Breastfeeding postural related aches and pain

July 9, 2009

"I am a recent mother. And I have been breastfeeding my 3-month old baby daughter. Since about 2 months ago, I have started have neck aches and around my upper back. I think this is related to my breastfeeding posture. Is there anything I can do about it? Thanks in advance! – Melinda Q."

Written by Cheryl Ng · Filed Under Have A Question?, Pregnancy | Comments

Does Labour Epidural Cause Chronic Backache?

April 4, 2009

After childbirth with an epidural, one may experience short-term back soreness at the catheter site where the medication was injected. As such, most women tend to associate labour epidural analgesia with chronic or long-term back pain. But is there really a connection between labour epidural and chronic backache?

Written by Cheryl Ng · Filed Under Pregnancy, Spinal Conditions | Comments

Belt Up Your Unstable SIJ

September 15, 2008

An unstable Sacro-illiac Joint (SIJ) can cause pain in the lower back and pelvic region. This happens when the core muscles surrounding it are too weak to support the SIJ. A sacroiliac support belt can help to provide support and stability to the joints during the initial stages of core stability training. Read more

Written by MCR · Filed Under Pregnancy, Sacroiliac/ Coccyx, Spinal Conditions, Treatment Options | Comments

Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women

August 19, 2008

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

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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:

Firstly, the rough, groove-like connecting surfaces of the sacrum and ilium interlock and help stabilise the joint, like two pieces of Lego together.
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.

Hormones released during pregnancy relax the ligaments of the body to allow the pelvis to enlarge, in preparation for childbirth
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:

Written by Cheryl Ng · Filed Under Pregnancy, Sacroiliac/ Coccyx | Comments

What is Symphysis Pubis Dysfunction (SPD)

August 1, 2008

If you are pregnant and experience pain in groin and inner thighs around the start of your second trimester, there is a chance that you are suffering from Symphysis Pubis Dysfunction (SPD). In one study¹of the British population, the incidence of SPD varies from 1:360.3% to 2.77%. Thankfully, the pain goes away after delivery.

What is Symphysis Pubis Dysfunction?

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The symphysis pubisis a fibrocartilaginous (a mixture of fibrous tissue and cartilaginous tissues) joint that connects the two halves of the pelvis together and keeps them steady during activity (see image). This joint is supported by a network of muscles and ligaments that allow very little movement to occur under normal circumstances. During pregnancy, the symphysis pubis widens an average of 2-3 mm from the usual 4-5mm gap. The average gap is about 7.7mm. This widening of the pelvic ring helps facilitate the delivery of baby.

Symphysis Pubis Dysfunction is when this joint becomes overly relaxed, allowing the pelvic girdle to become unstable. This leads to pain and inflammation.

In severe cases, the symphysis pubis partially or fully ruptures, increasing the gap to more than 10mm. This is known as the diastasis of the symphysis pubis (DSP).

SPD typically starts in the second trimester. The start of pain is usually gradual and can be very intense. It is usually relieved by rest. The good news is that symptoms commonly disappear shortly after delivery. A small percentage of women however, continue to experience pain for several months after delivery.

Why does it happen?

SPD is a result of a combination of factors; an altered pelvic load, hormonal and biochemical alterations causing ligament laxity and a weakening of pelvic and core musculature during pregnancy, leading to instability.

Symptoms

You may have SPD if you have one or more of the following:

Source: e-radiography.net
Pain localised to your symphysis pubis, including shooting, stabbing and burning pains, grinding and audible clicking sensations and/or persistent discomfort.
Pain radiating to lower abdomen, groin, perineum, thigh, leg and back
Difficulty in walking, climbing up or down stairs, rising up from a chair, impaired weight bearing activities, e.g. standing on one leg or lifting/parting the legs, turning in bed.

Diagnosing SPD

SPD today is becoming more widely understood by GPs, obstetricians and midwives. It is diagnosed by a combination of your own description of symptoms and a battery of tests designed to look at the stability, movement and pain in the pelvic joints and structures surrounding it. Imaging, such as X-rays, is the only way to confirm the misalignment of the pelvic bones. However, due to the concerns of fetal exposure to radiation, ultrasound is the preferred modality for assessing symphyseal widening in pregnancy.

Your doctor or midwife may refer you to a physiotherapist who has experience in treating this condition.

Management

A specialist physiotherapy assessment and review should be arranged. The physiotherapist can advise on back care and strategies to avoid activities that put unnecessary strain on the pelvis and on safe exercise during pregnancy.

Exercises for the pelvic girdle and core stabilizers of the trunk will form a large part of the treatment and are aimed at improving the stability of the pelvis and back. 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. The physiotherapist may also prescribe a pelvic support belt to give quick relief.

Other alternative treatments include hydrotherapy (exercise in water) and acupuncture which sometimes can be useful.

SPD Home Advice

Here are some things pregnant women with SPD can do to minimize their discomfort.

A void activities which cause discomfort, e.g. lifting, carrying, prolonged standing, walking and strenuous exercise
Rest more frequently in a position which is comfortable, such as:
- lying with your knees bent and supported
- lying on your side with a pillow between your knees
- sitting with your knees slightly apart
- avoid sitting with legs crossed.

Mild to moderate exercise, including abdominal wall and pelvic floor exercises, is acceptable.
Avoid straddling and squatting movements, which means moving with knees apart (hip abduction), when:
- getting in and out of car. Try to keep knees together.
- getting in and out of bed. When moving in bed, try to keep legs together particularly when moving from side to side. Do not push with one foot as this will worsen the pain. Push equally with both feet to move about the bed.
Adopt good posture, avoid bending and twisting.
If swimming, avoid the breast-stroke with the legs kicking outwards.
Ice packs can be used for five minutes at a time or an ice cube can be rubbed on the symphysis pubis for 20–30 seconds

Reference:

Owens K, Pearson A, Mason G. Symphysis pubis dysfunction – a cause of significant obstetric morbidity.Eur J Obstet Gynecol Reprod Biol 2002;105:143–46.
MacLennan AH, MacLennan SC. Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and development dysplasia of the hip.Acta Obstet Gynecol Scand1997;76:760–64.
Jain S, Eedarapalli P, Jamjute P, Sawdy R. Symphysis pubis dysfunction: a practical approach to management.The Obstetrician & Gynaecologist 2006;8:153–158.

Written by Cheryl Ng · Filed Under Pregnancy | Comments

The unstable SIJ

July 14, 2008

The sacro-iliac joint (SIJ) is a very stable structure connecting the spine to the pelvis. The stability is achieved by a system of active (force closure) and passive (form closure) stabilisers. Its main role is to helps absorb vertical forces through the body. An unstable SIJ can compromise the effectiveness of transmitting forces, causing symptoms like low back pain or sometimes radiating pain down the legs. Core stability exercises and a sacro-iliac belt can help with an unstable SIJ. Read more

Written by Cheryl Ng · Filed Under Pregnancy, Sacroiliac/ Coccyx | Comments

Pregnancy – Changes and Aches

May 8, 2008

If you are pregnant and feel your back or pelvic pains more often than usual, you are not alone. Studies have shown that more than two-thirds of pregnant women experience back pain and almost one-fifth experience pelvic pain^2,.3. As pregnancy progresses, the intensity of pain may increase and interfere with your work, daily activities and sleep.

Written by Cheryl Ng · Filed Under Lumbar, Pregnancy, Sacroiliac/ Coccyx, Spinal Conditions | Comments