Page 20

Patient Informatio n

Pelvic Girdle and Low Back Pain

during Preg nancy

Women’s Health Physiotherapy Team

Page 2

Page 19

Sit on a large ball. Bounce on the ball and hold your body in a squatting position with your weight on both legs. Bounce again and repeat. Do not let your knees turn in or out.

Further Information We endeavour to provide an excellent service at all times, but should you have any concerns please, in the first instance, raise these with the Matron, Senior Nurse or Manager on duty. If they cannot resolve your concern, please contact our Patient Experience Team on 01932 723553 or email patient.advice@asph.nhs.uk. If you remain concerned, the team can also advise upon how to make a formal complaint.

Author: Rachel Edward Department: Women’s Health Physiotherapy Team Version: 1 Published: Nov 2016 Review: Nov 2018

Page 18

Pelvic floor identifying exercise Lightly tighten your pelvic floor muscles. Feel the muscles rise inside you. Relax for about 5 seconds. You can improve identifying your pelvic floor muscles using the following techniques: - when squeezing your pelvic floor muscles imagine that the front and back passage closes and pulls inwards - when relaxing, imagine that the front and back passage falls down.

Sit on a therapy ball. Keep knees and ankles in line. Tilt the pelvis forward and let the ball move forwards. Keep pelvic floor muscles tightened. Return to the neutral position.

Page 3

Introduction The term Pelvic Girdle Pain (PGP) is used to describe pain experienced in the front (pubic symphysis joint) and back of your pelvis (sacroiliac joints). Pregnancy related PGP is common, around 1 in 5 pregnant women experience it, and Low Back pain during pregnancy affects around 1 in 3 women. Symptoms range greatly in severity, but the sooner it is identified and assessed the better it can be managed.

This booklet sets out the facts and shows you how to get better as quickly as possible.

What causes PGP and Low Back Pain in pregnancy?

•••• From the moment you become pregnant the changes in hormones work to cause softening of the ligaments, which will affect your posture; and cause extra strain on your back, pelvis, pelvic floor and abdomen.

•••• Changes in breast size and shape can strain the upper back.

•••• As the baby grows it puts pressure on the lower ribs which can cause soreness.

•••• Other causes of back pain unrelated to pregnancy include poor posture, poor work environment, sitting or standing for too long without moving, bending whilst twisting and lifting or carrying heavy objects or older children.

Page 4

What can you do if your back or pelvis starts to hurt?

•••• Don’t panic – most back pain does not have a serious cause. Acute pain usually improves in days or at most a few weeks. Occasionally some aches and pains can last for a long time but this does not mean the cause is serious; and they usually resolve once the baby is born.

•••• Ice packs (plastic bag with some frozen peas inside, wrapped in a damp flannel). Use for 10-15 minutes.

•••• Initially alternate periods of gentle activity with resting in the most comfortable position you can find.

•••• Warm baths can be very comforting but if it is difficult for you to get in and out of the bath it is better to have a warm shower.

•••• Gentle massage over the back or bottom. Oil or cream, may be used if you like but take care if using perfumed products. Sitting with a tennis ball under a buttock helps relieve buttock tension for some people.

•••• If, after discussion with your doctor or midwife, you decide to take some pain relief it will be more effective if you take it regularly.

•••• Gentle exercise for example walking, yoga or swimming (avoid breast stroke) can help to relieve the pain.

•••• TENS can be used for the relief of pain, under the supervision of a physiotherapist.

Page 17

Gym Ball Exercises

Shoulder Shrug and Bounce

STARTING POSITION: Sit

correctly on ball in optimal

posture.

MOVEMENT: Begin bouncing,

raising and lowering shoulders.

Bounce as vigorously as

comfort, balance and

coordination allow. Add light

weights to wrists or hands as

instructed.

Page 16

CAT STRETCH. Pull your stomach in, arch your back up like a cat. Hold for a few secs.

Repeat 5 times.

BACK STRETCH Crawling position. Knees wide apart, big toes together. Let your arms slide along the floor as far as possible. Push your bottom back and down and the chest towards the floor. Breathe out while doing the exercise, then rest in this position for as long as comfortable.

Page 5

What else can you do to prevent recurring pain?

1. Pace activity. People who experience pain have a tendency to overdo or push themselves when they are having a “good” day. Later, they find that the pain is so severe that they have to rest for long periods. This is called the Pain Cycle. It is illustrated below:

2. Don’t do one thing for more than 20-30 minutes without a break.

3. Spread shopping and housework over the week rather than doing it all in one go.

4. Avoid heavy lifting. If you feel that you have to strain get someone else to do it or get help. If you have to lift something, bend at the knees rather than the back. Carry loads close to your body.

5. Avoid constipation. Eat plenty of fruit and vegetable and cereals. Make sure you drink enough.

Page 6

6. Encourage toddlers and young children to come to you. Try not to lift them.

7. Try and avoid twisting movements. When changing direction imagine you are walking around a column or pillar rather than turning on the spot.

8. When getting in the car have both feet on the ground, sit on the seat sideways and take small steps with your feet close together until you are in the car. Use the reverse for getting out. Have frequent breaks on long journeys.

9. Move frequently used items in the kitchen to a convenient height.

10. Choose shoes with lower heels, and good arch support.

11. When working at a desk adjust the height of your chair to suit your desk. Arrange your keyboard, VDU and work so that you don’t feel strained. Have frequent stretches.

12. There is usually no reason why you should stop having sex because of back pain. You may need to try different positions for comfort.

13. Avoid rushing – when changing position e.g. standing from sitting, allow a second or so before walking off.

14. Be prepared to accept help. People love to offer and you can return the favor in the future.

Page 15

Buttock Stretch Sit on a chair with one foot on the floor. Lift your other foot onto your opposite thigh. Gently lean forward. Feel the stretch in your buttock. CAUTION/STOP IF PUBIC or GROIN PAIN

In a crawling position. Alternately lift your right and left arm whilst keeping a straight back, and gentle pelvic floor squeeze, and then return to starting position. Repeat 10 times.

Page 14

Sitting. Hold your hands and lift your arms over your head. Breathe in and slowly bend to the side. Hold for a few seconds. Breathe out and return to the starting position

Sit on a chair. Take hold of the back of a chair. Look over your shoulder while turning your upper body.

Page 7

Pelvic Floor Exercises

It is important to start these exercises now. Frequent, gentle contractions will help improve your core stability and support your back. They will also limit future problems with incontinence or prolapses. Initially, choose a position in which you are most comfortable. They can be done anywhere standing, sitting or lying. Try tightening the ring of muscles around the back passage as if to stop yourself passing wind. At the same time try tightening the muscles that would stop yourself passing urine. You should feel a tightening from underneath and a gentle lift, and then release back down.

© ladysytem.co.uk

Once you have found your pelvic floor muscles you can begin to build on their strength and endurance.

Vagina

Anus

Page 8

• Try and build up to holding for 10 seconds and repeat this 10 times.

• 10 Fast, quick squeezes with an immediate release are important and work the muscles differently.

Don’t worry if you can feel very little happening to start with. This is quite normal. Don’t try too hard, just persevere with what you can feel and gradually it will become stronger. Avoid holding your breath and tightening your buttocks and legs as you do this exercise. The hardest part is remembering to do the exercises 3 times a day forever. Find a memory trigger e.g. washing your hands, meal times or AFTER going to the toilet. You need a trigger that will stay with you wherever you are, whatever you are doing.

Page 13

Exercises to try at Home

Stand tall with a good posture. Push your hands back against the wall, soften your knees, tighten your stomach and pelvic floor muscles to hug baby, keeping your back in contact with the wall.

Sit with your back straight and feet firmly on the floor. Keep baby hugged towards you. Pull your shoulder blades together while turning your thumbs and hands outwards.

Repeat 5 times

Page 12

Warning Signs

Seek immediate medical attention via Accident and Emergency if you experience any sudden onset of:

- Difficulty using or controlling your bladder or bowels

- Numbness in the “saddle” area

- Numbness, pins and needles or weakness in both

legs

- Difficulty walking or controlling your legs

Page 9

How can you improve your posture in standing?

How should I sit?

Sit with a gentle curve in your lower back.

Page 10

What about sleeping?

Remember that during pregnancy it is not advisable to lie on your back for long periods of time.

Getting out of Bed

Turning over in bed

Normally turning over in bed involves rolling and shifting ’on the spot’ remember that during pregnancy it is advisable to roll and shift separately.

You might benefit from activating your core or pelvic muscles before you move and / or doing a few pelvic tilts (see page 18) before you try and move.

Roll onto your side with your knees bent up. Use your hands to push your- self up at the same time swinging your legs over the side of the bed. Use the reverse to lie back down

Page 11

Exercise during Pregnancy

Keeping fit and healthy will help you to cope with the physical and emotional demands of pregnancy. The exercise program and intensity at which you work will need to be tailored to your changing body.

For more detailed information please consult:

http://www.rcog.org.uk/womens-health/clinical-guidance/exercise-

pregnancy

or

http://acpwh.csp.org.uk/publications/fit-safe-physiotherapists-

exercise-childbearing-year

Relaxation

Relaxation can often improve back pain. This can be as simple as a warm bath, soft music and massage or you can use a specific relaxation technique for example those taught in ante natal clinics.

The following booklet:

http://acpwh.csp.org.uk/publications/mitchell-method-simple-

relaxation is one method of relaxation you can try.