By Sigourney Cross, DPT, PHRC Walnut Creek
Pelvic and low back pain during pregnancy affects up to two-thirds of women and can start anytime from the first trimester to months after giving birth.1 This is due to a couple of reasons. First, there is a change in your hormone levels. Increased levels of the hormones relaxin, estrogen and progesterone begin to loosen the ligaments that hold your pelvis together in order to prepare you for childbirth. When these ligaments get stretched too far, it can cause pain. Another cause for pain is your rapid weight gain. As your belly grows during pregnancy your center of gravity is shifted forward. This causes an increased lordosis or pronounced curvature of your low back. This places excessive strain on your lumbar spine as well as the muscles and ligaments around the pelvis. When pregnant you may also spend more time resting and sitting which can lead to muscular imbalances, weakness and trigger points.
The pain location and type women experience varies. Pain can be experienced in the lower back, top of your hip bones, back or front of your hips, groin, over your buttocks, down the back of the legs, over the pubic bone and into the vulva. The nature of the pain can be anywhere from a mild to severe achiness, stinging or burning sensation, or sharp and stabbing sensation. Thankfully, there are multiple measures women can take to alleviate their pain including pregnancy support garments such as leggings, belts, bands or girdles, sleep pillows for optimal posture and alignment, acupuncture, pregnancy approved pain relievers, prenatal massage, prenatal pelvic floor physical therapy, and of course exercise! Women with uncomplicated pregnancies are encouraged to engage in aerobic, stretching and strengthening exercises with the necessary modifications to ensure safety for both mom and baby. According to The American College of Obstetricians and Gynecologist an exercise program during pregnancy should include moderate intensity exercise for at least 20-30 minutes per day on most days of the week.
The following exercises can ease the aches and pains of pregnancy and prepare your body for the rigors of labor.
- Cat-Cow: Being on all fours, keeping the top of your feet flat on the ground. Your hips should be aligned directly over your knees and your shoulders over your wrists. To get into the cow inhale while letting your back arch and belly drop. Keep shoulders rolled back while looking slightly up. As you exhale, round your upper back and shoulders while looking down at your belly. This is cat. Continue moving into your cow on your inhales and cat on your exhales. This exercise helps increase spine mobility and circulation and gently strengthens your low back helping ease hip, pelvic, low back and round ligament pain.
PHRC Image
PHRC Image
2. Bridges: Begin by lying on your back with your arms at your sides. Bend your knees so that your heels are close to your butt. Next, press your heels into the floor and lift your hips up until you form a bridge with your body. As you are lifting your hips, remember to squeeze your butt muscles, hold this pose for a second at the top before slowly lowering your body back down. This exercise can help ease back pain by strengthening your glutes (butt muscles), low back and abdominals as well as providing a gentle stretch to your hip flexors.
PHRC Image
PHRC Image
3. Child’s Pose: Start out on all fours with your ankles together and knees wide apart. Next, slowly sit back bringing your butt down to your ankles as low as you can go. Then stretch your arms out in front of you on the floor. Allow your weight to sink down and back to slightly round. Hold this position for a few minutes, while breathing deeply. This is a great stretch for low back and hip pain. It helps elongate your spine and take away tension from the added weight you are now carrying, by relieving pressure on the surrounding nerves. This is also a great exercise to relax your pelvic floor muscles!
PHRC Image
4. Seated Piriformis Stretch: Sit on a chair with your feet flat on the ground. Cross one foot over the other knee making the number 4. Lean forward keeping your back flat until you feel a stretch in your low back and buttocks of your top leg. Hold this position for 30-90 seconds and repeat on the other side. The piriformis muscle is a small muscle deep in the glutes that can spasm during pregnancy. This can often cause back and leg pain because it extends across the sciatic nerve. Gentle stretching of this muscle can help decrease tightness and pain.
PHRC Image
PHRC Image
5. Seated Row: You can use either free weights or resistance bands. Begin in a seated position with your back upright. Tighten your abdominal muscles and have your arms extended forward in front of you. Slowly pull the weights or resistance band all the way towards your stomach, keeping your elbows down at your sides while pulling your shoulder blades together. Hold this position for one second before slowly returning to your starting position. Repeat. Remember to keep your shoulders down and back during this exercise. This is a great exercise to help improve your posture, relieve back pain and strengthen your back muscles and as they become weaker with your growing belly.
PHRC Image
PHRC Image
Other exercises that have been proven to be beneficial in preventing and/or reducing pelvic pain include walking, swimming and prenatal yoga. Walking is the number one option for many women as its low-impact, a great way to maintain and improve your cardiovascular fitness, easy to make a part of your daily routine and free! Swimming is another great way to get exercise, especially later in your pregnancy as the buoyancy of the water takes the strain off your joints and ligaments. Finally prenatal yoga is a great way to keep your core strength, flexibility and balance in check. It’s important to remember to maintain a mild to moderate intensity while exercising, to take frequent breaks, practice good form and posture, and avoid positions or movements that increase pain or discomfort. Whether you’re a seasoned athlete or a beginner, be sure to get clearance from your doctor before starting an exercise program while pregnant. Women with higher risk pregnancies may have more restrictions.
If these exercises don’t do the trick I recommend getting a physical therapy evaluation for a more focused program that fits your needs.
References:
- Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e135–42.
- Prendergast, SA. Pelvic floor physical therapy for vulvodynia: a clinician’s guide. (2017). Obstetrics and Gynecology Clinics of North America, 44(3), 509-522.
- Babycenter.com
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.