Sue about 34 weeks pregnant in 1991
Despite this photo being taken almost exactly 34 years ago, I can remember the discomfort I felt that day when I took Katie to school for her first day, like it was yesterday. I was heavily pregnant and suffering with pelvic girdle and low back pain – a common affliction of pregnancy. (Aren’t women amazing what they deal with to populate this Earth?)
Possibly I’m reminded of it because today, like then, I have some significant low back pain with muscle spasms. This current discomfort is a ‘campervan legacy’ – we have a new rule in our household. It takes two of us to pull the the ‘rock-and-roll bed’ bed out and put it away, as we both have the same ‘spasmy back’ affliction after each of us opened and put the bed away last weekend at Cotton Tree.
But do not despair – the Cotton Tree sojourn was definitely worth a bit of temporary back discomfort.
Sue at Cotton Tree with the campervan in the background and the late afternoon sky
But that pelvic girdle pain was a constant feature of my last 10 weeks of pregnancy. I only wish I had sought some help from a pelvic health physio then, rather than soldiering on like we tended to in those days.
We at Active Women’s Health have all just completed some continuing education with our guru educator Taryn Hallam and this year’s learnings was on the Pregnancy and Post-partum Year. Two of the most common concerns for women during pregnancy are Pregnancy related Pelvic Girdle Pain and Rectus Diastasis (Abdominal Muscle Separation in Pregnancy).
If you are suffering with either pelvic girdle pain or have a significant separation of your abdominal muscles (called DRAM and stands for Diastasis of the Rectus Abdominus Muscles) then ring and make an appointment to seek early help. Don’t needlessly suffer like I did!
Pregnancy related Pelvic Girdle Pain
Pelvic pain is common during pregnancy. The hormones of pregnancy (high levels of oestrogen of pregnancy and other hormones such as Relaxin), mean women may develop an overall increase in ligament laxity or a feeling of looseness. Increased laxity or movement across the Sacroiliac Joints (SIJ’s) and Pubic Symphysis in the pelvis during pregnancy for some women may result in significant pain, more likely from the second trimester. People with hypermobility (such as Ehlers Danlos Syndrome or EDS or other hypermobility disorders) may be at risk of developing pelvic pain earlier in pregnancy. In most cases this laxity will resolve within around 8 weeks post-partum, but pain can be severe throughout pregnancy.
What can a physiotherapist do?
Seeing a Pelvic Health Physiotherapist for assessment and management of Pregnancy Related Pelvic Girdle pain is recommended as soon as symptoms arise. The pelvis is innately a very strong structure, but in the presence of pubic symphysis or SIJ dysfunction, it may be beneficial to wear a ‘mechanical support’ like a brace or elastic support belt to provide additional stability and reduce your pain for periods throughout the day.
Other management strategies on which your pelvic health physiotherapist could provide advice:
- Strategies to adapt your movements in order to reduce torsion/twisting in the pelvis
- Avoiding positions and activities that put an asymmetrical load on the pelvis
- Work with you to find a way to lift to avoid aggravating the pelvic pain (those toddlers still want lifting even if you are in considerable discomfort!)
- How to manage stairs and walking to reduce pain
- What exercising is best for your condition so you maintain exercise during pregnancy which we know is so beneficial for you through pregnancy.
Your pelvic health physiotherapist will work with you to help you maintain the confidence to keep moving throughout your pregnancy.
Rectus Diastasis (or DRAM standing for Diastasis Rectus Abdominis Muscle) in Pregnancy
Rectus diastasis or DRAM as it is often known is the separation of the superficial abdominal muscles that can occur during pregnancy. It may appear as a bulge or ridge in the centre of the abdomen, which may increase when you sit up from a lying position. You may be able to feel a gap between the edges of the abdominal muscles in the centre of the abdomen.
Some slight degree of abdominal muscle separation is normal during pregnancy. It is how a baby can actually get to fit into a woman’s body! Mostly these abdominal muscles separations, which happen in almost 100% of pregnant women, resolve nicely by 6-12 weeks. However, sometimes the separation does not resolve post-partum, which can lead to low back pain, weakened abdominal muscles and dissatisfaction with the way the tummy looks.
Emotional impact of a large DRAM is real
It is important to recognise and understand the importance of this ‘look’ of her tummy on a woman who has just delivered her baby.So many emotions to deal with post-partumand if she has a significant separation or ‘loose’ skin due to her particular type of collagen, this can lead to anxiety and depression. This can manifest itself in many ways and is made worse if months or years down the track women are constantly asked are they pregnant again, because if they have bloating due to diet, bowels or their hormonal cycle, their belly looks ‘bulgy’.
Both during pregnancy and especially in the post-partum period, your pelvic health physiotherapist can assist you with advice regarding strategies aimed at minimising any bulging of your tummy.
Strengthening Rectus Abdominus (yes, curl ups and crunches)
Research has recently changed the way we think about addressing Rectus Diastasis in post partum women. Crunches and curl-ups have got a bad wrap for many years – both when treating pelvic floor dysfunction such as prolapse or incontinence and with treating DRAM. We have known for years that the increases in intra-abdominal pressure with a curl up or crunch is markedly less than going from sit to stand – and we don’t stop doing that. Similarly, doing crunches in your post-partum recovery may be the best exercise for closing the abdominal muscle gap.
Your Pelvic Health Physiotherapist can work with you in assessing for Rectus Diastasis and then assisting you with an appropriate targeted exercise program to improve abdominal strength, and maximise recovery of Rectus Diastasis post-partum.
Ring your nearest pelvic health physiotherapist with an interest in pelvic girdle pain and DRAM for an appointment to review your pelvic health, any pelvic girdle pain and your abdominal muscle status early during pregnancy and/or post-partum.
Don’t suffer needlessly, seek help.
For those women in the inner Brisbane area, ring (07) 38489601 and one of our lovely secretaries Katie, Cristina, Mette and Cathy can schedule you an appointment with one of our caring physios. If it is just pelvic girdle pain or DRAM assistance you are after let them know, as this will only require a shorter appointment.
