• Home
• Spinal Conditions
• Peripheral Joint
• Sports Injury
• Workplace Health
• FAQ
• About MCR

Subscribe

Medical Animation - Spondylolisthesis

Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women

Posterior pelvic pain (PPP) is pain felt at or near the sacroiliac joints of your pelvis as a result of sacroiliac joint dysfunction.

These are joints located at the 2 dimples of the lower back. The pain often feels deep within your lower back and can occur on one or both sides of your back. In some cases, pain radiates down to the buttock and the back of the thigh.

While pain may begin at any time during pregnancy, PPP on average begins in the 18th week of pregnancy and becomes more intense as the pregnancy progresses. The pain usually spontaneously resolves within 3 months post delivery. But in some cases it can become chronic and disabling.

What are the Sacroiliac joints?

The sacroiliac joints (SIJ) are formed between the sacrum, a triangular-shaped bone in the lower portion of the spine, and the right and left ilium of the pelvis. The SIJ is a strong and stable weight-bearing joint that permits very little movement due to its natural structure. The main role of the SIJ is to allow forces to be transmitted effectively through the body, absorbing impact from the legs to the spine during activities such as walking, running and jumping.

The SIJ is kept stable through two mechanisms:

1. Firstly, the rough, groove-like connecting surfaces of the sacrum and ilium interlock and help stabilise the joint, like two pieces of Lego together.
2. Secondly, the SIJ is further strengthened by a complex mesh of ligaments and muscles such as the core stabilizers. These core muscles, such as the transversus abdominis and multifidus which surround the SIJ, act as active stabilizers by actively contracting to create a compressive force over the SIJ, gripping the joint firmly together. They act as a natural corset by providing that compression around the lower back and pelvic region -much like wrapping your fingers around the two Lego pieces, keeping them firm and tight.

Posterior pelvic pain arises from sacroiliac joint dysfunction, in other words, when the stability of SIJ is compromised.

Why does it happen?

During pregnancy, mechanisms stabilising the SIJ is affected. This instability allows for increased motion, stressing the SIJ.

1. Hormones released during pregnancy relax the ligaments of the body to allow the pelvis to enlarge, in preparation for childbirth
2. Due to the growing uterus, some of the core muscles around the pelvis get ‘stretched’ and weakened.

Moreover, the additional weight and altered walking pattern associated with pregnancy can cause significant mechanical strain on the sacroiliac joints, which may result in SIJ inflammation, giving a deep ache in the posterior pelvis.

What are the symptoms?

Of all the back pains experienced during pregnancy, posterior pelvic pain is the most common - you are four times more likely to experience PPP than lumbar pain.

You may have posterior pelvic pain / sacroiliac joint dysfunction if you have:

• Deep, boring pain in the back of the pelvis (around the sacroiliac joints)
• Pain may occasionally radiate to the groin and thighs.
• The pain is typically worse with standing, walking, climbing stairs, resting on one leg, getting in and out of a low chair, rolling over and twisting in bed, and lifting. The pain improved when lying down.
• If there is inflammation and arthritis in the SI joint, you may experience stiffness and a burning sensation in the pelvis.

Diagnosing Sacroiliac Joint Dysfunction in pregnancy

Your doctor and/or physiotherapist will conduct a thorough history and physical examination to determine the underlying disorders for your pain. That includes your description of symptoms, a series of tests designed to look at the stability, movement, and pain in the sacroiliac joints and surrounding structures. Imaging, such as computed tomography (CT) scan and X-ray may also help in the diagnosis. Another reliable diagnostic method involves injecting an anesthetic agent into the SI joint, guided by an X-ray machine, numbing the irritated area, thereby identifying the pain source. However, due to the concerns of fetal exposure to radiation, diagnostic procedures involving radiation is generally avoided.

Treatment and Management

The first-line treatment of pregnancy-related sacroiliac joint dysfunction is physiotherapy and exercises that focuses on core stability of the trunk and pelvic girdle. Sometimes, a sacro-iliac belt is prescribed to complement the core stability exercises and to give quick pain relief. Exercises will form a large part of the treatment and in some cases, mobilisation (a gentler form of manipulation) of your hip, back or pelvis may be used to correct any underlying movement dysfunction. Other manual techniques include muscle energy technique (MET) and myofascial release. It is vital to engage a physiotherapist who is skilled in treating pregnancy-related pain as she is aware of the studies that support the use of specific stabilizing exercises and other treatment techniques, thereby preventing the dysfunction from escalating into a chronic condition.
Other alternative treatments include anesthetic and steroidal injections into the SIJ that can help in pain relief, which lasts from one day or much more long-term. Oral anti-inflammatory medications are often effective in pain relief as well. However, these two treatments may be contra-indicated during pregnancy.

Posterior Pelvic Pain Home Advice

Here are some tips for expectant women with posterior pelvic pain..

Lying down

• Avoid lying on your back for long periods of time, particularly after the 19th week of your pregnancy.
• Try lying on your side (preferably your left) with a pillow placed between your knees and another under your tummy.
• If your waist sags down into the bed, try placing a small rolled up towel under your waist.

Turning over in bed

• To turn to your right while lying on your back, arch your lower back, tighten your pelvic floor muscles and lower abdominal muscles and bend both knees one by one.
• Turn your head to the right and take your left arm over to the right of your body. Hold onto the side of your bed if you can.
• To turn, pull with your left hand and take both knees over to the right so that you roll to the right. As soon as possible, bend your knees up as high as they will go - this helps to lock out your pelvis and lessen pain.
• Reverse this to turn to the left.

Getting out of bed

• Roll onto your side with your knees bent up, move your feet over the edge of the bed and push yourself up sideways with your arms.
• Reverse the process when you lie down.

Standing from a sitting position.

• Sit on the edge of the chair.
• Keeping your knees apart slightly and lean forwards till your head is directly over your knees, keeping your back straight.
• Stand up by pushing up with your arms, with your back straight and tummy tucked in. This helps to hold your pelvic joints in their most stable position and may reduce your pain significantly.

Reference:

1. Fitzgerald CM and Le J. Back pain in pregnancy requires practitioner creativity. Biomechanics. 2007 November 
2. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991; 16:549-552.
3. Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B. Reduction of back and posterior pelvic pain in pregnancy. Spine. 1994; 19:894-900.
4. http://www.sidysfunction.com/articles/lumbarbackandposteriorpelvicpain.html

    

 

Sports Hernia

Sports hernia or Athletic Pubalgia is an injury to the groin or lower abdominal region which does not recover even with many months of rest, medication and physiotherapy. It affects mostly the elite athlete but an increasing number of “weekend warriors” are struck down with this frustrating injury. The most obvious symptom is pain in the groin area especially during athletic activity. A diagnosis is made after a thorough history and assessment, as well as investigations like X-ray and MRI are done to rule out other conditions. Keyhole surgery (Laproscopy) can be done to repair the injury with an expected return to sport in a month. Read more

Medical Animation - Degenerative Disc Disease

I keep getting stress fractures. Why?

This question was posed to Dr. Lewis G. Maharam. Often getting to the bottom of a problem is about asking the right questions. His answer covered the basic questions that one should ask for recurring stress fractures.

I am experiencing my fifth stress fracture in two years. First my right tibia, then my left hip, my right tibia, and now my fourth metatarsal. I heal fine; my doctor has me rest for eight weeks, and then I go back to run and another problem occurs. I work up slowly to 40 miles per week and then bam!… another stress fracture! Why does this keep happening to me? - Jennifer V., Little Neck, NY

Read about Dr. Maharam’s basic questions here.

Read more

Whiplash - Part I

In this article, we will be looking at the three most commonly asked questions:

1. What is a whiplash?
2. What are the signs and symptoms of a whiplash injury?
3. What are the common treatment techniques available?

What is a whiplash?

Whiplash is a common term for sudden acceleration-deceleration forced on the neck. This is usually as a result of rear-end or side impact motor vehicle accidents or any other mishaps. The acceleration-deceleration forces cause the head into forward flexion (head down position) and very quickly the head gets whipped back into extension (head in a looking up position).

When this occurs, the forces may result in bony or soft tissue injuries such as in the disc, ligaments, tendons, neck muscles and nerve roots.

There are several grades to the severity of whiplash associated disorders (WAD).

Grade 0: No pain or discomfort. No physical signs of injury.

Grade 1: Neck pain, stiffness or tenderness. No physical signs of injury.

Grade 2: Neck pain, stiffness or tenderness. Some physical signs of injury such as point of tenderness or trouble turning the head.

Grade 3: Pain, stiffness or tenderness and neurological signs of injury, such as changes to the reflexes or weakness in the arms

Grade 4: pain and fracture or dislocation of the neck.

What are the symptoms?

The most common symptoms after a whiplash injury are neck pain or stiffness. This can occur immediately after the injury or even after a few days.

Other symptoms may include

• Headache
• Pain in the shoulders and arms
• Dizziness
• Altered sensation, pins and needles, numbness in the arms
• Weakness
• Visual and auditory symptoms
• Difficulty concentrating
• Difficulty in swallowing

What are some treatments available for treatment of whiplash?

There are many treatments available for the treatment of a whiplash injury. In this article, we will only list what is available but not grade the quality of each treatment techniques. This will be done in the next article.

Some of the treatments include:

Treatment	What it means
Act as usual	Staying as active as possible within tolerable levels.
Active treatment	Actively perform repeated movements of the neck in a pain free range.
TENS machine	The current from the TENS (transcutaneous electrical nerve stimulation) machine may inhibit pain in the tissues surrounding the electrodes. It works by distracting your nerves and brain from the pain sensation.
Exercise	Exercise improves pain, range of motion, flexibility, function and physical fitness. It is thought that exercise promotes the production of endorphins, naturally occurring hormones by the brain that can help with pain control.
Manipulation	Also known as ‘adjustment’ or ‘cracking’. It is thought that manipulation of a spinal joint may provide temporary increase in joint range of motion. It also corrects spinal alignment which gives relief from musculoskeletal pain.
Mobilization	A technique that entails gentle, controlled movements of the joints affected. This aims to improve mobility in areas of the spine which leads to a decrease in restriction. Hence, removes a source of pain and provides symptomatic relief.
Pilates	Aims to selectively increase the strength and endurance of the deep core muscles of the torso. By doing so, posture and stability is improved, reducing the amount of pressure on the spine.
Acupuncture	A treatment modality of Traditional Chinese Medicine (TCM). Acupuncture influences the nervous system and neurotransmitter which respond to needling stimulation and electro-acupuncture, which in turns influences pain relief. From a TCM perspective, acupuncture is thought to restore the flow of “chi” through the body.

Medical Animation - Kyphosis

Medical Animation - Herniated Disc

Medical Animation - Facet Syndrome

How would you like your Swimmer’s Chicken-Wings?

If you are serious about competitive free-style swimming, you know that form matters. And if you are training competitively, you are more than likely (~66%) to be nursing some sort of shoulder injury. Recently, you heard from some that the "chicken-wing" is causes and aggravates shoulder injuries. Others say, it doesn’t? So should you chicken wing-it or not? Well, it is safe to get back into the water. What matters is not whether or not to chicken-wing, but HOW you chicken-wing it. Read more

Next Page »

Language Translation




Ask the Specialists

If I have a knee pain, should I get it manipulated?

  If I have a knee pain, should I get it manipulated? - Alex, Singapore Read more »  Read More →



If you have an question, feel free to drop us line. If the answer to the question is something more than a few people would be interested in, we will feature it.




Advertisement


 

• Popular Articles

  • Nerve Stretches
  • Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women
  • Pain Relief Medications: An Overview
  • Sports Taping - Knee
  • Myofascial Release
  • Sports Taping - Wrist
  • Iliotibial Band Friction Syndrome
  • Lumbar Supports Not Particularly Effective for Low Back Pain
  • Pregnancy - Changes and Aches
  • The Buckling Knee
  • Patellar Tendinitis
  • Sports Taping - Ankle
  • Neck-Related Headaches
  • Piriformis Syndrome - Sciatica
  • Hamstring Exercises for Long Distance Runners
  • Manual Therapy - Spinal Vertebra Mobilisation
  • Lumbar Spinal Stenosis
  • Shin Splints from the Periosteum
  • Does Bad Posture Lead to Scoliosis?
  • Last and Ring Finger Numbness in Cyclists

Musculoskeletal Consumer Review © 2007 - 2008 by Core Concepts Pte Ltd       Terms and Conditions | Policy

Musculoskeletal Consumer Review © 2007 - 2008 by Core Concepts Pte Ltd