Benefits of a Strong Core Before and After Pregnancy: Pre and Postnatal Physical Therapy

Have you ever wondered how physical therapy could fit into your wellness routine during preconception, pregnancy, and after? I had the pleasure of chatting with Effie Koustas, Pre and Postnatal Physical Therapist about all things core strength, posture, and wellness. Read more of our interview together to find out what we discovered.


Q: Effie, why don’t you tell everyone a little about yourself, what you currently do and how you got there?

A: Hi! Thank you for inviting me to be your guest today, I am excited to be here! I am a Physical Therapist here at Family Physical Therapy Services in Bedford, New Hampshire. I received my Master’s degree from Northeastern University in Boston. I have been primarily treating outpatient orthopedics, such as sprains and strains, for the past sixteen years. I have been with FPTS for over seven years, where I continue to treat orthopedic diagnoses, but I also specialize and have advanced training in pre and postnatal therapy. I also have three children of my own and understand firsthand how pregnancy feels and changes your body.

Q: What are the benefits of having a strong core BEFORE you get pregnant?

A: Let me first explain what makes up your core: The major players of your core are the transverse abdominal muscles in the front, the multifidi in the back, the pelvic floor muscles below, and the diaphragm above. When one of these pieces is not working correctly, there is a flaw in the system. You are missing a piece of the puzzle and it will not be complete. All four MUST work together to get the most benefit of your core. With that said, having a strong core is always important, especially during pregnancy where your body typically gains 25-35 pounds for a healthy pregnancy. Your center of gravity will be thrown off, as most of the weight gain will be in your midsection as your baby is growing. This added weight in one area, puts great strain on your low back and as a result causes pain. Strengthening your core will give you a strong foundation as you start your pregnancy. It decreases the tension in your back which allows you to move pain free as you continue through your pregnancy.

Q: What problems can arise during pregnancy that may be related to a weak core?

A: As I mentioned above, low back pain is the most common problem I see. Other complaints are upper back pain, sciatica, hip pain, sacroiliac joint pain/SIJ, piriformis syndrome, and diastasis recti to name a few. Specifically, up to 66% of women will experience a separation in their rectus abdominal muscle, called diastasis recti. This muscle, aka the “six pack muscle”, is separated by ligaments. This separation is due to pregnancy induced ligament laxity. This separation can worsen as pregnancy progresses and be the source of your low back pain. There are exercises you can do while pregnant to help prevent it from worsening. After delivery, you would then need to continue with these exercises to close the separation, which is possible with proper exercises and precautions. By strengthening your core, you can avoid most, if not all, pregnancy related “orthopedic” aches and pains.

Q: What benefits will Mom see DURING her pregnancy if she does have a strong, functional core?

A: The benefits are significant. I often tell all my patients you CANNOT put a price on pain relief, especially when you are pregnant. When your core is strong, you will have better control of your posture and therefore less pain. Because you are exercising, some other benefits include improved sleep, increased energy, decreased risk of gestational diabetes, staying fit, etc.

Q: And what about postpartum, how can having a strong core come into play during this time?

A: After you deliver your baby, you will now be lifting them from various surfaces. Such as from the car seat, out of the crib, off the changing table, or off the floor. If you can effectively isolate your core AND use proper body mechanics, you will NOT have to suffer from low back pain or other pains. With nursing or bottle feeding, you are prone to neck strain or wrist pain with improper positioning. However, since we are more concerned with caring for our baby, that can easily be forgotten and unfortunately overlooked altogether. Having this education prior to having your baby can provide tremendous relief to your body, all while still enjoying your newborn. As I mentioned earlier, this is the time to correct the separation in your abdominals.


Q: What can mom do to have a strong core?

A: Great question! I teach moms how to activate and isolate their transverse abdominal muscles. Once they have mastered this, they are then instructed to incorporate it into their day as they are carrying their baby and doing other chores around the house. This will not only help strengthen your core, but it will help minimize and resolve the separation like it was never there. When ready, there is a series of other exercises that I will teach you for you to safely return to working out, if that is your goal.

Q: How is your posture related to your core?

A: There is a direct relationship between the two. When you strengthen your core, you are simultaneously improving your posture. This then helps to decrease pain and tightness and improve strength. In addition, you will be able to move freely as you progress through your pregnancy.

Q: How can Mom use physical therapy before, during, and after her pregnancy?

A: They can absolutely come see me at any point! Studies have shown that PT with individualized treatment and specific stabilization exercises are more beneficial than traditional or group exercise classes, unless those classes are being taught by a professional specializing in pre/postnatal like yourself. While most moms think that taking an exercise class will help them through their pregnancy, most instructors may not be trained to customize the class for pregnancy and/or pregnancy related pains. This is where I come in. I will perform a thorough evaluation to differentially diagnose the source of pain. I will look at your posture, how you are walking, determine if there are any muscular limitations in mobility, strength and flexibility. From there, I will develop a program to treat you 1-2x per week for one on one treatment and give you a HEP. Studies also show that labor and delivery are easier with shorter recovery times in women who have been through PT and who doesn’t want that!

Q: Any last comments or things you want to share?

A: I think we have covered a lot of valuable information here today and my hope is that it will get moms thinking about how to keep their bodies moving during pregnancy. I know that as a mom who has been through three pregnancies, I was fortunate that I could apply what I know to self-treat before anything became an issue. Each pregnancy was different, of course because I was a little bit older each time, but also, I experienced some discomfort sooner in the 2nd and 3rd pregnancy. Had I not known what to do, it could have been very difficult to care for my other children and keep up at home and work, all of which are very physical. With any symptom, it is always best to address it sooner than later, which means faster pain relief.

Q: How can people get a hold of you?

A: If you are local to the New Hampshire area you can call the office to schedule an appointment with me at (603) 644-8334. You can also visit our website and request an appointment online. Thank you again for this great opportunity.