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Back pain in pregnancy

Pelvic Girdle Pain - What is PGP?
As many as 50% of women experience PGP during pregnancy. Happily, 90% of women recover from PGP within 12 months of having their baby. However, up to 10% of women can continue to have significant PGP and disability 2 years post-birth.


PGP refers to pain felt either in the back of the pelvis, on one or both sides and/or pain over the pubic joint. Pain in generally located between the top of the pelvis and the bottom of the buttocks. Pain may be referred into the buttock and/or down the leg, so it’s often confused with sciatica.

 
PGP involving the pubic symphysis joint can also refer pain to the groin, inner thigh, lower abdomen and vaginal area. 


PGP is a condition often misdiagnosed, misunderstood and poorly managed.


What causes PGP during pregnancy and after having a baby?
During pregnancy there are many changes that occur to your body that change the way it works. There are obvious changes that include:
·      Your tummy growing, which stretches your abdomen and stomach muscles
·      The weight of your baby sitting on your pelvic floor muscles throughout the pregnancy, providing a slight stretch to them 
·      Your centre of gravity, or balance point, moving forward as your tummy grows, which adds increased load to your back and challenges your balance

Less obvious are the hormonal changes that occur, right from the first trimester, which changes the ‘stretchiness’ of your ligaments. Relaxin is one of the hormones responsible for this increase in ligament laxity, as it changes the collagen structure of your connective tissue (which makes up ligaments). Connective tissue, including ligaments, helps control your joints and support your pelvic floor muscles.


Joints rely on your muscles to control their movement, helped by the ligaments around the joint. They have a good ‘job-sharing’ arrangement to allow work done by each component to give good movement control around the joint. When you become pregnant, the ligaments become stretchy, and the muscles need to work a little harder to maintain good control of the joints. 


The joints of the pelvis have very little, almost imperceptible movement in them when you are not pregnant. When you are pregnant this movement increases and although extremely small, it can be double the movement that was present prior to pregnancy. 
If the muscles are doing their job properly, then they work a little harder and good movement control is maintained. However, it is very common in pregnancy for the muscles not to recognise the need to change the way they work. This leads to poor control of the extra movement available to the joints, stressing the ligaments and resulting in inflammation and pain. 


It is very similar to walking over very rocky, uneven ground, with your ankles rolling more than they usually do, pulling on your ankle ligaments – this would result in inflamed and sore ankle ligaments. If you have PGP, when you have been walking around your pelvic joints may be sore, as they have experienced the same kind of stress. 
The joints of the pelvis transfer the load of our body weight from our legs to our trunk, and then to the other leg as we walk around. Higher loads, such as carrying a weight (toddler, shopping) or jogging/running significantly increases the difficulty for your joints to do this load transfer wit good control. As we have already discussed, poor control generally results in pain! As your tummy muscles stretch throughout pregnancy, and the weight of the baby increases on your pelvic floor muscles, it is harder for the muscles to tighten and support the pelvic joints, and this too can contribute to poor control of the pelvic joint movement, and increased pain. 

FAQ's

Should I stop exercising?
Initially you may need to stop exercising while your pain settles, but it is important that you re-commence exercising as recommended by your physiotherapist. Doing no exercise is as bad as doing the wrong exercise when you have PGP. You become deconditioned, and the muscles you need to help control your pelvic joints are less able to work for you.

What exercise can I do?
When your pgp is bad, walking is often not the best exercise. Swimming, exercise bike, and specific physio run pregnancy exercise classes are all ways for you to be able to maintain your cardiovascular fitness during pregnancy, and in the post natal period if you have PGP.
We specifically recommend physio classes during this time, as the physio will be able to modify the class for you if there are exercises in the class that are not PGP “friendly”.

What about Clinical Pilates?
Clinical Pilates is a method of exercising that targets your deep postural muscles, training them to work better to control your lumbar spine and pelvic joints. This is treating “the cause” rather than just treating the symptoms of PGP. Clinical Pilates is individually prescribed exercises, after a full assessment, by a physiotherapist with Clinical Pilates training. It is not a generic Pilates class where everyone does the same exercises and highly recommended for those with PGP.
 

Pregnant and with back pain?? You don't need to suffer. We can help settle the inflammation and gain back some control of your pelvis.

Book an appointment with Mosman Women's Health Physios today on 9968 3424 or online www.squareonephysio.com.au

July 8, 2018 0 Comments

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  • Back pain in pregnancy
  • Pelvic Girdle Pain - What is PGP?


    As many as 50% of women experience PGP during pregnancy. Happily, 90% of women recover from PGP within 12 months of having their baby. However, up to 10% of women can continue to have significant PGP and disability 2 years post-birth.
    PGP refers to pain felt either in the back of the pelvis, on one or both sides and/or pain over the pubic joint. Pain in generally located between the top of the pelvis and the bottom of the buttocks. Pain may be referred into the buttock and/or down the leg, so it’s often confused with sciatica 
    PGP involving the pubic symphysis joint can also refer pain to the groin, inner thigh, lower abdomen and vaginal area. 
    PGP is a condition often misdiagnosed, misunderstood and poorly managed.


    What causes PGP during pregnancy and after having a baby?
    During pregnancy there are many changes that occur to your body that change the way it works. There are obvious changes that include:
    ·      Your tummy growing, which stretches your abdomen and stomach muscles
    ·      The weight of your baby sitting on your pelvic floor muscles throughout the pregnancy, providing a slight stretch to them 
    ·      Your centre of gravity, or balance point, moving forward as your tummy grows, which adds increased load to your back and challenges your balance

    Less obvious are the hormonal changes that occur, right from the first trimester, which changes the ‘stretchiness’ of your ligaments. Relaxin is one of the hormones responsible for this increase in ligament laxity, as it changes the collagen structure of your connective tissue (which makes up ligaments). Connective tissue, including ligaments, helps control your joints and support your pelvic floor muscles.

  • Tiered Pricing Structure
  • Last month we welcomed Sol into the Titled Physio fold after she completed her Masters in Musculoskeletal Physiotherapy.
    SquareOne now have 5 Titled Physios - with only 1500 in Australia we sit well above the average for your average Physio clinic! (FYI -there are only 10 at the Australian Institute of Sport)
    Any wonder SquareOne continues to be the preferred Physio provider for Mosman and surrounds. 
    On 1st July we will move to a tiered pricing structure for our Physiotherapy consults to reflect the extra knowledge, expertise and case management you receive when seeing one of our Titled Physios. 

  • Runners Knee
  • "Running will ruin your knees," a phrase I’m sure we have all heard. Despite what your well-meaning but potentially ill-informed neighbours, co-workers, and relatives may have told you, there's no evidence that regular running damages knees.

  • Menopause, Exercise and Physio
  • Whilst menopause comes with many (not so pleasant) symptoms, the great news is that you can help manage many of them with exercise.
    Exercise has many benefits post menopause including maintaining and improving:
    • Muscle strength
    • Bone density
    • Mobility
    • Joint flexibility
    • Posture
    • Balance
    • Mood and general wellbeing


    There are many different types of exercise so you should choose something that you enjoy, fits in with your lifestyle and helps manage your individual symptoms.
    Types of exercise:
    Aerobic exercise: This type of exercise works your heart and lungs, and is also important to prevent or manage heart disease, high blood pressure, high cholesterol and high blood sugar. This is any exercise that gets you huffing and puffing including activities such as cycling, swimming, tennis and gardening. It is important to avoid high impact activities such as running and jumping to protect your joints and pelvic floor as these are weaker post menopause.


    Flexibility: Stretching and gentle respective movements increase the length of your muscles, resulting in improvement in your range of joint movement. Yoga is a great form of exercise to achieve this.
    Resistance/Strength Training: This exercise uses weights, exercise bands, or body weight to help strengthen your bones and muscles whilst also improving your balance and coordination.


    Functional Training (Clinical Pilates): Training your pelvic floor muscles to contract and relax as needed assists you to regain or prevent incontinence and prevent prolapse symptoms. This functional training is best done with an individualised exercise program that is designed to suit your individual needs. These exercises also enhance any strength training program and assist in flexibility or balance.
    At SquareOne we use Clinical Pilates equipment to rehabilitate the function of pelvic floor muscles and deep abdominals, so that they automatically work during everyday activities. Clinical Pilates combines with a specific home exercise program will assist in achieving optimal function more quickly.


    What can a Women’s Health Physiotherapist do for you menopausal symptoms?
    A Women’s Health Physiotherapist can assess you individually and tailor an exercise program to address any particular issues and goals that you may have.
    At Mosman Women's Health, our physiotherapists have extra training in managing older women and in particular exercise prescription for the different needs of the menopausal woman.

     

  • Exercise during Pregnancy
  • International guidelines all concur with the view that walking, jogging, cycling and swimming (at moderate intensity), muscle strengthening exercises (including pelvic floor exercises), water based exercise, and pregnancy-specific exercise classes are both safe and beneficial for pregnant women.

    If you have never been physically active – it’s also suggested that now would be a great time to start.