Prenatal Physiotherapy: Care During Pregnancy

Prenatal Physiotherapy: Care During Pregnancy

Prenatal physical therapy helps pregnant women manage pain, adjust their activities, and prepare for the movements involved in childbirth. The type of care you receive depends on your symptoms, your needs, and how your pregnancy is progressing.

Pregnancy changes body weight, balance, and the mobility of certain joints. These changes may be accompanied by muscle or joint pain, but they alone do not explain who will experience pain. The exact cause of back and pelvic pain during pregnancy remains poorly understood ¹.

At Physioactif, pelvic floor physical therapy focuses on the muscles at the bottom of the pelvis, which support the bladder and the uterus—the organ where the baby grows. Your physical therapist tailors this treatment to your pregnancy, in collaboration with your doctor or midwife.

This article discusses types of pain that can be treated with physical therapy, exercise modifications, childbirth preparation, and signs that warrant medical attention.

What is Prenatal Physiotherapy?

Prenatal physical therapy supports pregnancy through pain management, tailored exercises, and physical preparation for childbirth. Treatment may also focus on the pelvic floor muscles and resuming activities after childbirth.

Prenatal physical therapy combines several interventions:

Pain Management. Your physiotherapist uses gentle manual therapy techniques to relieve back, pelvic, and leg pain. These techniques are adapted to your trimester and follow safety precautions.

Prescription d’exercices. Votre physiothérapeute propose un programme selon votre santé et vos capacités. Les recommandations canadiennes sur l’exercice pendant et après la grossesse ont évolué². Le guide canadien de 2019³ précise les activités et les adaptations pendant la grossesse. Les exercices travaillent la force, la souplesse et l’endurance, c’est-à-dire la capacité de poursuivre un effort.

Pelvic floor exercises. Your physical therapist will teach you how to contract, coordinate, and relax these muscles. For pregnant women without urinary incontinence, a structured program can reduce the risk of developing it during pregnancy and up to six months after childbirth. ^{4, 5}

Education and prevention. You’ll learn how to vary your positions, adjust your activity level, and recognize symptoms that require medical attention. The goal is to move more comfortably, without having to maintain perfect posture.

Votre physiothérapeute échange avec votre médecin ou votre sage-femme, avec votre consentement, lorsqu’une précaution doit être clarifiée. Les recommandations américaines de 2015 encourageaient déjà l’exercice pendant une grossesse sans complication⁶. Leur mise à jour de 2020⁷ maintient cet appui, avec adaptation en présence de complications. Cet appui à l’exercice ne garantit pas la sécurité de chaque technique de physiothérapie.

Prenatal physiotherapy isn't just about treating existing problems. It also helps you develop healthy exercise habits that will support you throughout your pregnancy and after childbirth.

What Conditions Does Physiotherapy Treat During Pregnancy?

Physical therapy can help manage back and pelvic pain, certain types of pain that radiate down the leg, carpal tunnel syndrome, and the swelling in the legs that commonly occurs during pregnancy. The evaluation helps distinguish these issues from symptoms that require medical attention.

Pelvic and Lower Back Pain

Back and pelvic pain are common during pregnancy ¹. One study distinguished between lower back pain, pelvic pain, and a combination of the two; the group with pain in both areas experienced greater difficulty with daily activities ⁸. Appropriate exercises are part of the recommended care. A review of six studies on stabilization exercises during or after pregnancy reports benefits in some studies, but the results are variable, making it impossible to draw a firm conclusion ⁹.

Mechanisms. As weight increases, the body’s balance changes, and the ligaments—bands of tissue that connect bones—sometimes become more flexible. Greater mobility in the pelvis does not mean that it is damaged. Pain may affect the lower back, the sacroiliac joints at the back of the pelvis, or the pubic symphysis, the junction between the two sides of the pelvis at the front ¹⁰. Theories about these pains are not limited to hormones; earlier studies had already described several possible factors ¹¹.

The Symptoms. You may experience pain in your lower back, buttocks, groin, or the front of your pelvis. The pain can worsen when you walk, climb stairs, turn in bed, or stand for long periods.

The Physical Therapy Approach. Your physical therapist will assess your range of motion, strength, and the movements that trigger pain. Depending on your needs, the treatment plan may include the following interventions:

• Manual therapy uses gentle movements or pressure to relieve pain.
• Stabilization exercises help build control and strength in the core and pelvic muscles.
• A pelvic support belt can help make certain movements more comfortable, if wearing it provides relief.
• These tips help you find comfortable positions for sleeping, sitting, and moving around.

Check out our guide on back pain and our page on care during pregnancy and after childbirth. A review also lists education, exercises, and pelvic support among the options for managing this pain ¹².

Sciatica and Nerve Pain

Pain that radiates down into the buttock and leg is sometimes called sciatica. It may be accompanied by a burning sensation, tingling, or numbness. The examination checks whether a nerve is affected; not all leg pain necessarily originates from a nerve. Damage to the peripheral nerves—which connect the brain and spinal cord to the rest of the body—is generally rare during pregnancy. The spinal cord is a cord of nervous tissue within the spine ¹³.

Possible causes. Compression of the pelvic nerves can occur late in pregnancy or during childbirth, particularly due to the baby’s head. A herniated disc is another possible cause, though it is rare during pregnancy. A herniated disc occurs when part of a disc—the cushion between two vertebrae, the bones of the spine—protrudes. Pain in a gluteal muscle, such as the deep-seated piriformis, must also be distinguished from nerve damage. ^{13, 14}

The physical therapy approach. Your physical therapist may recommend gentle leg and back movements, comfortable stretches, and resting positions that help alleviate your symptoms. Neural mobilizations are movements designed to shift a nerve relative to surrounding tissues. The specific techniques used depend on the examination findings and your response; they do not force the tingling sensation or promise to relieve compression. New or worsening weakness requires medical attention.

Our guide to nerve treatment in physical therapy covers the assessment and exercises used for certain types of nerve pain.

Other Common Conditions

Carpal tunnel syndrome. Compression of the median nerve at the wrist can cause tingling or numbness in the fingers. This nerve transmits sensations from the thumb, index finger, and middle finger, among others. Fluid retention may contribute to this compression during pregnancy. Wearing a splint to keep the wrist straight—especially at night—and modifying activities that aggravate the condition are among the usual treatment options ¹³. Your physical therapist may also recommend exercises based on your examination and symptoms.

Douleur des ligaments ronds. Ces deux cordons de tissu relient l’utérus au bassin. Leur étirement peut provoquer une douleur vive dans l’aine, notamment en changeant rapidement de position ou en toussant. Bouger plus lentement, soutenir le ventre pour tousser et se reposer sur le côté avec un coussin entre les genoux peuvent aider. Une douleur importante ou inhabituelle doit être évaluée. La fiche du Royal Berkshire Hospital¹⁵ décrit ces adaptations.

Enflure des jambes, ou œdème. Une enflure qui apparaît graduellement aux pieds et aux chevilles est courante. Surélever les pieds, marcher régulièrement et bouger les chevilles peuvent aider : pliez et pointez doucement les pieds, puis faites de petits cercles. Une petite étude portant sur trente jambes au cinquième à huitième mois de grossesse a observé une diminution du volume après une séance de drainage lymphatique manuel, un massage doux étudié pour l’enflure¹⁶. Ce résultat immédiat ne garantit pas un effet durable. Une douleur ou une enflure du mollet, ou un gonflement soudain du visage, des mains ou des pieds, demande un avis médical rapide. Les conseils du NHS sur l’enflure pendant la grossesse¹⁷ expliquent cette distinction.

Is Physiotherapy Safe During Pregnancy?

Prenatal physical therapy can be performed safely when the treatment is tailored to your pregnancy and your health. A contraindication is a situation in which an activity or treatment should be avoided. Exercise is recommended in the absence of contraindications, but not every treatment is necessarily suitable for every pregnancy.

You can ask about the purpose of each medical procedure, its expected benefits, and its risks. Also, be sure to report any changes in the management of your pregnancy.

What the recommendations say about safety

Les recommandations canadiennes encouragent l’activité physique pendant une grossesse sans contre-indication¹⁸. Les recommandations américaines abordent ce sujet depuis plusieurs années¹⁹, avec une mise à jour en 2020⁷. Elles appuient les activités adaptées et le dépistage des complications, sans évaluer chacune des techniques de physiothérapie.

Your physical therapist tailors your treatment in the following ways:

• Joint movements should remain gentle; there is no need for sudden or rapid movements to receive treatment.
• Manual labor is performed at an intensity that ensures your comfort.
• Exercises done while lying on your back are appropriate if this position causes dizziness, nausea, or discomfort.
• The selection of positions and exercises takes into account your trimester and your health.

The Collaborative Approach

Your physical therapist will contact your doctor or midwife—with your consent—when precautions need to be clarified. The evaluation identifies symptoms and health issues that may require consultation before certain treatments or exercises are performed.

Contraindications

Certaines complications rendent l’exercice soutenu inapproprié et demandent un avis de l’équipe qui suit votre grossesse. Les recommandations canadiennes³ distinguent ces situations des précautions qui nécessitent une discussion. Parmi Contraindications à l’exercice soutenu figurent :

• A placenta previa after 28 weeks means that the placenta is covering the opening of the cervix.
• Cervical insufficiency means that the cervix opens too early.
• Persistent, unexplained vaginal bleeding requires medical evaluation.
• A work project that was started prematurely is preventing us from continuing our sustained effort.
• Uncontrolled hypertension—that is, high blood pressure—or preeclampsia requires medical care. Preeclampsia is a complication of pregnancy that combines high blood pressure with other health problems.
• If the membranes rupture, the amniotic fluid surrounding the baby may leak out.

Other situations, such as a history of preterm birth, may require discussion before engaging in moderate or vigorous exercise. This list is not a substitute for a medical evaluation. Your physical therapist coordinates your care with your healthcare team; a contraindication for sustained exercise does not necessarily mean complete rest.

Warning signs

Stop exercising or taking the medication and contact your prenatal care team or the hospital immediately if you notice any of the following signs:

• Vaginal bleeding occurs.
• Regular, painful contractions begin. Before 37 weeks, regular or frequent contractions also require medical attention, even if they are not painful.
• Amniotic fluid is leaking.
• Dizziness, a feeling of fainting, or fainting may occur. Shortness of breath that is present before exertion or is excessive during activity also warrants medical attention.
• Chest pain sets in.
• If you experience a headache or vision problems, seek medical advice. Abdominal pain, muscle weakness, or pain or swelling in the calf also require medical attention.
• You notice that your baby is moving less than usual.

Les signes d’arrêt de l’exercice de l’ACOG²⁰ et les signaux d’alarme de l’INSPQ²¹ aident à reconnaître ces situations. Une douleur dans la poitrine avec un essoufflement soudain, par exemple, exige une aide urgente : appelez le 911. Ne poursuivez pas une séance pour voir si une alerte disparaît.

These signs do not prove that a treatment caused the problem. The medical team must determine the cause before resuming treatment.

What exercises are recommended during pregnancy?

Recommended exercises during pregnancy, provided there are no contraindications, include walking, swimming, strength training, and pelvic floor exercises. The Canadian guidelines recommend at least 150 minutes of moderate-intensity activity per week, spread over at least three days ¹⁸.

Canadian Guidelines

The 2019 Canadian guidelines, published in 2018, recommend a combination of activities that build endurance and strength ¹⁸. A 2015 review had already described several potential benefits of exercise, while highlighting the differences between studies ²². These recommendations apply to pregnancies without contraindications and should be adjusted if a complication arises.

Recommended exercise prescription:

• Duration and frequency: Gradually work up to at least 150 minutes per week spread over at least three days. Exercising every day is encouraged.
• Intensity: Choose a moderate level of exertion that still allows you to carry on a conversation.
• Types of activities: Combine endurance activities with strength training.

Demonstrated benefits:

Physical activity during pregnancy can reduce the risk of gestational diabetes—high blood sugar levels during pregnancy—as well as preeclampsia, depression, and excessive weight gain ¹⁸. The effects vary depending on the measured outcome. These benefits do not mean that a woman who develops a complication has not been active enough. Our guide on the importance of physical activity during pregnancy details these effects on maternal and fetal health. Pelvic floor exercises, for their part, have a proven benefit in preventing urinary incontinence ⁵.

If you are not yet meeting the recommended level of physical activity, start with small amounts of physical activity and gradually increase the frequency, intensity, and duration.

Recommended Types of Exercises

Endurance activities. Walking is a good way to start with short sessions. Swimming reduces the weight borne by the joints thanks to the buoyancy of the water. A stationary bike avoids the obstacles and traffic associated with outdoor cycling, but the bike must be stable. Prenatal yoga combines movement, stretching, and relaxation; the poses should be adapted.

Strength training. Exercises using appropriate weights or your own body weight build strength. Your workout can focus on your back, hips, and glutes to support everyday movements. Breathe normally during the exercise; don’t hold your breath.

Pelvic floor exercises. Kegel exercises involve contracting and then relaxing the muscles at the base of the pelvis. They are particularly helpful for controlling urine. Both older and more recent reviews primarily support their use in preventing urinary incontinence in pregnant women who do not already have it. If you already experience incontinence, an evaluation will help determine the appropriate treatment; the effectiveness of the same program is not as well established in this group. ^{4, 23, 5}

Your physiotherapist can teach you the correct technique and ensure you are contracting the right muscles. For more information on pelvic floor training, consult our guide on pelvic floor physiotherapy.

Stretching and Mobility. The stretches should remain gentle and comfortable. You can focus on your calves, the front of your hips, and your lower back as needed, without aiming for maximum range of motion. Range of motion is the distance covered during a movement.

Évitez les sports avec collision, les activités avec risque élevé de chute et la plongée sous-marine. Évitez aussi l’exercice dans une chaleur excessive. Le guide canadien précise les précautions pendant l’activité physique³.

Adaptations by Trimester

First Trimester (0-12 weeks). If you were already active before pregnancy, you can generally continue your usual routine. If you are new to exercise, start gradually and listen to your body. Fatigue is common in the first trimester, so allow yourself rest as needed. Stay well-hydrated and avoid overheating, especially in hot or humid environments.

Second trimester (weeks 13–27). U.S. guidelines advise against lying flat on your back for long periods of time. The Canadian guidelines recommend changing positions if you experience dizziness, nausea, or discomfort. A reclined position, lying on your side, or standing may be more comfortable. This advice does not mean that all exercises done on your back should be avoided once the first trimester is over.

Your balance may change as your pregnancy progresses. Adjust any exercises that challenge your balance and use a stable support when needed. Find a comfortable position and continue with your pelvic floor exercises as part of your routine.

Third trimester (weeks 28–40). Adjust your running, jumping, or quick changes of direction if they become uncomfortable. Your balance and comfort may change; adjust your activity and footing as needed.

Continue gentle activities such as walking, swimming, stationary cycling, and adapted strengthening exercises. Maintain pelvic floor training and add breathing and relaxation exercises to prepare for childbirth.

If an exercise causes pain, discomfort, or increased pressure in the pelvic floor, modify it or stop doing it. Your physical therapist can suggest an alternative exercise. If you experience any warning signs, seek medical advice as described above.

For detailed recommendations on prescribing therapeutic exercises, consult our complete guide.

How does physiotherapy prepare you for childbirth?

Physical therapy prepares women for childbirth by teaching them how to contract and relax their pelvic floor muscles, use comfortable breathing techniques, and adopt effective labor positions. These skills provide options to use with the birth team, though they do not guarantee a faster delivery or prevent tears.

Pelvic Floor Training

The pelvic floor supports the organs during pregnancy. These muscles stretch during a vaginal birth. Learning to recognize when the muscles contract and relax helps you do the exercises without keeping them constantly tense.

Strength and Support. The pelvic floor muscles help support the bladder, uterus, and rectum—the final part of the intestine. Regular exercise can reduce the risk of urinary incontinence in pregnant women who have not previously experienced incontinence. ^{4, 5}

Coordination et conscience. Votre physiothérapeute peut vous apprendre à contracter ces muscles juste avant de tousser, d’éternuer ou de soulever, puis à les relâcher. Cette stratégie vise le contrôle des fuites à l’effort. Une étude comprenant 29 femmes enceintes²⁴ observait moins de fuites pendant un test de toux avec cette contraction qu’en toussant sans la faire. Ce résultat immédiat ne garantit pas la prévention d’une descente d’organes.

Relaxation and letting go. Also learn to let your muscles relax after a contraction. For example, lie comfortably on your side, breathe naturally, and see if you can relax the muscles at the bottom of your pelvis. The instructions for pushing will be tailored to you in consultation with your birth team.

Breathing and Relaxation Techniques

Une respiration lente et confortable peut aider à gérer la douleur et à se détendre pendant le travail. Inspirez sans forcer, puis laissez l’air sortir doucement. Une revue Cochrane rapporte des bénéfices possibles de la relaxation et du yoga sur la douleur ou la satisfaction, mais les résultats reposent surtout sur de petites études de faible ou très faible certitude. Elle ne montre pas de réduction claire des césariennes, les naissances par une opération du ventre, ou des naissances avec instruments. Consultez la revue sur la relaxation pendant le travail²⁵.

During or between contractions, choose a breathing technique that remains comfortable. Prenatal yoga has also been studied: one study followed 335 women in a non-randomized trial and compared yoga to walking. It found fewer cases of preterm labor and fetal growth restriction in the yoga group ²⁶. This comparison does not prove that yoga is the sole cause of the differences and does not guarantee the same outcome for everyone.

Positions for Labor and Childbirth

Your physiotherapist teaches you different positions that can facilitate labor and childbirth:

Positions verticales. Vous pouvez essayer la position debout, assise sur un ballon stable ou accroupie avec un appui. Une revue Cochrane trouve une première phase du travail plus courte et moins de césariennes avec des positions verticales ou la marche qu’avec les soins au lit. Les études utilisent des méthodes différentes et concernent surtout des grossesses à faible risque; cet avantage n’est pas clairement retrouvé dans le sous-groupe ayant déjà une péridurale, une anesthésie administrée dans le dos. Consultez la revue sur les positions pendant la première phase du travail²⁷.

Side-lying positions. You can lie on your side with a pillow between your knees. This position can provide rest and comfort. The staff can help you adjust the supports and switch sides as needed.

Position à quatre pattes. Prenez appui sur les mains et les genoux, avec un support confortable sous les genoux. Une étude incluse dans la revue Cochrane de 2007²⁸ observait moins de douleur au dos pendant le travail. La revue de 2022²⁹ reste incertaine sur les bénéfices des positions à quatre pattes ou sur le côté lorsque la tête du bébé est mal orientée. Choisissez une position confortable, sans compter sur elle pour faire tourner le bébé.

Squatting. Bend at the hips and knees while maintaining a firm footing or with the help of another person. This position requires leg strength. Choose a comfortable height; do not force yourself if you feel pain in your pelvis.

Practicing these positions during pregnancy helps you find what works for you and figure out which ones are comfortable. During labor, change positions based on your preferences and the team’s instructions.

Perineal Massage (Optional)

Perineal massage is an option during the final stages of pregnancy, often starting around 34 to 35 weeks. The perineum is the area between the vaginal opening and the anus. The massage involves applying gentle pressure and stretching these tissues. Your healthcare team can explain the technique and determine whether it is appropriate for your situation.

A Cochrane review of four studies found fewer injuries requiring stitches and fewer episiotomies—the incisions sometimes made in the perineum during childbirth. This benefit was observed in women who had not previously given birth vaginally. The review found no clear difference in the incidence of tears of various degrees ³⁰. Among women who have previously given birth vaginally, one study reports less perineal pain three months after delivery.

You may choose to try this massage after discussing it with your team. The data do not allow for the classification of massage, pelvic floor coordination, and relaxation based on their ability to prevent severe tears. None of these techniques guarantee that tears will be avoided.

When Should You Start Prenatal Physiotherapy?

You can begin prenatal physical therapy as soon as you experience pain, have difficulty with daily activities, or have questions about exercise. Childbirth preparation can be planned during pregnancy based on your needs; no specific trimester guarantees better results for all women.

For Pain Management

If you are experiencing pain in your back, pelvis, or leg, ask for an evaluation. However, if you have any of the warning signs described above, you should seek medical advice before proceeding with physical therapy.

You don't have to wait until the pain severely limits your activities. Learning strategies for movement, rest, and exercise gives you time to try them out and adapt them to your daily life.

First trimester. Physical therapy can begin in the first trimester after the necessary precautions have been taken. Back or pelvic pain may develop early on, especially if you experienced it during a previous pregnancy.

Deuxième et troisième trimestres. Les symptômes peuvent changer avec la grossesse. Une évaluation reste utile à ces étapes pour choisir des exercices, des appuis ou des façons de bouger plus confortables. Les conseils du RCOG sur les douleurs du bassin³¹ encouragent une prise en charge sans attendre une limitation importante.

For Childbirth Preparation

Childbirth preparation can begin in the second trimester if you wish. This gives you time to practice, but it is not a requirement, nor does it guarantee results.

You can learn pelvic floor exercises, build strength, and try out comfortable positions. Fatigue, nausea, and your schedule also determine how much you can realistically practice.

In the third trimester, you can still learn useful breathing techniques and positions. Your physical therapist will work with you to identify priorities, such as relieving pain during movement or practicing pelvic floor relaxation.

For Safe Exercise Prescription

If you're looking for guidance on safe exercises during pregnancy, you can consult at any time, even before conception or as early as the first trimester.

Your physical therapist will assess your abilities, goals, and concerns, and then tailor the activities to each stage. The program may focus on walking, building strength for daily activities, and pain management.

Warning signs

Contact your prenatal care team or a doctor right away if you experience any of the following symptoms. A physical therapy session should not delay this evaluation:

• Severe pain makes it difficult to walk, get dressed, or sleep.
• The pain is accompanied by vaginal bleeding.
• Pain is accompanied by regular contractions. Before 37 weeks, regular or frequent contractions also require medical attention, even before they become painful.
• Do you have trouble walking or putting weight on one leg?

The evaluation identifies the cause and determines the necessary treatment. Following this assessment, physical therapy may be part of the treatment plan.

A consultation can already provide you with strategies to try at home. Their effectiveness is assessed based on your symptoms and activities, and the plan is then adjusted accordingly.

What to Expect During Your First Consultation?

The initial consultation includes a discussion of your symptoms, a tailored examination, and a treatment plan that may include exercises or advice. Physioactif estimates that evaluations last about 60 minutes; please confirm the duration of your appointment when you book.

The initial assessment

Your physical therapist will ask you about your pregnancy, your symptoms, your medical history, and your goals. You’ll also discuss your daily activities and how they affect your pain.

Physical examination

The exam may include assessing your posture, the movements of your back and pelvis, your strength, and movements that replicate your symptoms. These tests are used to understand the problem and determine whether medical advice is needed.

An internal examination—performed through the vagina—may be recommended to assess your pelvic floor muscles. It is not performed automatically. Your physical therapist must explain its purpose, review any precautions, and obtain your consent. You may refuse the examination or ask to stop it. Advice and exercises may also be provided without an internal examination.

Treatment

After the evaluation, treatment may include gentle manual movements, exercises, advice on positioning, and comfortable breathing techniques. For each exercise, your physical therapist will specify the movement, the range of motion to aim for, and the signs that indicate the exercise needs to be adjusted.

The plan outlines the goals, the frequency of visits, and the activities to be performed in your home. Progress can be measured by how comfortable you are walking, the number of urinary leaks, or how easily you can turn over in bed. Visits are adjusted based on these results.

What to Bring

Bring comfortable clothing, a list of your medications, the results of any relevant tests, and any questions you may have. You’re in control of your care: let us know if a position, test, or exercise makes you uncomfortable.

How does physical therapy support recovery after childbirth?

Physical therapy supports postpartum recovery through pelvic floor exercises, pain management, and a gradual return to activities. Preparing during pregnancy can provide helpful techniques, but the program is reassessed after childbirth based on your recovery.

Your needs change throughout pregnancy, during childbirth, and in the months that follow. Your plan should take into account how the birth unfolds, your symptoms, and the support available at home.

Preventing Urinary Incontinence After Childbirth

Among pregnant women who do not initially experience urinary incontinence, structured training reduces the risk of incontinence during pregnancy and in the first few months after childbirth. This benefit does not guarantee less muscle damage during childbirth or a faster recovery. If urinary incontinence is already present, an evaluation guides the choice of treatment. ^{4, 5}

Managing Persistent Pain

Some pelvic or lower back pain persists after childbirth. The exercises and movement techniques learned during pregnancy can then be reassessed and adapted. The results of studies on postpartum stabilization vary; therefore, follow-up should take your individual response into account ⁹.

Exercise Habits

Exercise habits developed during pregnancy can serve as a starting point after childbirth. However, resuming exercise should be done gradually, depending on your symptoms and recovery. A gentle walk can be a good first step before moving on to more strenuous activities.

Les recommandations canadiennes de 2025 après l’accouchement³² soutiennent l’activité physique pour la santé mentale et la réduction de la fatigue, ainsi que des habitudes de sommeil favorables. Elles conseillent une progression adaptée à la guérison et aux symptômes. La revue générale de Guszkowska décrivait déjà des effets de l’exercice sur l’humeur et l’anxiété, sans porter spécifiquement sur la récupération après la naissance³³.

Common Problems After Childbirth

After childbirth, physical therapy can help people with the following issues:

Diastase des grands droits. La diastase est un élargissement de l’espace entre les deux bandes de muscles à l’avant du ventre. Les soins examinent cet espace, la force et la façon de bouger, par exemple pour se lever ou porter le bébé. Les recommandations canadiennes sur les soins postnataux³⁴ proposent de tenir compte aussi du plancher pelvien. La largeur de l’écart n’est donc ni le seul objectif ni une mesure à ignorer.

Pelvic floor issues. Urinary incontinence, fecal incontinence, organ prolapse, or pain during sexual intercourse may require an evaluation. Organ prolapse means that a pelvic organ descends toward the vagina. Physical therapy may involve strengthening, coordination, or relaxation exercises, depending on the issue; the same exercise is not suitable for all of these situations.

Persistent pain in the pelvis or lower back. Some pain that began during pregnancy continues after childbirth. A reevaluation allows for adjustments to activities and care.

Récupération après césarienne. La physiothérapie peut accompagner la reprise de la marche, des mouvements et du renforcement du tronc. Un massage doux de la cicatrice peut être proposé une fois la plaie complètement fermée, sans ouverture ni croûte. Certaines personnes le trouvent utile, mais les recherches sur son efficacité restent limitées. La fiche de Kingston et Richmond³⁵ décrit ces précautions. Une douleur forte, une plaie qui s’ouvre ou un écoulement inhabituel demandent un avis médical rapide.

When to Return to Physical Therapy After Childbirth

La période postpartum, c’est-à-dire la période après l’accouchement, commence dès la naissance. Le guide de soins postnataux de l’Organisation mondiale de la santé³⁶ couvre les six premières semaines. Une visite autour de six semaines peut servir à faire le point, mais il n’est pas nécessaire d’attendre cette date pour demander de l’aide. Notre page sur la physiothérapie après l’accouchement présente les soins possibles.

Request an evaluation before that date if you have, for example:

• You may experience urine or stool leakage, especially if the leakage is severe.
• Do you feel heaviness or pressure in the lower pelvis? This could be a sign of organ prolapse.
• Pain in your pelvis or lower back limits your activities.
• The C-section scar becomes painful or develops a complication. Contact a doctor immediately if the wound opens up, discharges pus or a foul-smelling fluid, or becomes redder, more painful, and swollen.

After an uncomplicated birth, you can begin walking gently and doing appropriate pelvic floor exercises early on. More strenuous activities should be postponed until the wounds have healed sufficiently and should not increase bleeding. Follow your healthcare team’s instructions and seek advice if new symptoms appear.

Prenatal physical therapy provides strategies for managing symptoms and performing beneficial exercises. After childbirth, follow-up care tailors these strategies to your recovery and your new activities.

What are your frequently asked questions about prenatal physiotherapy?

Frequently asked questions about prenatal physical therapy include the baby’s safety, the cost of care, access to a physical therapist, the duration of treatment, and signs that it’s time to stop exercising.

Can physiotherapy harm my baby?

Les exercices adaptés sont recommandés pendant une grossesse sans contre-indication. Les guides canadien et américain appuient l’activité physique^{18, 19}, avec des précautions précisées dans la recommandation américaine de 2020⁷. Ils ne garantissent pas la sécurité de chaque soin de physiothérapie. Votre physiothérapeute vérifie les précautions et consulte votre équipe de grossesse au besoin.

Does RAMQ cover prenatal physiotherapy in Quebec?

Les soins de physiothérapie dans le réseau public sont couverts par la Régie de l’assurance maladie du Québec (RAMQ), selon les modalités d’accès de l’établissement. En clinique privée, les tarifs et le remboursement dépendent de la clinique et de votre contrat d’assurance. Demandez le prix et vérifiez votre couverture avant de réserver. L’Ordre professionnel de la physiothérapie du Québec³⁷ explique cette distinction.

Do I need a doctor's prescription to see a physical therapist?

In Quebec, you can see a physical therapist directly at a private clinic without a doctor’s referral. However, some insurance plans or public health system access rules may require one. Check your specific situation and let your doctor or midwife know so you can coordinate your care.

How long does a typical treatment last?

The duration of follow-up care depends on what you want to improve and the results of the evaluation. An initial session can be used to learn the exercises and develop a program; follow-up sessions are then used to check your technique, assess pain or incontinence, and adjust the exercises. Your physical therapist will specify the recommended frequency and adjust it based on your progress.

Can I do physiotherapy if I've never exercised before my pregnancy?

Vous pouvez commencer des activités adaptées même si vous n’étiez pas active avant la grossesse, en l’absence de contre-indication. Commencez par de courtes périodes et progressez selon votre tolérance. Le guide canadien³ encourage cette démarche. Une complication ou un symptôme inquiétant nécessite un avis médical avant de poursuivre; une grossesse sans contre-indication ne demande pas automatiquement une autorisation médicale pour bouger.

When should I stop exercising and consult my doctor?

Stop exercising and contact your prenatal care team if you experience vaginal bleeding, a loss of amniotic fluid, abdominal pain, regular and painful contractions, dizziness, or fainting, shortness of breath before exertion or excessive shortness of breath during activity, chest pain, headache, blurred vision, muscle weakness, pain or swelling in the calf, or a decrease in the baby’s movements. Before 37 weeks, regular or frequent contractions also require medical attention, even if they are painless. Don’t wait for your next physical therapy appointment. If you experience chest pain accompanied by sudden shortness of breath, call 911.

References

1. Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine (Phila Pa 1976). 2005;30(8):983-91.↩ Back to text: 1st, 2nd mentions
2. Davies GAL, Wolfe LA, Mottola MF, MacKinnon C. No. 129-Exercise in Pregnancy and the Postpartum Period. J Obstet Gynaecol Can. 2018;40(2):e58-e65.↩ Back to text
3. 2019 Canadian Guideline for Physical Activity throughout Pregnancy. Canadian Society for Exercise Physiology (CSEP).↩ Back to text: 1st, 2nd, 3rd, 4th mentions
4. Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014;48(4):299-310.↩ Back to text: 1st, 2nd, 3rd, 4th mentions
5. Woodley SJ, Lawrenson P, Boyle R, Cody JD, Mørkved S, Kernohan A, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5(5):CD007471.↩ Back to text: 1st, 2nd, 3rd, 4th, 5th mentions
6. ACOG Committee Opinion No. 650: Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2015;126(6):e135-e142.↩ Back to text
7. ACOG Committee Opinion No. 804: Physical Activity and Exercise During Pregnancy and the Postpartum Period. American College of Obstetricians and Gynecologists (ACOG). April 2020 (reaffirmed 2023).↩ Back to text: 1st, 2nd, 3rd mentions
8. Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine (Phila Pa 1976). 2006;31(5):E149-55.↩ Back to text
9. Almousa S, Lamprianidou E, Kitsoulis G. The effectiveness of stabilising exercises in pelvic girdle pain during pregnancy and after delivery: A systematic review. Physiother Res Int. 2018;23(1).↩ Back to text: 1st, 2nd mentions
10. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819.↩ Back to text
11. Mens JM, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ. Understanding peripartum pelvic pain. Implications of a patient survey. Spine (Phila Pa 1976). 1996;21(11):1363-9; discussion 1369-70.↩ Back to text
12. Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract. 2010;10(1):60-71.↩ Back to text
13. Massey EW, Guidon AC. Peripheral neuropathies in pregnancy. Continuum (Minneap Minn). 2014;20(1 Neurology of Pregnancy):100-14.↩ Back to text: 1st, 2nd, 3rd mentions
14. LaBan MM, Perrin JC, Latimer FR. Pregnancy and the herniated lumbar disc. Arch Phys Med Rehabil. 1983;64(7):319-21.↩ Back to text
15. Round ligament pain in pregnancy. Royal Berkshire NHS Foundation Trust.↩ Back to text
16. Cataldo Oportus S, de Paiva Rodrigues L, Pereira de Godoy JM, Guerreiro Godoy Mde F. Lymph drainage in pregnant women. Nurs Res Pract. 2013;2013:364582.↩ Back to text
17. Swollen ankles, feet and fingers in pregnancy. NHS.↩ Back to text
18. Mottola MF, Davenport MH, Ruchat SM, Davies GA, Poitras VJ, Gray CE, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339-1346.↩ Back to text: 1st, 2nd, 3rd, 4th, 5th mentions
19. Artal R, O'Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003;37(1):6-12; discussion 12.↩ Back to text: 1st, 2nd mentions
20. Exercise During Pregnancy. American College of Obstetricians and Gynecologists (ACOG).↩ Back to text
21. Signaux d’alarme pendant la grossesse. Institut national de santé publique du Québec (INSPQ).↩ Back to text
22. Barakat R, Perales M, Garatachea N, Ruiz JR, Lucia A. Exercise during pregnancy. A narrative review asking: what do we know? Br J Sports Med. 2015;49(21):1377-81.↩ Back to text
23. Hay-Smith J, Mørkved S, Fairbrother KA, Herbison GP. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2008(4):CD007471.↩ Back to text
24. Miller JM, Sampselle C, Ashton-Miller J, Hong GR, DeLancey JO. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(6):773-82.↩ Back to text
25. Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. Relaxation techniques for pain management in labour. Cochrane Database Syst Rev. 2018;3(3):CD009514.↩ Back to text
26. Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med. 2005;11(2):237-44.↩ Back to text
27. Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;2013(10):CD003934.↩ Back to text
28. Hunter S, Hofmeyr GJ, Kulier R. Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. 2007;2007(4):CD001063.↩ Back to text
29. Barrowclough JA, Lin L, Kool B, Hofmeyr GJ, Crowther CA. Maternal postures for fetal malposition in labour for improving the health of mothers and their infants. Cochrane Database Syst Rev. 2022;2022(8):CD014615.↩ Back to text
30. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;2013(4):CD005123.↩ Back to text
31. Pelvic girdle pain and pregnancy. Royal College of Obstetricians and Gynaecologists (RCOG).↩ Back to text
32. 2025 Canadian Guideline for Physical Activity, Sedentary Behaviour and Sleep throughout the First Year Postpartum. Canadian Society for Exercise Physiology (CSEP).↩ Back to text
33. Guszkowska M. [Effects of exercise on anxiety, depression and mood]. Psychiatr Pol. 2004;38(4):611-20.↩ Back to text
34. Family-Centred Maternity and Newborn Care: National Guidelines. Chapter 5: Postpartum Care. Public Health Agency of Canada. 2024.↩ Back to text
35. Scar massage after caesarean birth. Kingston and Richmond NHS Foundation Trust.↩ Back to text
36. WHO recommendations on maternal and newborn care for a positive postnatal experience. World Health Organization (WHO). 2022.↩ Back to text
37. Physiothérapie : comment ça fonctionne ? Ordre professionnel de la physiothérapie du Québec (OPPQ).↩ Back to text

Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.