Pelvic and Back Pain in Pregnancy Physio Leaflet

Pelvic and back pain in pregnancy This leaflet provides information and management strategies for pelvic and lower back pain during pregnancy.

INFORMATION Lower back pain Most cases of lower back pain during pregnancy are due to an altered posture, muscle weakness and increased joint laxity which typically resolves postpartum in 80-95% of cases. Lower back pain in pregnant women is very common, however, pain may radiate down the back of the thighs, front of the abdomen and into the anterior thighs. This may start at any time during the pregnancy but is most prevalent in the second half of the pregnancy.

In an uncomplicated pregnancy you can expect: Increased laxity of the lumbar spine and pelvic ligaments in preparation for the passage of the baby through the birth canal Exaggerated arching (anterior tilt) of the lumbar spine which is correctable

Neutral Pelvis

Anterior Pelvic tilt

MANAGEMENT Helpful Tips Wear supportive, comfortable, low heeled (but not too flat) shoes

AVOID Non-essential weight bearing – sit rather than stand Prolonged walking and standing

Get help when lifting heavy objects

Long drives & get in & out of the car with care, keeping knees together

Sleep with a pillow between the knees for support

Strenuous exercise

Periods of rest laying on your side with knees and hips bent

Breaststroke

Exercise in normal pregnancy

Squatting & picking up things from the floor

Water based exercise

One leg standing: so sit to get dressed

Pain relief (see GP)

Stairs – try to bring down what you need for the day limiting the times you go up/down

When to seek medical attention: Numbness of the inner thighs, groin, genitals, anus Incontinence of the bladder or bowels Inability to pass urine/faeces from the bladder or bowels Increased weakness or loss of sensation in the lower limbs Spontaneous giving way of the legs Persistent back pain that is not eased by rest Back pain that radiates into the leg General symptoms of being unwell

Pelvic Girdle Pain (PGP) During pregnancy the stability of the pelvis is affected allowing the joints to move more than normal. This is caused by changes in the muscles and ligaments. As the pregnancy progresses your posture and your pelvis come under increasing pressures. Pain can be felt in the pubic region, groin, inner thigh and the back; it can be on one side or on both sides. One in five women are affected by PGP, but for the majority of women the pain resolves spontaneously post birth.

Baths – have a shower if possible

Twisting movements: always face the task you’re doing Carrying one sided/too heavy– ask for help with the shopping Sitting with legs crossed or up to the side or ‘L’ shape with feet up on a stool. All of these positions can aggravate your symptoms Lifting – try to persuade your toddler to stand on a stair so you don’t have to bend. Don’t lift heavy or awkward objects Avoid high heels as these can put a strain on your back & pelvis

DO Helpful Tips Pace yourself & reduce the housework, especially heavier tasks Sit correctly with your feet down – if you need to rest your legs, it’s better to lie down. Slouching can lead to back pain Walk with your pelvis in neutral and take shorter steps Pull in lower abdomen and tighten pelvic floor before changing posture Turn carefully in bed using your abdominal muscles, pelvic floor and buttock muscles Continue with any exercises you have done prior to your pregnancy (unless advised otherwise) Sleep with a pillow between the knees & ankles for support Periods of rest laying on your side with knees and hips bent or 4 point kneeling Pain relief (see GP) Rest when able Pregnancy support belt can be useful for a small group of patients Sitting to standing Straighten up first then ensure that the hips, knees and feet are all in line. Lean forward & as you go to stand squeeze your buttocks Turning in bed Turn your head in the direction of the movement, bend your knees up, pillow between knees, squeeze your buttocks, then throw your arm as you lead and roll your knees (this will enable you to roll without twisting) Getting out of bed Roll onto your side. Keep knees together and pop them over the edge of the bed - lower your legs to the floor to bring your upper body into sitting.

Then do your ‘sit to stand’ routine

EXERCISE EXAMPLES Engagement in aerobic and muscle strengthening exercises have a fundamental role in maintaining good health and treatment of PGP & back pain.

Light – moderate recreational exercise (able to maintain a conversation during exercise) Low intensity strength training with low weights or resistance bands with multiple repetitions. Focus on inhaling through nose and exhaling through mouth throughout the activity Aerobic training – walking, stationary cycling, light jogging (in previously active women) Water based exercise Yoga* and Pilates - increases strength, fitness and reduces strength. Avoid hot yoga and adapt yoga positions which are uncomfortable or increase the risk of falling. *Yoga should be avoided if you are hypermobile (double jointed) Daily pelvic floor muscle training – use/download Squeezy NHS Pelvic Floor App Pregnant women who are new to exercise should gradually increase exercise duration and should begin with 10 minutes. www.providephysio.org.uk

If you need this leaflet in braille, audio, large print or another language, please contact our Customer Service Team on: 0300 303 9951 / 0300 303 9952 or by email at: provide.customerservices@nhs.net Provide Corporate Offices 900 The Crescent Colchester Business Park Colchester, Essex CO4 9YQ

T: 0300 303 9999 E: provide.enquiries@nhs.net www.provide.org.uk

PBO-3569-2009-02