Pelvic pain in pregnancy
You’re growing a human – a tiny person that will change your life and body forever. Of course, we expect changes and some discomfort as our body adapts to our growing belly, but seriously – this pelvic pain is another level! But what is it?
Pelvic pain during pregnancy can be from a range of things, but Symphysis Pubic Dysfunction (called SPD) is a pretty common cause. It can also be called Pelvic Girdle Pain (PGP). SPD & PGP can be explained as a bunch of signs or symptoms relating to pain in the pelvic area and lower back. It also includes musculoskeletal pain radiating to the upper thighs and crotch area.
So why does this happen? At certain stages throughout pregnancy, your body produces the Relaxin hormone, which relaxes the ligaments, producing more movement in the pelvic region to allow for expansion, not just for the baby to grow, but ultimately for the delivery of bub. This relaxation of the pelvic ligaments leads to increased joint mobility. Where the ligaments usually provide support to the joints, the muscles now have to step in and help stabilise them – they get overworked and that’s when the pain starts. Symptoms of SPD can vary widely – from mild discomfort to severe pain that can see women bed-ridden or needing walking aids.
It’s hard to say how many women actually experience SPD in pregnancy. Research suggests it’s somewhere between 4 – 84%! The variation is because of the wide range of definitions and diagnosis of SPD, as well as differing research cohort selections. However research also suggests that the incidence rate increases during the later stages of pregnancy. So what influences its onset, and how do you treat it?
Influences of SPD
While there is no way of accurately predicting which women will experience SPD, common factors that might influence the onset include women:
- who have a history of low back pain or trauma of the back or pelvis
- with an increased number of previous pregnancies
- who partake in physically demanding work
- with a high Body Mass Index (BMI)
- experiencing emotional distress
- who smoke
There isn’t one particular treatment, but common treatments include:
- Physiotherapy: Research suggests that women receiving physio treatment reported less pain in the mornings and evenings than those women who didn’t have treatment.
- Acupuncture: As with physio, acupuncture helped with pain, and functional movement.
- Pelvic support garments: Research suggests that these improved women’s ability to do things like walk and perform basic movements.
- Exercise: This can also help improve functional movement and help decrease pain, but ensure you visit your physio first, to understand what exercise is right for you, your condition and your pregnancy.
- Rest: It’s not always possible to rest completely but try to limit doing the activity that causes the most pain, avoid standing on one leg, limit weight-bearing exercises like climbing stairs or standing for long periods of time.
Pelvic pain in pregnancy is common. If you are experiencing pelvic pain, your first step is to see your physio to understand what it is and how to treat it.
In the meantime, try changing your routine by sitting down to get dressed and rotate those stilettos for low heels or flat shoes. One of the best things to try is pretend you’re always ‘walking around in a pencil skirt’ – take small steps, and when getting out of the car, slide your bottom 90 degrees and get out with your legs together. Heat might also provide some temporary relief.
To help you see an end point of your pain, know that SPD usually sporadically fixes itself after birth. And of course, holding that tiny human in your arms makes up for the grief (and you can remind them about the pain they put you through for years to come).
Your 2019 self-care bucket list
“New Year, new you” is often the slogan thrown around at this time of year, but we’re changing that. We think you’re pretty awesome, so it’s not about a new you, it’s about taking the time and becoming a better version of you.
Women, traditionally, are the care givers – the women’s role used to be looking after the house and children (and husband), while hubby made the money. Of course, over time, the world has progressed, and we do it all. And while there are absolutely amazing husbands and fathers out there that are hands on, women still tend to feel the pressure of working (however you’d like to define it), running a house and looking after children. And with everything going on around us, we put ourselves and our wellbeing at the end of the priority line. And that has to change, so for 2019 we’ve created a short self-care bucket list, for you and all the women in your life!
- Accept that self-care is not selfish
Taking time for you needs to be a priority. Whether that’s booking a hair appointment, reading a book in the bath (without interruptions), or going for a walk or swim, you need to do it – for your wellbeing, and the wellbeing of your family! When you schedule in you-time, it gives you the ability to relax, reflect and Zen-out. It gives your mind a break from the daily rigmarole of life. Don’t think of it as selfish – it’s actually the opposite. Taking self-care time makes you less stressed, more relaxed and happier – it makes you a better version of you, and therefore a better mother, wife, daughter, sister and friend.
- Practice positive posture
Think about the way you sit, stand and go about things in your daily life – even holding your baby! Correct posture not only helps with aches and pains, and reduces the risk of injury, it can also help with improving oxygen and blood flow.
Also try to avoid sitting for long periods – research shows that sitting for long periods can have a negative effect on your body and can lead to lower back pain, as well as the onset of chronic diseases such as obesity, diabetes and cardiovascular disease. Avoid sitting for longer than 30 minutes at a time, and when sitting, change positions regularly.
If you sit at a desk for the majority of the day, check out our diagram and make sure you’re set up correctly. Also make sure you break every 30 minutes – this could simply be standing up and doing a simple chest stretch, walking to chat to a colleague instead of phoning, or invest in a standing desk so you can alternate between sitting and standing.
- Move more
Doing physical activity is not at the top of everyone’s priority list but staying active is so important – it is recommended that we do a minimum of 30 minutes per day. But now here’s the twist!
If the word ‘exercise’ makes you cringe, start small. Start by counting your ‘physical activity’ minutes. Vacuuming, park your car at the back of the car park to walk to the shops, do squats while you brush your teeth. If you can start including incidental activity while you’re doing your daily tasks, you’ll find it much easier to increase the amount of physical activity you undertake. You’ll start to have more energy, and then all of a sudden that 15 minute ‘me-time’ walk becomes a blissful idea, then an action. A couple of weeks later it has turned into a half-hour ‘me-time’ walk, because you simply have to finish that podcast! So, move more but start small!
- Make meditation moments
Keeping healthy isn’t limited to food and exercise – it’s also about your emotional and mental health. When you’re swept up in the craziness of school drop-offs, work, events, and children’s extra-curriculars, a great way to calm the mind is meditation. Meditation helps reduce stress, strengthen your ability to focus and can assist in getting a good night’s sleep.
You don’t have to be a yogi or hippy, nor do you have to sit cross-legged on the floor. Meditation attracts many people because it’s flexible and versatile – you can do it anywhere at any time. Try deep breathing for 10 mins before you sleep, have a relaxing bath, or even sit in your car while your child is at dance lessons or football practice, close your eyes and let your mind slow down for ten minutes – bring your mind to the present moment and just breathe.
You are important, so this year, let’s make a pact that we will put self-care as a priority. If we take better care of ourselves, we’ll be better versions of us, and a better mum, wife, sister, daughter and friend. Start small and commit to your self-care bucket list!
If you’re taking steps to implement this bucket list, we’d love to know what you’ve done, and with your permission, share it with our clients to inspire and encourage others to prioritise their self-care journey. Please send your stories and/or photos to us at firstname.lastname@example.org or post them on our Facebook page www.facebook.com/physiotherapyforwomen.
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.
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 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.
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.
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.
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.