Symphysis Pubis Dysfunction

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SPD, also known as pelvic girdle pain (PGP), is defined as mild to severe pain over the pubic symphysis (a small midline joint connecting the two pubic bones), which sometimes radiates into the groin and inner thighs.

In pregnancy normal physiological changes occur to allow your baby to grow. The pubic symphysis that is normally 4-5mm increases in size by 2-3mm and the ligaments surrounding the joint become lax due to the surge of relaxin in the first trimester.

It is important to acknowledge that although pain in pregnancy is common, it is not normal! For a lot of women who experience SPD there is likely to be an undetected predisposing problem such as weak ‘core stability’ or pelvic floor muscles, previous injuries, muscle tensions or other structural imbalances. These underlying conditions combined with the increasing weight of the growing baby and softening of ligaments can affect the normal transference of weight and movement through the pelvis and hips.

How does osteopathic treatment help?

At Kane and Ross we believe from our many years of experience treating musculoskeletal pain in pregnancy that SPD can generally be treated effectively with osteopathic treatment and management.  If a patient is seen early enough within 16-22 weeks, we can normally get symptomatic relief after 4-5 treatments.

Using osteopathic techniques, we can…

  • Correct the imbalances that exist in the pelvis and lumbar spine (normally pre-existing dysfunctions and asymmetries)
  • Release any tension in the muscles and joints
  • Give advice about posture and exercise
  • Give advice on pelvic supports

PELVIC AND BACK PAIN IS NOT NORMAL DURING PREGNANCY. If you are experiencing pain, consult with an osteopath or manual therapist as soon as you can for treatment and further advice. Please do consider booking an appointment at Kane & Ross Clinics to discuss how we can help you: http://www.kaneandross.co.uk

For more information on SPD and advice on self-help strategies see the following article written by Simone Ross a specialist in musculoskeletal pain in pregnancy: http://doctoranddaughter.co.uk/spd/

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Our simple do’s & don’ts during pregnancy.

DO

Continue with your exercise programme until advised to stop or modify your routine – the fitter you are the easier your pregnancy and delivery will be!

Exercise to strengthen the back and pelvis and to open the ribs.

Lift carefully by bending your knees and limit the amount of weight you carry.

Keep your pelvis above your knees when sitting.

Lie on your side when relaxing on the couch.

Put a pillow between your legs and under your bump when lying in bed.

Take walks after dinner and have small meals in the evening if you are suffering from heartburn.

Get someone to look at your ergonomics if you work in an office.

DON’T

Stand in one position for too long, stick your bump out or wear high heels.

Cross your legs when seated.

Lift and twist putting additional strain on your back.

Sit for more than 20 minutes at a time.

Slouch when sitting on the couch.

Get a massage if you are in pain. Specialist help will be much more beneficial.

Drink coffee, tea or eat red meat, oranges or tomatoes if suffering from heartburn.

 

Pelvic Girdle Pain

Pelvic girdle pain – local tenderness over the pubic bone or pain down the inside of your legs – usually occurs after 20 weeks.

It is due to instability and inflammation at the pubic symphysis joint.

Causes include current or previous lower back or sacra-iliac joint problems, ligament loosening due to the hormone relaxin, hyper-mobility or underlying issues such as scoliosis or unequal pelvic height.

To help reduce and avoid pain…

  • Limit any heavy lifting or carrying.
  • Avoid stairs when possible.
  • Do not cross your legs & keep your legs together.
  • Avoid long walks – it may not be painful at the time, but pain can occur later in the day.
  • Use a maternity belt if on your feet for long periods of time.
  • Avoid exercises that load the pelvis like squats, lunges and stretches with the legs apart.
  • Inform your exercise instructor about your PGP.
  • Use a sidelying position during sex.

KEY TIP: Get treatment as soon as symptoms arise to prevent pain increasing throughout your pregnancy.

S x

Rib pain

Rib pain is most likely to occur at 20-40 weeks.Ribs need to flare to accommodate the increasing size  of your abdomen.

Stiffness in the mid back or a history of long periods of sitting can prevent this from happening, leading to rib pain.

Stand upright, raise arm towards the ceiling & side bend to 1 o'clock to the left & 11 o'clock to the right.

Stand upright, raise arm towards the ceiling. Side bend to 1 o’clock to the left & 11 o’clock to the right.

Pain can also be due to inflammation of the softer rib tissue; costo-chondritis.

Ice applied three times a day may help alleviate or lessen your pain.

Stretch ribs as shown to the right to help ribs flare and alleviate pain.

KEY TIP: Treatment to the mid back, ribs and diaphragm often helps to ease rib pain.

S x

Second to Third Trimester change

Weeks Twenty to Thirty Two.

You may be experiencing difficulty in your body adapting to “pregnancy posture”, resulting in pain.

The hormone relaxin, which is released in early pregnancy, may cause instability in the joints, making them more vulnerable to INJURY and STRESS.

Recommendations:

The back exercises in this blog may help lessen or alleviate you pain. If back exercises do not help and you experience pain more than THREE TIMES PER WEEK or pain is DISTURBING YOUR SLEEP, then you should seek help from a specialized health professional as early as possible.

TIP OF THE DAY:

The earlier you receive treatment, the earlier it can be resolved or managed. If untreated, pain may continue and increase as your weight and size increase.

Take care.

Sx

Photograph: Dani de Pablos.

Twelve to Twenty

WEEKS TWELVE-TWENTY

Your body may be finding it difficult to adapt to changes in posture resulting in pain.

Mid back curves increase due to an increase in breast size.

Recommendations:

If sitting for long periods of time, get up and walk EVERY 20 MINS. If working at a computer ensure the computer and keyboard are directly in front of you. Do not ‘slouch’ in front of the computer. If possible, tilt the base of your chair TO ENSURE YOUR KNEES ARE BELOW YOUR PELVIS. Continue to exercise as normal or begin an exercise programme such as yoga or pilates for pregnancy (unless this aggravates your symptoms).

 

Photograph: Katie Collins/PA

TIP OF THE DAY

Seek help from a health professional to alleviate current pain and avoid future pain and problems. The earlier you seek help, the greater chance you have of avoiding worse back pain later on in your pregnancy.

Sx

Stay Back!

Remember: Back pain in pregnancy also includes sacro/iliac pain, two joints either side of the base of your spine.

WEEKS ONE TO TWELVE

Although your posture is starting to change at this time, it is more likely that pain is caused by a previous injury.

Mild back pain may be aggravated by morning sickness.

RECOMMENDATIONS

Early pain is more likely to be a ‘normal’ joint or muscular strain rather than related to your first trimester of pregnancy. Treatment during pregnancy is usually safe if given by an osteopath or physiotherapist who specializes in this area.

If you do have a history of back pain it is wise to see an osteopath prior to your posture changing. During your pregnancy do not start any new exercise programme unless it is specific exercise for pregnancy such as yoga or pilates for pregnant women. Try to maintain good posture.

Image: Area Yoga Brooklyn

“All the pregnant ladies”

So throughout pregnancy your body must adapt to the increase and changes in weight distribution.

If you have:

-previous back problems

-previous injuries

-long hours of sitting

your pain may be exacerbated by your new posture during pregnancy.

Common areas of pain are:

-back

-ribs

-pelvis.

Over the following weeks, I will give you a week-by-week guide to the various types of pain that occur during pregnancy and you will find out why each pain occurs.

You’ll get recommendations for how to alleviate or at least manage the level of pain you feel, so it doesn’t worsen week-by-week as your body begins to carry more and more weight.

TIP OF THE DAY

It is common but not normal to have pain during pregnancy. Make sure you inform your midwife, obstetrician or GP about your pain and ask to be referred for treatment.

 

Until next time,

S x