Pregnancy Related Pelvic Girdle Pain and Back Pain

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. It may be felt as pain on one side or it can alternate.  The pain may be felt at the front or it occurs only at the back of the pelvis.

When 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 you the appropriate advice. This is so important in helping a woman feel better within herself.

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, 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.

Pregnancy and Postnatal Physiotherapy

Reasons for aches and pains in the Childbearing Year

In the child bearing year many musculoskeletal changes occur within the women’s body. It is important to respect these changes during pregnancy, post-delivery and into the postnatal period. The pregnancy softening hormones continue to have an effect on joint tissues for some months postnatally.

Pregnant and post-natal women commonly experience fatigue. When you feel tired, muscle systems do not provide the usual support of joints and soft tissues. This results in movement patterns being often poorly performed and posture becomes sloppy. Repetitive movements of bending, lifting and carrying an increasing weight is also a daily challenge. These physical changes and challenges may place strain on tissues, leading to pain, tightness and movement difficulties.

Common Pain Complaints in the Pregnancy/Postnatal Period

Skilled physiotherapist’s, who have a special interest in women’s health, are trained in treating common pregnancy and postnatal complaints.

These may include:

• Back pain and sciatica
• Pelvic girdle pain, sacroiliac joint, pubic symphysis, coccyx pain)
• Buttock muscle/piriformis pain
• Headaches and neck pain/stiffness
• Shoulder and mid back pain
• Movement difficulties (walking, sit to stand, turning in bed)
• Carpal tunnel syndrome, wrist pain
• Pelvic floor weakness (poor bladder/bowel control/prolapse)
• Abdominal muscle separation and bulging (rectus abdominis diastasis)
• Post caesarean pain (after healing)
• Postural problems and pain
• Thumb/wrist pain (De Quervain’s tenosynovitis)
• Breast engorgement and mastitis

Physiotherapy Treatment Options

At Physiotherapy for Women our physiotherapist’s listen, assess, treat and educate pregnant and postnatal women. Having provided Pregnancy and Postnatal Physiotherapy Services to Adelaide women for over twenty years, we have the knowledge and skills to select the physiotherapy treatment option appropriate for each presenting condition.

The aim of physiotherapy is to gently restore balance, strength and flexibility to your body, selecting techniques that are right for you. Some of the treatment options we may use include:

• Joint and spinal mobilisation
• Massage techniques
• Exercise prescription
• Corrective taping and strapping
• Core and pelvic floor muscle training
• Clinical Pilates
• Heat and cold therapy
• Patient education
• Ultrasound
• SRC shorts/leggings
• Splints and support

Physiotherapy is a great way to reduce painful symptoms, feel more mobile, be flexible and comfortable in your movements, strengthen your body and minimise the reoccurrence of injuries. This means you can stay active during your pregnancy as well as optimise labour and your postnatal recovery.

Healthy Breathing and Physiotherapy

Healthy Breathing and Physiotherapy

Breathing is our life force, but how often do we spend any time thinking about this vital process. Do we know how poor breathing can create pain that may eventually require physiotherapy?

A good breathing pattern uses the diaphragm, which is the muscle that separates your chest cavity from your abdominal cavity. The diaphragm is also a core stabilising muscle of the trunk.

Healthy breathing has depth, fullness and freedom. The cycle of in and out breaths are not controlled. They happen naturally. The abdominal muscles relax with a diaphragmatic in breath, allowing the belly to become round. On the breath out, the diaphragm relaxes and the belly flattens.

Unhealthy breathing is shallow, where upper chest movement takes over from diaphragmatic movement.

Ineffective breathing patterns have become a part of our busy, modern life styles. Constant demands and daily stresses encourage our primitive fight-flight mechanism to be permanently switched on.

This mechanism is necessary when we are exposed to a threat or perceive danger. Our human body responds to the stress with:

• Shallower breathing
• Breath holding
• Faster breathing pace

Living with ineffective breathing patterns is energy sapping. Upper chest breathing and breath holding encourage the wrong muscle systems to be working. This leads to musculoskeletal changes in the neck, ribcage, shoulders, mid back, low back, and pelvis.

Over time the musculoskeletal changes to muscles, joints and nerves of the upper trunk, spine and pelvis promote poor posture and this leads to weakness and pain in different parts of the body.

Therefore, many conditions presenting for physiotherapy, may have unhealthy breathing patterns being one of the causes creating or adding to the problem.

Physiotherapists working in women’s health often need to include breathing awareness into their treatment program for some of the following conditions:

• Headache, neck and shoulder pain
• Pelvic floor muscle weakness, urinary stress incontinence and prolapse
• Rib and mid back pain
• Back and sacroiliac joint pain
• Hip and buttock pain
• Pelvic pain

A Physiotherapist can provide you with proactive treatment, strategies and advice where healthier breathing patterns may be an important option for you.

Tennis Elbow

What does Tennis Elbow mean?

Tennis elbow is a painful condition affecting the outside part of the elbow. This area is called the lateral epicondyle and so the medical term is lateral epicondylitis. Tennis elbow is usually caused by overuse of the forearm. The outer elbow tissues become inflamed. This involves wrist and elbow extensor muscles being overused in repetitive movement and/or sustained postures. Many forearm muscles attach at or around the lateral epicondyle so when they are overused they pull too much on the elbow and make it sore. Patients typically develop this condition in association with activities involving repeated wrist extension against resistance or from activities involving repetitive or forceful gripping of the hand. This includes sporting activities such as tennis and squash, manual work such as gardening, painting, cleaning, sewing and knitting or working at a computer.

What are the symptoms of Tennis Elbow?

Common symptoms of pain, stiffness and inflammation occur at the outer elbow.  Pain can be constant or it just comes and goes with particular wrist and elbow movements. The elbow and forearm pain is often aggravated with grip, lift and twist activities. Even a simple activity of holding a pen and trying to write or turning a door handle can be uncomfortable.

Pain and tenderness is usually felt on the outside of your dominant elbow and into the upper forearm. The pain is often aggravated by wrist movements such as gripping, where the use of inflamed forearm muscles and tendon tissues near the outer elbow hurts. Knocking the outer elbow against furniture may produce sharp, intense pain.

Most cases of tennis elbow settle well with appropriate physiotherapy. This requires careful assessment by the treating physiotherapist to determine which factors have contributed to the development of the condition. The assessment findings determine a treatment plan which will focus on correction of the factors causing the pain. When simple, everyday tasks or sporting activity continues to be painful then elbow condition can be very frustrating.

Physiotherapy Treatment for Tennis Elbow

Physiotherapy treatment for lateral epicondylitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Physiotherapy treatment may be a selection of the following:

• Soft tissue massage and myofascial release
• Electrotherapy
• Taping
• Bracing
• Joint mobilization
• Dry needling
• Ice or heat treatment
• Progressive exercises to improve flexibility and strength
• Activity modification advice
• Technique correction
• Education
• Anti-inflammatory advice
• Devising and monitoring an appropriate return to sport or activity plan

How long will my tennis elbow last?

With appropriate management, most minor cases of tennis elbow that have not been present for long can usually recover within a few weeks. In more severe and chronic cases recovery can be lengthy process and may take up to 6 months in those who have had their condition for a long period of time. For women experiencing tennis elbow symptoms, family and work activities can become quite difficult. Early physiotherapy intervention is therefore vital to hasten recovery and enable you to use your arm in everyday activity with comfort.

When do I use Heat and when do I use Cold

This is a question frequently asked by our clients in both consultations and exercise classes at Physiotherapy for Women. Hot and cold therapies have been used for centuries as healing modalities to promote health and well-being. Our physiotherapists will help you in your choice of thermal energy (hot or cold) with the following answers.

Cold Therapy Applications

When is an ice pack best used?

During the early acute phase of injury (first 24 to 48 hours) cold therapy or cryotherapy is a common choice. At this time of tissue trauma, cold can be applied in the form of ice packs, cold towels, ice compresses and iced water baths. Inflammation, swelling and muscle spasm are features of acute trauma.

What effect does cold have on tissue?

Cold therapy assists in reducing swelling by narrowing the blood vessels and decreasing blood flow to the injured tissues. As skin temperature is reduced, large diameter nerve fibres are stimulated. This leads to a local analgesia or numbing of tissues, which helps in pain control.

How long is an ice pack applied for best effect?

Apply the ice pack or cold compress to injured tissue for 15 to 30 minutes maximum. Do not apply again for a minimum of 2 hours. Usually, 3 to 4 applications of cold in a 24-hour period are advised.

What are the safety issues with cold therapy?

Avoiding “ice-burns” to skin is essential. It is always necessary to place a damp cloth between the skin and the ice pack. Never place a cold pack directly on the skin.

Do not use cold therapy in the following situations: open or infected wounds; cardiac issues; skin numbness; poor circulation; Raynaud’s disease; dermatitis or eczema flare-up; hypersensitivity to cold temperatures.

Heat Therapy Applications

When is a hot pack used?

The application of heat can be beneficial when the acute phase of injury (after 48 hours) is over, or when chronic soft tissue and joint pain and tightness are being treated. Heat can also be used before stretching, physical activity, soft tissue treatment or massage.

Heat can be applied in the form of heated gel, grain or heat-bead packs, electric blankets and pads, a warm bath, spa or sauna.

What effect does heat have on tissue?

Heat therapy assists in promoting healing, reducing long standing inflammation, decreasing muscle spasm and pain, enhancing blood flow, muscle flexibility and joint motion.

Heat increases blood flow to tissues by dilating blood vessels. This assists in delivering oxygen and nutrients to the tissue cells, removing cell waste products and promoting tissue healing.

Relaxation of muscles and the nervous system is enhanced in most people when warmth or heat is applied.

What are the safety issues with heat therapy?

Always protect skin from heat burns by placing several layers of towelling between the skin and hot pack.

Never lie down or fall asleep on a hot pack as both situations increase the chance of skin burn.

Application of a hot pack should be for 15 to 20 minutes.

Discontinue heat treatment if there is an increase in discomfort.

Maintain hydration by drinking water before and after immersion in baths, spas or saunas.

Pregnant women need to avoid immersion in hot baths, spas and saunas.

Very young and people who are elderly or frail need to be monitored for the entire time of heat therapy. Avoid warm water and saunas with these age groups.

Avoid heating in the following situations: acute injury or tissue trauma; open or infected wounds; swelling; severe bruising; areas of skin numbness; peripheral vascular disease; diabetes; poor circulation; poor thermal regulation; abnormal tissue and tumours.

Common Clinical Examples Using Heat or Cold

Pregnant women experiencing pubic symphysis pain often feel relief with a small ice pack placed on a moist flannel over the pubic bone.

Gluteal or buttock / hip muscle pain can be soothed with a hot pack and protective cloth placed over the top buttock muscle area in side lying.

Strained ankle or knee joints which are swollen and painful, will benefit from an ice pack application with protective moist cloth.

Tight shoulder and neck muscles related to holding and feeding a baby will benefit from a hot pack applied to the top shoulder and neck muscle area.

Our well-trained Physiotherapists can assist you if you still feel unsure as to what to do. Phone our friendly receptionist on 84433355 and make an appointment in our women’s health physiotherapy clinic.

Our greatest asset – movement!

If you’re going to jump on the movement train and try to increase your exercise this year, that’s a great aim, and we applaud you for it. Movement is key to everything we do, and as humans we need to move often in order to stay healthy. Moving often is very important, but we must also move WELL in order to get the most out of our bodies and be truly healthy.

Why is movement so important?

Our bodies are designed to move. Not only do we need to be able to physically move from place to place to carry out our daily tasks, but the insides of our bodies also rely on our movement to function properly. We’ll explain more, but first have a think about what it would be like to be unable to move. Without movement, we cannot reach for the box of tissues, kick a ball, blink or swallow. It’s easy to take it for granted, until you no longer have it. For some people in this world, having a lack of, or inability to move is a reality. There are conditions which change the way we move, or stop it altogether. Neurological conditions such as motor neurone disease, Parkinson’s disease and progressive supranuclear palsy are examples of progressive conditions that alter a person’s ability to move. As conditions progress, a person eventually requires help with daily activities, including toileting, dressing and eating, to name but a few. Hopefully this puts into perspective how important movement is, and how those of us fortunate enough to be able to move should make it our duty to move often, move well and make the most of life.

Benefits of moving

The benefits of regular movement include:

• Improved muscle and joint function: Movement is pivotal for our muscles and joints (and other body tissues) to remain fully functioning. If we want our muscles to get stronger, we have to contract and relax them over and over. Movement also helps to keep a steady production of fluid that nourishes the insides of our joints.
• Reduced pain: This is where moving well plays a big role. Our body systems have to work in unison in order for our movements to stay efficient. As soon as something in the chain begins to fail (e.g. muscle injury, joint restriction), our movement becomes inefficient and this paves the way for pain to develop. Following injury, we need to retrain our movements to a more efficient level in order for pain to disappear for good.
• Improved mental health: Movement in the form of exercise is a great way to keep your mental health in check. When we move, our body releases hormones that make us feel good. Endorphins (known as the happy hormones) are hormones that are released when we exercise. Regular movement equals regular release of hormones, and if you feel good, your mind remains clear, your motivation levels increase and your concentration levels improve. You become a more productive person, and you feel great for it. The world becomes your oyster!
• Improved circulation of fluids around the body: Our body relies on movement to help with the flow of different fluids around the body. Our lymphatic system (our bodies defence and waste disposal system) relies almost completely on our movements and muscular contraction in order to pump lymphatic fluid around the body. We also need to move to help pump blood from our limbs back up to the heart.
• Improved digestion and regulation of bowel movements: Moving helps our digestive system function more efficiently, by aiding with passage of food along the digestive tract and out again when we need to open our bowels. Movement is one form of treatment for constipation!
• Improved sleep: Regularly pushing our bodies during exercise can help increase the amount of deep sleep we get each night. Our bodies need this to repair and rejuvenate for the next day.
• It helps us to remain independent beings: As we have already mentioned, when we lose the ability to move, we become dependent on others around us to help us get through each day. Working on your body every day, ensuring you are moving well and often, will help you to maintain independence into your latter years. 

What happens when we don’t move?

It seems pretty straight forward that if we don’t move regularly, we are leaving ourselves open to a poorer functioning body. Essentially, the reversal of all the good things mentioned above:

• A weak body: If you don’t use it, you lose it! Lack of movement leads to weakened muscles and bones, stiff joints, and an increased risk of injury.
• Increased pain and swelling: Poor movement patterns lead to injury and pain. Lack of movement can also cause fluids in the body to pool in the extremities, leading to swollen limbs.
• Increased rates of depression and low mood: No movement means we don’t get that regular boost of the happy stuff. Over time this can lead to low mood and an increased risk of developing depression.
• Increased weight gain: Lack of exercise is a big risk factor for becoming overweight and developing many other related conditions including diabetes, high blood pressure and heart disease. People who move less and are overweight also at higher risk of becoming constipated.

Need help?

Looking to make some changes? We’d love to help you get where you want to be. Come and see us today, and we can look at you move, pick out what needs working on, and set you the task of putting it right. Don’t take movement for granted, it is a gift. Let us help you move well each day so you can keep your body functioning, your mind stimulated, and life good!