Are you suffering with antenatal backpain? Or sciatica, back ache, leg pain? SPD, PGP? Stand up, walk 2 steps in agony then actually ok once you are on the move? Or absolutely fine until you walk more than 100m? Tubrigrip or a support belt wonderful……or makes everything worse……?
Antenatal backpain and pelvic problems can seem very strange and individual presentations vary enormously. But the good news is that the majority of problems can be completely resolved or made very manageable.
Pain is an “unreliable witness” so though a pain pattern gives clues to a problem, a full assessment of the back, pelvis, muscles and nerves is needed to work out the true cause of the pain and guide you what to do (or not) to help.
Antenatal low backache can be an upper back problem
For example, end of the day low back ache is often due to a combination of a stiff mid back (thoracic spine) and weak abdominal support. Stiff bits usually don’t hurt much so a tightened mid back creeps up on you. You may only have noticed that you can’t turn to parallel park! The load shifts to the lower back and then the lower back aches and complains by the end of the day from having to overwork.
Physiotherapy treatment would first include manual therapy to loosen the spine and restore alignment. We modify treatment positions for pregnant women so that you don’t have to lie on your front, you can lie on your side or lean forward seated on the gym ball so that we can still properly apply manual therapy techniques but you and your baby are comfortable.
As experienced and passionate pilates instructors we would then teach you safe and effective exercises to maintain the new improved movement and stretch out the whole spine each day. We also have clever ways to keep your abdominals strong and toned through your entire pregnancy, for good spine support and a rapid postnatal recovery.
PGP or SPD – are TLA’s confusing you?
Medicine does love a TLA (three letter abbreviation). Pelvic Girdle Pain (PGP) is a fairly new term used for antenatal backpain which encompasses the traditional SPD (symphysis pubis dysfunction) but allows for the understanding that the pelvis is a ring made from 3 separate bones with problems able to originate in one place but be felt in another. That “pain is an unreliable witness” statement again.
A common complaint is to find that after sitting down for a while, quite fine, your first few steps on standing are agony, then you are ok again. This is usually a problem with one or both sacroiliac joints (SIJ if you want the TLA). Loose and open when sitting, they struggle to connect quickly as you stand and the brain tries to stop you taking weight through them by giving you pain.
Physiotherapy treatment aims to use connective tissue massage (also know as fascial release) to change the imbalance, manual therapy to align the joints and then exercise to strengthen your ability to hold this position unaided. Sometimes support belts are needed until your muscles have a chance to develop.
That’s why a sheet of exercises or being told to ‘strengthen your core’ might not have worked for you so far.
We don’t believe you should exercise your abdominals/core if you have moderate to severe antenatal backpain – at least not until you have been assessed and understand the problem you are trying to correct through exercise. If your pelvic alignment is wrong, then strengthening your core, at best won’t help and more likely will make you feel worse as you tighten your joints poorly aligned. Similarly, if you have already tried tubigrip or a support belt and found them to be more uncomfortable than helpful, this is a clue to seek a full musculoskeletal assessment.
Once you have alignment and imbalances sorted out, abdominal, gluteal and posture exercises are absolutely wonderful for all pregnant women. We have extensive experience of exercise and are fans of Pilates, yoga, barre work, and free weights too! We will work with you to develop the exercises that YOU ENJOY to ensure that they will be beneficial, safe and effective.
Amanda Savage, Hannah Maxey and Nicola Day all have postgraduate training in the management of pregnancy related problems. Please do contact us by phone or email if you would like to discuss your personal situation further.
Useful free resources for antenatal backpain:
Our Professional Network for Pelvic, Obstetric and Gynaecological Physiotherapists (POGP) publish a free guide about exercising safely during pregnancy.
Supported Mums is a new website compiled by Amanda Savage with advice and exercises for new mothers to improve pelvic floor and abdominal conditioning as well as help you regain optimum bladder and bowel function.
The Pelvic Partnership are a charitable organisation providing support and information about Pelvic Girdle Pain.