Pelvic Girdle Pain During Pregnancy

Lumbo-pelvic pain, which can be defined as, pregnancy related low back pain or pregnancy related pelvic girdle pain, occurs in 24%-90% of women while they are pregnant (Van Benten et al., 2014). Although this usually goes away after birth over 1/3rd of women still have pain 1-year post pregnancy (JOSPT, 2014).

What is Pelvic Girdle Pain?

Your pelvis is made up of your hip bones (ilium, ischium, pubis bones), your tailbone (sacrum/coccyx) and various muscles, tendons and nerves which all work together to support your pelvis and internal organs. When these bones, tendons and muscles do not work together as they should this is when you feel pain. Pain can be in the posterior pelvic girdle (below your lower back) most often caused by an unstable sacral iliac (SI joint), or in the anterior pelvic girdle (in your groin) due to instability in the symphysis pubis. These ‘joints’ are not meant to move, but due to the lovely relaxin hormone floating through your pregnant body they can easily become unstable and extremely painful!    pelvic girdle pain

Pelvic girdle pain (PGP) increases with everyday activities such as walking, standing, sitting and lying down. It can increase drastically after only 30 minutes of activity (Fagevik Olsen, Elden & Gutke, 2014). Sounds pretty annoying right?

Why is it important to identify and treat pelvic girdle pain?

This persistent and awful pain not only effects women physically but also puts them at an increased risk of depression and decreased quality of life. Lumbo-pelvic pain is responsible for a large percentage of sick leave costs for pregnant women as well (Fagevik Olsen, Elden & Gutke, 2014). I laugh because my doctor wrote me a note to have modified work due to pelvic pain and my restrictions were “no standing, no walking, no sitting, or lying down for more than 25% of the day”…Uh, so what exactly could I do? Obviously this resulted in me going off on maternity leave a little earlier than planned.

Identification of women with severe PGP is also important since they are at the “highest risk of persistent pain both during and after pregnancy…and have the greatest consequences in terms of pain, intensity, disability and health related quality of life” (Olsen, Elden & Gutke, 2014). As a sufferer of PGP I can attest that it absolutely affected my quality of life and overall mood since some days even walking around the house was intolerable.

How can I tell if I have PGP?

A recent study by Fagevik Olsen, Elden & Gutke (2014) looked at the effectiveness of self-tests for pregnant women to screen for pelvic girdle pain so that they can be referred to a doctor or physical therapist for evaluation. Here are some of the tests I pulled from this study and this study !  Now, just a warning, if you do have Sacroiliac (SI) joint pain or Symphysis Pubis Dysfunction (SPD) you will know within SECONDS of attempting any of these tests.

SI joint pain is felt beside your tailbone and is often a sharp, deep pain that occurs with certain movements. It can even feel like your hip or tailbone is ‘out of place’. Symphysis Pubis pain is a sharp, lightning bolt type pain that feels like it is often deep in your pelvis. These pains can range from a dull ache or nothing at rest to constant excruciating pain all the time.

Please note all the images and descriptions for these tests were taken directly from the two articles cited above. (Fagevik Olsen M et al, 2009) and (Fagevik Olsen, Elden & Gutke, 2014)

1) P4 Test

Lying in the supine position with 90-degree flexion at the hip the patient presses on the flexed knee, along the longitudinal axis of the femur.

Positive test = reproducing the pain in the SI area
POSH test self adminstered

http://www.thestudentphysicaltherapist.com/posh-test.html <– see more info on this test here

Patrick Faber Test

Lying in the supine position with one hip flexed, abducted and rotated so that the heel rests on the opposite kneecap. Positive test = reproducing the pain in the SI area

faber test self administered

http://www.thestudentphysicaltherapist.com/faber-test1.html <– see more info on this test here

Trendelenberg Test

Standing on one leg, flexing the other with the hip and knee at 90. Positive test = reproducing the pain in the SI area

trelenberg test

http://www.thestudentphysicaltherapist.com/trendelenburg-test.html

Bridging Test

The patient lifts the buttock and extended one leg. Positive test = reproducing the pain in the SI area

bridging test pelvic pain

Mat Test

The patient performed a movement of hip abduction and adduction simulating the movement to pull a mat across the floor. Positive test = pain in the symphysis
mat sliding test

Straight Leg Raise Test

Tests for disc involvement, see more info here.

straight leg raise test

Per (Fagevik Olsen, Elden & Gutke, 2014) , in order to be classified as PGP the following criteria had to be fulfilled…

  • Pain experienced between the hip bones and the gluteal fold particularly in the area of the SI joint in the symphysis.
  • Reports by the women of weight-bearing related pain and its duration in the pelvic girdle.
  • Diminished capacity to stand, walk and sit.
  • Positive clinical diagnostic tests, which reproduced pain in the pelvic girdle.
  • No nerve root syndrome (Negative SLR test).

Be sure to quantify your pain on a scale if you are bringing it to the attention of a doctor or therapist! It really helps them establish a baseline and help rule out other problems.

pain scale

What can I do about it?

Physical and Occupational Therapy during and after pregnancy can help decrease low back and pelvic pain and increase mobility and quality of life.

Van Benten et. al (2014) concluded “according to the literature there is moderate evidence for the positive effect of exercise therapy on pain, disability, and/or sick leave for the treatment of lumbo-pelvic pain during pregnancy. Moreover, data shows that patient education seems to be a helpful intervention”.

Talk to you doctor about a referral to therapy or seek out a therapist near you. A physical therapist who specializes in orthopedic rehabilitation or women’s health will be able to do a proper assessment and prescribe exercises for you to continue at home which can provide some relief! They can also recommend appropriate braces or taping techniques that may help decrease the pain and provide increased stability to those poor overstretched joints. If you are able to see an Occupational Therapist (usually covered by insurance with a doctors order) be sure to take advantage, a home visit will help identify the daily activities that are most difficult and how you can modify the activity or the environment to be able to complete them with as little pain as possible! Also, chiropractic care is fantastic for helping to realign your pelvic bones and spine. This can decrease pain due to nerve irritation and  inflammation. This is what helped me the MOST during my pregnancy and I always recommend chiropractic care to other pregnant mamas out there. As always please comment below or send me an email if you have any questions!

Hope this helps!

In fitness & good health,

Natasha

 

References

JOSPT (2014). “Pregnancy and Low Back Pain: Physical Therapy can Reduce Back and Pelvic Pain During and After Pregnancy”. J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505

Fagevik Olsen et al. (2009). “Self Adminstered Tests as a Screening Procedure for Pregnancy Related Pelvic Girdle Pain”. Eur Spine J (2009) 18:1121–1129 DOI 10.1007/s00586-009-0948-2

Fagevik Olsen, Elden, & Gutke. (2014) “Evaluation of Self-adminstered Tests for Pelvic Girdle Pain in Pregnancy”. BMC Musculoskelet Disord. 15(138)

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April is OT Month

So as you know if you’ve read my biography I am an Occupational Therapist (OT). Most of the time when I tell people what I do for a living I get, “That’s cool…so what is that exactly?” Since April is OT month I decided to write this post to share some of the reasons why I seriously LOVE my profession.

What is an Occupational Therapist?

An Occupational Therapist is a health and rehabilitation professional. Occupational therapists work with people of all ages who need specialized assistance to lead independent, productive, and satisfying lives due to physical, developmental, social, or emotional problems. Occupational therapists use the “occupations” of self-care, work, and play/leisure activities to increase independence, enhance development, and/or prevent disability. To achieve these goals occupational therapists may also adapt the task or the environment. (Source)

Where Do Occupational Therapists Work?

OT’s can work in many different settings. They work with children at school to assist with activities such as handwriting or socializing with others. They work in communities helping adults with brain injuries or disabilities re-integrate into the community or be able to function independently at home. They also work in special settings such as hand therapy clinics or spinal cord injury rehabilitation centers. The list goes on, as these are just a few examples of where you can find an OT.

Personally I have always enjoyed working with adults. I currently work in skilled nursing facilities with geriatric patients who have difficulty completing their activities of daily living (eating, dressing, bathing, etc) due to a physical or cognitive decline. Through the use of therapeutic exercises, therapeutic activities, cognitive retraining and neuromuscular re-education I am able to help my patients become stronger and more independent so they can ultimately return home or to a lower level of care. As an OT I work to make changes to the person, enviroment or occupation in order to ultimately increase health.

OT model Image Source OT model PEO

5 Reasons I Love My Job

  1. It’s Rewarding!
    It’s the best feeling ever to watch others make positive changes in their lives! The most rewarding part of my career is seeing a patient get stronger and healthier so that they can do the things they want to, or need to, do on their own.
  1. Different Settings
    The job description of an OT varies greatly depending on where they work and with what population. Since there is so much variety you can always find new places or different career paths to take, which prevents burn out and increases job satisfaction.
  2. Client Based Practice
    A big part of being an occupational therapist is helping patients do the things that THEY want to do in life. By having your client be an active participant in goal setting and treatment planning you achieve better outcomes and more effective therapy, as people are able to work towards goals that are important to them. For example, I had a man once tell me that his goal was to be able to play golf again by the spring, although we needed to work on strength and tissue healing we were able to create a customized treatment plan to make sure that he could do the things he needed to do to get back out on the golf course!
  1. Treating the ‘whole person’
    Working as an OT I have learned the importance of treating the whole person (mind, heart and body) rather than focusing on just the physical aspects. By being able to adapt the task or the environment you can make things that may of seemed impossible a reality. For example,  through training clients how to use assistive technology and adaptive equipment people with spinal cord injuries can lead full and productive lives despite their physical limitations.
  2. Perfect combination of creativity, science and problem solving
    By using all three of these skills OTs are able to make meaningful changes in someone else’s life. I love that there is room for some creativity because sometimes the solution isn’t always black and white! For example, I love using whatever I can find at the dollar store in order to make adaptive equipment for my patients to use at home, most of the time it’s the simplest gadgets that make the biggest difference! The possibilities are truly endless!

If you have any other questions about how an Occupational Therapist can help you be sure to send me an email or check out http://www.aota.org/ for more information.

This post was inspired by Christie at MamaOT.com . Check her out! She is a pediatric OT and has an awesome blog full of advice and resources for those who care for or work with young children!

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Lactation Smoothie

I posted another recipe on yummy lactation cookies that turned out great, so I decided to just take the ingredients and throw them all into a smoothie. It turned out great too! Here’s the recipe…

imageYou need, a blender of sorts – We have the Nutribullet and it’s awesome.

Ingredients
1/4 cup rolled oats (old fashioned works best)
1 tablespoon brewers yeast
1 frozen banana
1 tablespoon almond butter
1/2 tsp coconut oil or flax seed oil
Almond/Coconut/Cows Milk
Cinnamon for taste
Handful of Spinach (optional – you can’t taste it but it’s a good addition!)

Put all the dry ingredients in the blender, fill with milk, blend until smooth.

Enjoy!
Natasha

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Effect of Exercise on Breast milk

So with all this running I’ve been doing it got me wondering if I am negatively affecting my milk supply and if my baby was still receiving adequate nourishment (I think I was just looking for reasons NOT to train for this half marathon). This led me to do some research! Yes, I know… of course I’m a nerd like that but I didn’t become an evidence-based practitioner for nothing…this is how we roll! So let me share with you bits and pieces of what I learned.

women after long run

In summary, breastfeeding is not negatively affected by exercise whether it be prolonged cardiovascular exercise or moderate to high intensity training. There is some evidence that lactic acid levels increase if you feed your baby immediately after a high intensity workout (Carey & Quinn, 2001), which could cause a change in the taste of the milk but has no negative effects on the baby and most of the time they don’t notice. Even then, you would have to REALLY exert yourself to see this kind of change in milk composition.

In terms of milk supply, as long as adequate fluid and calorie intake is achieved exercise has no negative effect on milk supply (Dewy et al., 1994). This is what I was most worried about because after my long run last week I tried to pump afterwards and got very little! Which was stressful obviously! Of course I panicked, and then my husband reminded me that I just fed her before I left so it had only been a little over an hour and a half. Duh, that makes sense. Also, my own personal hypothesis is this… your body probably puts milk production on hold while exercising because it is using the energy for your muscles, BUT most likely makes up for it later in the day.

When the composition of breast milk was studied it was also found that there was no change in immune factors (such as SigA, lactoferrin, and lysozyme), major minerals (calcium, phosphorus, etc) and major nutrients (fat, protein, lactose) (Fly, Uhlin, Wallace, 1998).

I also found this to be super interesting ….

“ recreational athletes who performed an average of 88 minutes per day of aerobic exercise during the 6 months of breastfeeding had less body fat and produced a slightly greater quality and quantity of milk than postpartum non-exercising women” (Lovelady et al., 1990)

So pretty much because I am exercising I am producing higher quality and quantity of milk as well as reaping all the other benefits of postpartum exercise such as; decreased incidence of depression, decreased stress, improved mood and behaviour and increased weight loss. Guess this half- marathon training is paying off for everyone, including my baby & husband!

Now I have to add, after my quick literature review I did find there is definitely  room for further research on the subject, a lot of the studies were from the 90’s and came from the same few researchers, but it’s just not a very highly studied topic so have to take what I could get!

So there is it, you can put your mind at rest…. breastfeeding and exercise are actually a good combo! Few things to remember…be sure to keep your fluid intake up, especially if it is a hot day out! It’s crucial to replace everything that you sweat out to avoid dehydration. I aim for 16 cups of water a day, and I usually have a coconut water or electrolyte beverage if it’s a day where I particularly sweat a lot. Also, losing 0.5-1lb a week while breastfeeding is perfectly healthy but you don’t want to lose too much weight too fast so be sure to replace some of the calories burned by exercise by having an extra snack afterwards.

In fitness & good health,

Natasha

Sources

Carey GB, Quinn TJ 2001, Exercise and lactation: are they compatible? Can J Appl Phys 26(1): 55–74.

Dewy K, Lovelady C, Nommsen–Rivers L, McCrory M, Lonnerdal B 1994, A randomised study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. New Engl J Med 330: 449–453.

Fly AD, Uhlin KL, Wallace JP 1998, Major mineral concentrations in human milk do not change after maximal exercise testing. Am J Clin Nutr 68(2):345–9.

Lovelady C, Lonnerdal B, Dewey K. Lactation performance of exercising women. Am J Clin Nutr. 1990;52:103–9.

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Santa Barbara Hikes

So there are only a few days left in March! Crazy how the time flies. In terms of how I am doing with my March Madness personal challenge, I am pretty happy where I stand right now! I have been continuing to eat fairly clean, been working out 4-5x/week and getting walks in on my off days.

I mentioned in a previous post that I wanted to explore different areas of Santa Barbara, this week we went for walks at Shoreline Park down to east beach, met some clients at La Mesa Park, and did a hike in Montecito! Really hoping to finish this month strong and make these last few days count.

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What’s on the agenda tomorrow? 6 mile run. This should be interesting. My swolemate convinced me that I should sign up for a half marathon with her on Mothers Day. I am not much of a runner, but I must admit I feel different now, running has become slightly easier. Mind you, running after having a baby still feels strange ‘down below’ but I think that’s due to my core still needing some work. I used to HATE running because my hips would hurt, my lungs would hurt, and it was just an awful experience, there was no runners high for me! So this is definitely a new challenge.  If tomorrow’s run goes well I will be on track to finish 13 miles at the beginning of May!

family hiking in montecito

santa barbara beach

 

 

 

 

 

 

 

 

Hope you enjoy the pictures! 3 MORE DAYS of March, I will check in with my final measurements and set new goals for April!

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