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Treating and Preventing Common Postpartum Musculoskeletal Injuries:

A Biomechanical Approach to Moving with Your Baby

Background
I have always held an immense fascination and awe for the natural processes of pregnancy, childbirth, and mothering. The female body has the amazing ability to undergo significant changes to support life in the womb and bring that life to the outside world. I therefore naturally became interested in pelvic floor physical therapy upon listening to our first lecture on the topic in our Musculoskeletal 1 course. I further educated myself on this topic by attending advanced courses through the Herman and Wallace Pelvic Rehabilitation Institute. I had my first clinical education experience in pelvic health my 2nd year and will have another clinical education experience in pelvic health in my 3rd year. Furthermore, I myself am currently an expectant mother. As my body is going through the natural changes necessary to nurture my baby in the womb and in the outside world, I have become quite interested in postpartum care of women. This project has evolved out of my own interests, my current experiences as an expectant mother, and discussions with pelvic floor clinicians about postpartum pelvic physical therapy care.

 

Statement of Need
My project has specifically sprouted from the directly-stated needs of pelvic floor physical therapists. Over the past several months, I have talked with pelvic floor physical therapists on patient education needs they have in their settings. When asked what topics they spend the most time educating patients on and need better education materials for, they responded with this topic – how to move with your baby. They expressed that women commonly develop postpartum musculoskeletal injuries due to the dramatic shift in daily physical responsibilities, changes occurring in the postpartum female body, and the added weight of a little human they move around with all day. The most common injuries were stated to be coccyx pain, upper-back/thoracic pain, and diastasis rectus abdominus. These pelvic PTs expressed that mothers often are not educated on best ways to perform their new ADLs (changing diapers, carrying car seat to and fro, lifting baby out of crib, carrying baby, getting up from floor with baby, nursing baby, etc.) to prevent musculoskeletal injury. Therefore, my education materials are aimed at helping this population by providing recommendations on how to perform these tasks to avoid injury.

 

Purpose
The purpose of this project is to 1) review the current literature regarding common postpartum musculoskeletal injuries and their interventions and to 2) create patient education materials for postpartum women to avoid these injuries.

 

Products

For physical therapists, I wrote an academic paper providing an in-depth analysis of three common postpartum musculoskeletal injuries – coccydynia, diastasis recti abdominus, and thoracic pain. I provide a biomechanical and physiological explanation of why postpartum women are prone to these injuries and discuss the current research regarding interventions for these injuries. I also detail biomechanical recommendations on how to perform common baby caretaking tasks to avoid incurring these injuries.
Academic paper: Treating and Preventing Common Postpartum Musculoskeletal Injuries: A Biomechanical Approach to Moving with Your Baby

For patients, I developed an educational handout explaining recommendations on how to perform common baby caretaking tasks to avoid injury. I photographed a mother and her baby demonstrating these recommendations to provide a visual for patients. I also recorded video demonstrations of these recommendations that can be viewed on the public Instagram account @ergonomicmama.
Patient education handout: How to Perform Baby Caretaking Tasks to Avoid Injury

Video demonstrations of recommendations: Instagram @ergonomicmama https://www.instagram.com/ergonomicmama/

 

Evaluation Component
Throughout the project, I shared my progress with my primary advisor who helped me narrow my focus and fine-tune my products. I shared my patient education handout and demonstration videos with my expert clinicians and incorporated their feedback for improvement.

For gathering feedback on the educational materials from patients, I created a form that patients can complete after viewing the patient handout and demonstration videos.
Evaluation Form

 

Self-Assessment

At the early stages of this project, I wanted to create educational materials for prenatal exercise, childbirth ergonomics, postpartum return-to-sport, and baby caretaking task ergonomics. I received the feedback from my primary advisor and clinicians that I had far too wide a scope of material and that I needed to focus in on one of those topics. As the clinicians said they have the least educational material on baby caretaking task ergonomics, I went with that topic as the focus for my project. I learned so much in researching the biomechanics and interventions for the musculoskeletal injuries discussed in this project. I also learned how to instruct patients in these recommendations as I coached my mother and baby “models” in the recommendations to capture the photos and videos. I am proud that I have contributed education material that will fill a gap in resources for new mothers.

 

Acknowledgements

Dana McCarty, PT, DPT, for guidance and mentoring from this project’s early stages to its completion.

Abbie DeWitt, PT, DPT, WCS and Emma Shirley, DPT, for your project feedback and insight on what postpartum physical therapy patients commonly experience and what education materials would be useful to develop for this population.

Mama Stephanie and baby Davie, for being my lovely models for the handout photos and video demonstrations.

 

References

  1. Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J. 2014;14(1):84-87.
  2. Marnach ML, Ramin KD, Ramsey PS, Song S-W, Stensland JJ, An K-N. Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstet Gynecol. 2003;101(2):331-335. doi:10.1016/s0029-7844(02)02447-x
  3. Cherni Y, Desseauve D, Decatoire A, et al. Evaluation of ligament laxity during pregnancy. J Gynecol Obstet Hum Reprod. 2019;48(5):351-357. doi:10.1016/j.jogoh.2019.02.009
  4. Targonskaya A. How Long Will It Take Your Hormones to Settle Down After Childbirth? Flo – Recovering from Birth. https://flo.health/being-a-mom/recovering-from-birth/postpartum-problems/hormones-after-birth. Accessed January 24, 2022.
  5. Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women. Eur J Phys Rehabil Med. 2012;48(3):387-392.
  6. Pregnancy Weight Gain. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-weight-gain/art-20044360. Published April 1, 2020. Accessed January 24, 2022.
  7. Maigne JY, Guedj S, Straus C. Idiopathic coccygodynia. Lateral roentgenograms in the sitting position and coccygeal discography. Spine. 1994;19(8):930-934. doi:10.1097/00007632-199404150-00011
  8. Gunderson EP. Childbearing and obesity in women: weight before, during, and after pregnancy. Obstet Gynecol Clin North Am. 2009;36(2):317-32, ix. doi:10.1016/j.ogc.2009.04.001
  9. Contour – Kabooti 3-in-1 Donut Seat Cushion. AViVA. https://www.avivahealth.com/products/contour-kabooti-cushion. Accessed March 1, 2022.
  10. Elkhashab Y, Ng A. A review of current treatment options for coccygodynia. Curr Pain Headache Rep. 2018;22(4):28. doi:10.1007/s11916-018-0683-7
  11. van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001;39(4):395-408. doi:10.1016/s0005-7967(00)00007-3
  12. Maigne JY, Chatellier G. Comparison of three manual coccydynia treatments: a pilot study. Spine. 2001;26(20):E479-83; discussion E484. doi:10.1097/00007632-200110150-00024
  13. Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016;50(17):1092-1096. doi:10.1136/bjsports-2016-096065
  14. Thabet AA, Alshehri MA. Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: a randomised controlled trial. J Musculoskelet Neuronal Interact. 2019;19(1):62-68.
  15. Vesentini G, El Dib R, Righesso LAR, et al. Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis. Clinics. 2019;74:e1319. doi:10.6061/clinics/2019/e1319
  16. Reale J. Managing Movement: Part I Evaluation of Pressure Systems & Load Transfer. Presented at the: Herman & Wallace Level 1 Course; January 21, 2021; Online.
  17. Irion JM, Irion GL, Ph.D. Women’s Health in Physical Therapy  . Philadelphia: Lippincott Williams & Wilkins; 2009:310-326.
  18. Schröder G, Kundt G, Otte M, Wendig D, Schober H-C. Impact of pregnancy on back pain and body posture in women. J Phys Ther Sci. 2016;28(4):1199-1207. doi:10.1589/jpts.28.1199
  19. DeWitt A, Shirley E. Common postpartum pathologies treated by pelvic floor therapists. December 2021.
  20. Effects of Pregnancy on Musculoskeletal System. CSPC Physiotherapy. https://www.cspc.co.uk/complex-conditions/your-body-during-pregnancy/effects-of-pregnancy-on-musculoskeletal-system/. Accessed January 25, 2022.
  21. Katzman WB, Miller-Martinez D, Marshall LM, Lane NE, Kado DM. Kyphosis and paraspinal muscle composition in older men: a cross-sectional study for the Osteoporotic Fractures in Men (MrOS) research group. BMC Musculoskelet Disord. 2014;15:19. doi:10.1186/1471-2474-15-19
  22. How Much and How Often to Breastfeed. CDC. https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/how-much-and-how-often.html. Accessed January 24, 2022.
  23. Wren TAL, Ponrartana S, Gilsanz V. Vertebral cross-sectional area: an orphan phenotype with potential implications for female spinal health. Osteoporos Int. 2017;28(4):1179-1189. doi:10.1007/s00198-016-3832-z
  24. Lewek M. Muscle Mechanics. Powerpoint presentation presented at the: UNC DPT Biomechanics Course; October 24, 2019; Chapel Hill, NC.
  25. Gak H-B, Lee J-H, Kim H-D. Efficacy of kinesiology taping for recovery of dominant upper back pain in female sedentary worker having a rounded shoulder posture. Technol Health Care. 2013;21(6):607-612. doi:10.3233/THC-130753
  26. Hacke J. Soft Tissue Mobilization: Massage and Other Selected Techniques. Presented at the: UNC DPT Presentation; September 13, 2020; Chapel Hill, NC.
  27. Monteiro Rodrigues L, Rocha C, Ferreira HT, Silva HN. Lower limb massage in humans increases local perfusion and impacts systemic hemodynamics. J Appl Physiol. 2020;128(5):1217-1226. doi:10.1152/japplphysiol.00437.2019
  28. Field T, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies’ effects on depressed adolescent mothers. Adolescence. 1996;31(124):903-911.
  29. Ingraham P. Tennis Ball Massage for Myofascial Trigger Points. PainScience.com. https://www.painscience.com/articles/tennis-ball.php. Published October 19, 2018. Accessed January 31, 2022.
  30. Harrington J. Physical Therapy and Pregnancy. Presented at the: UNC DPT Lecture; June 18, 2020; Online.
  31. Hacke J. Selected Physical Therapy Modalities, Theory and Application. UNC DPT Lecture presented at the: PHYT 722; March 20, 2020; UNC Chapel Hill, NC.
  32. Erica. Pregnancy Yoga: How to Use Yoga Props to Get Comfy for Restorative Yoga Poses. Spoiled Yogi. https://www.spoiledyogi.com/pregnancy-yoga-how-to-use-yoga-props-to-get-comfy-for-restorative-yoga-poses/. Accessed January 31, 2022.
  33. Watts C. Using the Spiral–Diagonal Patterns of PNF. Presented at the: Online presentation; January 20, 2018.
  34. Vincent R, Hocking C. Factors that might give rise to musculoskeletal disorders when mothers lift children in the home. Physiother Res Int. 2013;18(2):81-90. doi:10.1002/pri.1530
  35. DeWitt A. Biomechanics of Common Infant Caretaker ADLs and Common Postpartum Injuries. January 2022.
  36. Schreiber S. Carry an Infant Car Seat. Good Housekeeping Home. https://www.goodhousekeeping.com/life/parenting/news/a44814/right-way-to-carry-car-seat/. Published June 26, 2017. Accessed February 22, 2022.
  37. Howland G. Breastfeeding Positions. Mama Natural. https://www.mamanatural.com/breastfeeding-positions/. Accessed February 22, 2022.

 

 

11 Responses to “Treating and Preventing Common Postpartum Musculoskeletal Injuries: A Biomechanical Approach to Moving with Your Baby”

  1. Emily Goodnight

    Marjorie, I love your capstone! So well done. I really appreciate the organization and how thorough your academic paper is. I am sure this will serve as a great reference to me and other clinicians as we work with postpartum moms. I am already getting some great ideas for body mechanics that I can teach patients on my caseload currently. I have really learned from the breastfeeding position options in particular. I like how you condense the information in a patient friendly way in your patient handout! A genius idea to include a Instagram account with videos of good body mechanics.

    Reply
  2. Abbie DeWitt

    Marjorie,

    The patient handout was visually appealing, easy to read and interpret, and provided good visuals for appropriate and inappropriate body mechanics. I also appreciated that for some of the sections (i.e. Getting up from the floor with baby) there were a variety of different methods depending on the strength, mobility, and function of the postpartum person.

    I greatly appreciated your leap into social media with this project as well. So many people are starting their recovery journey with online information (Facebook, Instagram, Tik Tok, Pinterest, etc), that it is more important now more than ever to have good information on these platforms. It also makes the visuals even easier to understand as the videos add greater dimension to the movements. I agree with a previous commenter in that I hope you continue with the Instagram page and/or find a way to translate the practiced movements onto physical therapy HEP programs one day!

    Reply
  3. Dana B McCarty

    Marjorie – congratulations on a job well done! These materials will enhance your own practice once you are a clinician. I think your handout and IG videos are stellar!

    Reply
  4. Stephanie Casnave

    Hi Marjorie,

    You did an absolutely fantastic job on your capstone project! Having had the opportunity to treat quite a few mothers during my clinical rotation at the UNC Spine Center and being a mother myself, I wish I would have had this information a lot sooner! Due to the breadth of other information we have to learn in the program, we oftentimes do not get an opportunity to take a deep dive into pelvic or postpartum health unless we individually seek additional training, so I appreciate these awesome resources you’ve provided on common conditions, interventions and educational materials. Particularly, I appreciated your acknowledgement of health literacy principles through the inclusion of patient-centered language as well as pictures in the handout as it really enhances the presentation and makes it a lot easier to understand. Additionally, your academic paper was extremely thorough and comprehensive including a myriad of common postpartum issues as well as conservative interventions we can practice as PTs which I definitely plan to utilize and share with my colleagues during practice. Moreover, your instagram page was phenomenal and is yet again another great resource for patients as well as the general public to not only advocate for moms but also advocates for the profession as it lets others who are going through this learn about how PT can help. Bonus points for the awesome name! Inappropriate ergonomics was a common issue with new moms at the spine center and this page serves as an excellent educational tool for patients and clinicians. Can’t believe you will soon be implementing this knowledge! Congratulations again and outstanding job on this capstone!

    Reply
  5. Lindsay Morrow

    Marjorie,
    You did such a fabulous job on your project! As a female and someone who desires to be a mom someday, I really appreciated all the information and guidance. I am sure that knowing more about the changes that the female body undergoes will make me more prepared and feel less scared when the time comes for me. Your paper was clearly laid out and provided physical therapists with sufficient information regarding background of the pathology and pathophysiology as well as some intervention methods. These tips will certainly be useful when treating post-partum women in a general orthopedic clinic. However, your project also illuminated how much we have not learned in PT school, and I will likely be referring patients to pelvic floor specialists like you for optimal outcomes.
    Also, your patient education handout was very succinct and easy to follow. These caretaking movements are really applicable to all parents/caregivers, and I can imagine this handout being extremely useful. The delivery of this information on your Instagram page is also very innovative and in line with how our society seeks information.
    Great job! You’re going to be an excellent mom!

    Reply
    • Marjorie McCarthy

      Thank you for the feedback Lindsay! I am glad you found the academic paper educational and the patient handout clear and useful!

      Reply
  6. Lindsay Morrow

    Marjorie,
    You did such a fabulous job on your project! As a female and someone who desires to be a mom someday, I really appreciated all the information and guidance. I am sure that knowing more about the changes that the female body undergoes will make me more prepared and feel less scared when the time comes for me. Your paper was clearly laid out and provided physical therapists with sufficient yet not overwhelming information regarding background of the pathology and pathophysiology as well as some intervention methods. These tips will certainly be useful when treating post-partum women in a general orthopedic clinic. However, your project also illuminated how much we have not learned in PT school, and I will likely be referring patients to pelvic floor specialists like you for optimal outcomes.
    Also, your patient education handout was very succinct and easy to follow. These caretaking movements are really applicable to all parents/caregivers, and I can imagine this handout being extremely useful. The delivery of this information on your Instagram page is also very innovative and in line with how our society seeks information.
    Great job! You’re going to be an excellent momma!

    Reply
  7. Emma Shirley PT,DPT

    Marjorie,
    This is excellent material and extremely helpful for education. Working in a rural area in NC, we definitely struggle with appropriate care for mothers part-partum and this kind of educational material is key to bridging this gap. With these handouts, I especially appreciated the simplicity of instructions so they are friendly to all health literacy levels. It is also nice to have the Instagram account with video options to accompany images to encompass different kinds of learners (especially with such an adorable baby to keep people’s attention!). In the research article, I appreciated the mixture of both active and passive interventions. It is obvious through your personal experiences and excellent project that you will be a wonderful, biomechanically-sound mother and pelvic physical therapist.

    Reply
    • Marjorie McCarthy

      Thank you so much for your help with this project Emma! I appreciate your clinical expertise and your feedback along the way. I hope my materials will be useful to you in your current rural healthcare environment and in your upcoming job in Charlotte!

      Reply
  8. Maureen Marquie

    Marjorie,

    I was thoroughly impressed by your capstone. I can tell reading through your paper, handout, evaluation, and watching your instagram videos how personal this capstone was to you and the amount of work and effort you put into it. I really appreciated how you created a handout that you could provide to patients during your clinical or have a few copies in your car to hand out to people you know as well as including the instagram account with videos. This way you are reaching a greater amount of people and providing different formats depending on if people do better with reading and pictures or watching a demonstration. Your educational paper was very thoughtfully written with expressing the details from literature in a succinct manner and providing pictures to enhance the reader’s learning. I found out many things I was unaware of while reading your paper and feel more prepared to help any patient I encounter with these problems in the future. Specifically, one example of something I learned is how relaxin can take 5 months to return to pre-pregnancy levels. This information is so important to know as many patients who are pregnant may be curious how long they will be dealing with laxity and now I have that knowledge to provide to them. My only question is do you plan on continuing the instagram account in the future with your baby? I’d love to see things you include as a new mom as you come across other areas to intervene and I’m sure the page would continue to provide education to other moms, PTs, etc. Overall, I think you did a wonderful job and filled a gap in education not only for PTs but also for patients and this information will make you an even better soon-to-be mom!

    Reply
    • Marjorie McCarthy

      Maureen,
      Thank you for the feedback! I am glad you found the diversity of materials and presentation styles helpful in your learning. And I am also glad you found the academic paper educational as we all will likely encounter post-partum patients no matter what setting we end up working in. Regarding your question, I do plan on keeping the Instagram page public and active in the future. I am interested in myself demonstrating some of the diastasis rectus abdominus exercises detailed in the academic paper and ways to workout with your baby as future video ideas.

      Reply

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