In this article, we discuss some of the most common problems that we are faced with during pregnancy, offering a professional explanation on why, as well as advice on how we can best deal with the issues.
Low back pain
Unfortunately, low back pain is one of the most common complaints during pregnancy, however, this does not mean that we have to suffer throughout our pregnancies. Due to increased weight and a growing bump, our posture will change to accommodate the weight-related changes and alteration to our centre of gravity. As a result, more pressure and strain may be placed on the lumbar spine (the bottom of the back) to help maintain balance with our growing bumps.
There are certainly things we can do to help minimise and reduce the likelihood of developing low back pain. Minding our posture and using a lumbar roll when sat can help take some of the pressure and strain off of the lumbar spine. Completing gentle pelvic tilts can help alleviate pressure and stiffness in the area. Regular gentle aerobic exercises, such as swimming can help keep your back mobile and reduce tension on the muscles. When stood for periods of time, placing our foot up on a step can help reduce ache and pressure.
We can seek advice from a Physiotherapist who can review our posture and provide us with tailored exercises and stretches to reduce low back pain. They can also give advice on day to day activities, posture in work, review lifting techniques and provide hands-on treatment to reduce the aches and pains.
Symphysis pubis dysfunction
Symphysis pubis dysfunction (SPD) is characterised by pain in the centre of our groin, directly onto the pubic bone, radiating down the inner thigh. This is a common pregnancy-related problem thanks to hormonal changes. Quite early on during pregnancy, our bodies produce a hormone called relaxin – this hormone is responsible for the relaxation of ligaments and soft tissue throughout the body, preparing us for labour and delivery. Located centrally to the pelvis between the legs is a cartilaginous disc which connects the two sides of the pelvis. Typically, this joint is rigid and does not move unless we are pregnant due to relaxin.
SPD symptoms may include: a bruised bone sensation (even with light pressure), burning or altered sensation along the pubic bone, sharp pain radiating down the inner thigh or grinding/clicking noises from the pubic bone. Although we cannot stop the production of relaxin during pregnancy, there are things we can do to reduce and alleviate SPD.
As the pain is caused by increased movement of the two halves of the pubic bone, it is important to keep our lower limbs moving symmetrically and with minimal torsion. For example, when getting in and out of bed, we should roll to our side, slide our legs off the bed as one and then sit ourselves up. When walking, we should reduce our stride length and pace so our legs are not as far apart. When climbing stairs, we should take it one step at a time or go up the steps side on, again, helping to reduce leg separation. When sat, we shouldn’t cross our legs as this can put increased pressure on the sore area. When carrying an object, we must try to keep the weight of the object central to our body rather than carrying it on the hip, helping to maintain symmetry. When resting, we can apply something cool to the centre of the groin to reduce ache – we just need to ensure that our skin and bump is protected with a towel.
A Physiotherapist will be able to review how we are moving and give advice on our posture and activities, as well as, reduce muscular tension around the pelvis and lower limbs through treatment.
Pelvic girdle pain (PGP)
Pelvic girdle pain usually involves all pains around the pelvis, this can be the front or back of the pelvis and can radiate up the back, into our bottom or down to our legs. Due to hormonal changes in pregnancy and the added weight and pressure of our bump, pains around the pelvis can be common. The joints within the pelvis may feel bruised, stiff or very mobile.
A Physiotherapist will be able to assess us and determine if we have PGP and which joints are affected. They can give us advice and education about how to move, postural advice when standing, sitting and lying down, and manual therapy to help alleviate the aches and pains, as well as exercises to keep things mobile and comfortable.
Carpal Tunnel and De Quervain’s Tenosynovitis
During pregnancy, our bodies take on a substantial amount of fluid retaining water due to hormonal changes. Because of this, swelling of the hands and feet can commonly develop. Due to the increased pressure within the hand, altered sensation, pain and hand/grip weakness can occur.
Carpal tunnel specifically refers to the wrist area, while De Quervain’s tenosynovitis refers to the base of the thumb. We may notice that hand/thumb pain or numbness predominantly occurs at night. This is likely due to the position the wrist or arm is resting in while we sleep. Pressure can build in the small joint spaces if our wrists remain bent for a period of time.
A Physiotherapist will be able to assess the painful areas and provide exercises, stretches, manual therapy as well as advice on the use of splints and activities during the day.
Hip pain is another frequent problem during pregnancy. As previously mentioned, soft tissue can become more lax thanks to the hormone, relaxin. This can lead to more movement around the hip joint which can cause pain. Commonly, we can experience hip pain at night when lying on our side due to the gradual pressure applied to the hip bones. To help alleviate hip pain, good symmetrical alignment of our lower limbs while led in bed or sat upright should be considered. Sleeping with additional padding under our hip bone, as well as, placing a pillow between our legs at night can help reduce the strain on the hip joints. Keeping active and maintaining strong muscles will help support our joints regardless of relaxin.
A Physiotherapist can help guide you on appropriate exercises, stretches, sleeping positions and posture.
Diastasis recti, refers to the separation of the superficial abdominal muscles during pregnancy. Due to the pressure and growth of our bumps, the abdominal muscles will do their best to stretch to accommodate the growth. Diastasis recti commonly occurs during the third trimester of pregnancy simply due to growth. We may feel discomfort or pain in our abdomen where the muscles have separated into two halves. As well as discomfort, we may also notice doming (a peak or bulge running vertically and centrally along the abdomen when moving in a sit-up position).
A Physiotherapist may be able to help. After a thorough assessment, they will be able to give us advice on posture and movement, as well as exercises to help stabilise the core during pregnancy and strengthen after pregnancy.
Pelvic floor weakness & incontinence
Due to relaxed ligaments and muscles, as well as the added pressure and weight of our babies, the pelvic floor can become weak leading to leaking urine (incontinence). This can occur when changing position, when coughing, sneezing or laughing or during sudden jarring movements like jumping. It is important to spend some time completing pelvic floor exercises to help keep the muscles strong and prevent incontinence. The muscles of the pelvic floor are a combination of fast twitch and slow twitch muscle fibres. This is important because it means the muscles need to be trained in two different ways. The first exercise is quick squeezes of the pelvic floor – try to complete three sets of ten repetitions. The second exercise is a slow, long squeeze of the pelvic floor – aim to hold the squeeze 10 seconds before relaxing.
If we become concerned about having a weak pelvic floor or suffer from incontinence, we can seek advice from either our midwife or a Physiotherapist. A Physiotherapist will be able to ensure you are completing the correct exercises, help increase your awareness of the pelvic floor and how to engage these muscles, as well as give you advice on diet and lifestyle, which may contribute to a weak pelvic floor.
Use our FREE Ask A Physio advice service online at www.physiofusion.co.uk to speak directly to our clinical manager about your queries.