From pelvic instability to pregnancy-related pelvic and back pain
We have learned a great deal about what used to be called 'pelvic instability' . Difficult to get out of the vernacular, but still an important goal.
Why? "What's in a name", you might think?
Because pelvic instability does indeed give a woman the idea that her pelvis would be unstable and vulnerable. The term or diagnosis can increase anxiety and encourage catastrophic thoughts. In contrast, we now know very well from research that a pregnant pelvis does not become so unstable.
Each pelvis remains stable and strong.
Relaxin is a hormone that increases laxity in connective tissue. So this hormone makes ligaments and bands more supple during pregnancy. Perhaps to prepare you for the eventual delivery. It used to be assumed that this was the major cause of pelvic pain, which is why the term "pelvic instability" was coined.
But the contribution of relaxin is really not significant. This means that pregnant women may experience a little more mobility in joints, for instance around the pelvis and the lower back (or for instance also in the feet or other joints). But in none of those pelvic joints (I mean your pubic bone or sacro-iliac joints) does the mobility really increase significantly.
Pregnancy-related pelvic and back pain is therefore a much more correct wording. Because we don't want to deny that pain complaints do occur and that some women really do experience a lot of pain and discomfort. That is true. But it is much more complex than simply thinking that it is about increased laxity or instability.
More and more evidence shows that it is about a hypersensitivity of the pain system, which results from all the changes together.
A pregnant body undergoes many changes. Weight increases, centre of gravity changes (because most of the kilos grow in front, think of the breast volume that increases and the belly that grows). As a result, posture often changes and some muscle chains are put under more strain than before your pregnancy. But also risk factors such as earlier back problems or weaker muscles, or even muscles that are too tight, play a role. Stress, fear and problems with your mental health can also increase your sensitivity to pain.
Small movements, changes in posture or heavier tasks can often be regarded as "dangerous" (by your overstimulated central nervous system) and this triggers the pain response. So the pain is certainly not imagined or dramatised. Women do feel those awkward pains, but often it is a kind of wrong response from their brain.
The solution is certainly not to be found in "flat rest".
Rest is good, rest is necessary, but preferably alternated with movement and physical activity as much as possible.
Building up exercises that do not hurt, to reassure the body in this new changing situation (growing pregnancy), is an absolute must!
It often helps to train your core muscles a bit better, especially your glutes, which can take a lot of the strain you put on your stomach side.
- Typical example: Do you have trouble and pain when 'starting to walk'?
Tense your buttocks firmly together, press your heels into the ground, walk two steps backwards and feel what it does.
Does it work without pain? Then you are reassuring your central nervous system.
Now step forward slowly and confidently. You will probably do better.
What can you expect?
Pregnancy-related pelvic pain often has a variable course. Sometimes they improve and sometimes they reappear. But with the right adjustments, you can achieve a lot yourself. All the tricks to get active again and reassure your body are recommended.
Often, small tips about changing your posture or moving differently are very helpful.
But it is certainly important to talk about it and to find those tips and tricks.
Don't dismiss the complaints. After all, pain sustained for a long time can be troublesome, weighs heavily and is a risk factor for work absenteeism, insufficient exercise and even chronic complaints.
Women in pain are more likely to avoid healthy exercise and that is a shame!
So stay active, seek help from a physiotherapist specialising in pelvic floor rehabilitation and perinatal physical therapy or a manual therapist who is also familiar with this type of complaint. (via our Links/FAQ)
Some additional tips
- Relaxed posture or tight corset?
Carry your baby close to you during walks and activities, don't let your belly hang down too much as this can sometimes cause your back to hollow.
But alternate with rest, retracting your navel all the time is really not necessary!
The stronger your gluteus muscles are, the better you can maintain this balance.
So train on that "glutei"! Squatings, bridgings... a strong poop, it will definitely help you.
- Wearing heels, standing elegantly and crossing your legs?
These are all things that can provoke additional pain. Try to walk more often in sturdy shoes, without heels. Avoid crossing your legs and standing on one leg.
A stable position on both legs and a good stable cross-legged position with your knees falling open. Preferably even with your knees supported by some cushions. These positions give your body a safe and supported feeling.
When you rest, it is best to find that comfortable support.
- Pelvic floor muscles
Women with pregnancy-related pelvic pain often have over-tensioned rather than weak pelvic floor muscles. So have that checked too.
- Respiration
Your breathing pattern and the tension in your diaphragm can also provoke unnecessary pressure. Regularly take a good deep breath in and out. So that you really feel that your whole torso expands and contracts again, 360° breathing is also called these days. Or see it as a combination of belly and flank breathing. Feel your body expanding and stretching on inhalation and contracting gently on exhalation.
- Dare to move and alternate
Also dare to make turning movements. Swing your arms, etc. In any case, avoid cramping your torso and corset.
- Taping
Taping can sometimes give a reassuring and comforting feeling. There are different kinds of tapes, some of which provide a "sensory input", or in other words a "human-speak", a more reassuring feeling. Other tapes provide a "neuromotor input" and help to activate the right muscles.
- Pelvic bands
Pelvic straps can also be used, but preferably only during activities that are really difficult and only for those women who really have complaints and cannot continue otherwise. (Preferably with tips from the physiotherapist and SEROLA bands are a good brand, for example)
Take Home Message: Find a gynaecologist, general practitioner or specialised physiotherapist who knows these problems well and take good care of yourself.
Good luck!
Hedwig
PS: Small disclaimer with this blog. Pelvic pain can also be caused by a trauma or accident or a very difficult birth. If your pain is really acute because of such a sudden event, then it is important to do some additional examinations. And the tips and guidelines may well differ from these average tips.
References
- Davenportetal. Exercise for the prevention and treatment of low back, pelvic girdle andlumbopelvic pain during pregnancy: a systematic review and meta-analysis. Br JSports Med .2018. 10.1136/bjsports-2018-099400
- Stuge etal. The association between pelvic floor muscle function and pelvic girdlepain--a matched case control 3D ultrasound study. Man Ther. 2012Apr;17(2):150-6. doi: 10.1016/j.math.2011.12.004.
- Mottola et al. Canadian Guidelines for physical Activity, Br J SportsMed. 2018 Nov;52(21):1339-1346. doi:10.1136/bjsports-2018-100056
