The vital role of physiotherapy during pregnancy

Pregnancy is a special and unique experience in every woman's life. During this period, the mother's body faces extensive changes; From weight gain and muscle strain to hormonal fluctuations and pressure on the spine. These natural changes, although they are a sign of the growth and development of a new life, are often accompanied by discomfort such as back pain, hip pain, muscle cramps, swelling of the legs, and even sleep problems.

Meanwhile, physiotherapy during pregnancy as a scientific and minimally invasive solution can play a key role in managing these symptoms. Contrary to popular belief, physiotherapy is not just for injuries or the elderly; Rather, it can help expectant mothers to go through this nine-month journey with peace, more health, and better physical and mental preparation.

Physiotherapy during pregnancy includes a series of targeted exercises, body posture correction techniques, strengthening of specific muscles such as the pelvic floor, and breathing and relaxation exercises. These methods not only help to reduce pain and discomfort, but by improving blood circulation, regulating breathing and strengthening the body's supporting muscles, they provide suitable conditions for the development of the fetus and preparation for childbirth.

On the other hand, basic physical therapy exercises are also effective in preventing complications such as gestational diabetes, excessive weight gain, and abdominal and pelvic muscle weakness. Also, by reducing muscle and mental tension, the quality of the mother's sleep improves and she feels more in control and satisfied with her body.

It should be noted that physical therapy exercises during pregnancy must be done under the supervision of a specialist and taking into account the conditions of the month of pregnancy and the mother's health. Choosing safe and appropriate exercises is the key to safely enjoy the benefits of physical therapy during this sensitive period.

In the rest of this article, we will take a closer look at the benefits of physical therapy, safe exercises and key tips for doing it correctly during pregnancy.

Why is physiotherapy important during pregnancy?

• Decreasing musculoskeletal pain and improving physical conditionWith the growth of the fetus, physical changes in the mother's body are inevitable. Arching of the back, prolapse of the stomach and stretching of the back muscles can all cause back pain, hip pain, and even pain in the neck and shoulders. By carefully evaluating the physical condition, the physiotherapist prescribes exercises that help maintain muscle balance, correct the way you sit and stand, and reduce pressure on the joints. These interventions not only reduce pain, but also prevent skeletal problems from worsening in the future.
• Prevention of gestational diabetes and control of weight gain Weight gain during pregnancy is normal, but its excessive increase can lead to risks such as gestational diabetes, high blood pressure or difficult delivery. Controlled physical activity under the supervision of a physiotherapist helps regulate blood sugar levels, improve body metabolism and control weight. Light and basic sports such as walking, stretching and gentle resistance exercises are the best options for maintaining fitness during pregnancy.
• Strengthening pelvic floor muscles for better delivery and faster recoveryPelvic floor muscles act like a vital support for the uterus and other organs. If these muscles are weak, the possibility of urinary incontinence, pelvic organ prolapse and even problems during childbirth increases. Exercises such as Kegels and gentle squats, which are included in physical therapy programs during pregnancy, can maintain the strength of these muscles and prepare the mother for a natural delivery and recovery afterwards.
• Improving blood circulation and reducing swelling and a feeling of heaviness in the limbsOne of the common complaints in pregnancy is swelling of the legs, hands and face, which occurs mostly in the third trimester. This is often due to the pressure that the uterus exerts on the large blood vessels. Physiotherapy with exercises such as keeping the legs up, ankle pump movements and lymphatic massage techniques, helps to reduce swelling, prevent varicose veins and feel lighter.
• Reducing stress and anxiety with breathing exercises and relaxing the mind and bodyHormonal changes and mental worries during pregnancy can increase stress levels and disrupt sleep. Physiotherapy, using diaphragmatic breathing exercises, mindfulness meditation and gentle stretching movements, helps the mother to find a sense of relaxation, control and a better connection with her body. These exercises not only help improve mood, but also play a key role in reducing tension during childbirth.

Features of a safe program for physical therapy during pregnancy

During pregnancy, any physical activity should be designed with special sensitivity and precision. A safe and effective physical therapy program should not only help reduce pain and increase physical fitness, but should also prevent any risk to the mother and fetus. In the following, we examine the key features of such a program:

1. Designed by a physiotherapist familiar with pregnancyThe most important principle of safety in physiotherapy during pregnancy is expert supervision. A physical therapist who has experience working with expectant mothers can provide a completely personalized program, taking into account the physical condition, underlying diseases, and month of pregnancy. General exercises or internet recommendations may not be suitable for everyone and may even be dangerous.
2. Adjustment of exercises with trimesters of pregnancyThe mother's body experiences different conditions in each trimester of pregnancy. In the first trimester, the focus is on controlling nausea, fatigue and light breathing exercises. In the second trimester, light strengthening exercises, maintaining balance and focusing on the pelvic floor are important. In the third trimester, exercises should be non-abdominal and focused on maintaining flexibility, reducing swelling, and preparing for delivery. A program that does not consider these steps may cause harm or dissatisfaction.
3. Avoidance of risky or stressful movementsDuring pregnancy, no direct pressure should be applied to the abdomen. Movements such as sitting, sudden twists or jumping, can damage the abdominal muscles, pelvic wall or even the health of the fetus. A principled program always offers safe and effective alternatives to risky moves.
4. Focus on balance, strength and flexibilityPregnancy changes the body's center of gravity and makes balance more difficult. Exercises that focus on strengthening the muscles of the back, abdomen, pelvic floor and thighs help maintain stability and stability. Controlled stretching also helps increase flexibility and reduce muscle cramps—without risking the mother or fetus.

Safe and effective exercises for pregnancy (based on the first, second and third trimesters)

🔸 First trimester (weeks 1 to 13): focus on breathing, gentle stretching and foundation

✅ 1. Diaphragmatic breathing exercise

Aim: reducing stress, increasing oxygen delivery to the fetus

How to run:

1. Sit or lie on your back in a comfortable position.
2. Place hands on stomach and chest.
3. Take a deep breath through the nose and raise the stomach.
Exhale slowly through the mouth

Why is it important? Correct breathing calms the nervous system, reduces nausea and improves concentration.

✅ 2. gentle rotation of the pelvis in a sitting position

Aim: reducing pelvic muscle tension and preparing the pelvic floor

How to run:

1. Sit on an exercise ball or chair.
2. Slowly move the pelvis to the left and right or in a circle.

It is safe for all weeks of pregnancy.

🔸 Second trimester (weeks 14 to 27): focus on muscle strength, balance and stability

✅ 3. Gluteal Bridge

Aim: strengthening hip muscles, reducing lower back pain

How to run:

1. Lie on your back, knees bent, feet on the floor.
2. Raise the pelvis slowly, hold for 5 seconds and lower.

Note: In the last weeks of the second trimester, this movement should be done with caution or under expert supervision.

4. Wall squat with a ball

Aim: strengthening thighs and hips, maintaining hip stability

How to run:

1. Place the sports ball between the waist and the wall.
2. Bend your knees and stay in a sitting position for a few seconds.
3. Get up slowly.

Benefits: helping to bear the weight of the belly in the coming months and preparing for childbirth.

5. Cat-Cow Exercise (Cat-Cow Pose)

Goal: reducing pressure on the spine and improving flexibility

How to run:

1. Be on all fours.
2. Breathe and arch the back down (cow).
3. Then exhale and round the waist upwards (cat).

Very suitable for reducing back pain in the second and third trimesters.

🔸 Third trimester (28 weeks until delivery): focus on relaxation, preparation for delivery and maintaining mobility

6. Pelvic floor exercises (Kegel)

Aim: strengthening pelvic floor muscles for childbirth and prevention of incontinence

How to run:

1. Contract the muscles that are involved during urination.
2. Hold for 5 seconds, rest for 5 seconds.
3. 10 repetitions, 3 times a day

Suitable for the whole period of pregnancy, especially the third trimester.

7. Butterfly Stretch (Butterfly Stretch)

Aim: to open the pelvis and improve the flexibility of the thighs

How to run:

1. Sit, feet together, knees open to the sides.
2. Slowly lean forward, feeling a gentle stretch in the thighs.

Suitable for easier childbirth and reducing muscle cramps.

8. Walking in water (light hydrotherapy)

Aim: reduce joint pressure, improve blood flow and relieve leg swelling

How to run:

1. Walk in shallow water or do gentle movements.

Benefits: safe, very soothing and suitable until the last days of pregnancy.

General safety tips for all exercises

• Always consult your doctor before starting.
• Avoid exercise in high temperature or without ventilation.
• If you experience dizziness, shortness of breath, abdominal pain or
• You have abnormal contractions, stop the exercise immediately.
• Do the movements lying on your back in the third trimester only with caution and under supervision.

Golden tips for doing physical therapy exercises during pregnancy

Physiotherapy exercises during pregnancy, if done correctly, can make the pregnancy experience much easier, safer and more enjoyable. But there are some points that must be followed to maintain the health of the mother and fetus. Next, we review the most important safety and professional tips for doing physical therapy exercises during pregnancy:

• ❌lying down completely on the back in the third trimester is prohibitedIn the third trimester of pregnancy, the uterus is enlarged and can put pressure on the inferior vein (vena cava); This condition reduces blood flow to the heart and may lead to dizziness, low blood pressure or lethargy. Therefore, movements that require lying completely on the back (such as lying down, some stretches or abdominal exercises) should be avoided or performed with safe alternatives.
• ❌Avoid exercise in hot weather or spaces without ventilationThe body is more prone to overheating during pregnancy, because the level of metabolism increases and heat tolerance decreases. Exercising in hot, crowded or unventilated environments can increase the risk of heat stroke, dehydration and damage to the fetus. Always exercise in a cool, well-ventilated area with light clothing.
• ✔ Consult a doctor or midwife before starting exercise Before starting any physical therapy or sports program, especially if you have a history of miscarriage, high-risk pregnancy, high blood pressure, heart problems or diabetes, be sure to consult a gynecologist or midwife. Some exercises may not be suitable for everyone and programs should be adjusted according to individual conditions.
• ✔ Listening to your body's signals while exercising sends important messages during pregnancy. If you experience dizziness, blurred vision, chest pain, shortness of breath, abdominal cramping, or vaginal bleeding during exercise, stop exercising immediately and see a doctor. The golden rule in pregnancy is: if an exercise causes discomfort or pain, stop doing it.

By following these simple but vital tips, you can safely enjoy the benefits of physical therapy during pregnancy — without putting yourself or your baby at risk.

How does physiotherapy prepare the body for childbirth?

Three main keys: facilitation, mastery, tolerance

Childbirth is a complex but natural process for which the female body is inherently designed. Physiotherapy during pregnancy elevates this innate readiness to an active and conscious level. Here's how this type of specialized practice directly impacts the birth experience — without repeating the previous ones:

🔹 Optimizing the position of the fetus

Unlike the correction of the mother's body position that we said earlier, here the focus is on the rotation and better placement of the fetus.

Exercises such as pelvic movements on the physio ball or birthing positions such as knee-to-chest can help the fetus to be in the anterior position (optimal position for natural delivery). This work reduces the pain of childbirth and reduces the possibility of medical interventions.

🔹 mastering the body's responses to contractions

Physiotherapy helps the mother guide her body during contractions instead of being surprised by labor pains. For example, teaching the techniques of "conscious breathing during contractions" or "simultaneous relaxation of facial and pelvic muscles" helps the mother not to have unnecessary muscle stiffness - because extra tension in the muscles makes labor pain more and longer.

🔹 Strengthening movement patterns in the critical moments of childbirth

Unlike only strengthening exercises, specialized childbirth physiotherapy exercises include labor-oriented movement patterns:

• shifting weight in semi-sitting position
• Effective pressure training (Bearing Down)
• Pelvic movements with rhythmic contraction of the pelvic floor

These patterns prepare the body not only physically, but also neuromuscularly for the moment of birth.

With the preparation of the pelvic floor muscles, better control becomes possible during the second phase of labor (before the birth of the baby). This allows the mother to apply the final pressures in a controlled manner and the possibility of tearing the perineum or the need for an episiotomy is reduced.

The end result?

Physiotherapy during pregnancy not only helps to reduce pain, but also puts the quality and control of the delivery process in the hands of the mother. This means active, conscious and effective participation in one of the most important moments of life.

Frequently asked questions about physiotherapy during pregnancy

1. Can all pregnant women do physiotherapy?

Physiotherapy is usually beneficial and safe for most pregnant women, but in cases such as high-risk pregnancy, high blood pressure, or special medical problems, a doctor should be consulted before starting. An expert physiotherapist can design a program suitable for each mother's condition.

2. When is the best time to start physiotherapy during pregnancy?

It is possible to start physical therapy at any stage of pregnancy, but usually starting from the second trimester is the best time because the mother's body gets used to the initial changes and the exercises are performed more safely. Of course, in case of severe pain or special problems, it may be recommended earlier.

3. Is it not dangerous to do physical therapy exercises during pregnancy?

If the physiotherapy program is supervised by an experienced specialist and tailored to the mother's individual conditions, it is completely safe. Risky or pressing exercises on the abdomen and pelvis should be avoided and exercises should be done gradually and with safety precautions.

4. How long is the duration of each session and how many times are the exercises performed?

Sessions usually last between 30 and 60 minutes and the number of times a week is determined based on the condition of the mother; Usually 2 to 3 sessions a week are enough. Daily home exercises and regular follow-up also help to improve the results.

5. How much does physiotherapy help to reduce pregnancy pains?

Physiotherapy can significantly reduce common pain such as back pain, hip pain, leg swelling and muscle cramps. Also, by strengthening muscles and improving physical condition, it prevents the occurrence of new pains and improves the quality of life of the mother.

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