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Pelvic Girdle Pain During Pregnancy – Women’s Health Physiotherapy

Pelvic Girdle Pain During Pregnancy -Women’s Health Physiotherapy

What is it?

Pelvic Girdle Pain (PGP) is a collection of uncomfortable symptoms caused by a stiffness of your pelvic joints or the joints moving unevenly at either the back or front of your pelvis. 

It is not harmful to your baby, but it can cause severe pain around your pelvic area and make it difficult for you to get around.

Around 20% of women suffer from Pelvic girdle pain.

Different women have different symptoms, and PGP is worse for some women than others.

Symptoms can include:

  • Pain over the pubic bone at the front in the center
  • Pain across one or both sides of your lower back
  • Pain in the area between your vagina and anus (perineum)
  • Pain in your buttocks.

Pain can also radiate to your thighs, and some women feel or hear a clicking or grinding in the pelvic area.

          

   

The pain can be most noticeable when you are:

  • Turning in Bed
  • Going upstairs
  • Walking
  • Standing on one leg (e.g. getting dressed)
  • Getting out of car
  • Standing up

What Causes PGP:

Sometimes there is no obvious explanation for the cause of PGP.

Usually, there is a combination of factors causing PGP.

Relaxin: During pregnancy, the placenta produces a hormone called relaxin, which softens your ligaments to loosen up your joints. Relaxin is very important as by loosening the joints it allows your baby to pass through more easily during childbirth however it can lead to the pelvic girdle becoming less stable and therefore painful during pregnancy.

Occasionally the position of the baby may also produce symptoms related to PGP.

With PGP the degree of discomfort you are feeling may vary from being intermittent and irritating to being very wearing and upsetting.

  

Treatment

Physiotherapy: Advice, Education, Exercises and Manual techniques can help!

The sooner it is identified and assessed the better it can be managed which may help to speed up your recovery, reducing the impact of PGP on your life.

If you have symptoms that do not improve within a week or two, or interfere with your normal day-to-day life, you may have PGP and should ask for help from your midwife, GP, physiotherapist or other health carer.

Tips:

  • Continue to be as active as your can within your pain limits, and avoid activities that make your pain worse.
  • Ensure your back is well supported while you sit down. This can be achieved by placing a towel between the curve of your back and the chair.
  • Wear flat, supportive shoes and avoid standing for long periods.
  • Get help with household chores from friends, partner, and family.
  • Rest when you can.
  • Sit down to get dressed-e.g. Don’t stand on one leg when putting on jeans.
  • Try and make sure any weight you carry is evenly distributed- this means no shoulder bags, and try nit to left your toddler up onto your hip.
  • Be careful and take your time doing any activities that may put strain on your pelvis i.e. getting out of a car- keep your knees together and squeeze your buttocks.
  • Sleep with a pillow between your legs
  • Squeeze your buttocks and keep your knees together when turning in bed.
  • Take the stairs one at a time, leading with the less painful leg.

Avoid:

  • Standing on one leg
  • Bending and twisting to lift
  • Carrying a baby on one hip
  • Crossing your legs
  • Sitting on the floor or in a twisted position
  • Sitting or standing for long periods
  • Lifting or pushing heavy objects such as shopping bags, supermarket trolley.
  • Carrying anything in one hand (try using a small back pack).

Physiotherapy

It is important if you pain is not manageable with general advise to book into a physiotherapist. Treatment includes:

  • Assessment
  • Exercises to specifically retrain and strengthen stomach, back, pelvic floor and hip muscles
  • Manual therapy to ensure your spinal, pelvic and hip joints are moving normally or to correct their movement.
  • Acupuncture
  • Exercises in water.
  • Provision of equipment e.g. pelvic girdle support belts, crutches

To Book an appointment with our Women’s Health Physiotherapist Mary-Kate call Personal Health at 01 4964002 or email info@personalhealth.ie.

Back pain,

Preventative Exercises for Santa this Christmas- By Dee Ryan

  Preventative Exercises for Santa this Christmas!

It is well-known to all that Santa has a very busy night ahead on Christmas Eve. We do not doubt that Santa is in top physical shape but we wanted to provide him with a few tips to ensure his risk of injury is at an all- time low to allow him to do what he does best. In order to be specific I am going to focus on the position which Santa will have to adopt for long periods of time  ….. driving his sleigh!

santa1

Santa will spend a lot of time sitting in his sleigh. As with any amount of prolonged sitting there lies the risk of developing low back pain. To ensure he does not stiffen we recommend pelvic tilts in sitting. This will allow Santa to mobilise his low back and to provide a relative stretch to the muscles positioned parallel to his low back. This exercise is simple and straightforward it involves rolling forwards and backwards off the sit-bones in a slow and controlled manner.   His back will be grateful for this movement little and often throughout the night. We feel Santa will find it easier to get on and off the sleigh as a result of keeping his back mobile, especially when considering how cold it will be that high up in the sky.

Sitting at desk

Physio Rathmines

Secondly as Santa is driving his team of superb reindeer he will be holding the reins out in front of his body. This can commonly cause us to allow our shoulders to move forward and to round our upper back. I recommend Santa does shoulder retraction exercises throughout the night. This involves moving the shoulder blades back and down. By doing so he will be enforcing correct alignment of his shoulders and will be opening up through his chest muscles.

shoulder-retraction

    

The third exercise we recommend is seated thoracic rotation- this will mobilise Santa’s upper back. We recommend that Santa continues to hold the reins throughout this exercise and that he hips his hips forwards to further bias his upper back.

Other tips for the night:

When placing the presents under the tree we recommend Santa should bend down onto his knees and keeps the presents in close to his body until he is close to the ground – this will prevent excessively loading his low back.

santa-3

Similarly, when going down the chimney Santa should try keep in arms in close to his body to ensure his shoulders are not stretched beyond their capacity.

Back pain,

Our Team at Personal Health are in complete agreement with Theresa Mannion- we do not condone unnecessary journeys on our roads- particularly over the Christmas period when the weather can be treacherous. However, should you find yourself driving for a prolonged period of time we recommend the top 3 exercises on our list for Santa.

Wishing you a very Merry Christmas from the Team at Personal Health!

The Role of the Brain in relation to Pain

Pain perception

The Complex Homunculus

homonculus1

 

Brain Map

There is a representation or map of every body part in the brain. Consider this the ‘virtual representation’. The correct term for this representation is a homunculus. These virtual bodies inform us of what our ‘actual’ bodies are doing in space.

Above are 2 homonculi, 1 representing the skin and the other representing movement. In the sensory homunculus, you will notice the areas in the brain devoted to the lips, hands and face are larger. This indicates that areas which require better sensation have a larger representation. The same is said for the motor homunculus as areas which you use more have a bigger representation. Again this is adaptable depending on your line of work, hobbies etc. For example an author will have a bigger representation of their dominant hand due to writing with the hand a lot.

Chartered Physiotherapy

Smudging & the Homunculus

Smudging

Imaging studies reveal that chronic pain results in changes in the virtual representation of the area affected. ‘Smudging’ of the virtual limb so that there no longer is a clear defined outline of the body part is one such change. This can result in an overlapping of neighbouring body parts. I like to compare this to driving in fog. When driving in fog, your vision is compromised. You are no longer sure of what is ahead on the road.You slow down, turn down the music, you may even roll down the window. You become very cautious and hyper-vigilant in an attempt to control the environment.  The brain is similar when unsure of what exactly is happening in an area. It can become very conservative in its management at times causing the neighbouring areas to hurt or areas that didn’t hurt before can start to hurt.

The more chronic the pain is, as in the longer you have been experiencing the pain, then the more advanced changes in the brain have occurred. For example the more difficult that body part will be to use or the more sensitivity you will have in that body part or the neighbouring areas. Ultimately, the physical body mirrors the state of the virtual representation in the brain.

Educated Movement

The great news is that smudging is reversible. Educated movement is excellent in helping to normalise the virtual representations in the brain. Every time you move in a pain-free controlled manner it is positively reinforcing normalisation of smudged representations. Furthermore, it is the understanding why pain occurs and removing the threat of the pain which enables you to move freely. This reason alone is why so much emphasis is placed upon the biology of pain. It is a huge help to understand the science behind this marvellous process. By gifting ourselves with this knowledge, we are allowing ourselves to increase our physical capacity, reduce pain and improve quality of life.

‘Explain Pain’ by Lorimer Moseley and David Butler is a brilliant book which has formed the basis of these blogs. It is written with the aim to enable individuals who experience chronic pain. I would highly recommend it.

Should you require any further information on this topic of pain please do not hesitate to contact me in Personal Health on 01 4964002.

Personal Health, Rather Road, Chronic Health intervention

Surprise Your Bones….

Exercise for Osteoporosis

Medically Led Fitness

Responsible Exercise for Osteoperosis

When I was training as a student in Cork University Hospital our lead Clinical Educator, Fiona, had a stock phrase for helping patients with Osteoporosis.

‘Surprise your Bones’ said Fiona regularly, in a gentle Scottish lilt. Whether it was her accent or it’s ‘catchiness’, the phrase seemed to stick!

Fiona was a Clinical Specialist in the area and really believed in the positive benefits of exercise for Osteoporosis. The tricky part is knowing what are the correct exercises, what are the safe ones and what needs to be avoided. The even trickier part is making a class relevant/enjoyable to a 60 year old lady. We know you would rather be on the golf course or anywhere else!

Medically Led Fitness Osteoperosis Classes

Exercise can be responsible and good fun

Personal Health Exercise Classes

At Personal Health, our Chartered Physiotherapists manage a nice happy medium in this class. We aim for the whole thing to be enjoyable, sociable and challenging enough to ‘surprise the bones’ into shape.

Typically Osteoporosis affects females far more than males, usually over the age of 55. It is diagnosed by DEXA scan which is able to measure bone density. This is usually through imaging of the hip bone.

For those managing Osteoporosis it tends to be a quiet process. There’s typically no pain, and one might only be alerted to it’s complexities when in the A&E room after something has caused a fracture.

Areas such as the base of the thumb/ wrist and hip are more vulnerable for fracture. This is based on the age and activity profile of those diagnosed with the disease. Similarly a focussed approach to improving balance and/or falls prevention can be a smart way to approach the condition.

Frequently an osteoporotic patient will be undergoing ‘medical’ management of the condition by taking prescribed tablets –  ’Calcichew’- or something similar. It has various classifications in terms of severity. Often patients opt for a sustained (but finite) period of injection therapy as treatment. These injections aim to increase the strength of cortical bone structure in addition to the focussed dietary and exercise interventions.

Personal Health Dublin 6

Chronic disease is just a definition not a life sentence

Medically Led Fitness

In Personal Health our Medically Led Fitness programmes are geared towards optimising chronic health issues. By definition, ‘chronic’ relates to time and duration – not severity.

So with a chronic diagnosis like Osteoporosis, you have the power to successfully thrive. At Personal Health, we provide a helping hand, some time and a refreshing enjoyable approach to managing your chronic health issue.

Football, Physio, sport, Physiotherapy, Fitness

Will Jonathan Walters be fit for Saturday ? by Ronan Fallon

Well is he going to be fit to continue?

Last night’s match in Paris saw the boys in green put in a great performance on the European stage. It’s fair to say that we could have easily taken all three points. Unfortunately, this result did have an impact on Jonathan Walters.

It is well known that he has been struggling with an Achilles tendon problem for the last few weeks. The Achilles tendon is the common tendon from the calf muscles into the heel bone.
It is a notoriously tricky problem for anyone from an international footballer to a mid-week 5-a-side social footballer or tag rugby player. As such, it was not a good sign that Jonathan Walters reported last night that he was struggling with this issue from the very first minute!

Achilles tendon
As you can see from the image, pretty much all activity on the football pitch requires load to go from the calf muscle and through your Achilles tendon. This allows the athlete to propel forward to run & jump.

 

MANAGEMENT

Chartered Physiotherapy Dublin 6

Decisions Decisions…..

There is no doubt that the Irish medical team are using all of the resources at their disposal in an effort to get Jonathan fit for Saturday. This is a very quick turnaround for an injured achilles such as this one.
I suspect that they will be using a battery of treatments including anti-inflammatories, Icing, Soft tissue for the calf muscles and most importantly rest.
The crucial component in this management strategy is controlling loading. Thai is the weight that he takes through that inflamed tendon. He should be on crutches for 48 hours. This would allow the Achilles to recover without the stress of his bodyweight on every step.

Medical Team

This is a tricky conundrum for the medical team today. How long can they afford to rest Jonathan from team training in preparation for the Belgium match? Martin O’Neill and his team will have  already discussed this and may have even made a decision on ruling him out.
It’s very difficult to see how Jonathan Walters will be fit for Saturday. An MRI scan will show the true extent of the damage. As a result all we can work off are the soundbites from Management and player alike.

In conclusion, we’re all hoping for a speedy recovery and that his removal from the game early might just give him a chance for the big game on Saturday.

COYBIG !

Ronan

Cycling, physio, physiotherapist, movement, fitness, health

Summer, Sunshine & Spandex by Tim Ahern, Chartered Physiotherapist

We cyclists call it Lycra and there is a lot of it about lately. Here on Rathgar road we see hundreds of commuters and leisure cyclists pass by our clinic on their way to and from work every morning. This is great to see. All sorts of people are cycling now on all sorts of machines. Some new, some old and many ill-fitting.

IMG_1189

New to Cycling?

For those of you who are new to cycling and training for that first triathlon, charity cycle or are just beginning in the sport, bike fit is important. The usual hotspots of discomfort for the beginner include the lower back and the back-side. This is a normal and temporary phenomenon. But often times pain and discomfort in these areas persists. Knee, neck and wrist pain are also common. Therefore having a bike that is comfortable and suitably set-up for your requirements is a must in order to minimise or indeed prevent such injuries. Appropriate bike set-up is key to enjoying injury free cycling and this becomes more pertinent as time in the saddle increases. Despite the myriad of different bike designs and new technologies available, a bicycle remains a bicycle.

IMG_1551

Rider and bike have 5 contact points, both hands, both feet and the one bottom! The bike is a symmetrical machine. Many of us are not. Parameters such as handlebar reach, handlebar type and angle, the degree of knee flexion in pedal stroke, shoe cleat position and saddle position are the main interfaces between the rider and the bike. That results in a huge number of possible position permutations. Many people are now measured and fitted for their bikes before they purchase them. This is very useful. As with clothes, not everyone can buy “off the peg”.

MLF cycling

 

Assessment

Personal Health offer an individualised assessment of the individual’s anatomy and injury history. We take into account the type, the intensity and the volume of cycling of each client. We don’t try to make radical changes to set-up or position, rather we look at making micro adjustments to the bike set-up. This may stave off injury and reduce discomfort based on our physical assessment of the body first, and then the bike.

Based on our findings, we will provide a relevant exercise programme for the body. This is a bespoke service and some clients require more focus on the physical and others require more attention on the bike set-up. Most often though, it is a combination of the two.

Tim Ahern is a Chartered Physiotherapist, an Exercise Physiologist, and a hugely passionate cyclist. He is an integral part of Personal Health, providing a valuable link between our clinical expertise and the practical aspects of exercise prescription. 

Mobility, Flexibility, fitness, movement, health

The Pursuit of Flexibility

As the years go by, the pursuit of flexibility can be a wistful bygone goal. In reality we stiffen up a fair bit as time flies. So, what seemed to be regular flexible movement at one stage, now seems difficult to attain. Why do I groan all of a sudden when I’m standing up from a chair ???

Let’s be kind to ourselves here – mobility and flexibility are often impossible due to our lifestyle demands. Similarly, if we do find some free time, is stretching a priority? It seems so boring… Perhaps not?

Well, there is a lot more to flexibility than static muscle stretching…. A lot more!

And best of all, it can genuinely provide relief, positively affecting your mood.

 

Be kind to each other

Many components affect our flexibility including:

Joint Capsule
Muscle
Ligaments
Tendons
Nerves

I am going to focus on joint stiffness in the thoracic (mid) spine as this is a common presentation across office workers. It is also equally common in multiple sports including cycling, rowing, boxing, wrestling and hockey.  Here is why…

The thoracic spine is the area of our spine located between your neck and low back. Thoracic mobility is important for optimal movement. The mobility of spinal joints and their surrounding capsules adapt depending on the activities performed. Multiple sports require the athlete to move with their arms positioned in front of their body, this positional demands often result in the shoulders sitting forward and a round upper back consequently increasing the risk of developing stiffness in this area.

As the mobility of the thoracic spine affects the function of the shoulders, neck and low back, it is strongly recommended to spend time ensuring your thoracic mobility is being maintained. It is all about balance.

IMG_2129
The more time you spend sitting at your desk, or training, then the more time you need to invest in maintaining your mobility and flexibility. To prevent long-term changes the idea is to position your body in the opposite positions from what you train or work in. For most people this will involve mobilising your upper back in extension and in combined extension and rotation. In other words, straightening your spine.

Over the past years I have found the following thoracic mobility exercises to be highly effective in maintaining and restoring thoracic movement:

1.Thoracic extension on foam roller:

Stretches the pectoral muscles and forces extension in the upper back. Ensure your low back is flattened on the roller for most efficiency. Hold for 30 seconds. Repeat 2-3 times. You can alter the position of your arms between 90 degrees and 120 degrees to bias different areas of your upper back. See image below.

IMG_3255 (1)

 

2. Segmental flexion and extension over the foam roller:

Place fingers on temples to promote thoracic extension. Position the foam roller horizontally and roll along your upper back. Stop at the segments which feel more uncomfortable and stiff. To bias the mobility at these segments, slowly extend over the roller towards the ground. Support your lower back whilst doing this by tucking your bum in. See pictures below as the athlete moves from thoracic flexion into segmental extension.

IMG_3256 IMG_3257

 

 

 

 

3. Bows and Arrows:

Position yourself in side-lying so that shoulders and hips are in line. Bend your knees so that your hips and knees are in line (this offloads your low back ensuring the movement is coming form your upper back). Outstretch both arms. Reach the top hand past the bottom hand and then pull backwards as though drawing the arrow on a bow. In this drawing back motion, aim to have the top shoulder facing up towards the ceiling. This is a slow and controlled movement and aim for 10 repetitions 2-3 times on each side. See the images below.

IMG_3258

IMG_3259

4. Shaking it all out:

Finally, if all else fails….Try loosely and gently relaxing your stomach, if you have ‘a belly’ (everybody does by the way) let it real and hang over your belt. Then gently allow some light  shaking through all the main joints, neck, shoulder, spine, hips, knees, ankles and feet. Just like the way Diego Maradona used to warm up for football games…..

 

 

Tag a friend if you feel this article is relevant to them, or that co-worker who constantly complain of upper back stiffness! If you have any further questions or queries regarding thoracic mobility or wish to purchase a foam roller contact us at Personal Health on 01 4964002 or email info@personalhealth.ie.