/Upper Back Pain: Shoulder, neck, and/or upper back pain is common during the postpartum period due to positioning habits and breastfeeding (1). New mothers spend more time breastfeeding than probably anything else (or at least it feels that way!). Oftentimes, the positioning used during breastfeeding has the shoulders curving forward and the upper back slightly flexed forward, as well. This can create tightness within the upper back (thoracic spine) and pectoralis muscles. 

    • There are lots of ways to avoid or reduce upper back pain during breastfeeding. Your physical therapist can provide you with exercises for stretching and mobilizing this area, as well as advice for how to best position yourself and your baby during breastfeeding. No position is one-size-fits-all. I’d recommend trying out a few different positions and seeing what works best for you and your baby. Even better, change positions often! This allows the body to get more variety and less time in a single, sustained posture. Perhaps most essentially, bring your baby to you, rather than bending down to meet the baby. This means using an appropriate pillow (such as the My Breast Friend (better than the Boppy)) that allows for optimal positioning.

  • Diastasis Rectus Abdominis (DRA): DRA is common in the postpartum period. During pregnancy, the rectus abdominis (RA) muscles move apart in order to make room for the growing fetus (2). This can make it difficult to utilize the core muscles for their typical activities since they are not in their typical optimal position. After childbirth, the RA muscles take some time migrating back together while the non-contractile tissues in the abdomen adapt to the abdominal positioning sans-baby. It takes time for things to return to “normal,” and even with time, they may never be exactly the same as they were pre-pregnancy…and that’s totally okay! 

    • Physical therapy can help teach you the most appropriate ways for engaging the core musculature in order to effectively carry out your regular tasks. The proper core contraction can prevent doming/coning and even help with the aesthetics of the abdomen, if that is something that matters to you (3). 

  • Low Back Pain: Low back pain or pelvic girdle pain (PGP) is common during the postpartum period for a few reasons (4). First, the body is recovering from major trauma, whether that be vaginal or cesarean childbirth. All methods of delivery take a toll on the body. Secondly, levels of relaxin hormone can remain elevated for months after childbirth (5). As we discussed last time, relaxin helps ligaments and other structures stretch to accommodate the growing fetus (6). However, its lasting effect on ligament laxity can be uncomfortable and cause pain as the joints lack their typical level of stability. Thirdly, in the postpartum period, one is spending an increased amount of time carrying around a baby–and babies are heavier than they look! This new level of activity can take a toll on the lower back, especially if your posture isn’t ideal. Finally, DRA during and after pregnancy means the core is not as effective as it was pre-pregnancy. The spread-apart positioning of the RA muscles means less overall core support and this can result in lower back pain (7). 

    • Low back pain during the postpartum period is extremely common, with 50% of women reporting these symptoms during pregnancy or postpartum (8). However, over time and with physical therapy intervention, outcomes are very positive for this group. Your therapist can teach you stabilizing exercises for the lower back and abdomen. They can also talk about posture while holding your baby. Ice, heat, and/or a transcutaneous electrical nerve stimulation (TENS) unit can be beneficial for managing symptoms and are relatively noninvasive (always check contraindications). It is essential to take symptoms of low back pain during the postpartum period seriously. Studies found that symptoms of postpartum depression were three times more prevalent in postpartum folks with low back pain or PGP than in those without (9). Be sure to talk with your medical provider if you are experiencing any of the symptoms of low back pain or postpartum depression after delivering your baby. 

  • Dequarvain’s Tenosynovitis: Dequarvain’s tenosynovitis is an inflammatory condition affecting the Extensor Pollicis Longus and Extensor Pollicis Brevis muscles of the thumb where pain is present at the thumb-side of the wrist. It is sometimes referred to as “Mommy Thumb” or “Baby’s Wrist” because of how commonly it occurs in the postpartum period. Why does it happen? The aforementioned thumb muscles have a sheath of tissue surrounding them which can become inflamed when they are overworked. This can happen to new moms because they are constantly picking up and putting down their babies. The repetitive motion of the wrist along with the weight of the baby can result in Dequarvain’s tenosynovitis. 

    • In order to reduce wrist pain during the postpartum period, be sure to hold the wrists straight (not bent to either side) when picking up, putting down, or carrying the baby. You may benefit from splinting in order to help the wrists stay in a neutral position. Rest (reducing the source of the repetitive trauma), ice, and non-steroidal anti-inflammatory drugs can also help (10). Your physical therapist can help you find the right splint for you and will work with you to create activity modifications that mean your wrists get a break while still being able to interact and care for your baby. 

If you’re a postpartum mom, which of these have you experienced? How did you deal with your symptoms? Next time, we’ll chat about a few more common issues new moms face during the postpartum period and how to manage the symptoms. 


XOXO,

Your Pelvic Bestie 


References:

  1. Koyasu K, Kinkawa M, Ueyama N, Tanikawa Y, Adachi K, Matsuo H. The prevalence of primary neck and shoulder pain, and its related factors in Japanese postpartum women. Clin Exp Obstet Gynecol. 2015;42(1):5-10. PMID: 25864273.

  2. Patrícia Gonçalves Fernandes da Mota, Augusto Gil Brites Andrade Pascoal, Ana Isabel Andrade Dinis Carita, Kari Bø,. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain, Manual Therapy, Volume 20, Issue 1, 2015, Pages 200-205, ISSN 1356-689X,https://doi.org/10.1016/j.math.2014.09.002.

  3. Lee D, Hodges PW. Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study. J Orthop Sports Phys Ther. 2016 Jul;46(7):580-9. doi: 10.2519/jospt.2016.6536. PMID: 27363572.

  4. Simonds, Adrienne H. PT, PhD1; Abraham, Karen PT, PhD2; Spitznagle, Theresa PT, DPT, WCS3. Clinical Practice Guidelines for Pelvic Girdle Pain in the Postpartum Population. Journal of Women's Health Physical Therapy 46(1):p E1-E38, January/March 2022. | DOI: 10.1097/JWH.0000000000000236

  5. Borg-Stein J, Dugan SA. Musculoskeletal disorders of pregnancy, delivery and postpartum. Phys Med Rehabil Clin N Am. 2007 Aug;18(3):459-76, ix. doi: 10.1016/j.pmr.2007.05.005. PMID: 17678762.

  6. Dehghan F, Haerian BS, Muniandy S, Yusof A, Dragoo JL, Salleh N: The effect of relaxin on the musculoskeletal system. Scand J Med Sci Sports 2014;24:e220-e229.

  7. Sokunbi G, Camino-Willhuber G, Paschal PK, Olufade O, Hussain FS, Shue J, Abjornson C, Zelenty WD, Lebl DR, Cammisa FP, Girardi FP, Hughes AP, Sama AA. Is Diastasis Recti Abdominis Associated With Low Back Pain? A Systematic Review. World Neurosurg. 2023 Jun;174:119-125. doi: 10.1016/j.wneu.2023.03.014. Epub 2023 Mar 8. PMID: 36894002.

  8. Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A, Alpantaki K. Pregnancy-related low back pain. Hippokratia. 2011 Jul;15(3):205-10. PMID: 22435016; PMCID: PMC3306025.

  9. Gutke A, Josefsson A, Oberg B. Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms. Spine (Phila Pa 1976). 2007 Jun 1;32(13):1430-6. doi: 10.1097/BRS.0b013e318060a673. PMID: 17545912.

  10. Spicer PJ, Thompson HK, Montgomery JR. Mommy's thumb: De Quervain's tenosynovitis in a new mother with cardiomyopathy. Radiol Case Rep. 2022 Sep 17;17(11):4368-4370. doi: 10.1016/j.radcr.2022.08.069. PMID: 36188089; PMCID: PMC9520491.

*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives

Sarah Cline
Previous

Poisonous Metals In Your Tampons?
Next

Common Issues During Pregnancy