When it isn’t just Morning Sickness



Prince William's wife, the Duchess of Cambridge, recently hit international news headlines after being admitted to hospital with Hyperemesis Gravidarum (acute pregnancy sickness). Whilst not the way the couple were intending to announce the news that they are expecting, it has raised awareness of this debilitating condition and other pregnancy health issues.

We spoke to Dr. Sarah J. Haag, PT, DPT, WCS, co-owner of Entropy Physiotherapy and Wellness to find out more about what Physical Therapists can do to help pregnant Moms-to-be who are not 'sailing' through their pregnancy.  

Iv-drip-2Hyperemesis Gravidarum's cause is obscure. We know that it is brought on by a rise in hormone levels during the initial weeks of pregnancy and that it results in extreme vomiting and exhaustion.  Hospital treatment is often required to replace lost fluids and address electrolyte imbalances via intravenous drips.  For some women the condition clears itself during the first trimester but for others it can go on for months, and for some their entire pregnancy.

In talking to Dr. Sarah Haag it becomes clear that although Hyperemesis Gravidarum doesn't affect everyone, there are more women affected by pain and illness during their pregnancies than statistics show.  "The movies make women look as though they're all glowing throughout pregnancy and, unfortunately, that's what most women expect.  When something seems to be different from that picture and they eventually get around to asking their doctor, many of the responses they receive are along the lines of 'Well, that's just part of pregnancy', and women literally limp through the following months." 

We asked Dr. Haag whether Physiotherapy was routinely suggested for expectant Moms.  
"In the US, Physiotherapy during pregnancy is not currently 'standard of care'.  I think that traditionally, Physicians would advise that if the baby seemed to be developing ok they would simply suggest 'take it easy and don't worry about it."  

Easier said than done?  "Oh absolutely, this type of advice isn't terribly helpful for many women because 1) resting doesn't generally make pain go away, and 2) there are many women who usually have demanding jobs, small children and other family members to care for and homes to run – it's just not practical to say 'take it easy' .. it doesn't get everything done!"

Have we managed to learn anything about pregnancy related illness?  
"Yes, definitely.  There are resources and health professionals who can help women who are experiencing sickness and pain during their pregnancy.  Physical Therapists are able to offer advice, education and support and help a woman understand the impact that her pregnancy is having on her muscles, joints and how to help them function to allow for better and less painful movement."

Five of the most common complaints women have during pregnancy

  1. Low back pain
  2. Pelvic Pain:
    symphysis pubis dysfunction &
    – sacroilliac dysfunction
  3. Hip pain
  4. Upper back and neck pain
  5. Wrist pain/carpal tunnel syndrome

Four things a Physiotherapist can do to help:

  1. Functional Training
    – specific to activities that are difficult due to pain 
    – gait training
  2. Manual therapy:
    – soft tissue mobilization
    – joint mobilization
  3. Therapeutic Exercise:
    – strengthening
    – stretching
  4. Education:
    – why they are likely to be experiencing pain
    – how to manage and prevent pain during their pregnancy and after they go home with   their new baby

H20-4_01_Female-Pelvis-with-Ligaments-Vessels-Nerves-Pelvic-Floor-OrgansDr. Haag is a firm believer in educating women about their pregnancy using 3D models and anatomy charts.  "The educational part of Physiotherapy is key. Using models and charts to explain anatomy and what we think is going on is really useful.  It can take away some of the fear and worry that patients have regarding their pain and what it may mean for them during and after pregnancy."  She says that many patients are intrigued to learn more about body mechanics, "Seeing how a joint should be working and then altering a movement to improve the joint mechanics – I often use a pelvic model with a lumbar vertebra included."

In addition to educating patients, Dr. Haag recommends that Physiotherapists offer abdominal and pelvic supports to help relieve some of the symptoms caused by some of the most common causes for pain during pregnancy.  There are lots of products that a Physical Therapist may suggest to aid better sleep at night and to improve posture and feel more comfortable throughout the day.

"Most Physical therapists obtain additional training through post-graduate professional courses.  The Section on Women's Health, from the American Physical Therapy Association, is the leading provider of pregnancy and post-partum Physical Therapy Education.  Residency Programs, that include education in pregnancy and post-partum physiotherapy are also now on offer."

Click the link if you're looking for a Physical Therapist in the US who is specialized in treating women during pregnancy or for other countries click International Organization of Physical Therapists in Women's Health

In summary Dr. Haag says "The advice I'd give to any pregnant women would be: If you're hurting (especially if the onset is during pregnancy, and especially if it's impacting daily function), talk to your doctor.  If they aren't sure how to help, then ask them for a referral to physiotherapy.  Often education about what physiotherapists do isn't available and many physicians don't think to suggest it as a the first line of defence.  If a patient asks, many times the physician is willing to give it a try!"

We'd like to thank Dr. Sarah Haag for her time and help in answering our questions for this blog post.   Wherever you are in the world, if you're an expectant Mother, we'd like to wish you and your family a healthy and happy time.



Dr. Sarah J. Haag, PT, DPT, WCS, is co-owner of Entropy Physiotherapy and Wellness.  She is also the Director of Financial Development for the Section on Women's Health.


1 Comment

  • Physiotherapists are now having their specialties. It’s good that therapists now manage cases on pregnancy and some even help with issues on fertility. You can always ask from the nearest physiotherapist clinic about your case and their expertise.

    The House Clinics Reply

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