Is your pregnancy pain musculoskeletal? Try these stretches!

There are several reasons why you might experience pregnancy pains related to muscle, joint and nerve. Depending on where the pain is, the intensity of the pain and the type of pain will determine the best course of action to resolve your pain. If the following exercises don’t help or if your pain is intense, please get a consultation for personalised advice or visit your doctor. Furthermore If you are unsure of why you have pain (i.e. it’s an unfamiliar pain), if this is your first pregnancy or if your pain is severe, sharp, shooting, throbbing or deep you should see your doctor or specialist before all else.

Low Back Pain

This is the most common pregnancy pain we see at the clinic. The pain is usually right on the dimples at the very bottom of the low back. Sometimes there is referral up and down or across the low back as well. From how long women leave it before seeking treatment, I sense that there is a lot of pregnant ladies putting up with low back pain unnecessarily. Although low back pain is a common part of pregnancy and a lot of women experience it, this doesn’t mean you have to put up with it. Here in the clinic we find treating the gluteal and hip flexor trigger points together with some exercises and sometimes ROCK taping very effective. We treat either lying on your back, side lying or face down with a supportive belly pillow depending on how far along with your pregnancy you are, what area we are treating and depending on what you find most comfortable. We won’t keep you in any one position for too long and we will support you with pillows and towels where needed.

Try this exercise at home to see if it helps with your low back pain. Its purpose is to gently mobilise the spine allowing all the ligaments, tendons and muscles to get some blood flow and relax. If one way feels better than the other, you could try just doing one part of the cat stretch and finishing back at neutral spine (where the spine is in its natural position with the little dip in the low back).

Cat Stretch

1. On hands and knees gently curve your back towards the roof like you are trying to lengthen the back of your shirt. Make sure you softly drop your head as you get to the end of range.
2. Now do the opposite. Gently dip your stomach and ribs towards the floor this time softly lifting the head as you reach the end of your range.
3. Repeat 5-10 repetitions. Once you get the pattern working try moving one spinal segment at a time starting at the base of the spine and working your way up to the head. Try adding a breath, breathe out to move and take a breath in to prepare at either end.

 

Rib Pain

Depending on how far into your pregnancy you are, the pregnancy rib pain your experiencing could likely be your baby pressing up against your rib cage, especially in your 3rd trimester if your baby is in the breech position. If this is the case, positional changes, heat and if really bad pain, paracetamol (at the recommendation of your doctor or specialist only) might be of assistance. The most common musculoskeletal cause of rib pain we see in the clinic however is from the change in spinal position. This is from changes to your centre of gravity along with increased levels of the hormone relaxin. This makes the deep supportive spinal muscles (multifidis & rotators) work harder and in a shortened position which activates their Trigger Points which so happen to refer around the ribs. If your pain seems to start at the back or side of the ribs and run around towards the front, this is the most likely cause of your pain. To help alleviate this pain at home, try the following stretch.

Side Lying Rib Rotations

1. Lie on your side and support yourself with pillows, cushions or towels as needed. One under the head, under the belly and between the knees is often helpful.
2. Bend your elbow of the arm that’s on top, drawing the elbow to the roof and sliding your hand along the lower arm.
3. If it feels comfortable open out further by extending the arm behind you until you feel a gentle stretch around the chest area.
4. Bend the elbow to gently bring the arm back through to the start position.
5. Repeat 10-15 times each side.

Notes: Shorter limbs make for lighter work, so always start with the elbow bent and lengthen it to increase the exercise. Don’t forget to breathe! Try a breath in for step 2 and a breath out for step 3. Then a breath in to hold and a breath out to come back to the start position.

Sciatica

Sciatica is a very common pregnancy pain. It can come from the lower back or from a deep muscle in your bottom called the piriformis muscle. Sciatica is distinguished by a pain starting around the bottom or hip area and travelling down the leg past the knee, sometimes as far as the ankle or the foot. During pregnancy the hormone relaxin increases making the ligaments soften. This increases the amount of load placed on your muscles, sometimes the muscles can cause the problem, other times you can end up hanging into new postural positions and putting a lot of strain on the joints especially around the lower back and hips which can aggravate the discs or nerve spaces in the lower back. We treat sciatica a lot in the clinic. Try the following exercise for the back and see if it helps.

4 point kneeling – The rock back

1. On your hands and knees make sure your hands are under your shoulders and your knees are under your hips. Also make sure you are in neutral spine (no dip, no curve).
2. Gently rock back towards your feet about half way then slowly return to the start position.
3. Repeat 10 -20 times remembering to maintain neutral spine the entire time.

Hip/Groin Pain

There are several things that can cause hip and groin pregnancy pain depending on where the pain is therefore it is essential that you get a proper diagnosis before progressing with any exercises or stretches to help. A more serious causes of pain in this area is a DVT or deep vein thrombosis which is a type of blood clot. Some other things that can cause pain in this area are the round ligament, osteitis pubis, pubic symphysis irritation or inflammation and referral from the lower back.

In the clinic we mostly see people with pain relating to an imbalance of muscles around the pelvis and low back. Due to being right or left dominant in stance and exercises we tend to be a bit stronger on one side. As the relaxin hormone kicks in these muscles have to support your pregnant body more and more. If some muscles are stronger than others they start to play a game of tug of war which can cause pain in many different areas. We get people in who have already been diagnosed with things such as symphysis pubis, osteitis pubis, lower back disc irritation and round ligament pain just to name a few. Most people we see have more general aches and pains through the glutes, hips and groin and have not yet had a musculoskeletal diagnosis. We find either way, it comes back to this imbalance of muscles so our assessment, treatment and prescribed exercises will revolve around loosening off the tight muscles and strengthening the weak muscles. If there is inflammation we might use taping to help support to give the area a chance to heal. Taping is very safe during pregnancy unlike many anti-inflammatory medications.

One of the most common exercises I give to pregnant women is to strengthen their glutes and hamstrings. If you are still comfortable lying on your back try the first exercise, otherwise try the side lying exercise.

Pelvic Curl with Thera-band

1. Tie the band firmly around your thighs and lie on your back.
2. Place your knees and feet approximately hip width apart. Make sure your knee heights are the same before continuing, we want everything in alignment.
3. Next imagine dots on your shirt and pants where your spinal segments are. What colour are your dots?!
4. Press with 50% effort out into the band and peel one dot at a time away from the floor starting at the bottom and working you way up to your shoulders. This should take about a 5 seconds and is nice to do on a breath out.
5. Take a breath in at the top to prepare.
6. Breathe out to slowly return the dots back down to the mat, this time starting at your shoulders and working down towards your bottom, try not to skip the lower back and maintain the pressure out into the band if you can.
7. Repeat 5 repetitions the first time you do it and see how you feel the following day. Slowly add an extra repetition each day until you are doing 20 a day.

Sidelying leg kick with Thera-band

1. Tie the band around your thighs just above your knee and lie on your side supporting yourself with pillows particularly for the head and your belly.
2. Lift your leg to hip height then keeping your body steady, squeeze your glute muscles to take the leg behind you about 5-10 cms depending on your flexibility.
3. Slowly return it back to the start position and repeat 5 times each side. If you feel good the next day you can add 1 repetition each day until you are doing 20 each side.

 

I hope you’ve gotten something out of todays article on pregnancy pain. Please remember that these are not tailored exercises for you specifically so if your pain persists or gets worse please come in and see us or if serious problems with your doctor or specialist. Here at Waverley Myotherapy Clinic we use a pregnancy pillow so you may be able to lie face down, a real treat during pregnancy! Once you are too big for the pregnancy pillow we will support you with pillows in the sidelying position. If you have any questions please contact us.