Advice from a chiropractor:
It is estimated that around 1 in 5 women experience pain during pregnancy or postpartum. In my experience the actual figures are much higher.
The technical term for most back pain experienced by pregnant women is Pelvic Girdle Pain (PGP/formerly Symphysis Pubis Dysfunction or SPD). It is defined as a collection of uncomfortable symptoms caused by a misalignment or stiffness of your pelvic joints at either the back or front of your pelvis. Pain or stiffness can be felt at the pubic joint at the front of your pelvis, lower back or in the perineal area.
Why do we get pain during pregnancy?
To understand how problems develop we must first look at pelvic anatomy. The pelvis is made up of two large C-shaped bones, which connect together forming two large joints at the back and a smaller joint at the front. These joints are held together by a complex system of muscles and ligaments, which stabilize the pelvis and facilitate all lower body movements. The muscles around your buttocks are your pelvic stabilizing muscles, and the muscles underneath your pelvis between your legs are known as your pelvic floor muscles.
During pregnancy the changes in weight distribution combined with the increase of the hormone relaxin (a hormone which loosens joints and muscles to prepare for birth) cause many women’s pelvises to become mis-aligned. If you imagine the two sides of your pelvis to be like a train track (symmetry is essential!) if one side is askew then the muscles and ligaments cannot function correctly, resulting in stiffness and discomfort.
What can we do to help?
1. Do Your Stretches
Regardless of exactly where you feel your pain, it is very likely that there is an imbalance in the alignment of the two sides of your pelvis. One safe way to alleviate the symptoms of this is to stretch out your pelvic stabilizing muscles (your gluteus minimus, gluteus medius and piriformis). This can be done easily by lying on your back with both knees bent and feet flat on the floor. Take one leg up placing the outer surface of your ankle onto the opposite leg just above the bent knee. You may feel a stretch around your buttock at this point, if not, then raise the first leg using your hands to grab around your thigh, going very slowly until a gentle stretch is felt. See a great video here: http://www.youtube.com/watch?v=gE6mJ0VjK7Y
It is very important to repeat on both sides regardless of where the pain is felt, as your pelvis is more likely to re-align if both sets of pelvic muscles are relaxed.
2. Get Squatting!
It is never too early in your pregnancy to practice squatting. In fact we should all practice squatting. The movement created by squatting is actually a very natural every day motion rather than simply a targeted exercise, however most of us can’t perform it properly. If you have moderate or severe pain then squatting is not recommended until you have been assessed by a health professional. However, if your pain is mild or if you are not suffering then performing this exercise daily will increase your pelvic strength and may even shorten your labor! Follow these tips to perform squatting exercises correctly and safely:
A. Your back must remain straight, as soon as you feel your lower back start to curve, that is your limit. Do not try to squat deeper if you cannot do so correctly, a gentle squat performed properly is much better than a deep squat performed badly.
B. Hold on to something as you squat, such as a doorframe or partner. This will improve your squatting posture as well as stabilize your body.
C. Your feet must remain flat, if your heels start to rise then stay where you are. Do not squat any lower. Most people can do a full squat on their tiptoes, but it can be very damaging to the knees.
D. Ensure that your knees stay in line with your ankles and do not let them go over your toes.
E. Go slowly and use deep breaths, gently pulling in your pelvic floor and abdominal muscles as you do so. It may help to exhale on the way down and inhale on the way up.
Some women even practice squatting by peeing in the shower every day! http://www.mommypotamus.com/why-you-need-to-pee-in-the-shower/
3. Pay Attention to Pelvic Floors!
Of course all expectant mothers will have heard that they need to do the dreaded pelvic floor exercises, or “Kegel’s”, named after Dr. Arnold Kegel who first developed the system of exercises. Poor pelvic floor strength can lead to stress incontinence, and may also contribute to back, hip and pelvic pain. However, there is a growing community of health professionals who are recommending a different approach to pelvic floor strength. Your pelvic floor can become weak over time whether you have had children or not, mostly because most of us have long standing postural problems. So how do we fix this? The answer may not lie in the well-known “hold and release” Kegel technique, in fact some health professionals believe Kegel’s may accentuate the problem, and here are some excellent diagrams to explain how: http://www.katysays.com/1234-we-like-our-pelvic-floor/.
The answer may be to realign your pelvis by correctly performing your squats (see #2), which will improve the position of your pelvis and let your pelvic floor muscles function as they should.
4. Pre-natal Yoga
When you are pregnant and especially if you have pain it is very easy to spend the majority of your time on the sofa. However this will only make matters worse, as your mis-aligned pelvis will continue to put pressure on your surrounding muscles and ligaments. Pregnancy is a perfect time to practice yoga, and I would recommend starting antenatal yoga classes as soon as possible. If you are already a yoga fan then continue with your regular classes until 12-18 weeks. A good specialist yoga class will offer you a chance to get to know your changing body and prepare it for birthing. It will also help to keep your hip and pelvic muscles strong but supple, maintaining pelvic alignment. Always make your teacher aware if you have experienced any lower back or pelvic pain.
5. SEEK HELP!
The most important thing to take away from this article is to seek help as soon as you feel that things are not right. A slightly mis-aligned pelvis is relatively easy to fix and preventative measures can be introduced. A chronically severe mis-aligned pelvis is more difficult to manage and is likely to get worse as your pregnancy progresses. I would advise seeing a chiropractor, osteopath or physiotherapist that specializes in pregnancy related problems. Make sure you check they have had post-graduate training in this area before you book, don’t worry - health professionals don’t offend easily.
This is a frequent conversation with my pre and postnatal gals.
Question: When can I start running again?
Answer: Probably (read: definitely) not after your 6-week check-up when your doctor "clears" you for all exercise.
(Side note, but docs, can you please use different wording with your postnatal clients when it comes to this? Running is not the same as core activation, breathing, resistance training, etc.)
Postnatal ladies, I need you to be patient with this one, because it will significantly impact your recovery in the short term and health in the long-term. Postnatal exercise is fantastic and I encourage it as soon as you're ready and feeling up for movement. Working on abdominal and pelvic floor activation exercises, retraining your breathing patterns, doing exercises such as squats, lunges, hip thrusts, pulling, and scapular slides are all amazing. They will be extremely helpful in your healing and fat loss journey, if that is a goal of yours.
(Working core control through band resisted squats, to increase activation of glutes)
However, running, and any high impact exercise for that matter, is a completely different story. What your body has undergone during pregnancy, labor and delivery is no joke. I've said it before, and I'll say it again (and probably continue to keep saying it :)). If you think that running is going to be your best bet for getting back to your "pre-pregnancy" weight, or into your jeans, or even get your abs back, it's just simply not going to be. There are much more effective and safe ways for you to do this, I promise you that. Read this post for your best bets if any of the above is what you're striving for.
I understand that you may love to run and I fully support you in getting back to it. But please, keep reading to find out why I need you to wait at least 3 MONTHS to pound the pavement. To be crystal clear, this is with 3 months/12 weeks of structured postnatal specific resistance training (core retraining, glute/back strengthening, breathing exercises), not just 3 months from delivery day.
1). You are mega sleep deprived. You likely do not have the ability to focus on a million things at once right now, which is what running will take when you're getting back into it. Abs bracing, pelvic floor engaged, glutes firing, diaphragmatic breathing, etc. through hundreds and thousands of steps? Sounds exhausting just thinking about it and I got a full 8 hours last night ;)
2). Your new body is unstable right now. Not just because of the changes to muscular strength, but also because the hormone relaxin is at an all time high for first few months postpartum. This is the hormone that made it possible for your body to be able to carry a baby and birth it. It makes your soft tissues (for example, ligaments) more lax and therefore, you are far more susceptible to injury. Especially injury to hips, pubic symphysis, low back, and knees.
3). It is essential to retrain your core and floor. Your core muscles are not ready to support your body through repetitive pounding food strikes. It is a recipe for disaster. Your posture is likely not optimally aligned, especially if you are spending long days breastfeeding and carrying your baby. You probably have some degree of diastasis recti (abdominal separation) and your spine is not well supported. Your pelvic floor might not be functioning at 100% and you could be experiencing incontinence symptoms. You will exacerbate these issues with running.
(Training the abdominals through dead bugs exercises can be a great place to start)
4). Uterine and bladder prolapse are real things to be aware of. I recommend all my ladies go see a pelvic floor physiotherapist to put both our minds at ease. If you are experiencing ANY issues with urinary and/or stress incontinence, see a PFP so they can give you treatment and exercises to help rehab you. If you're having incontinence with sneezing or laughing, or if you are running wearing a pad because you're leaking, just back up and keep training the basics of core/floor healing.
5). Acknowledge you are in recovery mode and start slow. To get back out there, start building up your mileage slowly. Maybe you start your runs with 1 minute + 1 minute walking, and add 30 seconds to a minute on your run time weekly if it feels good. You will need to keep up your strength training routine as your get into a regular schedule of running. Do not let this fall off.
Good luck, ladies!
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