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Pregnancy
Symptoms
First Trimester
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Nausea
Frequent urination – initially hormonal, later pressure
Constipation – hormonal
Low Blood Pressure – hormonal
Breast enlargement
Musculoskeletal changes – relaxin increases elasticity in joints capsules,
ligaments, fascia – pelvic, SI joints, ankles, knees affected most
Mood – fatigue, anxiety
Second Trimester
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Edema – legs especially
Hypertension
Supine hypotension – compression of aorta and IVC
Shortness of breath
Back pain – stretched ligaments and tendons of pelvis and lumbar spine,
ribs flare out, muscles spasms to support laxity in ligaments, postural
changes – hyperlordosis and hyperkyphosis – abd muscles stretches and
not supporting low back anymore, excessive weight gain, shoes, previous
injuries become re-activated
Abdominal pain – stretching of ligaments ie. round ligament of
uterus/groin, stretching of abdominal muscles, linea alba, may lead to
diastasis recti
Diastasis symphysis pubis – pubic and inner thigh pain due to separation
of pubic symphysis
Varicose veins –
Hemorrhoids
Pigmentation
Stretch marks
Other – headaches, migraines, nosebleeds….
Emotional changes
Third Trimester
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Gestational diabetes
Ketoacidosis
Edema – legs, hands, fingers, face
Compression Syndromes – TOS, CTS, sciatic, piriformis – lead to muscles
tension and TPs
Back pain
Sacroiliac pain
Leg cramps
Pelvic discomfort – softening ligaments, pressure from head of baby on
pelvis or nerves
Costal margin pain
Frequent urination
Fatigue
Insomnia and restlessness
Emotional changes
Postpartum
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Physical changes – unstable joints, severe back pain, shoulder pain, poor
posture with breast feeding
Post-surgical recovery
Breast pain
Emotional changes – depression
Contraindications for Massage Therapy
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Essential oils – may induce uterine contractions
Abdominal and sacral massage – use caution or avoid in first trimester
Deep massage over low back in first trimester
Caution with abdominal massage throughout whole pregnancy
Avoid aggressive joint play
Avoid deep pressure over varicose veins
Avoid massage if blood pressure unstable
Use caution with diabetes – encourage eating prior to and after treatment
Alter position as necessary – seated or sidelying, supine
Modify if client experiences heartburn
Health History Questions
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General health status
Any health conditions posing risk to the pregnancy
Stage of pregnancy
Previous pregnancies? Complications?
Family history of complications?
Current symptoms
Blood pressure
Be aware of serious symptoms where immediate medical attention is
needed:
 Bleeding
 Severe abdominal pain
 Water breaking
 Pre-eclampsia signs – vision changes, BP, severe headache
 Swelling in hands
 Upper right abdominal pain
Massage Treatment
Goal – relaxation, reduce MSK discomfort
Hydrotherapy
 Warm foot bath
 Heat for hypertonic muscles
 Cold to feet and legs to reduce edema
 Cold to breasts to decrease pain
 Essential oils only after first 4 months
First Trimester
 Prone, supine or sidelying
 Relaxation massage, focus on discomfort areas
 Abdomen, low back, sacrum – gentle massage (stroking or petrissage) or
avoid these areas
Second and Third Trimesters
 Goal – reduce pain and postural discomforts
 Sidelying, seated, supine
 Reduce trigger points, spasm, hypertonicity of low back, gluts
 Address hyperlordosis and hyperkyphosis muscles
 Treat nerve compression – treat hypertonicity and edema
 Treat breast congestion with cold and drainage techniques
 Left sidelying may be most comfortable
 Supine hypotension may occur – raising right hip may help
 Reduce time spent supine in final couple months or use extra pillows
 Hyperlordosis – treat QLs and erectors, iliac crest to relax obliques
 Intercostals, serratus anterior, lats
 Hyperkyphosis – upper back, anterior chest, lateral neck, fascial
techniques
 Upper traps, scalenes
 Subscapularis, infraspinatus, teres major, teres minor, supraspinatus,
levator, rhomboids, middle traps, serratus posterior superior
 Don’t stretch overstretched, fatigued hyperkyphotic rhomboids and middle
traps
 Gluts, piriformis, SI joint, greater trochanter
 Fascial work and PIR for adductors and gluts
 Long circulatory strokes and lymphatic drainage on legs
 Foot massage if pes planus present
 Stretch neck, pecs
 Abdominal massage helps constipation, relaxation
 Passive ROM, gentle joint play mobilizations to GH joint, SI joint, spine
Self-Care
 Relaxation exercises, diaphragmatic breathing
 Self massage – costal border, abdominal attachments at pubis
 ROM of ankle and feet for leg cramps
 Care for varicose veins – avoid standing still and crossing legs, elevate,
PROM
 Mild to moderate exercise – walking, swimming
 Stretch scalenes, scapular muscles, shoulder internal rotators, levator
scapula, hip adductors plantar flexors – to balance postural imbalances
pre and post birth
 Strengthen neck flexors, shoulder extensors, external rotators, scapular
retractors, depressors, hip extensors, knee extensors, dorsiflexors
Self-Care after delivery
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Exercises to restore postural alignment
Hydrotherapy for inflamed muscles
Relaxation