Prenatal Health & Nutrition

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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: 

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!

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:  

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. 


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.  


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