This brochure is not intended as a substitute forprofessional health care.

1991 APTA. All rights reserved.

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For Women of All Ages

Women are unique in many ways. At the mostfundamental level, women’s bodies are

structured to give birth and supply early nutritionto the next generation. But whether or not awoman decides to have children, her reproduc-tive system affects her body throughout herentire life.

While the changes and stages of the maturingfemale body are certainly natural, there may betimes when a woman needs extra help to copewith modern demands — athletics, later child-bearing years, and career stress, to name a few.Many physical therapists concentrate their prac-tice in obstetrics and gynecology and can helpdesign an exercise program to fit each woman’slifestyle and take care of the body that will carryher comfortably through life. Physical therapistsalso may recommend that their clients withOB/GYN concerns see a physician for a fullevaluation.

While many states require a doctor’s referral to make an appointment with a physical thera-pist, other states have direct access, where anindividual can contact a physical therapistherself.

This booklet discusses the various stages awoman’s body goes through, from adolescenceto the mature years, and describes how a physi-cal therapist can help ensure a healthy body.

Adolescence

Adolescence is a time when girls begin tomature into women. Girls start developing

breasts and hips, their hormones go into over-drive causing oily hair and skin blemishes, andmenstruation begins. There is no standard start-ing age for adolescence: it can start when a girlis as young as nine or when she is well into herteens.

Adolescence is a perfect time in life to developgood exercise habits. When a girl’s body begins

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producing the hormone estrogen, which helpstrigger sexual development, she may notice anincrease in body fat. She may then try a varietyof crash diets to maintain what she thinks is anideal body image. Physical therapists agree thatexercise is a safer way to maintain ideal weightthan dieting by itself. They can help the adoles-cent girl determine her appropriate body weightand encourage her to enjoy aerobic and resist-ance exercise, such as walking, swimming ordancing.

Menstrual Pain

Once menstruation begins, and over the nextseveral decades, many women suffer from

some degree of dysmenorrhea, or pain, duringtheir monthly menstrual cycle. Symptoms canrange from slight irritability to intestinal upset,severe cramping, and even fainting.

Coping with pain during your period can be avicious cycle: the menstrual cramping causespain in the lower abdomen, so your musclestighten and cause you more pain, which then

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makes you tense, causing your muscles to tight-en even more. Over-the-counter medicationswork well for some women, but others cannottake these remedies because of stomach upset.And some prescription medications can causeunpleasant side effects.

Once your gynecologist has determined thereis no abnormal cause of pain, a physical thera-pist can help you deal effectively with the painbrought on by menstruation. Recommendationsinclude a postural evaluation to rule out muscu-loskeletal dysfunction and exercises to help yourelax tense muscles. A physical therapist canteach you pain control techniques such as deepbreathing exercises.

Physical therapists recommend these easyexercise techniques to relieve menstrual pain:Lying down — bring your knees up to your chest,hugging them with your arms. Hold for 10 sec-onds. Sitting — rock back and forth in your chair(a rocking chair is ideal) to pump the blood intoyour abdominal muscles. Standing — face thewall with both your elbows touching the wall ateye level. Then try to lean forward slowly untilyour tummy touches the wall, without bendingyour spine forward. Hold for 10 seconds. Thisaction stretches your anterior abdominal wall andhelps loosen those tight muscles.

Women with severe cramping have reportedsuccess with TENS (transcutaneous electricalnerve stimulation). Physical therapists are expe-rienced in the use of TENS for a variety of con-

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ditions that require pain management. A TENSunit is a small machine that delivers mild electri-cal stimulation to the pain site through electrodesplaced around the areas of discomfort. This stim-ulation blocks nerve impulses to help controlpain.

Dyspareunia (painful intercourse)

There are many reasons for painful inter-course. A physician’s thorough assessment canrule out serious medical problems. A physicaltherapist can help your decrease pain throughrelaxation techniques, exercise and scar tissuemassage if you’ve had an episiotomy, cesareansection or hysterectomy.

Women Athletes

While a lifelong exercise program is essentialto healthy living, some women approach

athletic training with extra intensity. Professional

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athletes who train every day, sometimes for sev-eral hours, have special health concerns. For onething, a rigorous athletic regimen can lead toamenorrhea (cessation of menstruation).

If you plan to become pregnant, yet want toremain active, then your physical therapist mayrecommend a few changes in your lifestyle. As apregnant athlete, your training program may bemore moderate than you’re used to. Your physicaltherapist will help you modify your exercise pro-gram and train you to monitor your heart rate sothat you can continue to enjoy the advantages offitness in pregnancy.

The Childbearing Years

G iving birth and raising a family can be one ofthe most exciting times of your life. But you

may be so busy focusing on the child that’s grow-ing inside you, that you neglect the changingneeds of your own body.

When you’re pregnant, your posture, center ofgravity and body size all change as the fetusdevelops. Keep in mind that all these changesmight be accompanied by some discomfort. Butdon’t dismiss these aches and pains as merely apart of the pregnancy. Physical therapists will tellyou that the “grin and bear it” approach is wrong.They can work with your doctor to determinewhat’s causing your pain and tell you if it’spregnancy-related.

A physical therapist will start off with a com-plete evaluation to determine how your bodymovements might be causing added strain onyour spine. You’ll learn how to maintain goodposture throughout the day and even at nightwhile you’re sleeping.

Back pain is a frequent complaint of pregnantwomen and has many causes. The hormonalchanges that occur in pregnancy cause ligamen-tous laxity, a loosening of the ligaments, whichhold bones together, especially where the pelvisand spine connect. As the weight of the babyincreases, so does the pressure on your spine

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and pelvic area. The lumbar curve in your lowerback can increase and cause poor posture: yourshoulders begin to round and your head tilts for-ward.

Some women experience such laxity that theyneed to wear an orthotic support for their lowback and abdomen. This type of belt is worn toimprove stability and function. It can help correctfaulty alignment and relieve the strain on musclesthat are stretched by the increasing size of theuterus in pregnancy.

As your size changes, your balance, center ofgravity and ability to move alters, and the extraweight can strain your back as well as stretchyour abdominal muscles. Even the arches of yourfeet can fall due to the added weight of a babyon board (wear lower heals and use heel insertsfor shock absorption).

Since your balance changes during pregnancy,

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a physical therapist will teach you to be morecautious in your movements. Be careful using thestairs, and when you’re sitting, try not to crossyour legs, which could slow down the bloodreturning to your head.

Prenatal Exercise

Even if you’re not especially athletic, it’s impor-tant to both you and your baby that you be in thebest shape possible during your pregnancy.Physical therapists recommend some guidelineson safe exercise for expectant mothers. Theseguidelines take into account the safety of thefetus and encourage regular exercise, not vigor-ous, competitive exercise. A complete exerciseprogram includes flexibility, low-impact aerobics,muscle strengthening, endurance and relaxationexercises.

Key muscle groups targeted during prenatalexercise include: the postural muscles — alongthe spine and between the shoulder blades; theabdominal muscles and iliopsoas — the iliopsoasis the deep muscle in front of the pelvis andspine; and the pelvic floor muscles — that layerof muscle deep within the pelvis which is a baseof support for the pelvic organs and openingsfrom the vagina, urethra and rectum.

If you enjoy the water, swimming or walking ina pool will give your muscles a well-roundedworkout and keep your body cool.

Natural Childbirth

More and more women today are choosing todeliver their babies without taking pain medica-tion. Some physical therapists are also childbirtheducators and can teach you about the laborprocess, nutrition and various birthing positionsthat provide a more comfortable delivery. You’lllearn relaxation and breathing techniques, painmanagement, and prenatal and postnatal exer-cises.

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Cesarean Section

A cesarean section (C-section) is major surgery— an incision is made through the skin and mus-cles of the abdomen and the baby is removedthrough the open area. Women have C-sections fordifferent reasons: the baby’s head may be too largeto come down through the birth canal; the babymay be very large at birth due to the mother’s med-ical condition, such as diabetes; or an emergencymight develop during labor, such as abnormalchanges in the baby’s heart rate.

Whatever the reason for a C-section, womenrecovering from this surgery need help with painmanagement and learning how to move in a pro-tected way to avoid strain on the abdominal area.Even the simple motion of sitting up can bepainful after a C-section.

A physical therapist teaches post-cesareanpatients how to guard their movements to keep

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from hurting themselves and how to managetheir pain. Gentle massage techniques and scartissue management, modified postnatal exercises

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and the use of a TENS unit can help patients getback in action as soon as they are safely healed.

Postnatal Care

After you’ve had your baby, you’ll want to getback on track with postnatal exercises.Your physi-cal therapist can evaluate you for postural problemsor abdominal weakness and then put you on a pro-gram to gradually strengthen those muscles. Theprogram may include pelvic floor exercises to pre-vent incontinence (difficulty with bladder control).

Simple attention to little details in everyday lifewill make a big difference in your comfortablerecovery.Your baby’s changing table, for instance,should be at waist level, so you don’t have to bendforward and strain your back. In fact, try to keepfrom bending over from the waist as much as pos-sible. If you stand a lot, try resting one foot on astool or box. This will give your back addedsupport.

Breastfeeding

Breastfeeding is a perfect opportunity for mater-nal infant bonding. But many moms tend to bringtheir breast to the baby instead of their baby to

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the breast. This can lead to pain between theshoulder blades and strain on the lower back. Aphysical therapist can instruct you on the properpositions for comfortable breastfeeding.

Physical therapists will tell you to make the fur-niture and pillows do the work for you, not yourmuscles. Sit in a chair with a soft pillow behindyour lower back to give it support. Rest your babyand your arms on a pillow to keep your shouldersfrom rounding and placing strain on the musclesbetween your shoulder blades.

After a long session of breastfeeding, standup, put your hands on your hips and lean backslightly to help reverse the strain on your backfrom prolonged positioning. Repeat this motion,gently, three to five times.

Handling Your Baby

Lots of touching, holding and interacting isgood for your baby and for you, too. Studies haveshown that this kind of tactile stimulation encour-ages the baby’s development. But while you’relearning about handling your baby correctly and

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gently, you need to be careful not to do your ownbody some damage.

When picking up your baby — or younger child— remember to protect your spine. Bend yourknees, keep your child close to your body and liftwith your leg muscles, not your back. Also, don’tcarry your baby all day on one hip.

As You Get Older

Your reproductive system continues to influ-ence your life long after you’ve given away

the last of your children’s outgrown clothes andtoys. As they’re putting on their graduation capsand gowns or beginning families of their own,your maturing body is taking you through morechanges.

Menopause

Menopause is a biologic phase that marks theend of hormonal changes and ovary function andmenstrual periods. Some women notice “sideeffects” of menopause, including hot flashes, tin-gling, muscle aches and pains, and changes intemperament and sleep patterns.

Physical therapists understand the importanceof exercise and fitness for the mature woman.They encourage continued exercise, with modifi-cations if necessary, with special emphasis onpreventing osteoporosis.

Osteoporosis

Osteoporosis is the loss of bone density thatbegins by your early 40s. How much density youlose depends on your diet and exercise choices.Once the bones lose a significant amount of cal-cium, they become brittle and can break easily.

For women who already have osteoporosis,physical therapists will recommend posturalstrengthening exercises and activities such as

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walking, possibly using an exercise bicycle, andperhaps some light swimming.

Good nutrition, plenty of calcium, estrogensupplements after menopause, and weight-bearing exercise such as walking with good pos-ture can help prevent this debilitating conditionfrom happening to you.

Hysterectomy

Hysterectomies, the surgical removal of theuterus, are prescribed by physicians for a varietyof reasons. While new developments in diagnos-tic procedures and surgical techniques have pro-vided options, you may someday need to under-go this operation.

A physical therapist can put you on a goodpostoperative treatment plan to ensure a healthyrecovery after the hysterectomy. Physical therapytechniques for hysterectomy recovery includepelvic floor exercises, stretching, deep breathing,and weight-bearing exercise.

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Incontinence

Incontinence means difficulty with bladder con-trol. The bladder’s function is to store and emptyurine. Normally, it fills to capacity and the detru-sor, the muscle that lines the bladder, contractsand causes the urge to relieve. Incontinenceoccurs when the lining of the bladder becomesirritated, causing the bladder to contract prema-turely and/or frequently.

Incontinence strikes all ages. Over 12 millionAmericans experience some form of inconti-nence, twice as many women as men. Factorsthat can contribute to incontinence are weight,number of babies you’ve delivered, chronic ill-ness, smoking, caffeine, and certain medicinesthat cause bladder irritability. But understandingincontinence doesn’t make it any less embar-rassing if you have a bladder-control problem.

Two major types of incontinence that physicaltherapists work with are stress and urge. Stressincontinence is the sudden, involuntary loss ofurine because of physical stress, such as cough-ing, laughing, jumping or sneezing. Urge inconti-nence occurs when the urge to urinate is sostrong it can’t be overcome — the bladder doesnot relax so that it can fill normally and you getthe sensation to go — and you have no controlover it.

Mastectomy

Women who go through a moderate or radicalmastectomy are often worried about their bodyimage and are afraid to move because of thetightness they feel in their chest and shoulders.

A physical therapist will help you becomeaccustomed to your new shape. You will learndeep-breathing techniques for stress reductionand how to gently massage your scar tissue toprevent adhesion. Your physical therapist also willtailor an exercise program that will help youregain the full range of motion in your shoulderand upper body.

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Incontinence is a symptom of an underlyingproblem, not a disease itself. Incontinence canbe a sign of a bladder infection or more seriousdisease. But once these conditions have beenruled out by a physician, the source of the prob-lem might be weak pelvic floor muscles.

Knowing that you can do something about it isa step in the right direction. Physical therapistsare trained to rehabilitate muscles and have avariety of methods to teach clients how to correctpelvic floor weakness. More important, they canteach you how to exercise your pelvic floor mus-cles to prevent the onset of incontinence or helpto reverse the process.

You also can check the strength of your pelvicfloor the next time you urinate. Partially emptyyour bladder, then try stopping or slowing downthe flow of urine. If you’re successful with either,

Above: Good pelvic floor support.Below: Inadequate pelvic floor support.

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then you’re contracting (tightening) the right mus-cles. Try doing these contractural exercises(called Kegel exercises after the physician whodeveloped them) throughout the day, driving, sit-ting in a meeting or talking on the phone.

You can also vary these exercises: contractyour pelvic muscles and hold for 10 seconds,then relax the muscles for 10 seconds. Or con-tract and release quickly. Or contract, and whileholding, cough. The purpose is to vary theseexercises and do them several times throughoutthe day. Remember that Kegel exercises are dis-creet. Nobody will notice.

A Life of Many Choices

As a woman in today’s world you enjoy a lifeof many choices. And the choices you make

will determine the way you use your bodythroughout the decades. But regardless of thepaths you select—such as whether or not tohave children—a physical therapist will be therefor you as you progress through all the stages ofyour life.

About APTA

The American Physical Therapy Association(APTA) is a national professional organization

that represents members throughout the UnitedStates.

Physical therapists are vital members of the mul-tidisciplinary health care team. They provide treat-ment and can refer clients to other health care spe-cialists. APTA serves its members and the public byexpanding understanding of the physical therapist’srole in the health care system. APTA also promotesexcellence in the field with improvements in physi-cal therapy education, research, and practice.

Other APTA BrochuresM Fit KidsM Fit TeensM Fitness: A Way of LifeM For the Young at Heart: Exercise Tips for SeniorsM Taking Care of Your BackM Taking Care Of Your Foot and AnkleM Taking Care of Your Hand, Wrist, and ElbowM Taking Care of Your HipM Taking Care of Your KneesM Taking Care of Your ShoulderM What You Need to Know About Carpal Tunnel

SyndromeM What You Need to Know About Neck PainM What You Need to Know About OsteoporosisM What Young People and Their Parents

Need to Know About ScoliosisM You Can Do Something About Incontinence

Bulk quantities available. Send for the PublicationsBrochure, APTA, 1111 North Fairfax Street,Alexandria, VA 22314-1488Or order via the Internet at www.apta.org

AcknowledgementsRhonda Kotarinos, PT, MSJane Frahm, PTKathe Wallace, PTLinda O’Connor, PT, MSFatima Hakeem, PT

20M/9-00/PR38Printed on recycled paper

Prepared as a public service by the

American Physical Therapy Association

1111 North Fairfax StreetAlexandria, VA 22314-1488

www.apta.org