Thursday, 17 January 2013

Living with Pelvic Girdle Pain After Pregnancy

As a baby and toddler yoga teacher, I have noticed an increase in the number of mum's attending baby yoga classes suffering with Pelvic Girdle Pain (‘PGP’). I have a basic understanding of Pelvic Girdle Pain having trained as a yoga teacher and a massage therapist, but felt a need to deepen my knowledge and find out more practical information to help my clients. If you are experiencing any symptoms of PGP, I recommend a visit your GP to receive professional guidance, if you haven’t done already.

As many as 80% of women experience pelvic girdle pain in the first trimester of pregnancy. One in ten women will still suffer Pelvic Girdle Pain post pregnancy.
What is Pelvic Girdle Pain?
Pelvic Girdle Pain feels like anything from a minor ache to a searing sensation across your lower back and sometimes underneath your tummy.

Although the pelvis appears to be a firmly fixed circle of bone, it consists of four parts – the sacrum and coccyx at the back and at the sides and the two hip bones which curve around to meet at the front. These are joined at the front by the symphysis pubis.

“After having my third child, the problems began when I was in my third trimester. I started having pain walking and standing for long periods of time. It has been 4 years now and I live with this horrible pain every day. Some days are better then others. I am very active, I go to the gym, practice yoga, and dance. Sometimes I can't get out of my car or walk up the stairs.” Katy

What Causes Pelvic Girdle Pain?
Pelvic Girdle Pain is caused by a combination of extra pressure placed on your bones and ligaments during pregnancy and a release in hormones to relax the ligaments in your body.  Pelvic Girdle Pain can be diagnosed as Symphysis Pubis Dysfunction (‘SPD’), although please note that Symphysis Pubis Dysfuntion only applies to the symphysis pubis joint and most sufferers also experience pain in other joints in the pelvis.
What is Symphysis Pubis Dysfunction?
Symphysis Pubis Dysfunction applies to where the pregnancy hormone relaxin causes the pelvic ligaments to slacken so much that the front joint of the pelvic girdle called the symphysis pubis, separates.

It is normal for there to be a gap of 4-5mm between the two pubic points at the symphysis pubis joint and during any pregnancy this widens by another 2-3mm. If this gap widens more than this pain may occur and in some cases a severe form of the condition called diastasis symphysis pubis is diagnosed.

The job of the symphysis pubis joint is to hold the pelvis steady when we use our legs, and if the ligaments have softened or stretched too much the joint stops working properly and strain is put on the other pelvic joints, causing pain.
How do I know if I have PGP / SPD?
The main symptom of PGP is pain in the pelvic joints. There can also be instability of the joints, which makes walking and day-to-day activities difficult.

If in any doubt of the severity of your problem, it is advisable to have an x-ray to see how far the pubic bones are separated.  If they are separated far enough it won't matter how much muscle and core work you do, you will experience pain because you are out of alignment because of the separation.  To continue trying to ‘fix’ the problem without surgery could cause more damage.
Ideas to Offer Some Relief
Yoga can help to realign the spine and stabilise the pelvis by strengthening muscles that support it. Yoga postures also engage the core muscles and the pelvic floor muscles. If you would like to attend a yoga class, it is advisable to contact your teacher before the class and let him/her know of your condition. However, remember that pain is your body’s way of telling you that you have a problem.  It is important to listen to your body and become aware of any ‘twinges’ or areas of pain.  If you have been diagnosed with SPD/PGP, please contact your GP for medical consent before carrying out any exercise.
Yoga Postures for SPD/PGP
1.    Pranayama (Abdominal Breathing)
Abdominal breathing helps to strengthen abdominal muscles, relaxes the mind and body, optimally oxygenates the blood and cleanses the lungs of residual toxin.

Step 1: Sit in a comfortable position with your spine, and neck straight. You could also lie down on your back. Start by taking slow, long, and deep nasal breaths
Step 2: As you inhale, let your abdomen fill with air. As you exhale, let your belly deflate like a balloon. Repeat the exercise a few times, keeping your breath smooth and relaxed. Never strain
Step 3: Breathe into your belly as in Step 2, but also inflate your thoracic region by letting your rib cage open up. Exhale and repeat the exercise a few times
Step 4: Follow steps 2 and 3 and continue inhaling by opening the clavicle region or upper chest. Exhale and repeat the exercise a few times
    Combine all three steps into one continuous or complete flow.

2.    Tadasana (Mountain Pose)
This pose increases awareness of your posture and also aligns your spine. It is a good idea to practice this posture in front of a mirror to check your alignment.

Stand straight and pull both your legs and feet together. Take your toes and raise them all up, let them flex out a little and set them down again as you allow the arches of your feet to lift.  Your big toes should touch.  Tighten your legs together and allow your spine to lengthen. Your chin should be parallel to the ground and your arms relaxed at your side. Breathe into your chest, with slow deep breaths. Gently move your abdomen, towards your spine. Pull your shoulders first back and then down.

Other Pain Relief Suggestions
  1. Using a u-shaped maternity pillow in bed can provide support to your pelvis.
  2. Acupuncture can offer pain relief.
  3. Contact the Pelvic Partnership, a registered charity ( via telephone and request a local specialist osteopath. 01235 820921      
  4. A support belt. Try doubling up with a wide elasticated belt to take the weight off your symphasis pubis and a stiff non- stretchy thin belt to support your pelvis.
Here is the experience of Pelvic Girdle Pain from one of the mum's from a Teeny Tiny Baby Yoga class:

I got spd symptoms at around 5 months pregnant and it was manageable with excercises, a bit of physio and as time went on, a support belt. At 8 months pregnant, I woke up unable to walk at all, the pain was so severe I couldn't even drag myself on the floor to get to the bathroom let alone limp. Things improved gradually towards final days of pregnancy and disappeared as soon as I had my baby. It reappeared 3 weeks later, after I walked further then normal and has not gone away since, 6 months later. Its nowhere near as bad and is now like a chronic nagging pain in my right sacroiliac joint which flares up with walking longer than approx 10 mins. I manage by not being too active and taking paracetamol and ibuprofen when need be. I've seen physios since and do my pelvic floor excercises and stretches advised but it continues. I just live hoping it will go but I can't see it going anytime soon. I think pregnancy hormone relaxin doesn't help, which is still present as still breastfeeding. It gets me down and limits me in what I do and frustrates me not being able to start getting fit again. My advice would be to make sure a GP refers you to physio when pregnant if bad hip pain, either demand or go private of which I did both. It was quite late before I got help. GPs dont really know much about it. Also, to rest as much as possible. I should have gone on maternity leave long before 8 months, this would probably have meant the joint not getting so inflamed according to hospital.

Jenni Grossman is the Director of Teeny Tiny Yoga.  Baby, toddler and children’s yoga classes run from Totteridge Tennis Club in North London.

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