So I am 24 weeks pregnant today with my first baby due on the 24th May 2016 which is all very excitingly overwhelming. As promised with this blog I am going to share with you the 'inner workings' of a pregnant women's health physio, all the ups and downs of the entire process from start to finish, and beyond (other WH Physios I hear you saying 'ha! did you not learn better than to get yourself pregnant?!').
Two weeks ago was a low point, the onset of a right pain in my bum, literally. Over the course of a few days I developed left buttock and sacroiliac pain to the point that I couldn't stand up, lift my leg, get in and out of the car without wincing or feeling a click and having to do it at half speed. This was hard hitting, I have never had to slow down like that, ever! This was when the hormones started to make me freak, all rationality wanted to go out of my head, I was already imagining crutches and the consequences of putting on extra weight due to inactivity. Then, I thought no - and copped myself on. After having a word with myself I thought 'I can be my own case study' and put to the test what I preach to all the ladies I treat with Pelvic Girdle Pain.
My pain was triggered by changes in load to my pelvis, with activating my gluts it eased, even just doing a isometric bum squeeze whilst sitting caused an anaesthesia effect. A main contributing activity to the onset of the pain was walking our 6 month old pup on the lead, or should I say her taking me for a walk. When she pulled on the lead it sent spasms into my buttock, this could be translated to poor anticipatory activity and neuromuscular control of my pelvic stability muscles and their insufficiency to react to this increase in load on my pelvis and sacroiliac joints, thus causing spasm and pain.
It all made sense, so I got to work at addressing it, with well structured exercise and rest to allow recovery. The primary things I used were squats, single leg squats, stiff leg deadlifts and single leg stiff romanian/ stiff leg dead lifts. A little help also came from my women's health colleagues (shout out) who did an 'IOU' deep tissue massage which allowed a window of relief to be able to address the instability. Stretches including pretzel stretches / piriformis / obturator internus stretches also featured for a little short term relief to the spasm. Whilst these activities do give a little bit of relief, it must be highlighted the greatest gains (which i would mark as 'how long an intervention had an effect') were definately the strength exercises. A pelvic stablity belt also enabled me to keep mobile at work and continue with my daily activities. A very important but upsetting point was recognising the need to stop the aggravating activities which unfortunately meant not walking our pup which made me very sad. I had already given up running a few weeks prior and so giving up country walks just felt like I had nothing left! dramatic I know!
I am pleased to say two weeks down the line I am significantly better, I can walk the pup (off the lead), swim breaststroke, front crawl and backstroke again (yay!) and just completed two hours of leading antenatal and postnatal pilates classes to no detriment.
A big learning curve I have to say. It was very interesting to see the psychological effects this pain had on me and the way in which I subconsciously adapted my movement patterns and so only feeding in to the issue. This is the kind of stuff I tell my patients all the time and successfully work to address with them, but when it was myself it was a whole other ball game to address. There was great deal of denial of it initially, until my husband who is a clinical specialist musculoskeletal physio refused to have me deny it anymore! He put up with me for a week before releasing his bottom lip from his teeth one evening in the kitchen and had an hour off from 'caring husband Ady who'd better not be a smart alec' to become 'physio, smart alec and risks having to sleep in the spare room Ady'. And voila, as soon as I started to address the fear of moving and not adapt my movement patterns to avoid the anticipated pain a vast improvement was seen. The joint hadn't 'moved' and my strength hadn't gone - my butt had simply switched off as it thought it was the safest thing to do as it stops me doing 'perceived' dangerous things.
If I hadnt done this, I would have stopped other enjoyable things that keep me mobile, which would have only contributed to genuine weakness, stiffness and even more fear when other things start to trigger off the area. The start of a downward spiral...
The importance of seeing ladies early onset of pelvic girdle pain is therefore invaluable, pregnancy is already a nerve racking time and reassurance is needed early doors to avoid a chronic pain state.
Watch this space to see if it stays at bay from my left bum cheek!
Ive included some pictures for reference as to what these exercises are. Feel free to try them, but a little guidance may be useful/ safer- if so, why not book in for assessment to go over them and other interesting ways of managing your pain in the bum. Please note, I can treat actual bum pain, not 'smart alec husbands'...