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.

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.

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 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.

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.

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!

Tape has been used as a treatment tool for decades. There are many different types, each designed to aid the body in some way during the recovery period of an injury (anywhere from the onset of injury to return to sport training or match play). It can be used before, during and after activity. It is widely available, relatively cheap and is an excellent tool to use alongside other forms of treatment, including massage, joint mobilisation, needling and exercise therapy. A physiotherapist may even use it on your body even if you are not injured, in order to reduce the risk of one happening.

The reasons a physio may use tape are:

• To reduce pain
• To stabilise / support a joint
• To correct posture and increase awareness of a particular body part
• To aid in achieving efficient movement of a body part
• To prevent a joint from moving
• To reduce the risk of injury or re-injury
• To increase feedback to the brain of a particular body part
• To increase confidence in a person looking to return to sport / activity
• To reduce swelling of a particular body part

Types

There are several different types of tape. Some of the more commonly used types here at Physiotherapy for Women include rigid and kinesiology tape (aka K-tape). Read on to find out a bit more on these types.

Rigid tape

Rigid tape (aka sports or athletic tape) is an inelastic type of tape primarily used to provide stability at a joint. Joints that require stability may be those that move excessively, or where the integrity of the joint has been compromise. Like when you seriously sprain your ankle chasing your children playing tag or when enjoying a social netball match with your girlfriends.  In the ankle sprain a ligament can be overstretched or torn, making basic weight bearing activity such as walking very painful.  To assist the ligament to heal correctly, tape can be applied in a special pattern which provides a rigid barrier to specific movement which could further damage the ligament. The taping may be soon after the ankle injury (this depends on severity) or when your return to moving quickly and/or when you return to quick movements in a family situation or when back on the court. Rigid tape can provide support to the joint and give a person confidence to start using the joint as it should be, without fear of re-injury. This is usually a temporary treatment though as the aim of the physio and the injured person should always be to return to a pre-injury state, if it’s possible. In the unfortunate event that a person’s injury means they cannot return to a 100% pre-injured state and perform at a high level, tape is a cost-effective way of providing support needed to play, even if at a reduced intensity or level.

Here at Physiotherapy for Women, we are super conscious of what effect tape can have on a person’s skin. Some people are sensitive to the adhesive or glue that is used on the sticky side. And sometimes tape needs to be in place for many days at a time. For this reason, under-wrap was designed. Under-wrap is applied to the skin first to provide a barrier against the glue of the tape. The rigid tape is then placed over the top where its full effects can still be experienced. Your skin care is a priority of ours, so we always use under-wrap before applying rigid tape to an injured body part. We’ve got your back (or you knee)!

Other examples of injury where rigid tape may be used include knee sprains, pregnancy sacroiliac sprain, shoulder dislocations or ligament sprains, or in the treatment of plantar fasciopathy or a dropped foot arch.

Kinesiology tape (K-tape)

K-tape is an elastic type of tape that has several proposed uses. It molds to the counters of the body well and is designed to promote movement, rather than restrict it. K-tape may be applied to a body part to:

• Reduce pain and/or delayed onset muscle soreness (DOMS) following exercise
• Increase blood flow to, and drainage of fluid away from the body part
• Increase awareness of the body part to the patient
• To guide effective and efficient movement with minimal to no restriction

The increase of awareness of the affected body part is a particularly useful tool for us as physiotherapists when planning our treatments. After an injury, the intimate connection of the body part and the brain can become foggy. The brain may slightly lose its ability to know exactly where the joint is and what it should be doing. It sounds scarier than it is, but with exercise and rehabilitative treatment, this connection can be regained. K-tape is a great way of assisting with this, as the covering of the skin over the injured area provides extra input to the brain about what is going on at the joint(s). It’s complicated, but pretty cool huh?!

Another fantastic quality of K-tape following injury is its ability to assist the body in ridding fluid or swelling around an injury joint or muscle. The tape is applied in a special way which lifts the top layers of skin away from the underlying muscle to allow for greater flow of fluid… It can speed up the whole process considerably!

Ready for your dressing now?!

It depends completely on the type of injury and where you are in the recovery process as to which type of tape we choose to use on you. We will always discuss with you the benefits of tape so you can make an informed decision with us for your treatment and plan going forward. And don’t worry, we will avoid turning you into a mummy (often less is more with taping).  If you are worried about skin reactions we can trial small patches of several different tapes on your skin before doing a big taping of a body area.

If you’re keen to learn more, or find out if tape can benefit your recovery, just ask next time you are in for a treatment with us.

Diabetes in-depth

The main characteristic of DM is high blood sugar (aka hyperglycaemia). Sugar in the form of glucose is the body’s primary source of energy. The body gets glucose by breaking down carbohydrates from foods we eat (i.e. breads, grains, fruits and vegetables). Glucose is then distributed to all of the cells around the body via the blood. In order for our cells to reap the benefit of glucose, they require the help of a hormone called insulin to grab the glucose and take it into the cell. We get insulin from the pancreas, an organ found tucked away behind our stomach. In DM, there is a problem with the production of insulin in the pancreas. It either is not produced at all, or not enough good quality, usable insulin is produced. Without insulin, glucose in the bloodstream builds up and up, the body is not able to get the energy it needs, and this is a huge problem.

Types of DM

There are three main types of DM:

• DM type 1: This form of the disease is caused by an autoimmune response of the body. In simple terms, the body’s defence system sends in the cavalry and destroys the insulin producing cells in the pancreas. People with DM1 are required to inject a synthetic form of insulin regularly throughout the day using either a needle or pump mechanism. 

• DM type 2: By far the most common form of DM. One of three mechanisms exist… 1) The pancreas doesn’t produce enough insulin. 2) The insulin produced is ineffective. 3) The cells of the body do not respond to insulin in the correct way. In many cases, DM2 can be managed effectively by making lifestyle changes and without the need to have to inject synthetic insulin. However, some people require medication and may eventually need the help of insulin injections to effectively manage the condition.

• Gestational DM: Ladies… this one is just for us! Gestational DM may develop during pregnancy. The good news is that most cases will automatically resolve once your little bub is born. In this form, the blame doesn’t lie with the pancreas not producing insulin. Instead, hormones produced by the placenta during pregnancy block the effect of insulin, and the cells are not able to take up glucose. The pancreas will try to produce more insulin to fight the effect of these hormones, but as pregnancy progresses, hormone production ramps up and your poor little pancreas is sometimes unable to keep up. The result is gestational DM.

Signs and symptoms

Uncontrolled blood sugar levels can lead to the development of immediate symptoms including:

• Excessive thirst and hunger
• Increased urination
• Tiredness and fatigue
• Headaches

Over a prolonged period, if blood sugar levels are poorly managed, it can result in damage to blood vessels throughout the body. Common long-term effects of uncontrolled diabetes include:

• Damage to nerves that affect the limbs, including the hands and feet
• Kidney disease and failure
• Blindness
• Heart attack
• Stroke
• Ulceration of the skin that take a long time (or are unable) to heal
• Skin infections
• Weight and mood changes

During pregnancy, the mothers blood sugar levels are closely monitored, especially if the mother is at high risk of developing gestational DM. Those at greater risk include overweight, older women, and those with a family history of DM. Uncontrolled gestational diabetes can lead to a baby with a high birth weight, and needing help to stabilise their own blood sugar levels immediately following birth.

Our role

Although much of the diagnosis and medical management of DM will be handled by your doctor, we as physiotherapists have a very important role to play. Exercise is a key player in the management of type 2 diabetics especially. Exercise helps to improve how efficient your insulin works, which helps you to control your blood sugar levels. Exercise will also help with weight management, reducing the risk of cardiovascular problems such as heart attack and stroke. If implemented in a controlled way, there is good evidence suggesting exercise, as well as a super clean and controlled diet, can reduce the impact, delay and even prevent the onset of DM type 2. As well as helping you implement a healthier lifestyle overall, we can also help in the following ways:

• Screening your body for signs of nerve and blood vessel related problems
• Educating you on what to look out for regarding skin issues
• Screening you for associated conditions, including frozen shoulder, carpal tunnel syndrome and other musculoskeletal problems
• Reminding you to get your eyes tested
• Screening and monitoring for signs of depression (which is strongly associated with DM)

Our main goal, whether you are pregnant or otherwise, is to encourage you to be active on a daily basis and provide education on what is important to you from an individual perspective. If you need some help to get your head around diabetes, and especially the role of exercise for its management, then please get in touch today.

Self-care is a vital part of life. We know it’s a bit of a cliché, but if you don’t look after yourself first, how can you look after others, or work, or do anything? You’d be surprised how little time many of our patients spend looking after themselves. It often takes being in pain for someone to realise that something has to give, and change is needed. It’s also regularly the case that someone is stressed, exhausted and moving poorly (and not enough too!), which all play a role in why they have pain. And this is where we ask the questions about self-awareness and attitudes towards themselves.

Let’s give you an example… A working mum comes to us for help with neck and shoulder pain. She has two children, one at school, one at daycare, and her and her partner work a job each. The week is full of running around organising the kid’s drop-offs and pick-ups, working, cooking, cleaning and washing. Weekends are full of kids sports and visiting relatives. Sound familiar? Where is the time for anything else? For many it’s a source of stress in itself. Being time poor is a huge factor in why people fail to look after themselves and end up in pain (and stay there). For this working mum, her pain is now affecting her ability to ‘do’ life. The really hard thing is, something has to give if the cycle is to be broken and for her pain to become a thing of the past. She needs to prioritise self-care and learn that it is OK to spend time on herself. It is pivotal that she does, so she can get back on track ‘doing’ life.

As her physiotherapist, our primary goal is to get her out of pain. Our second goal is to keep her out of pain. And this is where advice on lifestyle, exercise and moving well (and often) comes into play. One of the hardest jobs we have as a physio is educating people on how to change their lives, so they can work towards preventing injury rather than waiting for it to happen and then seeking help. In the case of the working mum, it involves helping her change her attitude towards self-care to ensure she is running at 100%, so she can give everything she needs to her family and work. Some of the topics we might discuss with her and suggest changes to may include:

• Exercise — a must for all humans. Our important bodily functions rely on us moving regularly. Try taking a walk in the evening once the kids are in bed (get your partner/family member/friend to watch over them). It will allow you to unwind from the days’ events whilst giving your body some valuable movement. Alternatively, reserve one evening in the week or weekend to attend a yoga or pilates class. Or think about what you can do at home (incidental exercise while doing mundane tasks, or a nightly 20 minutes of exercise in the lounge room or on the deck!)
• Diet — a sticking point for time-poor people, but eating a diet rich in fruits, vegetables and other nutritious foods will keep your energy levels pumping and ready for everything. Diets high in fast or nutrient poor food will leave you sluggish and tired. Try packing your own healthy lunch and snacks, when you pack your child’s lunchbox!
• Meditation or mindfulness — a great way to have you time. It only requires 10-15 minutes a day and is a fantastic way to unwind and clear the mind. It takes practice but can be very beneficial to easing stress. We can advise on where to get started.
• Keep a gratitude diary — every morning when you wake up, immediately write down 5 things you are grateful for. While you can pop it in the ‘notes’ section on your phone, try opting for a pad and paper on your bedside table. It helps give you focus on what’s important to you. This is great motivation for keeping yourself healthy, happy and grateful.

There are many other areas we may discuss with you. We won’t pretend it’s easy to make these changes, but we are here to help guide you through all of it one bit at a time. Our main message here is that whilst we appreciate you have many responsibilities and important things in your life, we would like you to make YOU a high priority. Yes, this is us telling you to read that book, take that bath and take up that hobby you’ve always wanted to! Be important to yourself and make 2020 a year for self-care.