The journey to and through motherhood is, no doubt, filled with an array of emotional, mental, and physical changes. It can and should be, one of the most empowering times in a person’s life, but it can start to feel overwhelming when there is any degree of uncertainty or when there are obstacles that present themselves throughout the journey. The body is expected to change and grow in ways that are both magical and daunting for the birthing person and the clinicians in the pelvic health arena should be providing the education to help the pendulum swing towards the magic. Unfortunately, access to this education is sparse, recommendations can be conflicting (pending who you're talking to), and an understanding of the services that we can, and should be, providing in the perinatal period are not well defined nor understood by the majority of the healthcare continuum of providers.
During pregnancy, the body transforms with such beautiful intent. The overarching intention is to support adaptation to nurture and accommodate the developing fetus. During this transformation, the body will inevitably undergo physiologic changes in every system of the body, including the neuromusculoskeletal system. These changes in the neuromusculoskeletal system can contribute to the common ailments and complaints of our clients who are pregnant. Pregnancy-related low back pain, pelvic girdle pain, pubic symphysis dysfunction, and neuropathy are amongst some of those ailments whose symptom drivers are the nerves and muscles. As pelvic health clinicians, what is our best effort to treat these tissues during the gestational period?
How does dry needling fit in during pregnancy?
The way we approach tissue dysfunction during the gestational period is no different than at other times in a person’s life. We do, however, have to consider things like the stage of gestation, appropriate zones of treatment, dosage, and patient positioning for certain interventions, one of those being dry needling. In regards to dry needling intervention, we avoid implementing this in the first trimester secondary to the higher risk of spontaneous miscarriage.
There is no evidence to suggest that dry needling intervention would contribute to spontaneous miscarriage. However, as a clinician, we want to protect ourselves so as not to be associated with this unfortunate adverse event. We also withhold implementing dry needling in the zones of the thoracolumbar junction, the pelvic floor musculature, and the anterior abdominal musculature throughout the entire gestational period; this is due to avoiding the region of innervation to the uterus to mitigate association with a possible spontaneous pre-term labor and to abstain placing a needle within geographic proximity to the developing fetus. Otherwise, dry needling is an appropriate intervention for the management of neuromusculoskeletal conditions in this patient population, especially when other clinical approaches for pain mitigation (i.e.: pharmaceutical use) are contraindicated or simply not offered by other healthcare providers. A properly trained clinician can safely implement dry needling as a powerful intervention for pain relief and neuromuscular reset to allow for better activity and load tolerance during the gestational period. Improving activity and load tolerance for the expecting mother has a multitude of benefits for both physical and mental wellness.
Amazing!! What about in the postpartum period?
In the postpartum period, the body will inevitably go through a massive shift in the overall performance of the neuromuscular system. Birth-related neuromuscular dysfunction is common following both vaginal and cesarian delivery due to the mechanical and biochemical stressors placed on the involved tissues, a concept that shouldn’t be surprising for the rehabilitative clinician. Consider your postoperative patient following a total knee replacement; there is a certain degree of expectation surrounding neuromuscular shutdown following the procedure secondary to the inflammatory cascade that follows. Performance for daily activities such as ambulation, transitional movements, and ability to participate in recreational tasks is limited during the acute and subacute recovery period. It takes time to regain mobility of the involved joints and the neuromuscular coordination and strength of the impacted tissues. We progress the patient through our plan of care to reset the dysfunctional tissues, reinforce good movement strategies, and reload the tissues back to function. The neuromuscular performance following a vaginal or cesarean delivery is no different. The muscle groups impacted following birth are typically those of the core canister including the diaphragm, abdominal wall, pelvic floor, and lumbopelvic posterior stabilizers.
One of the best reset tools we have as rehabilitative clinicians is dry needling. We are able to specify treatment to the tissue targets that are unique to each client’s symptom presentation while utilizing electrical stimulation to influence the nervous system for both tissue recovery and performance. Being a bioelectric system, our bodies respond beautifully to this type of input, especially when followed with appropriate interventions to reinforce neuromotor coordination and functional loading. This sequence of interventions optimizes the overall function of the nervous system which ultimately dictates the behavior and performance of the rest of the body. As it relates to our postpartum clientele this should be something we are considering in the immediate postpartum period to optimize birth recovery, especially for the heavily impacted tissues like the abdominal wall, lumbopelvic stabilizers and pelvic floor.
We have a continuously developing body of evidence that supports the utilization of dry needling for tissue health and performance. The mechanisms behind this are biomechanical, biochemical, vascular, and neural in nature. There is also emerging evidence that is exploring the utilization of dry needling with electrical stimulation (aka neuromodulation) for wound healing. The possible impact that we can have on the healing of episiotomy incisions, cesarean incisions, or perineal tears in the acute and subacute postpartum stage is encouraging given the evidence, and has also been seen to be very powerful anecdotally.
If you want to learn more about the implementation of dry needling into your practice as it relates to the perinatal period, join us on an upcoming Dry Needling and Pelvic Health: Pregnancy and Postpartum Considerations! There are two more courses scheduled this year. One this summer in Arlington VA on June 22-23, and the other this fall in Seattle WA on October 18-20.
AUTHOR BIO
Kelly Sammis, PT, DPT, OCS, PCES, AFDN-S, CLT
Kelly Sammis is a physical therapist, educator of dry needling and all things pelvic, Pilates instructor, wife, and mama living and working in Parker, Colorado. Her passion for treatment in physical therapy is in sports performance, pelvic health, and overall wellness. She specializes in the treatment of male and female pelvic floor dysfunction, athletic injury/return to sport, sports performance, and persistent pain. Her formal education took place at Ohio University (2007) and The University of St Augustine for Health Sciences (2010).
She is a Midwest native with a strong history of treating persistent pain, pelvic floor, and return to sport dysfunctions. Kelly serves as lead faculty developing and teaching dry needling and pelvic health courses nationwide. When she is not treating clients or teaching you can find her spending time with her husband, two children, and labradoodle, Dexter, exploring our landscapes and the beautiful mountains of Colorado!