pregnancy

Working in a specialist Physiotherapy and Pilates centre, the Physiotherapists at KTB have extensive knowledge of applying the Pilates principles and exercises with mums to be. We see many uncomplicated, pain-free pregnancies, however, we are experienced in diagnosing antenatal spinal and pelvic dysfunction and can manage these from a range of Physiotherapy interventions.

We recognise that this is an important and special time for you and we are here to make things easier. You can be assured of a personalised, safe service that cares not only for your needs but also for those of your unborn baby. Pregnancy brings about some major temporary changes to the body that affect the skeletal system. Weight will increase, particularly in the abdominals where the muscles are stretched and weakened, there is a shift in the centre of gravity and posture will be affected, often increasing stress to the lower back. Hormonal changes not only affect mood but also cause the ligaments to soften, increasing joint flexibility and vulnerability.

The most common complaints that we see as Physiotherapists are:

 

Low Back Pain

Back pain often occurs if the stretching abdominals pull the pelvis forward increasing the stress on the joints of the lower back. Back pain can be problematic only towards the end of the day or if you have been on your feet for a long time. This is due to the weight of your body and baby causing your ligaments to stretch slightly and your muscles to tire.

 

Pelvic Pain

The pelvis is formed from four bones joined together. The back of the pelvis is the sacrum and coccyx (tailbone) and the two innominate bones come from the back around the sides to meet at the front. The two curved pelvic bones are joined at the front by the symphysis pubis. The pelvis has an important role in stabilising the central spinal column whilst the legs move reciprocally. The symphysis pubis holds the pelvis steady as the legs move. In pregnancy the hormone relaxin, causes the ligaments of the pelvis to soften. This is important in the preparation for birth. Sometimes, the ligaments stretch too much and the pelvis loses its stability placing increased strain on the pelvis and contributing to joint pain. In severe cases this widening of the pelvis at the front occurs to cause a significant split. This is known as diastasis symphysis pubis. Please see below for more information:

 

Neck and rib pain

This can occur with or without pins and needles into the hands and is often the result of your growing breasts and altered posture

Stress Incontinence (bladder leakage)

The pelvic floor muscles are placed under enormous stress as the weight of your growing baby increases throughout your pregnancy and presses down on them. To withstand this pressure they must be strong pre-pregnancy. If they are weak leakage can occur with activities such as jumping, coughing, laughing and sneezing.

 

Our Physiotherapists at KTB will use the following techniques as part of an antenatal Physiotherapy appointment:

– Pain management techniques including TENS, warmth, gentle manual therapy and massage techniques

– Techniques to improve joint mobility and to regain normal function. Including muscle energy techniques, manual techniques and exercise therapy

– Postural management. This includes taping, feedback, core stabilisation exercises, gym ball and studio Pilates work

– Advise on safe exercise including improving fitness, stability and strength

– Breathing control and relaxation techniques

– Postural and positioning advice including the use of wedges, pillows and supports at work and at night

– Guidance on pelvic (SIJ) belts and maternity back supports

– Complete pelvic floor retraining and strengthening

– Support with planning the birth and assisting with the return to pre-pregnancy fitness and shape

See our Pilates for Pregnancy pages for more information on Pilates in Pregnancy.

 

Pelvic Girdle Dysfunction (Formerly SPD)

If you are experiencing pain in your pubic area and groin with or without lower back pain you are suffering from pelvic pain. SPD is identified by the symptoms increasing when one leg has lifted off the floor. Activities therefore that aggravate the pain are walking, getting in and out of a car and turning in bed. Some patients report a clicking from the pelvis with walking, most will avoid taking the legs apart as this will be painful. These symptoms are common during the latter stages of pregnancy as the strain on the pubic symphysis is increased.

Management of SPD will include avoidance of activities that aggravate the problem including taking the legs apart. You will often be advised to keep a pillow between your legs in bed and keep the legs together when getting out of a car. A pelvic support often gives a lot of relief and your Physiotherapist will advise you on the best support for your symptoms. Walking will need to be modified and this may include the use of crutches. If you are in the third trimester then delivery options will be discussed. It is important to build as much stability of the pelvis as possible without placing excess strain on the ligaments. You will be given a modified Pilates programme for this. One of the most important things is to avoid aggravating the problem and correct information, an accurate diagnosis and ongoing support is all needed. KTB will keep you reassured; you will be in safe hands.

 

Strengthening the Pelvic Floor

The pelvic floor is a sling of muscle that forms the base of the pelvis. Pregnancy places large stresses on the pelvic floor muscles. The weight of your growing baby pushing down onto these muscles stretches the pelvic floor and therefore causes it to weaken. The stress begins as early as at twelve weeks. Constipation, a common side effect of pregnancy also increases the stress on the pelvic floor. Many mums notice some leakage with activity after the birth of their baby. A normal delivery can just be the final straw for these muscles if they haven’t been targeted effectively throughout the pregnancy.

It is important to strengthen the pelvic floor before, during and after your pregnancy for the following reasons:

Before: to ensure that the muscles are in top shape to cope with the extra demands the pregnancy is going to put onto the muscles.

During: to help to prevent leakage with coughing, sneezing or laughing as the baby grows and the weight onto the pelvic floor is increased. During the birth if you have an awareness of the pelvic floor then you will be more able to release this effort, allowing the pelvis to stretch in order to assist the delivery.

After: A strong pelvic floor will help to prevent a prolapsed (a dragging sensation between the legs). Contracting this muscle soon after the birth will also help improve blood flow through the bruised or damaged tissues improving healing and easing perineal pain. The stronger your pelvic floor the more sensation you will have when making love to your partner.

If you are pregnant you may also like to see our web page: Pilates for Pregnancy