Women, headaches and stress

The idea of Christmas usually fills us with joy, but as we start thinking of logistics and ticking things off our mental to-do list, it can become quite overwhelming and stressful. With stress often comes headaches, so we’ve listed the most common headaches women experience at this time of the year, and what you can do to help.

Tension headache

These are the most common types of headaches, and about 42% of women experience these (men are 36%). On average, they start in teenage years, peaking in your thirties and then decline.

These can be triggered by:

  • Poor posture
  • Bright lights, prolonged reading, loud noise
  • Medication overuse
  • Stress, anxiety
  • Fatigue, emotional upsets, depression.

You can help relieve a tension headache by:

  • Reducing stress, or being in a state of mental and physical relaxation
  • Leading a healthy life: Get the right balance of work, fun, rest, sleep and exercise
  • Psychological treatment to help with anxieties or emotional pressures
  • Manual therapy treatment, such as massage or dry needling
  • Other physiological treatment such as heat pads, compress and deep breathing
  • Over-the-counter medication such as aspirin, paracetamol or ibuprofen.
Migraines

Migraines can be pretty severe, and there are many types. They are usually one-sided and often accompanied by sensitivity to light, sound or smell, nausea, vomiting or cold hands. Some people also experience migraines with ‘aura’ which may include visual disturbances or numbness in the arm or leg. They can last from part of a day to three or four days and affect about 15% of Australia’s population.

It’s shown that your susceptibility to migraines is normally inherited (now which side of the family do you blame?), and there can be certain triggers (different for everyone), which include:

  • Dietary triggers: Some common ones include missed, delayed or inadequate meals, caffeine withdrawal, certain alcohol, chocolate, citrus fruits, aged cheese and cultured products, monosodium glutamate (MSG) and dehydration.
  • Environmental triggers: Common ones include bright or flickering lights, bright sunlight, strong smells, travel or flying, weather changes, loud sounds, going to the movies or overuse or incorrect use of computers.
  • Hormonal triggers: Three times more women suffer from migraines than men, with the difference being most apparent during reproductive years. Some common ones include your last menstrual period, menstruation, ovulation, oral contraceptives, pregnancy, hormone replacement therapy and menopause. We’ll go into more detail about this below.
  • Physical and emotional triggers: Common ones include lack of sleep, oversleeping, illness, back and neck pain, sudden, excessive or vigorous exercise, emotional triggers such as excitement or arguments, and relaxation after stress (known as a weekend headache).

There is no cure for migraines, but medication or alternative therapies might help. Alternative therapies include physio and massage, as well as many other areas like aromatherapy and meditation.

Hormones and headaches

Women get more headaches than men, with the difference noted most during the reproductive years, as mentioned above. There are three main areas to hormones and headaches:

  • Migraine and menstruation: The ratio of migraines in children is 1:1 female to male. During reproductive years that ratio changes to three females to every one male. While there are many opinions as to why this is the case, most experts do agree that it’s mainly to do with a fall in oestrogen that triggers a migraine. Migraines associated with PMS (pre-menstrual syndrome) may improve with over-the-counter medications such as evening primrose oil, vitamin B6 or magnesium supplements. Always check with your doctor before taking vitamin B6 as it can have toxic side effects. Doctors can also prescribe other medications. Think about keeping a headache diary so your doctor can better understand the relationship between your cycle and headaches/migraines.
  • Migraine and contraception: The effect of hormonal contraception on migraines is varied – some women get migraines when they start contraception, sometimes it makes them worse, and sometimes it has no effect. Generally speaking, a high dosage pill tends to increase the frequency and intensity of headaches, however a small number of women reported an improvement when they started taking the pill. Talk to your doctor about the best way forward.
  • Migraine and pregnancy: Migraines don’t put pregnancy at risk, but they can be a concern, especially if it occurs for the first time. Studies suggest that 60-70% of migraine sufferers feel an improvement in their migraines during pregnancy – especially during the second and third trimesters. If you’re getting migraines during pregnancy, consult your doctor as many manufacturers don’t recommend their medication. After giving birth, many new mother’s (3-40%) suffer from headaches, migraine re-starts, or may get a migraine for the first time. However, if other headaches occur, see your doctor, as they could be related to a number of other medical issues that may need investigation.
  • Migraine and menopause: Many women find that their migraines worsen leading up to their last period, and shortly after. Those who may not have noticed a link with their menstrual cycle might start developing regular monthly migraines. Some women choose to undergo Hormone Replacement Therapy (HRT), which replaces oestrogen that the ovaries can no longer produce. In theory, this should help migraines, but alas, the reality might not reflect this! HRT can both relieve migraines and aggravate them. Research suggests oral HRT is better for women who suffer migraines, but always talk to your doctor.

There are so many different types of headaches, and treatment varies from medication to manual therapy and physio. Whatever you’re experiencing, consult your doctor, or get in touch with us – we help many women with their headaches, and would love to help you too.

 

5 reasons why your shoulder is hurting

Our shoulders are pretty awesome, but they are indeed a complex little network of muscles, tendons, ligaments and bones. And an injury or imbalance can cause anything from a niggle to excruciating pain. Here’s a list of five common shoulder injuries to help you figure out why your shoulder is hurting.

Frozen shoulder

Do you have severe stiffness in your shoulder, unable to move it the way you normally would? You might have frozen shoulder. Its medical name is Adhesive Capsulitis, and it happens when the connective tissue that lines your shoulder joint becomes thickened and inflamed. It’s most common in middle-age women, and there are certain factors that put you more at risk. For example, up to 20% of people with diabetes develop frozen shoulder, and those with thyroid problems or Parkinson’s disease may also be more at risk of developing it.

If you think you have frozen shoulder, see your physio. It’s often a long road to recovery, and while frozen shoulder might fix itself eventually, a physio helps speed that process up.

Rotator cuff tendonitis

There are four rotator cuff muscles in the shoulder joint. They are responsible for keeping the ball of your upper arm bone (humerus) in the shoulder socket (scapula – or shoulder blade), and they help you rotate, lift and drop your arm.

If you perform repetitive movements using this joint, it could lead to inflammation of the rotator cuff tendons, which can cause pain. Tendonitis usually begins as a mild weakness or pain when moving the joint, but if left untreated, can become more severe and constant. To help it heal, avoid doing the repetitive activity, use ice or heat, and see your physio for manual therapy and strengthening exercises. Anti-inflammatory medication, like ibuprofen, may help with the pain.

Rotator cuff tear

You can partially or completely tear a shoulder tendon from excessive repetition or direct trauma, like a fall. If you have a sudden tear, your pain can be severe, however if you have a chronic tear, your pain, weakness or stiffness can worsen over time – so much so that you may not realise it’s even torn due to the gradual onset.

Rest from aggravating movements, ice or heat are helpful in recovery from tears. Anti-inflammatory medication may help with pain, but usually physio will be recommended to strengthen muscles and improve the mechanics of the shoulder joint. In some cases, a cortisone injection or surgery may be required.

Shoulder impingement

Any of the tendons or bursa (a fluid-filled sac that provides a smooth surface for your bones and muscles to glide over) that run through the small space in your shoulder joint can get impinged or pinched between the bones if inflammation occurs. You usually experience pain when moving your arm, especially when reaching overhead or backwards, or lying on your sore side. Many impingements are the result of repeated overhead activity, like when cleaning windows and bathroom tiles or when swimming.

Impingements may eventually weaken the rotator cuff, so if you think you have one, visit your physio. It’s important that you get treatment to alleviate pain, strengthen appropriate muscles and make sure your muscles are balanced so it doesn’t occur again.

Osteoarthritis

Often known as ‘OA’, Osteoarthritis stems from wear and tear on the shoulder joint. Your cartilage acts as a cushion between your bones, helping them to glide easily. OA destroys this cartilage, so that your bones rub against each other, instead of over the cartilage. This is painful and can cause swelling as well, making it difficult for you to move your arm. People sometimes say they hear a grinding or clicking sound when moving the shoulder.

Movement is medicine when it comes to OA, although there may be times when rest or modification of movement from aggravating activities is required. You can also use heat or ice, and anti-inflammatory medication might help. Your physio will also treat your shoulder, giving you exercises to both stretch and strengthen the muscles in and around the shoulder joint. In some cases, steroid injections might also be recommended.

 

These are just five common reasons your shoulder might be hurting – there are many more. Other reasons could include neck pain which presents in the shoulder, or a labral tear. If you experience any of these, reduce or stop the activity that is causing pain, and book in to see your physio for treatment. Trauma to the shoulder may lead to dislocation or a bone fracture, which will likely require an initial emergency department visit. Also keep in mind that pain in your left arm/shoulder (accompanied by chest pain) can also be a sign of more severe conditions, such as a heart attack. If you think you’re experiencing symptoms of a heart attack, ring 000 or go to the hospital immediately.

Pregnancy Related Pelvic Girdle Pain and Back Pain

What does pelvic girdle pain in pregnancy mean?

Pelvic girdle pain (PGP) in pregnancy can arise from the three main joints of the pelvis and the muscles, ligaments and nerves associated with these joints. There are two sacroiliac joints (SIJ) at the back of the pelvis. The SIJ exists between the sacrum and the side pelvic bone called the ilium. At the front of the pelvis is the pubic symphysis (PS).

A pregnant woman’s discomfort may come from the front PS and/or the right or left SIJ. It is possible for the pain pattern to shift day to day or week to week, where it may be just one sided, or it alternates, or the pain is only felt at the front or the pain is only at the back of the pelvis.

When only the pubic symphysis is involved the pelvic girdle pain is sometimes referred to as Symphysis Pubis Dysfunction (SPD).

Varying levels of pain can be felt in different areas, which may include the pubic symphysis, groin, lower abdomen, inner thigh, hip, buttock, outer thigh, entire leg or low back.

Pain may be constant or intermittent often described as an ache. Pelvic girdle pain can also be felt as a shooting/stabbing pain in the buttock, down the leg or at the front of the pelvis. Weight bearing on the leg/s may be quite difficult because of this pain experience.

Pregnancy pelvic girdle pain can occur early in the first trimester or at any time during the second and third trimesters.

What causes Pregnancy Pelvic Girdle Pain and Back Pain?

During pregnancy a combination of hormonal changes, altered posture and ineffective muscle support systems of the low back and pelvis may lead to feelings of discomfort and difficulty with walking and general movement. Hormonal softening of joint ligaments and muscle tissue means the joints and tissues of the pelvis and lumbar spine will be easily strained with repetitive activity, poor posture and incorrect exercise.  The pain occurs because the pelvic joints have difficulty transferring weight bearing forces through the pelvis due to the physical and hormonal changes in pregnancy.

Unsupportive muscle systems then overwork to try and hold the pelvis together, creating shortened, tight muscles with painful trigger points in the buttock, thigh, hip and lumbar spine. Pregnant women experiencing pelvic girdle pain will often speak of stiffness as well as pain.

What are the Symptoms of Pregnancy Pelvic Girdle Pain?

Symptoms of pelvic girdle pain in pregnancy can be a combination of the following:

  • Shuffling gait
  • Difficulty weight bearing on one leg
  • Difficulty climbing stairs
  • Pain turning in bed
  • Poor sleep with difficulty getting comfortable because of hip pain
  • Inflammation or swelling over the sacrum or pubic bones
  • Sciatic type pain down the leg
  • Pain with long periods of sitting or standing
  • Difficulty going from sit to stand
  • Increased discomfort with routine daily activities
  • Hip stiffness
  • Pelvic floor muscle weakness

Can Pelvic Girdle Pain appear outside of Pregnancy?

Yes, pelvic girdle pain can occur in the postnatal period and is often related to a woman experiencing a small amount of buttock or hip discomfort in the last weeks of her pregnancy. In this scenario, the pregnant woman puts up with the pain in her third trimester, but after delivering the baby her pelvic joints and muscles struggle with the increased lifting, bending and holding movements that are required with baby care.

Injury can produce sacroiliac joint dysfunction and pain at any time in a woman’s life. This SIJ dysfunction has the same symptoms as pelvic girdle pain in pregnancy. The type of injury producing pelvic girdle pain is commonly a fall and landing on one side of the body or buttock. The position of the sacroiliac joint surfaces can be upset in this injury, leading to dysfunction because the transmission of weight bearing forces through the pelvis is upset.

Hormonal changes in the menstrual cycle and at the time of menopause can create muscle imbalances and hip problems that produce a pelvic girdle pain picture.

Overtraining in the gym or in sport may also produce sacroiliac joint dysfunction and pelvic girdle pain, this being related to muscle imbalance and overworking muscle systems that are not supporting the pelvic joints.

What is the Role of Physiotherapy in Treating Pelvic Girdle Pain in Pregnancy?

A physiotherapy assessment is essential to determine the treatment approach and advice for women experiencing PGP. It is recommended that an experienced Physiotherapist treats your presentation. This means a physio who knows the relevance of the musculoskeletal changes occurring in pregnancy. The Physiotherapist must have expert clinical skills in treating pelvic girdle pain with manual therapy and exercise, along with giving the appropriate advice to you.

At Physiotherapy for Women a research based Pelvic Girdle Questionnaire is given to each pregnant woman presenting with PGP. This assists in giving the physio a picture of the level of pelvic girdle pain and dysfunction the client is experiencing. The response to the questionnaire becomes a clinical measure for the effectiveness of the physiotherapy treatment approach over several treatment sessions.

The physiotherapy evaluation is important to determine what pelvic joint, ligament and muscle tissue is not working properly with specific movement testing. This will determine the cause of your pain, stiffness or loss of movement. Specialised clinical tests will be performed to rule out any problems that may require further medical intervention.

Listening to your goals and what is important to you will determine the direction of the treatment program. Physiotherapy treatment for pregnancy pelvic girdle pain may include:

  • Manual therapy Massage, soft tissue and trigger point release for tight, sore muscle groups is a part of manual therapy. Correcting pelvic joint or SIJ alignment requires specific manual therapy skills, including muscle energy techniques.
  • Core activation Training of pelvic floor and transversus abdominis muscle activation is important in resetting a background of core muscle support around your pelvis and lumbar spine. Selecting the right positions for core exercise is necessary. Then progression of the exercise can occur with graded loading that is safe and appropriate for you.
  • Strengthening exercises Reducing ligament sprain and pain in your pregnant pelvis requires strengthening of weak gluteal, lower abdominal and pelvic floor muscles to improve stability of the sacroiliac, pubic symphysis and spinal joints.
  • Flexibility exercises Tight muscles often need to be stretched to improve your flexibility, but selection and timing of when these stretches start requires the skills of the physio. If an overworking muscle system is stretched too soon before a background of core muscle support is happening in the pregnant woman’s body, pelvic joint pain can increase.
  • Modalities To alleviate pain or to soften tight muscles prior to treatment or exercise, hot or cold treatments are often prescribed. Electrical treatments can also be a choice of treatment. Small ice packs placed over a painful pubic symphysis may be instructed by the physio as a home treatment.
  • Bracing Your physio may recommend wearing a pregnancy pelvic belt that needs to be correctly fitted to support the pelvic ring. Specific taping with either rigid tape or kinesiology tape may be chosen to better support the SIJ’s and dampen trigger point activity in muscles. Wearing pregnancy support shorts, such as SRC or Solidea, may be suggested to provide necessary pelvic and low back support in daily activities and at work.
  • Education Your physio will teach you postural correction, back support in sitting, how to improve your general movement approaches in daily activity and how to carry or lift light objects safely. This information will assist in making you feel more comfortable. Being encouraged to have a daily rest may also be advised.

 

The earlier you seek physiotherapy treatment for pelvic girdle pain symptoms the better it is for you. Treating the pelvic joint niggle or slight buttock/hip muscle ache is preferred, as you can take the physios advice home with you and make your pregnancy a happier time in general. Thinking pelvic girdle pain is simply a part of pregnancy and nothing can be done for this condition is incorrect. However, it is true that in severe cases of PGP in pregnancy women are unable to walk short distances without using crutches or a walking frame. So please be wise and take the healthy approach by seeking out the skills of Physiotherapists working with pregnant women.

Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Your pelvic organs include your bladder, bowel, rectum, uterus and vagina, which are supported underneath by your pelvic floor muscles.  The pelvic floor muscles extend from your pubic bone at the front to the tail bone at the back and to your sitting bones at the sides, like a trampoline. Connective tissue, fascia and ligaments also hold your pelvic organs in place. It will be helpful to follow this link to aid in understanding how the pelvic floor muscles support your pelvic organs http://www.thepregnancycentre.com.au/return-to-sport/articles/protect-your-pelvic-floor

Age, pregnancy, childbirth, vigorous high impact exercise, excessive lifting and constipation can stretch your supportive tissues.  If your pelvic floor muscles are also weak this may allow your pelvic organs to bulge down and prolapse into your vagina. Hormonal changes with decreased oestrogen in the peri and post-menopausal life stage can promote muscle weakness.

The name of the prolapse depends on the organ prolapsing. A bulge at the front of the vagina is usually called a cystocele. A bulge at the back is usually called a rectocele. When the uterus drops it to the vagina is a uterine prolapse.  Prolapses vary in severity from an internal bulge to bulging of organs outside the vagina to varying degrees.

anterior-wall-prolapse-copy

What are the symptoms of Pelvic Organ Prolapse?

Common symptoms may include one or more of the following:

  • Bulge or lump in the vagina
  • Heaviness or dragging in the genital area
  • Feeling of something falling out of the vagina
  • Feeling like you are not completely emptying your bladder or trouble starting the flow or weak stream
  • Feeling like you are not emptying your bowel completely
  • Sexual discomfort or reduced sensation
  • You may feel a bulge coming out of your vagina when you are cleaning yourself
  • Recurrent urinary tract infections

Some women will have a prolapse but will not have any symptoms

Who is at risk and how can pelvic organ prolapse be prevented

If you have family with prolapse, have given birth vaginally, are post-menopausal or have a history of constipation or heavy lifting you may be at increased risk of vaginal prolapse.  Consulting a pelvic floor physiotherapist for advice and to prescribe appropriate exercises may help reduce your risk of developing a pelvic organ prolapse.

How can Pelvic Floor prolapse be assessed?

If you have the above symptoms assessment usually requires an external and internal vaginal exam to assess where the prolapse is and to grade the severity.

How is pelvic floor organ prolapse treated?

When prolapses are moderate to mild the first line of treatment is non-surgical. This may include:

  • Individual pelvic floor training, prescribed by a pelvic floor physiotherapist. Training the pelvic floor muscles helps support the pelvic organs.
  • Lifestyle modifications, appropriate exercises and healthy eating
  • Using good bladder and bowel habits
  • Managing constipation
  • Pessary

If prolapse is severe or simpler treatments have not improved symptoms surgery may be considered.  Surgery attempts to repair the connective tissues, fascia and ligaments.  Be aware that surgery usually requires rehabilitation and long term activity modifications. Additionally 1 in 3 women that has prolapse surgery will prolapse again.

If you want to make an appointment or speak with one of our understanding, highly trained physiotherapists, please phone Physiotherapy for Women on (08)8443 3355.

Stress Urinary Leakage – Incontinence

Stress urinary incontinence is leaking of urine when sudden pressure is created in the tummy, for example when you cough, sneeze, laugh, lift, jump, run or bend over. The cause of stress incontinence is usually weak or injured pelvic floor muscles.  Hormonal changes at the time of menopause and aging connective tissue can also contribute to pelvic floor muscle weakness. The leaking usually occurs when the pressure from the tummy is stronger than the pelvic floor can resist. This means the pelvic floor muscle clamp and lift around the urethra (wee tube) is inefficient, resulting in urinary leakage.

Incontinence effects at least 1 in 4 women and although it is common it is not normal and it is not something you need to live with.  Pelvic floor physiotherapy is very effective in treating stress urinary incontinence with research indicating up to 80% cure rate.

It has been shown that 1 in 3 women are doing pelvic floor muscle exercise incorrectly.  Therefore it is so important to get a full assessment by a qualified physiotherapist when experiencing urinary leakage. At Physiotherapy for Women we will assist you with your pelvic floor problems to help reduce or stop urinary leakage, so you can live a happy and healthy life style.  We provide a relaxing environment where your privacy and comfort is maintained.

Phone or email us now for an appointment.  If you have any queries on bladder control or pelvic floor concerns we are happy to assist you.

Bladder Urgency

Bladder urgency is a sudden, urgent and at times uncomfortable need to empty your bladder immediately. It is often described by women as “a busting need to go to the toilet many times a day”. It may feel like your bladder is the boss and you have very little control.  Bladder urgency may be contributed to by the brain and nervous system being overly sensitive to sensations in the bladder. This is why you often feel busting even with small amounts of urine in the bladder. This urgency may result in incontinence (leaking urine) on your way to the toilet.

Urgency can be due to:

  • An overactive bladder that contracts when it should not
  • An overly sensitive bladder
  • Weak or damaged pelvic floor muscles
  • Poor toileting habits
  • Constipation
  • Overactive pelvic floor muscles
  • Overly sensitive nervous system, along with stress, anxiety and poor sleep.

Good bladder control depends on correctly functioning pelvic floor muscles and an awareness of how to activate and relax this system.  The pelvic floor muscles control the bladder, vagina and bowel openings. If the muscles are working incorrectly or are weakened or stretched, control and support of the surrounding tissues and organs are compromised.  The end result may be incontinence which is the uncontrolled loss of urine.  One in four women are affected by this embarrassing condition at some time in their life.

Urgency is a common condition effecting women of all ages. Onset is often during pregnancy, after childbirth or through menopause. Thinking that incontinence or poor bladder control is a part of aging or part of a woman’s life is unhealthy.  Those thoughts set up barriers for women to seek treatment and advice. Correct management of urgency can often greatly reduce or eliminate symptoms.

Bladder urgency requires a full assessment by a trained women’s health professional to work out what may be contributing to the problem. Management will address any pelvic floor dysfunction and will involve exercises, education and advise to treat other contributing factors.

At Physiotherapy for Women, only physiotherapists with post-graduate continence training will be treating clients presenting with poor bladder control. The importance of respecting privacy and providing a relaxing environment for treatment purposes is a feature of our physio health services at Physiotherapy for Women.

Phone or email us now for an appointment.  If you have any queries on bladder control or pelvic floor concerns we are happy to assist you.