Perinatal Massage Therapy

Perinatal Massage Therapy: Alleviating Pregnancy Pain

We know, from what our hands and a growing body of scientific evidence tell us, that massage therapy improves the experience of being pregnant. Back and pelvic pain, and other muscle discomforts, are nearly universal in pregnancy.

Let’s explore that pain, including its sources and frequency, and how you might offer help.

Structural Imbalance During Pregnancy

The belly’s growing weight shifts forward. It strains a pregnant person’s body. As pregnancy goes on, her pelvis tends to rotate forward. This pushes the uterus against the abdominal walls. The lumbar curvature increases and the abdominal muscles stretch.

Effects on the Pelvic Region and Management Techniques

Then she gets double compensation: She leans her upper rib cage back. Then, her head and neck jut forward of the best vertical line. The stretch is most pronounced in the abdomen’s midline, called the linea alba. By the third trimester of pregnancy, the stretch usually separates the abdominal muscles. This condition is called diastasis recti. Trigger points often develop in the abdominal muscle attachments, too.

These compensations also strain the back muscles. This strain causes fatigue, tightness, trigger points, and fibrosis. Too much lumbar lordosis is linked to shorter hip flexors, the iliopsoas, and the tensor fasciae latae. It also shortens the thoracolumbar fascia, which makes the spine less flexible. Enlarging breasts pull her pectoral girdle forward. This causes tight pecs and stretched rhomboids. Increased uterine weight also strains the pelvic floor.

Addressing Abdominal Muscle Changes and Diastasis Recti

Pregnant people often widen their stance and rotate at the hips. Chronic tension then builds in the piriformis and other external hip rotators. Also, the knee and foot are no longer aligned with the hip. This prevents the iliopsoas from stabilizing or flexing the pelvis when walking.

In compensation, the gluteus medius must first abduct the thigh for the quadriceps to complete a step. This creates the characteristic waddling gait of many pregnant people. To prevent falling forward from the increased front weight, pregnant people tend to overextend their knees. Their weight then collapses into their tired foot arches.

Sources of Back and Pelvic Pain During Pregnancy

These postural adjustments and weight gain tend to destabilize, strain, and compress the weight-bearing joints and their myofascial structures. Pain and limits on function often follow.

Common Postural Adjustments and Their Impact

An estimated one in five women feel pelvic pain during pregnancy or after birth. The pain has no obvious cause, other than the many changes of pregnancy. This is called pregnancy-related pelvic girdle pain. It is also called perinatal pelvic pain syndrome. These women feel the most pain near the sacroiliac joints, lumbosacral joint, and pubic symphysis. But other parts of the pelvis and legs hurt too. This includes compression in the hip joints.

At the sacroiliac joints, each ilium’s relationship to the sacrum shifts greatly. This happens as the abdomen enlarges and protrudes forward. When the pelvis tilts forward, it compresses and strains the ligaments of these deep pelvic joints. They can become either too mobile or not mobile enough, and painful, in response. Sacroiliac joint strain may refer to pain in the lower lumbar region, the buttocks, and inner thighs, and as far as the lower extremities.

Managing Sacroiliac Joint Pain and Other Related Discomforts

As pregnancy progresses, relaxin and other hormones begin softening the body’s connective tissue. This allows more pelvic flexibility and space for the growing fetus. Most importantly, for its passage through the pelvis during birth. But, as with other body systems, the pelvis is not the only target for these hormones’ effects. Laxity in ligaments, tendons, cartilage, and fascia makes joints unstable and strains them. This affects all joints, especially weight-bearing ones. It’s worse in the lower spine and pelvis.

Many people report their first incidence of chronic back pain during pregnancy, but it can take various forms. The generalized back pain of pregnancy is usually described as fatigue, tightness, and achiness. In contrast, sacroiliac pain feels like chronic soreness. It is in the upper, or middle part of the buttocks, across the iliac crest, or at the back of the pelvis. It can spread for several inches.

Pain from other pelvic joints varies depending on the source. Achiness in the center of the sacral and lumbar areas may indicate strain and compression of the lumbosacral joint. Sharp, stabbing pain in the front of the pelvis shows that the pubic symphysis is unstable. This condition is called symphysis pubis dysfunction. Trigger points and fatigue of the gluteus medius also contribute to back and pelvic pain.

Uterine Growth and Ligament Pain

The growing uterus itself is also part of the pelvic pain picture. During pregnancy, the uterus grows. It goes from a small pear-sized organ to the size of a watermelon. Eight uterine ligaments make this big change happen. They suspend and support the uterus in the pelvic cavity.

Uterine growth stretches these ligaments. It distorts and pulls their fascial continuations. These changes can result in referred pain:

• broad ligaments: low back, buttock, and sciatic-like pain.

• round ligaments: diagonal pain from the top of the uterus to groin; usually one-sided, depending on fetal position; can extend as far as the vulva and upper thigh

• sacrouterine ligaments: achiness just lateral to or beneath the sacrum and in the lower back.

Other Possible Pain Culprits in the Back and Pelvis

There are a few other possible pain culprits in the back and pelvis. Severe postural imbalance in the lumbar spine can cause radiating pain through the buttocks and down the posterior leg. More commonly, chronic tension in the piriformis traps and squashes the sciatic nerve. This is known as piriformis syndrome. From either source, this pain burns, sometimes worsened by tingling, numbness, and weakness in the legs. Some women have coccygeal and other pelvic floor pain, too. The possibilities for back and pelvic pain, in other words, are multiple, especially when there are multiple fetuses!

Managing Other Musculoskeletal Complaints During Pregnancy

Although not as common as back and pelvic pain, headaches and pain in the lower extremities are experienced by many expectant people. Edema produces some of this achy, sore, tense feeling, as does the strain on the muscles and joints of the feet and legs. Nerve compression of the tibial and lateral cutaneous femoral nerves can create numbness and pain. Cramps hit in the gastrocnemius, soleus, and the peroneals. They torment some women’s sleep. So do the vibrations and irritations of restless leg syndrome.

Addressing Headaches and Lower Extremity Pain

Pregnancy often worsens past postural imbalances and injuries. These can include:

• lumbar and cervical lordosis
• scoliosis
• disc issues
• thoracic outlet syndrome

Bad posture compresses the brachial plexus. It causes pain, numbness, or tingling in the whole hand and arm. But, edema-based carpal tunnel pain happens more often. Rib cage pain may occur in later pregnancy as organ space diminishes. As the lower circumference widens, the ribs spread. This straining can hurt abdominal attachments and intercostal muscles. Trigger points develop, referring to pain in the mid-and lower back and sometimes throughout the rib cage. The baby may intensify this discomfort with frequent kicks or stretching.

How Perinatal Massage Helps in Pain Control During Pregnancy

Amidst these seemingly endless structural changes, there is much that we can do. Experienced maternity massage therapists help their clients prevent, reduce, and manage pain. They do this by supporting the body’s adaptation to these many myofascial and proprioceptive changes.

Massage therapy’s effectiveness in reducing pain has been validated. This is not just by individual studies but by many literature reviews and meta-analyses.

Techniques for Alleviating Pregnancy-Related Pain

Many people have said massage helps pregnancy pains. But, there is little specific research. Few well-structured studies have looked specifically at massage and pregnancy. In one of them, massaged clients reported less back pain and a similar drop in leg pain. They had these benefits compared with those who had an equal amount of relaxation therapy. Women in the second trimester had similar pain reductions from massage therapy. This was true rather than just relaxation or normal prenatal care.

We still do not fully understand why it works. But, we have developed many techniques that prevent and reduce pain in our prenatal clients. Rhythmic passive movements are effective in pain management. They include small Trager^TM movements, and osteopathic strain–counterstrain and muscle energy techniques. Deep tissue work and other myofascial release forms may reduce pain by stretching bunched connective tissue. Deep cross-fiber friction may also reduce pain and the restricted movement of fibrosis. Swedish massage and other strokes use rhythmic movement and mindful attention. They may activate the client’s parasympathetic nervous system.

Trigger-point therapy involves focused pressure and stretching around trigger points. It can reduce the pain from these points by, scientists think, easing tissue ischemia and restoring normal blood supply. Asian bodywork modalities are also effective. Our pregnant clients welcome the lessening pain these techniques can bring.

Educational Support for Pregnant Clients

In addition to hands-on techniques, education also helps reduce pain and decrease stress on structures. Safe activities strengthen the abs. They also are guidelines for how to use the body in daily activities like breathing, walking, sitting, and sleeping. They will further reduce strain on the neck, back, and pelvis. These better movement patterns make therapy more effective.

This introduction covered the musculoskeletal system during pregnancy. We hope it improves your understanding of what your pregnant clients are likely experiencing. We encourage you to learn more about pregnancy, labor, and the time after birth. This will help you offer safe and effective maternity work. It will help you no matter where you provide massage therapy.

Guaranteeing the safety and well-being of your clients is paramount, especially when working in such a sensitive environment as perinatal massage therapy. It is necessary to have liability insurance to protect yourself and your practice. At Massage Magazine Insurance Plus, we proudly support practitioners dedicated to helping pregnant individuals manage their pain and discomfort. Our comprehensive coverage includes over 500 modalities, providing you with the peace of mind to focus on delivering exceptional care.

Join Massage Magazine Insurance Plus today and ensure your practice is protected while you support those in need.

About the Authors:

Carole Osborne, CMT, is an integrative bodywork practitioner, author, award-winning course developer/instructor and mentor. Her work pioneered the reintroduction of therapeutic massage and bodywork to American maternity health care. She’s in private practice in California and has led training programs worldwide at bodytherapyeducation.com.

Michele Kolakowski, LMT, CD & CPD (DONA), CLC, has decades of diverse experience serving women and babies, including leading a hospital-based postpartum program, since 1992. She founded Sanctuary Healing Arts LLC, which specializes in hands-on maternal and infant care including massage therapy and doula care in Colorado.

David M. Lobenstine, LMT, BCTMB, aims to facilitate ease and awareness for each client at his private practice, Full Breath Massage in New York. He also designs and teaches continuing education workshops, both around the country and online, at bodybrainbreath.com.

This article was excerpted and revised from “Pre- and Perinatal Massage Therapy: A Comprehensive Guide to Prenatal, Labor and Postpartum Practice, Third Edition.” Copyright © Handspring Publishing 2021; reproduced with permission.

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