It is truly remarkable how much the body changes over the course of the nine months of pregnancy. During this time, it is common to experience some aches and pains as the ligaments loosen, the baby grows and weight changes, and the muscles adapt in kind by working a bit differently than they used to. Once the baby is born and mom’s body is healing from the pregnancy and delivery, there are new, repetitive stressors on the physical body which include holding, carrying, bending over a bassinet, and nursing, all of which may contribute to development of injuries in the first few months of parenthood.
The physical demands of motherhood can very quickly reach a threshold where the body’s ability to adapt becomes compromised, especially as a first-time mom. This threshold is the point where pain and weakness can start to develop: pain is often seen in the upper back, neck and shoulders, sometimes radiating down the arm even as far as the hand. These symptoms stem in large part from having to spend so much time holding the baby and nursing: in this position moms are looking down for long periods of time with the shoulders tending to be rounded forward. This position causes the muscles in the front of the chest and neck to shorten, while the muscles of the back body lengthen; both the shortening and lengthening can lead to weakness of the muscles.
To help counteract this muscle imbalance, moms can try modified feeding postures, such as reclining further back in the chair, the “football hold”; which involves placing a pillow next to you and supporting the baby with one arm at your side, or a side-laying position. Even with these modified nursing postures it is often difficult to avoid the forward rounded shoulders entirely, and chiropractic adjustments to the neck, shoulders and surrounding areas may be helpful in restoring balance, and reducing pain.
In conjunction with muscle imbalances, we also see a lot of restriction in the joints of the neck and upper back, as well as restricted movement of the higher ribs in new moms. This rib restriction is another effect of the common shoulders rounded forward and looking down posture. The constellation of various muscle and joint dysfunctions contribute to neck pain, back pain, shoulder pain with or without radiation into the arm, as well as headaches. Relief from these pains is very accessible through a combination of lengthening the muscles of the front body, chiropractic adjustments to improve the structural alignment and free up motion of the joints, as well as some gentle activation exercises for the back body. These exercises are used to strengthen the muscles that are involved in the maintenance of ideal posture, which ultimately serves to reduce pain.
Given the fact that these muscle strains arise from repetitive postures, many of the injuries of new motherhood are considered repetitive stress injuries. Another very common injury in new moms is one that is often diagnosed as carpal tunnel, is linked to the frequency of holding, lifting and carrying (i.e. using the hands a lot), and has symptoms of weakness in the hand, tingling into the fingers, along with pain and tension in the arms.
What is more commonly seen in the office in cases of hand weakness with pain and tingling is not true carpal tunnel syndrome, in which the structure of the wrist causes compression on a large nerve that supplies the majority of muscles and skin in the hand. Rather, the condition we see in new mothers is peripheral nerve entrapment, where the nerves that supply the forearm and hand become compressed by muscles at multiple points along the path that they travel into the hand. The cause of the extraordinary muscle tension in the neck, upper back, and arms is a combination of joint restriction in the neck and upper back, including the ribs, and repetitive and sustained use of the associated muscles. When muscles are tight, they have reduced circulation which leads to formation of tender bands and nodules within the muscle called myofascial trigger points.
Myofascial trigger points can cause numbness, tingling, and weakness in the area that has the trigger point, as well as areas distant from it. In addition, these tight, overused muscles can cause compression on any of the 3 main nerves that supply the forearm and the hand, which augment pain, tingling, and weakness. In any case where these symptoms are present in the arm or hand, a thorough history and exam is necessary to determine the cause so that treatment is specific to the unique individual.
Addressing complaints of weakness, tingling, and pain in the arm and hand is likely to involve assessment and treatment of the neck, upper back, shoulder, and along the rest of the arm. Treatment typically includes a combination of adjustments to free up motion in joints that are restricted, and soft tissue work to improve blood flow to the muscles. Compromised tissues may include nerves, muscles, tendons, and ligaments; both adjustments and soft-tissue work serve to restore flexibility and appropriate motion, thereby reducing symptoms and allowing these tissues to heal. Your chiropractor will also give you home care to support the healing process and prevent recurrence of the injury.
To round out the list of common repetitive stress injuries in new motherhood, we have what is colloquially called “mom thumb”. This is a tendonitis of the tendons on the back of the thumb and on the thumb side of the wrist. The cause of the injury is having too much wrist movement when lifting the baby. Though the baby may not be heavy, the repetitive stress and strain on these small muscles causes inflammation and thickening of the tendons, making it difficult to lift, grip, and use the hands for any activity.
As it is impossible for mom to avoid using her hands while the tendons heal, wrist splints can be incredibly helpful in protecting the injured tendons. Treatment typically also includes chiropractic adjustment, muscle work – your chiropractor may recommend ART or massage therapy, as well as some home exercises to strengthen the bigger muscles in shoulder and back to counteract posture. This combination of treatments will help ensure the muscles in the forearm, wrist, and hand are supple and strong, and that the related joints are freely moving. It is also necessary to add in some strengthening exercises for those thumb muscles once the inflammation has improved. Your chiropractor will also check the rest of the arm and the shoulder complex to assess for appropriate biomechanics of all connected areas, thereby allowing hidden contributors to the tendonitis to be addressed.
Please note that the advice in this article doesn’t replace personalized medical advice from a professional.
Are you experiencing any of the symptoms described above? Are you pregnant and interested in preparing your body more for the physical demands after the delivery of your baby? Email us at info@evolvevancouver.ca to book in with our experienced chiropractors for a consultation and customized treatment plan to suit your needs and goals.