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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Bellefit Product Review

So I’ll start off by saying I am writing this review out of my own free will, I was not compensated for this review. I purchased the Bellefit postpartum girdle when I was 40 weeks pregnant and wore it after I got home from the hospital for 4-ish weeks. So first off, this product was awesome! If you aren’t familiar with it, Bellefit postpartum girdle is to be worn after delivery to assist with ‘shrinking’ your abdomen back and offer some external support. I ordered 2, based on my measurements at 40 weeks. I got this one herebellefit front closure girdle review.Image source

They have a great little calculator on their website to figure out what size and style would work. I got the front closure one in size large and medium. The large fit me VERY snugly (which is the point) right after getting home, I was able to wear it over my granny panty underwear/depends (come on, you know you were all wearing them too). It has a bottom closure so you don’t have to take it off to go to the bathroom and it keeps it in the right place so there’s no awkward adjustments every time you stand up from a chair! Within one week my stomach reduced dramatically. The large no longer fit me and I was able to progress to the medium, which I wore for the remaining 3 weeks. Just a word of advice, if you have wider hips and a smaller waist like myself definitely go with the front closure. I ordered the side zipper one initially and it was extremely challenging and uncomfortable to put on, so I returned it for the front closure instead, MUCH more comfortable and it has two size settings (two rows of fasteners) as opposed to just one. Now this product isn’t cheap, $110 dollars each, but it was extremely well made, washed well, maintained it’s elastic stretch and I was even able to resell my size large for $50 used! Amazing. I personally feel that it helped heal my diastasis faster by holding the muscles together where they should be, and it did offer some support to my lower back as my body adjusted to not carrying around an extra 20 pounds. If you are looking for something to offer substantial back support or compression at the hips then this is not the product for you. Back/hip braces can be worn overtop of this, but professionally I wouldn’t recommend this as I’m not a fan of compensating with braces unless absolutely necessary (e.g. you are in so much pain that you can’t function without a brace). This is also why I don’t think this product is beneficial past 4-6 weeks, but that is just my own personal opinion. Overall, I was very pleased with my purchase! Good customer service as well, they responded to my emails in a timely manner and shipping was quick! Lastly, this product isn’t pretty lingerie, I looked ridiculous and you can still see it under tight clothes, gave me a ‘double bum’ haha…but hey, my husband didn’t care and I just didn’t wear anything tight for a while! Also, since it’s my first baby I’m not sure what the results would of been if I didn’t wear it, so not much of a scientific study but I felt pretty good about it. I’d love to hear about other women’s experiences with this product. Hope this helps!

Natasha

Check out this awful picture! But the results were too good not to share a picture!

bellefit girdle before and after

 

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Pregnancy Core Strength Exercises

As promised here are some core exercises that I started while I was pregnant and am still continuing today!

Transverse Abdominis (TA) Activation

  • Sitting against the wall, best to sit on a ball for beginners
  • Take a deep breath and while slowly exhaling pull your belly button to your spine keeping everything tight. Hold for 3 seconds and relax.
  • Repeat this 5-10 times increasing the amount of time spent in a static hold.
  • VISUALIZATION TIP – I think of a string attached from the inside of my bellybutton to the wall, I imagine this string shortening, pulling on my bellybutton and getting my stomach as flat as possible WITHOUT moving my ribs. This will ensure that you are working the right muscles!
  • Maintain good posture, shoulders back, head up.
  • FOR MORE OF A CHALLENGE – do this without a ball under you, in a sitting position supported by your legs.

Core strength wall sit

Kegels

  • Start by doing these in sitting, then try lying on the ground, side lying, or standing as I find the different positions activate different areas.
  • Feel as if you are trying to stop the flow of urine, pulling that pelvic floor up as high as possible, hold for 10 seconds then relax.
  • It is just as important to be able to completely relax these muscles (feeling almost as if you are going to go to the bathroom) as it is to tense them. Muscles only function properly if there is a good balance between tension and relaxation, therefore muscles that are too tight don’t work very well!
  • VISUALIZATION TIP – Think of a string going through the midline of your body out the top of your head. As this string shortens it pulls up on your pelvic floor. Try to activate this area without using any other muscles like your buttock or thighs!

kegel exercises

These exercises and daily walking and squats are the key to an easy and successful labor and delivery! Make time for exercise now before baby and you will reap the benefits later.

 

After Pregnancy… Exercises to rebuild that core and heal your diastasis!

 

TA Activation, Lying Down
  • Lying on the ground have your legs bent at a 90 degree angle
  • Take a deep breathe, as you exhale pull your stomach flat into the ground. Feel like your bellybutton is sinking.
  • I like to keep my hands on my stomach to make sure im working the right muscles, you should feel yourself ‘get skinnier’ without sticking your ribs out, or arching your back.
  • Back and shoulders should be flat on the ground with a slight neutral curve in your lumbar spine.

This is your starting position for the following exercises.

core strength activation

 

Heel Slides
  • From your starting position rest both heels on the ground. Slowly slide one heel out being careful not to not move anything other than your leg.
  • Do 5 on each side, rest, repeat 3 times.

core strength exercises

Leg lifts – Knees bent

  • From your starting position, take a deep breath, then as you exhale lower one leg down to the ground, touch your foot to the ground without resting and return to starting position. Try to not let your abdominals relax or arch your back.
  • If you cannot maintain a strong core position while doing this, start with going halfway to the ground.
  • Alternate legs, do 10 repetitions, rest, repeat 3 sets.

core strength exercises

Only when the above feels too easy, move on to the next exercise

Leg Lifts – Legs straight

  • From starting position straighten you legs. Keep your core tight and don’t let your back arch while doing this.
  • Take a deep breath in, as you exhale  lower one leg to the ground, bring back to starting position, repeat on other side.
  • Alternate legs, 10 repetitions,rest, complete 3 sets.

core strength exercises leg lifts

Hope you get the chance to try some of these ! The great thing is that they can be done in your bedroom with no equipment so they are easy to sneak in during nap time!

On another note, it’s really challenging to find pictures to demonstrate these exercises without infringing on some copyrights so I just took these myself after the gym really quick while the baby was still sleeping in her carseat!! So no judgement please! I am still getting my own body back and I have a long way to go,  but I am definitely feeling pretty great about where I am with my core strength right now. I was hoping to make a video but quite honestly between the baby crying and the dog barking I think it would take about 100 takes.

Take home points – key things to remember to do these correctly…

  • Never lift your head off the ground, keep a neutral neck, chin slightly tucked
  • Keep your core tight, as soon as your hips, lower back or anything else lifts off the ground or shifts in the wrong direction you are no longer working the right muscles.
  • BREATHE, it is important to breathe through these exercises as holding your breath doesn’t help much, and as much as that’s common sense its surprisingly hard to do sometimes!

See this picture for the WRONG way to do these exercises. By lifting your head up off the ground you are putting a lot of outward stress on your abdominals which can actually make your tummy look worse!

bad core exercises after baby

If you have any questions about any of these exercises please comment below or send me an email at natasha@fitmamasb.com and I will be happy to help!

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Postpartum Abdominal Recovery

Wow! Let me just say I never anticipated just how weak my core would be after delivering my beautiful baby girl. For weeks I felt like jello, and looked a little like it too! Ladies don’t be fooled…you are much stronger PREGNANT than you are after delivery. After delivering my nearly 10 pound baby and ridding my body of all that associated with it my abdomen was a mess. I’m pretty sure I had intestines floating around for weeks and my organs were all in shock trying to make their way back to where they should be. All those ligaments that have been stretched out for the past 6 months were getting some relief (finally no more pain!), but still affected by relaxin they were nowhere near where they should be. Now in order to understand the concept of abdominal rehabilitation after delivery there are a few things you must know first. a) What is relaxin, and b) Basic abdominal anatomy and c) What to do before you hit the gym!

What is relaxin hormone?

Relaxin was discovered in 1926 in pregnant guinea pigs. It was shown to cause the pelvic ligaments to relax, allowing the body to accommodate the strain of pregnancy and ease the passage of offspring through the birth canal. The hormone was later demonstrated to have a role in the softening, or ripening, of the cervix through collagen remodelling. Relaxin is produced in the corpus luteum, the placenta, and the uterus in females, as well as in other reproductive structures; this varies by species. (http://www.britannica.com/EBchecked/topic/496940/relaxin

Relaxin hormone is responsible for many injuries during and after pregnancy as it is present in your body for up to 6 months after delivery! It is important to remember this as you continue your journey of health in order to take extra caution and prevent setbacks due to injury. Your ligaments and joints are loose, particularly in your back and pelvis causing instability and contributing to pain and misalignment. That extra flexibility you gained during pregnancy can work against you when you start training again, so my biggest advice is to not overdo it!

Abdominal Anatomy Overview

Abdominal muscles

Image Source

Your ‘abs’ are actually composed of 4 different muscles, they are arranged in layers stretching in different directions across your abdomen. Your rectus abdominus is the muscle that most people associate with a 6 pack. This is where your diastasis will be if you developed one during pregnancy! See my post here for more information. Then you have your external and internal oblique muscles, your external oblique form that nice V shape you see on the cover of Men’s Health, and the internal oblique muscles run the opposite direction providing added stability, torque, and assistance with side bending. Lastly there is the transverse abdominus which in my case is the most important to be aware of postpartum. This is the deepest muscle of your abdominals. It wraps all the way around your midline in a horizontal fashion acting essentially as a corset keeping everything together. As you can guess, with all that stretching and movement in there during pregnancy this deep core stabilizer is incredibly weak postpartum and makes even simple movements, like a squat or pushup, extremely difficult. You truly do not realize how much you use these stabilizer muscles in everything you do until you lose them!

Before you hit the gym…

Lastly, I will review some things to keep in mind before you hit the gym…this may sound a little intense but I really really want to get my point across because I have seen too many people causing permanent damage while trying desperately to lose that baby weight.
1) If you are like me and feeling good after a few weeks you may just want to jump back into what you were doing before you got pregnant…STOP RIGHT NOW! Your body needs a much needed break after all that torture you put it through! Wait the recommended 4-6 weeks postpartum before working out again or you may find yourself dealing with unnecessary postpartum complications such as bleeding, pelvic pain, incontinence, or worse. This is granted you had a regular delivery, C-section recovery is obviously more challenging and as always, everyone should consult their doctor or midwife before starting any new exercise program.
2) Remember to take it slow, if it hurts, stop, think about it, and modify. Start with a simple walk, personally I couldn’t believe how challenging even walking is after not doing anything for a while!
3) Your baby and your health come first. If you aren’t sleeping, barely eating and trying to go hard at the gym you are going to compromise not just your milk supply (if you are nursing) but also your sanity. Be kind to yourself.
4) If you have any lingering impairements from pregnancy especially diastasis recti, hip instability, pelvic floor dysfunction, healing stiches, broken tailbone, etc, etc. make sure you check with your doctor first and take the proper precautions during your workouts!  Remember, even after you are cleared to workout your body is still healing and is very easily injured. I highly recommend hiring a trainer/kinesiologist/physical therapist educated and experienced in postpartum recovery. They will be able to guide you in doing proper exercises and modifications to avoid injury and gradually get back into a solid workout routine.
5) Lastly, CORE CORE, PELVIC FLOOR & MORE CORE…that is what you need to work on before even attempting any heavy lifts, strenuous movements, jumping, or anything else putting strain on those poor abdominal muscles and pelvic floor. Do you want to be incontinent and have a mummy tummy forever? If the answer is no then start doing those kegels and stay tuned to my next blog post for some exercises to do everyday!,

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My how time flies! 16 weeks postpartum.

February 8th, 2015

My how time flies. I decided after the birth of my daughter that I would take a little break from my website. I didn’t anticipate it to be a 3-month break but here we are! Babies are a lot of work! We have been truly blessed that our daughter sleeps well at night, but this means that she is up a lot of the day, leaving little spare time for myself. But now that we have started a more consistent nap routine I desperately would like to pick up where I left off. So this week I’m going to be playing catch up and try to write a few articles sharing what I have learned in these first few months postpartum. So here are some updates!

My daughter was born 9 days late, I ended up being induced, which was definitely not part of my ideal birth plan, but it was in the best interest of my health and my daughters. She was born vaginally, at a whopping 9lbs 12oz and 22.5” long. I won’t bore you with the details but I am happy to say that all my exercise prior to delivery paid off! I was able to push very efficiently and got that baby out as fast as I could with little injury. Even the nurses asked after my first push… “Do you workout? This is going to be easy for you!” That was probably the best thing I had heard all day. I will review my pre-delivery exercises and labor preparation in a future post so stay tuned for that!

It has been 16 weeks since she was born, and I have to say I am starting to feel more like myself everyday. In total I gained 65 lbs. during my pregnancy. Let me tell you, I never want to see those numbers on a scale again. I was large and uncomfortable. I had continued to walk my dog 45 minutes a day up until the day of delivery, completed my home exercises before bed every night and made sure I stretched and practiced my breathing techniques, but let me tell you…it was not easy carrying around all that extra weight, even having a shower was mildly exhausting! I currently have lost the majority of the weight and am happy to say I have 7 lbs. left to reach my target. Because I am nursing I decided that it was best to keep a few extra pounds over my pre-pregnancy weight and shed the rest gradually through proper diet and exercise, and not through starvation. Because I had no postpartum complications I was able to return to exercising at 5 weeks, which was probably the best thing for myself and for my baby! She has been coming to the gym with me 4x a week since then and loves going out on our daily walks. It has helped make her a happy, well-adjusted baby who loves seeing new places and interacting with new people. I will talk more in the next post about what I have been doing in terms of exercise and how I have been working out safely in order to get my body back without causing injury. So excited to continue sharing this whirlwind adventure with you.

In fitness and good health,

Natasha

baby 16 weeks old postpartum

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