Pelvic and back pack in pregnancy

Pelvic and back pain in pregnancy This leaflet provides information and management strategies for pelvic and lower back pain during pregnancy. /ProvidePhysiotherapy @ProvidePhysio @ProvidePhysiotherapy providephysiotherapy.org.uk

Management Helpful Tips Walk in supportive and comfortable shoes, swing arms and wear a backpack, rather than a handbag for symmetry. If walking is painful try shortening your stride length or slowing your speed.

Be as active as possible, avoid aggravating positions or movements where possible.

Sit down to get dressed.

Keep your legs together when turning in bed and when getting out of a car.

Avoid heavy lifting, ask for help.

Sleep on your side with a pillow between your knees.

Keep moving regularly and exercising if you are able to.

Seek help from your GP/midwife if the pain is persisting.

Get into bed in your hands and knees and turn onto your hands and knees to changes sides in the night.

When to seek medical attention: Numbness around the genital region and or inner thigh area.

Incontinence of the bladder and or bowel.

Inability to pass urine.

Increased weakness or loss of sensation in the lower limbs.

Persistent back/pelvic pain that is not improved with rest.

Information Pelvic girdle pain and lower back pain About one in five women will experience back pain or pelvic girdle pain (pain in and around the pelvis) at some point during their pregnancy. Pain may be felt in the pubic region, inner thigh, back. It may be worse on one side or on both sides. The severity of this can vary from one person to the next.

If your pain persists for more than two weeks or it is affecting your ability to carry out normal day to day tasks then you should tell your midwife or GP. In approximately 85% of cases, the pain resolves within a few weeks of giving birth. If the pain does persist after this, please tell a health professional.

The pain can be caused from changes to your posture which will affect the muscles and joints around your back and pelvis. This can allow more uneven movement to occur around the pelvis which can cause pain. It is important to identify what activities or movements are triggering your pain. You will be asked this by the health professional who is seeing you.

In an uncomplicated pregnancy you can expect: Increased tilting of the pelvis (anterior tilt).

This also causes more arching of the lower back. See diagram below Changes to the muscle length and strength of the abdominal muscles, back muscles and pelvic muscles.

Neutral Pelvis

Anterior Pelvic tilt

Avoid Prolonged periods of sitting.

Movements that are aggravating your pain (eg walking for long periods).

Long drives. Get in and out of the car by keeping your knees close together.

Breaststroke swimming.

Baths-showers are preferable.

Positions involving standing on one leg.

Sitting down to get dressed might be easier.

Lifting. If you need to lift your children, try to get your toddler to stand on a step so you don’t need to bend as far. Get them to climb onto your lap for a cuddle. Avoid carrying children up and down stairs. Don’t do any heavy lifting.

Avoid high heels as they will change your posture putting more strain on your back and pelvis.

Avoid sitting with legs crossed or up to one side. These positions can aggravate your pain.

Stairs-try to plan what you need to bring down for the day to avoid too much stair climbing.

Do Helpful Tips Keep active-keep doing exercise you have done prior to your pregnancy Regular change position Ask for help with housework Pace yourself Sit with feet supported and avoid slouching Sleep with a pillow between your knees Wear a support belt if it feels comfortable Ask for help from family and friends

Sitting to standing Straighten up first then ensure that the hips, knees and feet are all in line.

Lean forward and 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.

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