Prenatal & Postpartum Care
One-on-One Pregnancy PT with Dr. Maks Birikov
Pregnancy changes your body's mechanics faster than most treatments account for. Every session at Physica Medica is one-on-one with me — no aides, no rotations, no 15-minute check-ins between other patients. I assess, I treat, and I adjust as your body changes trimester to trimester and into postpartum recovery.
What I Treat
What Pregnancy Physical Therapy Actually Treats
Pregnancy PT is not a category for vague discomfort. The conditions I treat have specific mechanical causes — and they respond to specific interventions. Pelvic girdle pain develops as relaxin loosens the ligaments stabilizing your SI joints and pubic symphysis. The pelvis becomes hypermobile before the surrounding musculature can compensate. That instability is what generates pain with walking, rolling over in bed, or climbing stairs.
Round ligament pain is sharp, often unilateral, and typically misread as something more serious. It is a traction response to the uterus shifting your center of gravity forward — and it is addressable with soft tissue work and postural load management. Diastasis recti is a separation of the linea alba, the connective tissue running down the center of the abdomen. It does not always resolve on its own postpartum, and incorrect exercise in the interim makes it worse. I assess for it during pregnancy and treat it directly after birth. Forward head posture and thoracic load compound as your center of gravity shifts anteriorly. The resulting tension across the upper back, neck, and ribcage is mechanical — and it compounds breathing mechanics as the diaphragm gets crowded.
These are not things to wait out. Untreated SI joint dysfunction and pelvic floor imbalance during pregnancy frequently persist postpartum and become the chronic pain patients bring to me a year later, frustrated that nothing has worked.
Before and After Birth
How Sessions Work — Before and After Birth
I treat across the full arc — first trimester through postpartum recovery — because the problems that appear after birth usually originate before it. Prenatal sessions focus on managing postural load as your body changes, addressing pelvic and SI joint mechanics, reducing soft tissue tension in the hips and thoracic spine, and preparing the pelvic floor for labor. Positioning and breathing mechanics are part of this work, not afterthoughts.
Postpartum sessions shift focus to diastasis recti assessment and rehabilitation, pelvic floor recovery, scar tissue mobilization after cesarean delivery, and progressive reloading of the core and hip stabilizers. The timeline varies. Most patients benefit from beginning postpartum work between six and eight weeks after delivery, though I assess readiness individually.
Continuity matters here. If I treated you during pregnancy, I already know your movement patterns, your compensation habits, and what your tissue felt like before delivery. That context shortens the postpartum assessment considerably and makes the treatment more precise from the first session back.
The One-on-One Model
Why One-on-One Care Matters During Pregnancy
Insurance-based PT clinics operate on volume. A therapist sees multiple patients per hour, delegates hands-on time to aides, and manages billing constraints that limit session length and treatment selection. That model works for straightforward cases. Pregnancy is not a straightforward case.
Your body during pregnancy is mechanically variable in a way that most PT protocols are not designed for. What is appropriate at 16 weeks may be contraindicated at 32. Positions that were comfortable last session may not be this one. Tissue response changes as hormonal levels shift. This requires a clinician who is present for the entire session, reassessing in real time — not a protocol handed off to a technician.
ViewAt Physica Medica, every session is a full hour with me. I do the assessment. I do the hands-on treatment. I make the clinical decisions. Cash-pay practice removes the billing constraints that determine how much time most patients actually receive from a licensed clinician. You are paying for direct access to that clinical judgment for the entire session — not for a facility and an aide.
ViewYour First Appointment
What to Expect at Your First Appointment
History and Intake
I start with a detailed intake: where you are in your pregnancy, what symptoms you are experiencing, when they started, what makes them better or worse, and what you have already tried. If you have imaging or prior PT notes, bring them. They are useful context.
Movement and Postural Assessment
I observe how you move — how you stand, how you transfer weight, how your thoracic spine and pelvis relate to each other. Pregnancy shifts the center of gravity forward and changes the load on every structure above and below the pelvis. I am looking for where your body is compensating and what that compensation is loading.
Hands-On Evaluation
Palpation across the SI joints, pelvic musculature, thoracic fascia, and hip stabilizers to assess tissue quality, joint mobility, and pain response. I check for diastasis recti if you are in the second or third trimester. Everything is explained before I do it.
Plan and First Treatment
At the end of the assessment, I tell you what I found, what I think is driving your symptoms, and what a realistic treatment arc looks like. Treatment begins the same session. You leave with a clear picture of the plan — not a vague promise to reassess next time.
Plan for 60 minutes. Most prenatal patients start with weekly sessions and adjust frequency based on symptom progression and trimester. I give you a session estimate at the first visit, not an open-ended commitment.
Before You Book
How This Differs from Insurance-Based PT Clinics
Is pregnancy physical therapy safe in all trimesters?
Yes, with appropriate clinical judgment. The techniques I use — soft tissue mobilization, joint mobilization, postural correction, and therapeutic exercise — are adapted to your trimester and your specific presentation. Certain positions and techniques are modified or avoided depending on how far along you are. I assess this at every session, not just the first. If there is a medical reason PT is contraindicated for your pregnancy, I will tell you directly and refer you appropriately.