Pregnancy and Chronic Pain

The primary hormone of pregnancy that affects pain and Fascia is relaxin. It is produced from early in the first trimester and increases throughout pregnancy. Its purpose is to loosen the ligamentous system to allow the pelvis to widen for birth.

Relaxin affects the entire ligamentous and fascial system rather than loosening only the structures that need to widen for birth. For someone who already has fascial restrictions or instability, this means the body is working with more laxity than usual, which can make existing tension patterns more noticeable during pregnancy. Understanding this means treatment can be adapted precisely for it.

The implication for Fascial work is that technique and pressure must be adjusted. The sustained, firm pressure used in a non-pregnant patient is too much for the laxer tissue of pregnancy. A practitioner experienced with pregnant patients works with lighter, more sustained holds and focuses on releasing tension rather than mobilising joints.

Medical clearance from your midwife or obstetrician is always the starting point before beginning or continuing manual therapy during pregnancy. It is the right foundation for safe, appropriate care.

Gentle Fascial work remains appropriate and beneficial for most of pregnancy, provided it is carried out by a practitioner experienced with pregnant patients and with medical clearance in place.

In the first trimester, work on the back, hips, legs, shoulders, and neck is generally appropriate and beneficial. Direct compression or pressure in the lower abdomen is avoided. The focus is on maintaining mobility and addressing the compensations that begin to develop as the body changes.

In the second trimester, as the bump becomes more significant, positioning needs to adapt. Side-lying work and supported positions replace face-down positioning. The focus tends to shift towards pelvic comfort and managing the tension patterns that develop as the centre of gravity changes.

In the third trimester, the work is primarily supportive. Maintaining comfort, managing pelvic girdle pain, addressing sciatica, and preparing the tissue around the pelvis and lumbar spine for the demands of labour.

Pelvic girdle pain is one of the most common pregnancy-related pain conditions, involving the sacroiliac joints and pubic symphysis, usually from the second trimester onwards. Gentle fascial work around the hips, sacrum, and adductors can provide significant relief when carried out by a practitioner experienced with pregnant patients.

Sciatica in pregnancy is often caused by the shifting pelvic position and increased lumbar curve placing pressure on the sciatic nerve pathway. Addressing the gluteal and piriformis Fascial restrictions, along with the lumbar and sacral area, can reduce sciatic symptoms significantly. This is one of the conditions where the right practitioner can make a very large difference to quality of life during pregnancy.

Postural back pain is almost universal to some degree in pregnancy. The changing load distribution creates new tension through the lumbar and thoracic Fascial lines. Regular, gentle work to maintain Fascial mobility through this time makes a meaningful difference to daily comfort and to how the body manages the increasing load.

After birth, the body begins a significant process of physical reorganisation. Relaxin levels start to drop. The structural demands change dramatically. The Fascial system, which has spent nine months adapting to pregnancy, now needs to adapt again.

For vaginal birth, most practitioners recommend waiting six to eight weeks before returning to hands-on Fascial work. For caesarean birth, the surgical healing of the abdominal Fascia needs more time. Twelve weeks as a minimum is a sensible guideline, though individual healing varies. Always follow the specific advice of your own medical team.

The pelvic floor is always part of the post-natal picture regardless of delivery type, and input from a specialist pelvic health physiotherapist is a valuable starting point before introducing any fascial work that loads the core or abdominal area.

The post-pregnancy period is often an excellent time to address Fascial patterns properly, because the body is in a phase of adaptation anyway. Women who were in chronic pain before pregnancy sometimes find that working with a skilled Fascial practitioner in the post-natal period produces results faster than they experienced before, because the tissue is more responsive and the body is already in a process of reorganisation.