By Anna Scammell
Masters-trained Women’s Health Physiotherapist
Back and pelvic girdle pain is very common in pregnancy, affecting up to 76% of women. Whilst being common, there is a lot you can do reduce your pain, and therefore have a happier pregnancy!
1. Understand your pregnant body.
Understanding your pregnant body helps to explain why you are feeling this pain and gives you reassurance that in most cases it will go away straight after you have your baby (if not before).
During pregnancy the biomechanics of your body changes dramatically. An increase in weight, a reduction in core muscle strength, abdominal stretching and a shift in centre of gravity lead to postural changes and musculoskeletal imbalances. As a result, the joints and muscles of your lower back & pelvis can be strained and overcompensate, causing pain.
In addition to this, hormonal changes take place to make space for your growing baby and to prepare your body for childbirth. The body releases a hormone called Relaxin, which relaxes/softens the ligaments in your pelvis. This can lead to inflammation. As a result, the joints and muscles of your pelvis and lower back can stiffen/tighten in attempt to increase stability. This protective response of the body can create tension and therefore pain.
2. Modify the way you move.
It might sound simple, but modifying the way you move in your everyday life can have a dramatic difference on your pain.
- Keep your pelvis & hips level during all movements.
- Avoid movements that create shearing through the pelvis like stairs and standing on one leg.
- If you have to take the stairs, do one step at a time.
- Sit down to put your underpants, pants and shoes on.
- Sit in your car by lowering your bottom onto the seat first then lifting your legs in carefully.
- Sit on the edge of the bath to get in rather than stepping over the edge.
- Avoid carrying a toddler on one hip as much as you can.
- Avoid lifting anything heavy or awkward.
- Keep your knees together when you are rolling in bed.
- To get out of bed, roll onto your side, drop your legs over the edge of the bed and push yourself up to sitting using your arms.
To help settle inflammation and pain you need to have adequate rest. This might mean having a lie down for 10 minutes after work or when your toddler is sleeping, or getting family help to look after your toddler so you can rest. Prioritising 7-9 hours of sleep at night is also important.
4. See a Women’s Health Physiotherapist.
Seeing a Women’s Health Physio (not General Physio) who treats pelvic pain in pregnancy can make a huge difference to your pain. I have helped hundreds of women with mild to severe pelvic pain by using techniques such as joint mobilisation, dry needling, massage, postural education and exercises.
5. Neutral posture.
Learning how to stand with a neutral pelvis in pregnancy can help alleviate pressure off your lower back & pelvis, improving your pain. The key is to stand tall, with weight equally on both feet and gently tuck under your tailbone, flattening your lower back.
6. Core & pelvic floor exercises.
Correct activation of your deep abdominal muscles and pelvic floor can help to increase stability around the pelvis, and therefore reduce pain. Making sure you do this correctly is key. Learn how using my E-book here. https://www.thewholemother.com/product/pregnancy-pelvic-pain/
7. Strengthening & stretching exercises.
Regular strengthening & stretching exercises for your hips, pelvis and lower back can both prevent and improve pelvic pain in pregnancy. Learn how using my E-book here. https://www.thewholemother.com/product/pregnancy-pelvic-pain/
8. Physio-run Pilates.
Prenatal or 1-on-1 Pilates run by a Physiotherapist is a safe way to exercise if you have pelvic pain in pregnancy. Pilates can help stabilise the pelvis and spine, which can in turn improve pain. Exercises that involve standing on one leg or single leg extensions (out to the back) or abductions (out to the side) should be avoided.
9. Avoid aggravating exercise.
Exercise within your pain limits. Avoid any exercise that aggravates your pain. This might mean modifying the duration or the way you exercise.
- Avoid shearing movements such as the stepper machine, the cross trainer or exercises that involve standing on one leg.
- If walking for long periods is a trigger then do shorter walks more often e.g. go for a 10-minute walk before work, after work and in your lunch break, rather than 30 minutes straight.
- Swim freestyle or backstroke, but avoid breast-stroke legs. Swim with a pool buoy between your legs if kicking of any kind is painful.
- Walk in the pool or do aqua aerobics.
- Choose weights in a standing or seated position, where you feel supported.
- Avoid warrior pose or any single leg poses in yoga.
- Stationary-seated bike may be ok for you.
10. Wear a compression garment.
Compression garments are necessary to increase stability around your pelvis and reduce your pain. I highly recommend SRC pregnancy shorts/leggings as I have seen them help countless women with pelvic pain. They are comfortable and can be easily worn under your clothes. Another good, but more cumbersome option, is the Serola SIJ Belt.
11. Spikey ball release.
Using a spikey ball against a wall is a great way to release the muscles around your pelvis (especially the glutes) at home. There are no 2 ways about it, the spikey ball hurts when you do it, but the results will be worth it!
12. Sleeping positions.
Finding a comfortable position when you have pelvic pain in pregnancy can be difficult. (Obstetricians also advise you to go to sleep on your side in the later stages of pregnancy, as going to sleep flat on your back can be associated with stillbirth). Here are some tips to help you:
- Keep your pelvis/hips in a neutral position by placing a pillow between your legs when lying on your side.
- Lie quarter turned to your left by placing a pillow under the right side of your pelvis/back. You can also use a wedge to achieve this. This will take the pressure directly off your hip, which can be a source of pain.
- Use a butterfly pillow to support your belly and your back when lying on your side.
- Using a whole body pregnancy pillow to avoid a million pillows in your bed!
- If you have hip pain lying on your side, try a shell foam mattress.
Kanakaris NK et al (2011) Pregnancy-related pelvic girdle pain: an update. BMC Medicine 9:15.
Verstraete EH et al (2013) Pelvic girdle pain during or after pregnancy: a review of recent evidence and a clinical care path proposal. ObGyn 5:33-43.
Anna Scammell is a Masters-trained Women’s Health & Pelvic Floor Physiotherapist in Sydney, and Founder of www.thewholemother.com. Anna offers home visits, clinic consults in North Bondi, and online consults. She combines her 10+ years of clinical experience and evidence based knowledge to bring women consults, E-books and Free Resources. Anna’s mission is to educate, empower & inspire as many women as possible to be the best version of themself during their childbearing years and beyond.