11. Women’s Health & Recovery: Pregnancy & Postpartum Tips with Emily Yorkston

Join April Patterson and Emily Yorkston on the RX Physiotherapy Podcast as they dive deep into women’s health, pregnancy, and postpartum recovery. 

In this episode, Emily, a women’s health physiotherapist, shares expert advice on managing pregnancy-related pelvic pain, diastasis recti, and core health.

Discover practical tips for exercising safely during and after pregnancy, reducing discomfort from round ligament pain, lower back pain, and pelvic girdle pain, and returning to your pre-pregnancy fitness routine. 

Emily also explains what’s normal versus what’s not, including bladder leakage, posture changes, and core muscle separation, empowering women to advocate for their own health.

Whether you’re pregnant, recently postpartum, or simply interested in understanding women’s musculoskeletal health, this episode is packed with actionable advice, evidence-based guidance, and practical strategies to support your body through pregnancy and beyond.

Key topics covered:

• Pregnancy-related pelvic girdle and lower back pain
• Round ligament pain and fetal positioning
• Diastasis recti: causes, prevalence, and postpartum management
• Safe exercises during pregnancy and gradual return to activity postpartum
• Tips for managing day-to-day pain and discomfort
• Advocacy and self-care for women’s health concerns

Listen now for expert insights on supporting your body, reducing pain, and confidently navigating pregnancy and postpartum recovery!

Disclaimer: Before making any health changes, consult with a healthcare professional.

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Transcript

April: 0:00

Welcome to the RX Physiotherapy Podcast, your go-to destination for all things physio, rehab, health and wellness. I'm April Patterson

Emily: 0:09

and Emily,

April: 0:10

and each week we will dive deep into fascinating topics within the health world. From physiotherapy to nutrition and beyond. We cover it all. So sit back, relax, and enjoy the journey as we explore the exciting world of health and wellness. Let's get started. Hello everyone. Thank you for tuning into another episode of the RX Physiotherapy podcast. Today we'll be going through some women's health information and Emily will be answering some questions. So we're all, uh, dying to know about some general women's health staff, and we'll even get into some more specific stuff about returning to exercise, um, and exercising during pregnancy as well. We'll start off just by going into some pelvic related pain, so that's just around the hips. So many women describe pelvic pain during pregnancy. What are the most common causes you see? In your practice?

Emily: 1:07

I think the most common cause would be pregnancy related pelvic girdle pain, which is a fairly broad term that we use, but it generally just describes pain that sits around the pelvic region, so just above the hip bone and down to the gluteal fold. So anything. Behind that bottom there, and the pain may also radiate down into the thigh and it can occur as well with pubic synthesis pain. So that's in through the front of the pelvis. It's also pretty common for women to also experience pregnancy related lower back pain or a combination. Of both, and that's what we refer to as pregnancy related lumbo pelvic pain, and it generally arises due to changes of hormones during pregnancy. So relaxant, but relaxant isn't the only hormonal change that we see in pregnancy. We also see a rise in estrogen, so that increases the laxity through our connective tissues. So that's also for our hypermobile clients. Um, they may be more prone to this type of pain due to the already lax laxity that they're already experiencing in their joints as well. There's also some upper back pain women can start to experience too, and that's due to elevation of the ribs as the uterus expands. So that can also cause a bit of pain. More so through the upper back though. Pregnancy related pelvic girdle pain generally arises around 14 to 1330 weeks of pregnancy, and generally will get worse as the pregnancy progresses. But good. The good news is that it generally does go away postpartum. In some cases it may persist, but most of the time it will start to settle down once you do have the baby. The other causes as well is round ligament pain, so the round ligament is a bunch, basically a bunch of muscular cords that attach from the U onto the uterus to help stabilize it during pregnancy. And they can cause muscle spasms, particularly when moving quickly, and that's what results in pain. Um, so generally with that type of thing, our advice is just to try and keep movement nice and slow and avoid any sudden movements. But that type of pain will generally resolve quite quickly after stopping the movement. As well as fetal position. So that's where we generally see spine against spine. So if B'S spine is up against mum's spine, that can cause pain and it is generally worse when laying down and improves when you get up onto all fours as well as osteous pubis. So that is similar to what some women may experience with pelvic related pain. But it is due to more so irritation through that pubic synthesis and the, um, the joint at the front of the pelvis there, that's more so due to long-term irritation. So that can be combined with the pregnancy related pelvic pain, though there are some more sinister. Pathologies that we wanna keep an eye on and concerns that can arise during pregnancy. So that's where we're looking at, say, pregnancy associated osteoporosis, or as well as transient, transient osteoporosis of the hip. And that generally occurs due to reduced bone, um, density during pregnancy, and that can increase risk of fractures. So that's one condition that we wanna keep an eye on, as well as avascular necrosis or osteonecrosis. So that can be bunched in with transient osteoporosis of the hip, and that's something that also can. Be a little bit more nasty and we wanna keep an eye on making sure it isn't that as well, as well as our general other pathologies that we wanna keep an eye on for when people do come into the clinic for any other musculoskeletal concerns. So any malignancies, cor aquina, systemic infections, but there's also our obstetric concerns, so preterm labor or placental abruption. So those are probably most of the things that we'd see in the clinic.

April: 5:32

Yeah, no, that all sounds. Very on point. Another question that I'm sure you're all dying to know about is the separation that occurs during pregnancy. I'm gonna butcher saying this word dias, diastasis recti. Can you just talk us through exactly what that is and. How common it is during and after pregnancy. I feel like there's a lot of conflicting advice out there, so I'd love to get your opinion on that

Emily: 6:01

for sure. So it is essentially the widening of the linear alba. Linear alba is the connective tissue that connects out to, um, muscle bellies of director abdominis and helps provide support and translates force through the abdomen region. It's generally thought to occur due to the increase in estrogen, which changes the collagen fibers in our connective tissue, and again, increases laxity within our body and through that connective tissue, as well as that mechanical pressure that's placed on the area due to the expanding uterus. Um, so unfortunately for our hypermobile clients. They may be at increased risk of experiencing diastasis recti, but it's generally considered you, it's you're generally considered to have it if there's more than a two finger width space between each abdominal muscle and the prevalence really varies. But what we, from what the research currently says is that about 33.1% of women at 21 weeks is considered to have diastasis recti, and by the third trimester, 66% of women. So yeah, that's pretty significant, but it can spontaneously improve and will resolve in the early weeks of postpartum. So at 12 weeks, they found that. 32.6% of women have a two finger with gap, and then by six weeks, um, 60% of those women, it's improved. Wow. So that's fairly significant in terms of management, it's a tricky one because there's not much research in regards to how we should manage it or prevent it even. Despite there being so much talk in the media in regards to diastasis recti, in terms of early postpartum, we wanna avoid increasing our intraabdominal pressure. So that's where we're gonna put too much pressure through that linear alba. So with exercise and movement, we wanna ensure that we're moving correctly and using our core correctly. So we wanna avoid any superficial. Exercises that help contract the superficial abdominal muscles, such as sit-ups. Rather, we wanna work on the deeper core, but when we do work on the deeper core, we also wanna make sure that we are doing that correctly. So making sure that there's no doming and that we can brace through that core correctly without increasing that intraabdominal pressure. As well. I think another nice little thing to add is that there's been a lot of talk in regards to diastasis recti and that contributing to lower back pain and pelvic floor dysfunction, but there's actually been no correlation found between the two. So in terms of management, it can, I guess, impact how well we can use our core. But that doesn't mean that. You are at increased risk of lower back pain and it is more of a cosmetic concern as well. So in terms of management, we just really wanna make sure that women can use their core correctly. And apart from that, if they can, they should be right to go with exercise.

April: 9:31

Hmm. Okay. That's really good to hear. That's a question I've been asked multiple times in my practice is. Should I get this fixed in terms of am I doing more damage to myself and. It's great to hear that the answer is no to that. And if it is something that you want to change, cosmetically, there's always that option, but it's not something that you need to do. Mm-hmm. In a sense, which is, which is really good to hear, especially'cause it's such a prevalent thing too in, uh, in the population. So a lot of women experience like posterior pelvic pain or round ligament pain, which you touched on a little bit before. What are some practical techniques they can use just to like help manage their pain day to day?

Emily: 10:15

Sure. Some nice little practical techniques that I generally advise the women that come through my doors is trying to minimize single leg movements as much as possible. Um, so if you're still in the gym and moving. Trying to keep everything double leg. Say if you're having pain when getting dressed, sit down to get dressed so you're not having to stand on that one leg. Trying to minimize stairs as much as possible to avoid exacerbating that pain. So if need be using the elevator instead of the stairs, if there's that option, wear low heeled shoes that can in reduce that pressure through the pelvis, as well as avoid standing and walking for prolonged periods of time. So making sure that we're pacing our activity and movement. So just doing small bits at a time rather than trying to get everything done at once. Mm. Big one is to avoid hip abduction. So that's where we're taking our leg out to the side away from our midline. So for instance, when we get in and out of the car, that's when we are taking our leg into that hip abduction. Mm. So when getting in and out of the car, trying to move with the legs together, the same as getting in, in and out of bed. Rather than taking one leg out at a time, try and move both legs together. I find that generally helps as well as avoiding any fast sudden movements, particularly for the round ligament pain. Um. Just trying to keep our movements nice and slow, and then if it's safe to do so during pregnancy, you've had no complications and you've been cleared by, say your OB or midwife. Just keeping up a safe, gentle movement routine that's appropriate for you. And there's been quite a few studies that have shown women who fear, who are fear avoidant of movement at 34 to 37 weeks of gestation are at greater risk of having their lumbar pelvic pain persisting past six months of postpartum.

April: 12:26

Interesting.

Emily: 12:26

Yeah. So I think the biggest thing is just trying to stay as active as possible and not fearing particular movements, but just trying to implement a few of those management strategies. Yeah, no, that makes

April: 12:39

a lot of sense. Yeah, that's really interesting to hear that. Um, yeah, six months into it. So yeah, doing things you can, within your power to reduce any sort of, um, flareups, like bringing the legs together, et cetera. But then not fearing movement either because we're, our bodies are incredible and. What we can do even into the latest stages of pregnancy is a lot more than probably the media says. That makes a lot of sense. So probably a big question that a lot of women have is when is it actually safe to exercise during pregnancy and like post pregnancy and yeah, maybe some like safe entry points women can look at for like, okay, can I get back to exercise now or, mm-hmm. What do you see in your practice?

Emily: 13:30

Most of the time it is safe to exercise during pregnancy, and I generally recommend to women as long as you've been doing that form of exercise prior to pregnancy, you are safe to do that during your pregnancy, provided that you have no complications during pregnancy. There are some conditions that. You will need to get clearance from for, from your midwife or OB before commencing exercise during pregnancy, if you're considered high risk. And there are some conditions where exercise is completely contraindicated, so you should not exercise at all, but some of those include, say, women with high blood pressure or who've been diagnosed with preeclampsia. That's one that you should get cleared by your OB or midwife from antepartum hemorrhage. So that's where you're bleeding in the general tool track after 20 weeks of pregnancy. That's just something. Make sure that you're fine to exercise if you've been cleared, that's okay. As well as placental abruption. And any other placental variants, you wanna make sure that you are safe to exercise from a medical professional before commencing cases where say a woman has cervical incompetence or premature rupture of membranes, that's where exercise is a definite no go. Um, your OB has probably informed you not to exercise, and that's where we really don't want to exercise.'cause I guess that's where we can look at preterm labor and we don't wanna be risking that with just trying to exercise. We wanna keep bob safe. Yeah. In terms of returning to activity postpartum, the biggest thing is making sure that you have clearance from your OB and midwife as well, particularly if you've had a complicated birth, and it's just going to be a nice gradual return. To activity. So that's where we probably generally start with something light in terms of just light walking, light mobility exercises, and then slowly build up that intensity. We do wanna keep in mind the pelvic floor strength and control, as well as core and pelvic stability, and keeping in mind that over the past nine or so months that. You may not have been as active as what you generally would be, so your body in overall is probably a little bit deconditioned too.

April: 16:04

So

Emily: 16:04

we wanna just keep it nice and slow and if you are concerned in regards to, I guess, getting back into exercise. It's not gonna hurt, just popping in seeing a pelvic floor or women's health physio just to get that guidance.

April: 16:18

Hundred percent makes sense. Okay, so what would be one piece of advice that you wish every woman knew about their body during pregnancy and recovery?

Emily: 16:28

I don't know whether it's advice, but I say this all the time, that it's not normal to have bladder leakage. I think. In just day-to-day conversations, so many women just think that it's a part of life. And it's definitely not something that you should just have to deal with. And if you are having bladder leakage, there is a reason why you are experiencing that and things can be done to help manage or solve that.

April: 17:01

Yeah,

Emily: 17:02

I think that's the biggest thing.

April: 17:03

Yeah, that's, that is a big one. And even when we look at women's health in general, like gymnasts, dancers, CrossFitters, we all experience that and we're like, oh, it's just. Part of it, but you're right, like it's, it's not normal. Yeah. Um, your body has an inbuilt mechanism to keep that bladder tight unless you tell your brain that you need to go to the bathroom. So for it to override that there's something going on that your body's not handling. So it makes, makes sense. How can women advocate for themselves if they feel their pain or their symptoms are being dismissed by a health practitioner?

Emily: 17:43

Sure. Um, I generally say to patients that you know your own body best and if something doesn't feel quite right, express that to your health professional and persist for further investigations to rule out other pathologies. Yeah, I think at the end of the day, we know our body's best. We know what's. Feels right or what feels wrong, um, and really just advocate for yourself and inform your health professional. I don't think this feels right. Can we investigate this further?

April: 18:14

No, totally agree with you on that. And lastly, if someone's listening right now and they're struggling, what would you say the first steps you recommend that they? Take.

Emily: 18:25

Sure. Well, I think the first step is what they're really doing right now is seeking further information by listening to this podcast.

April: 18:34

Yep.

Emily: 18:34

But I would ultimately say trying to create a support network of people that are there to help you. So whether that's starting with friends, family, partners, and then creating a network of health professionals around you, and I think that's where a women's health physio is a great spot to start. Yeah.

April: 18:54

No, that makes total sense. Thank you so much, Emily. That was very insightful. If you have any questions or if you've got any concerns that Emily has covered, she is here Monday to Friday and we'd love to help you out. So thank you so much for listening and catch us next time. Thank you.