Symphysis Pubis Dysfunction (SPD) or Pelvic Girdle Pain (PGP): Minimising Pain During Everyday Activities

This is part 2 of 3 posts covering SPD / PGP during pregnancy. Yesterday I posted on Exercises for SPD / PGP, today its about living with it!

A Few Tips that Might Help:

DO:
• Be as active as possible within pain limits and avoid activities that make the pain worse
• Ask for help! Many household chores & everyday activities may be difficult or painful – ask for & accept help wherever you can get it
• Rest & relax when you can. Sitting on a large exercise ball is often more comfortable than a chair & easier to get up from.
• Sit down to get dressed and undressed – avoid standing on one leg
• Wear flat supportive shoes
• Avoid standing for prolonged periods (someone else’s turn to do the ironing:))
• Try to keep your knees together when moving out of the car.  A plastic carrier bag on the seat may help you to swivel (another top tip from the Association of Chartered Physiotherapists for Women’s Health)
• Sleep on your side with a pillow between your legs
• Try different ways of turning in bed e.g. turning under or turning over with your knees together and squeezing your buttocks
• Roll in and out of bed keeping your knees together
• Take the stairs one at a time or go down on your bottom (top tip from Nisha at the Nine Month Club – see her blog for more)
• Use a small rucksack to carry your stuff around – this leaves your hands free to hang onto something for support or to use crutches if you’ve been given them

AVOID activities which make the pain worse:

• Standing on one leg
• Bending and twisting to lift or carrying a toddler or baby on one hip
• Crossing your legs
• Sitting on the floor
• Sitting twisted
• Sitting or standing for long periods
• Lifting heavy weights (shopping bags, wet washing, vacuum cleaners, toddlers)
• Vacuuming
• Pushing heavy objects like supermarket trolleys
• Carrying anything in only one hand

Of course not all of these activities CAN realistically be avoided – you may have to lift & care for other children, pick up something or go to the supermarket. Just try to get as much help as you can, go slowly & think before you move.

Stay as active as you can. Follow your physiotherapist’s guidelines & keep doing the core activation & pelvic floor exercises described in yesterday’s post EVERY DAY. You will get some relief as well as be training your vital core muscles in preparation for your post-baby flat tummy!

Thanks again to the Association of Chartered Physiotherapists for Women’s Health for their great guidelines & also have a look at the Pelvic Partnership for more tips & information on SPD / PGP.

All No More Excuses personal trainers are experienced & knowledgeable when dealing with SPD / PGP – if you would like to meet with a trainer for a free consultation then just fill out the form in the column on the right.

What strategies worked for you? Please share your SPD / PGP stories – I know many women suffer (1 in 5 pregnancies) but often don’t realise how common the condition is. If you know something that does or doesn’t work, please leave a comment here!

Symphysis Pubis Dysfunction (SPD) or Pelvic Girdle Pain (PGP) During Pregnancy: How Exercise Can Help

Symphysis Pubis Dysfunction (SPD), now referred to as Pelvic Girdle Pain (PGP) describes pain in the joints that make up your pelvis. They include the symphysis pubis joint (SPJ) at the front &/or the sacroiliac joints (SIJ) at the back. The result is pain felt across the front or back of the pelvis, which can range from mild discomfort to severe pain.

This is the first of 3 related posts on SPD / PGP coming over the next few days. I have dealt with exercises first as that’s what so many of you have asked for! The next one will deal with everyday activities & minimising discomfort & the third will give more of an explanation of the diagnosis & causes. Apologies offered at the outset  that these posts are a little longer than usual!

If your SPD / PGP is causing you pain, you should be referred to a physiotherapist who will assess the position and the symmetry of movement of your pelvic joints, especially the sacro-iliac joints at the back of the pelvis. Treatment will involve a combination of joint realignment or mobilisation and soft tissue or muscle treatment.

When the body is experiencing pain, muscles tighten & compensate, causing asymmetry & misalignment of joints. It is important that you receive treatment from a physiotherapist, chiropractor or osteopath to correct this, as well as carrying out these exercises on a daily basis, preferably 2-3 times every day. Complimentary therapies such as acupuncture or cranial sacral therapy may also provide relief. Please share your stories on what has or hasn’t worked for you!

Exercise cannot realign joints or tighten ligaments affected by the hormone relaxin, but it CAN help to stabalise the pelvis by strengthening the muscles that support it.

The muscles that need to be strengthened to improve stability for SPD / PGP are the core muscles, particularly the Tranverse Abdominus (TVA) & the pelvic floor. Depending upon the level of pain & range of movement, bodyweight exercises such as a supported squat (adapting the depth of the squat & how far your open your legs) will also improve strength & stability.

SPD / PGP Exercise No.1 TVA Activation: To start identifying & ‘engaging’ your transverse abdominus, you need to practice abdominal or belly breathing. Sit on a chair, exercise ball or cross-legged on the floor & place your hands on your belly. Breathe in, fill your lungs & let your belly expand. Then exhale, emptying your lungs, whilst drawing your belly button right back towards your spine. Keep your shoulders down & your neck relaxed.

SPD / PGP Exercise No.2 Pelvic Tilt: Get on your hands & knees, with your hands directly underneath your shoulders & your knees directly underneath your hips. With good neutral posture position, inhale, allowing the TVA to relax. On exhalation draw the bellybutton towards the spine & contract the PF. Draw the pubic bone toward the belly button & your pelvis will tilt slightly. Avoid excessive spinal movement. Hold in for a count of 10, then relax for a count of 10. Keep going for 2 minutes.

You can also do a pelvic tilt from sitting on an exercise ball. Sit tall at ‘12 o’clock’  (i.e. not on the edge) of the ball, hands folded across chest, exhale & draw navel to spine as you roll the ball forwards slightly as your pelvis tilts. Lift pelvic floor and engage your TVA. Control the movement with your abs not your shoulders. Inhale & return to neutral spine as the ball rolls back to the starting position.

SPD / PGP Exercise No.3 SuperMum (adapted): On all fours as above, with your hands directly underneath your shoulders & your elbows slightly bent. Engage TVA & raise your left hand & right knee approximately one cm off the ground (no higher). Remember to breathe (!) & hold this position for 5-10 seconds before lowering & repeat with the right hand & left knee. If you start to wobble, focus again on engaging TVA to stabilise yourself, then lower. Keep alternating sides for 2 minutes.

Make sure to not allow the hamstring to tighten & that the pelvis does not load (shift) into the hip that is in contact with the ground. Your core muscles should be doing the work!

SPD / PGP Exercise No.4 Kegels: Kegels or Pelvic Floor Exercises are often described as stopping yourself from urinating, but are more actually more effective if you imagine you’re trying not to fart… if you pull in your sphincter muscles (but don’t squeeze your buttocks), your vaginal muscles will also tighten. Then imagine you’re trying to stop yourself from urinating – try to differentiate & identify front, middle & back. Squeeze & release them from front to back, then back to front.

Try quick squeezes, as you contract & release the muscles for just a second at a time. Do this 10 times, rest for a couple of seconds, & then do another 10. Also longer holds. Starting with 5 seconds, repeat 5 times. Take a minute break then do the set again. You can build up to 10 second holds with 10 repetitions. Do both types & aim to do the whole set 2-3 times a day. It might not feel like much, but as well as stabilising your pelvis, these exercises are the difference between post-baby bladder control & wetting yourself. They’re worth it…

SPD / PGP Exercise No.5 Hip Bridge: Lie on your back with your knees bent & feet flat on the floor. Push down into the floor with your hands & raise your hips, off the floor. Your feet, shoulder blades & head remain on the floor, & your chin will tuck into your chest. Hold for 3 seconds before lowering hips back to the floor. Again remember to engage TVA as you raise & exhale, take a breath as you hold, then lower as you inhale.

Only exercise on your back for short periods of time during pregnancy & only if you are comfortable. If at any time you feel breathless, dizzy or uncomfortable, simply roll onto your left side & then slowly come up.

SPD / PGP Exercise No.6 Adapted Squat: Strengthening the muscles of the lower body will also help to stabilise the pelvis, & so try some squats, but with adaptations: Stand side-on to the back of a chair or sofa & hold onto it for support. With legs only just wider than hip distance apart, lower your bottom down as if you were going to sit down. Keep your knees behind your toes & only go as low as is comfortable. Imagine your tail bone is reaching away down to the floor behind you, rather than sticking your bottom up in the air. To come back up, exhale, engage TVA & push up through the outside of your feet & your heels. You will feel the muscles in your backside & thighs working.Repeat 10 times.

Keep active, as doing nothing at all will make the pain worse. Walk as much as you can, using smaller strides if large steps are painful. Walk with good posture – don’t hunch your shoulders or bend forward from the hips. Drop your shoulder blades down & draw them together, engage TVA, breathe deeply & look straight ahead.

Try to do each of these exercises at least once a day. They will only take a few minutes. If your pain is severe & debilitating make sure you also get referred to a physio, chiropractor or osteopath to realign your pelvis. Your muscles will be inhibited from allowing these exercises to work for you properly  if they are overcompensating for misalignment or pain.

Please let me know how you get on, & share your stories on what has or hasn’t worked for you!

Next post on this topic coming very soon: Alleviating pain for SPD / PGP during everyday activities.

Diastasis Recti, Pregnancy Pelvic Girdle Pain, Symphysis Pubis Dysfunction, Rectus Distension… What Does It All Mean?

Diastasis Recti is one of the causes of your mummy tummy, Symphysis Pubis Dysfunction means you can’t get out the car comfortably when pregnant… and then there’s the acronyms for all these pregnancy & postnatal aches & pains: SPD, PSD, PGP, DR, RD. You need a copy of Gray’s Anatomy just to give a name to your sore joints & back ache once you’re pregnant!

Confused? You’re not alone. A few new clients lately have been feeling a little flummoxed by some of the terms being used for whatever it is they’re suffering from…  sometimes midwives, antenatal teachers, doctors, personal trainers or your best friend, don’t use the same language.

So I’ve done a mini glossary of the ones you’re likely to come across or suffer from. Hope it helps, & if you have any others you’d like to know about, do ask!

Diastasis Recti, Rectus Diastasis or Rectus Distension all refer to a very common separation of the rectus muscles at the front of your tummy during pregnancy. I post frequently on this condition & here you can find some instructions on how to test for diastasis recti, which exercises are recommended & which ones you should avoid.

Diastasis Symphysis Pubis (DSP) is not the same as diastasis recti, it is an actual separation of the Symphysis Pubis Joint. This can only be confirmed by diagnostic imaging by a doctor or physiotherapist.

Pregnancy-Related Pelvic Girdle Pain (PGP) & Symphysis Pubis Dysfunction (SPD) refer to the same thing.

Pelvic Girdle Pain is the term more used more nowadays, but both refer to pregnancy-associated pain, instability & dysfunction of the Symphysis Pubis Joint &/or the Sacro-Iliac Joint.

Pain may be a minor discomfort, necessitating some modification of movement… right up the scale to severe pain & disability. Make sure you consult a physiotherapist or professional trainer who specialises in this area, & don’t go to just any generic exercise class or instructor.

The joints affected are the ones at the front & back of the pelvis. You may feel pain over the front of the pubic bone at the front, across your tummy, or across one or both sides of your lower back, or down your legs.

You may feel a clicking or grinding in your pelvis & have difficulty walking, especially up or down stairs. This ’shearing’ movement (one leg in front of the other) or abduction (legs out to the sides) may also hurt, making getting in or out of a car, your bed, or any number of other everyday activities, painful.

Pregnancy-Related Pelvic Girdle Pain affects around 1 in 5 women, at varying degrees of severity. Around 7% of women continue to have problems postnatally.

In general:

You will be advised by your Midwife or doctor to avoid or adapt as many painful movements as possible. So avoid heavy lifting, go carefully & slowly up stairs; keep your knees together as mush as possible when getting on or out of the car; roll over onto your side to get out of bed…but many of these are part of life, & can’t realistically be avoided.

You can however help to alleviate pain with correctly prescribed core strengthening exercises.

The stability of your joints is affected by the pregnancy hormone, relaxin, but also by the strength of the muscles that hold them in place. Do NOT go to a generic class or instructor with PGP, they cannot be expected to accurately prescribe the correct exercises for you. But controlled, guided core strength & lower body resistance work will definitely help to strengthen & stabilise your joints, & reduce pain.

Let me know what else you need on these conditions – I know from my clients that they are  commonly diagnosed, but also often misunderstood pregnancy & postnatal considerations which affect the exercise you can comfortably undertake.