Hello and Happy New Year!
I have been getting a LOT of questions about Pregnancy Related Pelvic Girdle Pain of late – I think it is always a topic of confusion and debate – do biomechanics matter? Is it all about anxiety? (and does that mean it’s all in my head?!) What does the evidence tell us we can actually DO about it? Does manual therapy even work? And if not, is it just about exercise?!!!
A couple of interesting papers have come across my desk of late so I wanted to put them together in a way that (hopefully!) makes sense and will inform our thinking as we move forward in our discussion, which isn’t going away any time soon as we know that up to 86% of women are affected by PRPGP.
PRLBP – Pregnancy related low back pain and PRPGP – Pregnancy related pelvic girdle pain – are overlapping terms but generally we are talking about pain anywhere from the 12th rib to the gluteal folds
What do we know?
It isn’t Relaxin’s fault….
Your pelvic isn’t unstable….
We need to address stress, sleep, constipation, pelvic health, local strength and coordination and CONFIDENCE in improvement for optimal results.
(To paraphrase Greg Lehman, we need to calm things down then build things up!)
And that is where manual therapy comes in – not to fix scary ‘side bent rotated’ sacrums (what is the plural of sacrum – sacra?!) but to use non painful hands on skills to calm down the nervous system via the biggest organ we have – our skin. If we can reassure, improve proprioceptive awareness and promote ‘fearless movement’ (hat tip to L Gifford!) AND follow it up with functional movement that allows women to complete their everyday activities and enjoy their pregnancies – well that for me is the ideal prescription for PRPGP!
What does the research tell us?
You’ll hear me talk, in the video below, about a couple of interesting papers that I’ve come across lately:
This interesting paper by Chen et al (2020) discusses how gut dysbiosis may be a driver for pre-eclampsia…so eating a wide vaiety of vegetables and fruit is not only great for avoiding pregnancy related constipation, (which can drive pelvic girdle and low back pain!) but looking after your microbiome may be protective against pre-eclampsia!
Rogers et al 2017 paper, ‘ Pelvic floor symptoms and quality of life changes during first pregnancy: a prospective cohort study’ discusses how pregnancy (and not just mode of delivery!) can impact on pelvic floor muscle function, showing increased urinary and anal incontinence trends as pregnancy progresses, as well as an increase in pelvic pain. You can find the paper here
Rodriguez-Ayllon et al’s 2019 paper showed that an increase in moderate to vigorous activity in pregnancy (yes, that’s safe!) lead to a decrease in depressive symptoms, that decreasing sedentary behaviour improved positive affect and really interestingly, that upper body flexibility was linked to improved emotional regulation in pregnancy – all of which is good news for pelvic girdle pain!! You can find that paper here
If you’re looking for more resources on FUNctional movement and problem solving in pregnancy, I have a couple of suggestions…
The POGP have made their booklets free to download – check them out here
If you’re in Ireland (or fancy a trip?!) the HSCP are sponsoring my Pregnancy and Postnatal courses (2day live!) in Naas, Co. Kildare in February (this course is full, waiting list only) or in Cork in March (3 places left) You can email me at firstname.lastname@example.org for details
If you’d like an introductory course into Female Pelvic Floor Function and Dysfunction that is external/movement based, then come along to Dublin in February where I’ll be teaching a one day course at Live and Breath Pilates. More information here
Or if you prefer continuing education in the comfort of your own home…may I suggest our online Advanced Pregnancy Wellness course, which goes all the way from pre-conception to postnatal care – you can check it out here…
And finally…here’s a short(ish!) video with some of my thoughts on PRPGP
Until next time!