Back pain in new mums
Mother’s Day is just around the corner, so we wanted to dedicate this blog to all the mum’s out there. Being a mum is a tough job for anyone. Juggling work, keeping a home, family and friends, and of course caring for your little ones, can be draining both emotionally and physically. This is especially the case if you are a new mum, when life with your new addition is in its settling in period. Your body has been through a major change over the last 10 months, and it’s still changing now. Having a baby is a big deal, and you now have a recovery period ahead of you. But of course, you have a child to care for constantly, so there’s no time to worry about yourself, right? Wrong… it’s a difficult balance for sure, but looking after yourself means you’ll be able to look after your new recruit to the very best of your abilities.
My back STILL hurts 🙁
Pain is a common symptom experienced by new mums, with approximately 10% of women still experiencing pain two months post-delivery. Imagine being in pain all that time AND having a baby to look after – it doesn’t sound fun does it? Now, whether you’ve been through a natural birth or c-section, your body is vulnerable and weaker than pre-pregnant you, so it’s important to look after yourself to ensure you recover quickly and nip that pain in the bud!
The back is one of the most common areas of the body affected during and after pregnancy. Other areas include the pelvis and the wrists. The main reasons your back will complain in those early days boils down to the fact your posture won’t have a clue what has just hit it. Firstly, during pregnancy, ligaments become lax, muscles stretch or separate, which can produce imbalances or weakness. Even your breathing might change, depending on where bub is sitting in your uterus. Then of course your body is frantically trying to realign your centre of gravity to deal with your growing bump. Your body is working like crazy simply to keep you upright!
Then baby comes along. Of course, there’s the trauma you may experience with a vaginal or cesarean birth. Then, straight away, you will be feeding, changing, bathing and dressing/un-dressing your bubba multiple times a day. All these activities require you to have your baby lying down in front of you, with you bent over them, keeping them fed, warm, and happy. This continuous motion, combined with broken sleep, tiredness, and a recovering body, can lead you to over-work those back muscles. It’s also important to remember that your core muscles will have taken a big hit during pregnancy, so you won’t be as stable in the trunk as you were pre-pregnancy. Eventually your body will let you know things are not right by sending a few signals to the brain – hello pain!
What can I do to help?
Now you know why you may experience back pain, we want to let you know some of the things you can do from the very first day you bring your newborn home, to care for your back (and the rest of you of course), and reduce the risk of injury and pain. That way, you can dedicate 95% of your time to looking after your son or daughter. “Only 95%” we hear you ask – don’t worry, we’ll get to that!
To reduce the impact of feeding on your back, consider the following tips:
- Get a comfortable and supportive feeding chair: Avoid chairs that allow you to sink into them, such as a low arm chair or sofa. You will struggle to get yourself up from a slouched position, whilst holding your baby, without risking strain on your back and shoulders.
- Move regularly: Enjoy the one on one time, it’s magical! But, when you sit for long periods, your back and neck muscles will eventually feel it. Try some light neck stretches, and gentle spinal movements like rotating side to side and extending to open out the chest.
- Try a feeding pillow: As your baby grows, they will get heavier and heavier. A feeding pillow will take the weight of your baby so your arms, shoulders and back don’t have to bear the brunt of it all.
- Get your partner involved: If you’re a bottle feeder, then spread the load and ask your partner (or another family member) to feed when possible to give you a break. If you are breast feeding, they can still help by taking the baby from you when you have finished so you can get yourself up off your chair, minus the weight of your baby.
Oh so many nappies! “I didn’t sign up for this!” Ahem, sorry, yes you did! Just embrace the poo… It gets easier ;). The following tips also apply for dressing your baby:
- Get a change table: Whether it’s a nappy change or outfit change, do it at a height where you can stand comfortably and not be bent over for long periods.
- Following on from the above point… Avoid changing your baby on the floor. It’s not only your back that might complain, but your neck, shoulders and knees also!
There is no easy solution to this one. Most baths are low to the ground and require you to kneel and lean right over to get to where you need to be. However, we have found that baby baths can be useful as they are small, mobile, and can be placed at a height that suits your back better. Some change tables even double up as baby baths. Obviously be careful about carrying a heavy bath of water though – as long as it’s safe, try to bath your baby near a sink where you don’t have to carry the bath to fill and empty it.
So, you mentioned 95%?
You’re right, we did! And this is very important. Your baby is going to need lots of attention. But you also need attention. So, the remaining 5% is just for you. The following tips are aimed to address other areas of your life that often get neglected when being a new mum:
- Sleep when the opportunity arises: Whether this is when your baby is sleeping, or when your partner or family member are looking after your baby, getting sleep is very important. You need time to restore energy levels and allow the body to repair and recover. Who cares if the housework gets left for an extra day or two – it will still be there when you are ready to do it. Better still, get a family member to help. Team work!
- Eat well, stay hydrated: Don’t forget about the importance of a good diet. Eat lots of fresh, nutrient rich food, such as fruits and vegetables. And keep a bottle of water on the go constantly. It’s easy to forget and become dehydrated. If you are breast-feeding, remember where the water in the breast milk comes from… YOU!
- Have a bath: Of course, this doesn’t have to end at bathing. Read a book, do a crossword, go and sit in the garden with a cuppa… Our point is, make time for yourself regularly. These little breaks will keep you sane during a chaotic time of life. If help is at hand, use it. It is OK to have a break from it all. We cannot stress this point enough.
These last points can also help in the fight against back pain. Sleeping, eating and relaxation will help to reduce the risk of fatigue. Fatigue will compromise your ability to hold your posture in standing, sitting, and other positions such as bending. So, you can see why the 5% is so important.
At some point, you will need to address the physical changes that have occurred as a result of pregnancy and giving birth. These may include abdominal and pelvic floor muscle dysfunction, as well as spinal and other joint restrictions and dysfunctions. Every woman that has given birth needs to rehabilitate and strengthen their core again. Unfortunately, many don’t get around to it or it isn’t high on their priority list. However, (see points above) it needs to be! And of course, if you’re reading this and are pregnant, or thinking about having a child, there is so much you can do pre-birth to aid your recovery after having your baby, so come and see us!
If you’re a new mum or have had a child in the last few years, we can’t recommend enough to come and see one of our women’s health focused physios. We’ll assess you, and advise you on the best course of treatment and exercise to get you ‘back’ (excuse the pun) fighting fit and who knows… Another baby anyone?!
Healthy hips are here to stay
April is here, and with that comes Healthy Hips week (1-7 April), so we thought we’d write a blog about some of the common hip issues we regularly see in clinic, so you can ensure your hips stay healthy, and keep your body moving for longer.
The hip is a pretty complex joint, with numerous muscles, tendons, ligaments and other tissues attaching in and around it to provide support and movement. Because there are so many structures, it means there are lots of possibilities for things to go wrong. And therefore, lots of potential sources of pain when something does go wrong. Fortunately for us clinicians, the common things are common, and the rare things are, well, rare! This helps us to work out quickly what’s going on, so we can put you on the road to recovery.
Do I need a scan?
One common issue we are faced with in clinic, is that our patients will often come to us having seen their GP, following a scan on their hip, and have been told that they have ‘bursitis’ or ‘arthritis’, and this is what is causing their pain. This can be a little problematic for everyone sometimes, for a few reasons. Firstly, many people that have reports that suggest bursitis, or hip osteoarthritis, do not even have pain from that condition – sometimes these findings are simply incidental and have no bearing on our patient’s issues… Secondly, it plants a seed. What we mean by this is that people tend to trust what they see. So, if they see suggestions of bursitis, or arthritis, they suddenly start to believe that this is what must be the cause of their pain, rather than something else (like muscular weakness). Getting the patient to understand that their scan’s diagnosis may not be the cause of their pain (if it is indeed not the cause of their pain) is part of our job as educators of the body, and this can sometimes be difficult!
Common causes of hip pain
In our experience, the most common cause for hip issues in our clinic is muscular imbalance and gluteal weakness. Muscle imbalances are very common throughout the body, throughout the population. We all live different lives, playing different sports, having different hobbies and working different jobs. Look at an example of a desk worker who sits for their job, plays tennis left-handed, and is a keen candy-crush game addict. It’s easy to see over time how their body might develop muscular imbalance from favouring certain positions and sides of the body over long periods of time. Our bodies are rarely 100% symmetrical and can adapt extremely well, but there is always a point where it can no longer keep adapting. This is generally when you start to feel pain. Your body is telling you to do something about it. And this is where we come in!
Weak gluteal muscles are a really common problem for the general population. Why you ask? It’s because a large amount of people now sit more than move. People are more sedentary than ever. Technology is advancing and feeding our need for constant entertainment. And you can actually see it… The world is growing more obese and Type 2 Diabetes rates are continuing to grow. All this being sedentary malarkey is not good for our poor gluteal muscles. When we sit, they don’t get used, and when they don’t get used, they get weak! And they have a pretty important role to play, being responsible for several hip movements, helping to keep the pelvis stable when we walk, and allowing you to advance forward when walking, running and jumping. You see, they want to move you! Weakness in these muscles then leads to bio-mechanical changes around the hips (which spills over into the lower back, knees and ankles), and those fundamental movements suddenly become difficult to perform without major compensation and adaptation occurring. And we know what adaptation over long periods can lead to don’t we? That’s right – pain. Good… You’ve been listening!
Some of the effects of weak glutes include hip, knee, low back or heel pain, poor/slouching posture, and a change in the way you walk (your ‘gait’). If you’re a runner, you may even notice an increase in the number of blisters you are getting, due to the change in your running style (of course, you may also need new runners, so worth getting these checked too!).
What should you do?
If you are experiencing hip pain, please come in and see us… We’ll assess you to see where your imbalances are, and what is causing the pain. Whether it’s down to muscular imbalance, weak glutes, or any other cause, we’ll teach you how to put it right and get those glutes firing properly in no time.
Stress urinary incontinence – what causes it, how to treat it and how to prevent it
Running, sneezing, jumping, laughing – they should be normal activities, but for some women they bring embarrassment or anxiety. Bladder weakness, incontinence and urinary leaking are common problems, especially in women after giving birth or going through menopause. There are many causes of bladder weakness, but today, we’re focusing on one of the most common: Stress urinary incontinence (SUI).
What is stress urinary incontinence?
SUI is where the bladder leaks a small amount of urine during activities that put pressure on the abdomen and push down on the bladder, like coughing, running or laughing.
What causes it?
Stress incontinence in women is often caused by pregnancy,
childbirth and menopause. In a quick anatomy lesson, your urethra transports urine from your bladder out of the body, via a muscular structure called the urethral sphincter. The sphincter contracts to hold urine inside your body until you’re ready to go.
During pregnancy and childbirth, your pelvic floor muscles can stretch and weaken. The muscles normally support the urethra, so when they, or the sphincter muscles, are weak, they can’t do their job properly and hold your wee in. During menopause, the female hormone, oestrogen, is produced in lower quantities. Oestrogen helps maintain the thickness of the urethra lining, so sometimes with decreased oestrogen, the lining is affected, and some women experience SUI.
It’s most common with activities such as coughing, sneezing, laughing, walking, running, lifting or playing sport. Other factors that can contribute to SUI include diabetes, obesity, constipation, and a chronic cough (often linked to asthma, smoking or bronchitis).
How to treat it?
Every single person is different, so it’s always best to see your Pelvic floor physio so we can assess you and work out the best treatment plan for you. However, some common treatments we recommend to our patients include:
- Pelvic floor exercises (see below for more information!).
- Changes in fluid consumption: This could include drinking certain amounts of fluids at certain times of the day. Or it could involve cutting down caffeine or alcohol to see if they irritate your bladder.
- Healthy lifestyle changes: Quitting smoking, losing excess weight or treating a chronic cough will decrease your risk of SUI, as well as improve your symptoms.
- Bladder training: We may recommend a schedule for toileting, depending on the type of incontinence you have. This is more so used when it’s a mix of SUI and another type of incontinence.
- Manual therapy: You may have some muscular imbalances that are inhibiting your pelvic floor from working properly or are impacting on other parts of your body. We’ll assess you, and then put together a treatment plan, which may include soft tissue massage, other musculoskeletal therapies, strengthening or stretching exercises, or more.
How do I prevent it?
Remember your physios, nurses, doctors, female relatives, mum friends (and the list goes on) telling you to do your pelvic floor exercises or Kegels when pregnant? Well, that’s one piece of advice you should listen to! In fact, it doesn’t matter whether you’re pregnant or not, you should always do your pelvic floor exercises to help strengthen those important muscles. Some basic pelvic floor exercises include:
- Draw your pelvic floor muscles in and up, like you are trying to stop urinating mid-flow. Hold for 10 secs. Relax for 5-10 secs between each tightening and repeat 10 times. (Don’t actually do your pelvic floor exercises on the toilet – trying to stop while actually urinating can cause other bladder issues)
- You can add faster pelvic floor lifts to the exercise by holding for 1-3 secs and relaxing for 1-3 secs. Repeat 10 times.
- Progressing the long holds to 20 secs and then 30 secs may be a goal to reach for.
Try and make pelvic floor exercises part of your routine. For example, do them when you brush your teeth each morning and evening, and when eating lunch. There are also many more exercises to help you, including core exercises such as Pilates.
Pelvic floor exercises should not cause any discomfort or pain. If you have a history of pain with intercourse, vaginal exam or using tampons, or if you have trouble emptying your bladder or starting a wee, you should see a Pelvic Floor Physio prior to starting pelvic floor exercises.
If you’re experiencing urinary leaking, are pregnant, have given birth (at any point in your life!), or if you want help with a preventative program, please come and see us. It is always best to see a Pelvic Floor Physio to get an individual program and to be confident on correctly tightening your pelvic floor muscles. We have helped thousands of women with stress urinary incontinence over the years and would love to help you live a happier, less-anxious life, so you can laugh all you want without having to worry about incontinence!
Pelvic pain in pregnancy
You’re growing a human – a tiny person that will change your life and body forever. Of course, we expect changes and some discomfort as our body adapts to our growing belly, but seriously – this pelvic pain is another level! But what is it?
Pelvic pain during pregnancy can be from a range of things, but Symphysis Pubic Dysfunction (called SPD) is a pretty common cause. It can also be called Pelvic Girdle Pain (PGP). SPD & PGP can be explained as a bunch of signs or symptoms relating to pain in the pelvic area and lower back. It also includes musculoskeletal pain radiating to the upper thighs and crotch area.
So why does this happen? At certain stages throughout pregnancy, your body produces the Relaxin hormone, which relaxes the ligaments, producing more movement in the pelvic region to allow for expansion, not just for the baby to grow, but ultimately for the delivery of bub. This relaxation of the pelvic ligaments leads to increased joint mobility. Where the ligaments usually provide support to the joints, the muscles now have to step in and help stabilise them – they get overworked and that’s when the pain starts. Symptoms of SPD can vary widely – from mild discomfort to severe pain that can see women bed-ridden or needing walking aids.
It’s hard to say how many women actually experience SPD in pregnancy. Research suggests it’s somewhere between 4 – 84%! The variation is because of the wide range of definitions and diagnosis of SPD, as well as differing research cohort selections. However research also suggests that the incidence rate increases during the later stages of pregnancy. So what influences its onset, and how do you treat it?
Influences of SPD
While there is no way of accurately predicting which women will experience SPD, common factors that might influence the onset include women:
- who have a history of low back pain or trauma of the back or pelvis
- with an increased number of previous pregnancies
- who partake in physically demanding work
- with a high Body Mass Index (BMI)
- experiencing emotional distress
- who smoke
There isn’t one particular treatment, but common treatments include:
- Physiotherapy: Research suggests that women receiving physio treatment reported less pain in the mornings and evenings than those women who didn’t have treatment.
- Acupuncture: As with physio, acupuncture helped with pain, and functional movement.
- Pelvic support garments: Research suggests that these improved women’s ability to do things like walk and perform basic movements.
- Exercise: This can also help improve functional movement and help decrease pain, but ensure you visit your physio first, to understand what exercise is right for you, your condition and your pregnancy.
- Rest: It’s not always possible to rest completely but try to limit doing the activity that causes the most pain, avoid standing on one leg, limit weight-bearing exercises like climbing stairs or standing for long periods of time.
Pelvic pain in pregnancy is common. If you are experiencing pelvic pain, your first step is to see your physio to understand what it is and how to treat it.
In the meantime, try changing your routine by sitting down to get dressed and rotate those stilettos for low heels or flat shoes. One of the best things to try is pretend you’re always ‘walking around in a pencil skirt’ – take small steps, and when getting out of the car, slide your bottom 90 degrees and get out with your legs together. Heat might also provide some temporary relief.
To help you see an end point of your pain, know that SPD usually sporadically fixes itself after birth. And of course, holding that tiny human in your arms makes up for the grief (and you can remind them about the pain they put you through for years to come).
Your 2019 self-care bucket list
“New Year, new you” is often the slogan thrown around at this time of year, but we’re changing that. We think you’re pretty awesome, so it’s not about a new you, it’s about taking the time and becoming a better version of you.
Women, traditionally, are the care givers – the women’s role used to be looking after the house and children (and husband), while hubby made the money. Of course, over time, the world has progressed, and we do it all. And while there are absolutely amazing husbands and fathers out there that are hands on, women still tend to feel the pressure of working (however you’d like to define it), running a house and looking after children. And with everything going on around us, we put ourselves and our wellbeing at the end of the priority line. And that has to change, so for 2019 we’ve created a short self-care bucket list, for you and all the women in your life!
- Accept that self-care is not selfish
Taking time for you needs to be a priority. Whether that’s booking a hair appointment, reading a book in the bath (without interruptions), or going for a walk or swim, you need to do it – for your wellbeing, and the wellbeing of your family! When you schedule in you-time, it gives you the ability to relax, reflect and Zen-out. It gives your mind a break from the daily rigmarole of life. Don’t think of it as selfish – it’s actually the opposite. Taking self-care time makes you less stressed, more relaxed and happier – it makes you a better version of you, and therefore a better mother, wife, daughter, sister and friend.
- Practice positive posture
Think about the way you sit, stand and go about things in your daily life – even holding your baby! Correct posture not only helps with aches and pains, and reduces the risk of injury, it can also help with improving oxygen and blood flow.
Also try to avoid sitting for long periods – research shows that sitting for long periods can have a negative effect on your body and can lead to lower back pain, as well as the onset of chronic diseases such as obesity, diabetes and cardiovascular disease. Avoid sitting for longer than 30 minutes at a time, and when sitting, change positions regularly.
If you sit at a desk for the majority of the day, check out our diagram and make sure you’re set up correctly. Also make sure you break every 30 minutes – this could simply be standing up and doing a simple chest stretch, walking to chat to a colleague instead of phoning, or invest in a standing desk so you can alternate between sitting and standing.
- Move more
Doing physical activity is not at the top of everyone’s priority list but staying active is so important – it is recommended that we do a minimum of 30 minutes per day. But now here’s the twist!
If the word ‘exercise’ makes you cringe, start small. Start by counting your ‘physical activity’ minutes. Vacuuming, park your car at the back of the car park to walk to the shops, do squats while you brush your teeth. If you can start including incidental activity while you’re doing your daily tasks, you’ll find it much easier to increase the amount of physical activity you undertake. You’ll start to have more energy, and then all of a sudden that 15 minute ‘me-time’ walk becomes a blissful idea, then an action. A couple of weeks later it has turned into a half-hour ‘me-time’ walk, because you simply have to finish that podcast! So, move more but start small!
- Make meditation moments
Keeping healthy isn’t limited to food and exercise – it’s also about your emotional and mental health. When you’re swept up in the craziness of school drop-offs, work, events, and children’s extra-curriculars, a great way to calm the mind is meditation. Meditation helps reduce stress, strengthen your ability to focus and can assist in getting a good night’s sleep.
You don’t have to be a yogi or hippy, nor do you have to sit cross-legged on the floor. Meditation attracts many people because it’s flexible and versatile – you can do it anywhere at any time. Try deep breathing for 10 mins before you sleep, have a relaxing bath, or even sit in your car while your child is at dance lessons or football practice, close your eyes and let your mind slow down for ten minutes – bring your mind to the present moment and just breathe.
You are important, so this year, let’s make a pact that we will put self-care as a priority. If we take better care of ourselves, we’ll be better versions of us, and a better mum, wife, sister, daughter and friend. Start small and commit to your self-care bucket list!
If you’re taking steps to implement this bucket list, we’d love to know what you’ve done, and with your permission, share it with our clients to inspire and encourage others to prioritise their self-care journey. Please send your stories and/or photos to us at firstname.lastname@example.org or post them on our Facebook page www.facebook.com/physiotherapyforwomen.