After the Christmas festivities, you may be thinking that we can all relax and put our feet up. But as we approach the New Year, there may be more parties to attend! If you’ve ever wondered why your feet feel sore and why you often have backache after a night out, it may not be your style of dancing that is the culprit.
This time of year, we see an increase in people coming to see us for new episodes of back pain. These often follow a similar sort of story- carrying heavy bags of Christmas shopping, twisting awkwardly bringing the decorations down from the attic, or falling off ladders putting up festive lights.
If you’re struggling with back pain at Christmas, there are a few simple things that you can do to help yourself recover from an acute episode of back pain.
We are delighted to announce Philippa Oakley DC MChiro won runner up for “Business Personality of the Year” in last nights Havant Small Business Awards!
The recipients of these awards are nominated by the community and this award highlight’s Philippa’s tireless dedication to improving the health of the community. She works tirelessly to meet the growing demands and healthcare needs of our community to build an enduring, reputable healthcare facility.
In addition, the award recognises Philippa’s dedication to giving back. She runs healthcare workshops and seminars to educate our community on health matters. Recent ones include “Running without Pain” and “Kinesiology Taping for Pain.” Acorn Health are involved in charitable fundraising and raised over £500 for local charity Hounds for Heroes in April 2017, and are currently fundraising for children’s cancer charity Neuroblastoma UK.
I saw a lovely lady in clinic today who was suffering with symphysis pubis dysfunction (SPD), which had been bothering her since she was just 16 weeks along in her pregnancy (she’s now nearing her due date). This is quite a common reason for people coming to see me in clinic, so let’s talk about pelvic girdle pain and how a chiropractor can help you.
Pelvic girdle pain (PGP) is common, but not normal, and as anyone will tell you, being in pain can really sap the joy out of your pregnancy. Symphysis pubis dysfunction is now broadly categorised as PGP- an umbrella term for all pain in the pelvic area which could include the lower back, abdomen, hips and thighs. PGP can cause back, hip and groin pain, disrupt your sleeping and affect your walking, amongst other issues. It’s really not fun! Just to complicate matters further, SPD can affect you at any time during your pregnancy, and sometimes even after giving birth (if not managed appropriately). Needless to say, this can cause physical discomfort and emotional distress so it is important to seek help early on- the sooner treatment begins, the sooner you’ll feel better.
What is Pelvic Girdle Pain?
Pelvic girdle pain simply means pain in the joints of the pelvic girdle, including the two sacroiliac joints at the back of your pelvis and the symphysis pubis joint at the front of your pelvis. Dysfunction within the pelvic girdle can affect the pelvic floor (the basket of muscles which hang from the bones of our pelvis), and if the pelvic bones are rotated or dysfunctional, the muscles don’t hang (or function) correctly, affecting spreading of the pelvic floor muscles and symmetrical dilation of the cervix during labour. This can lead to a difficult birth process for both mum and baby, but fortunately if good care has been taken to protect the pelvic girdle from additional strain and trauma, most women with PGP can have a normal vaginal birth. If you are concerned about the birth process, do discuss this with your practitioner, midwife or GP.
SPD can worsen as the baby increases in weight, as a result of postural changes as pregnancy advances, and resultant changes in the body’s centre of gravity. During pregnancy, our body releases a hormone called relaxin which softens our ligaments (which are like strong elastic bands which connect our joints)- this is to allow the baby to pass through the pelvis during birth, and normally lax ligaments in the pelvis during pregnancy do not cause an issue, however uneven movement in the pelvic joints (often termed “misalignment”) or imbalance in the muscles can cause irritation to the joints of the pelvis, resulting in pain.
To a chiropractor there are numerous other issues in the pelvis that can cause PGP without it being SPD (Gosh, that’s a lot of abbreviations!) so it’s important to rule out other possible causes before working on a diagnosis of SPD.
What are the symptoms of PGP?
Pain in the joints of the pelvis
Clicking or grinding in the pelvic area
Pain on weightbearing on one leg (for example when climbing stairs)
Pain when performing straddle movements (for example getting in or out the car or bath)
Difficulty lying in particular positions (often side-lying)
Pain during intercourse
Why do some pregnant ladies develop PGP and others don’t?
It’s hard to say… the research in this area is largely inconclusive when it comes to identifying risk factors for developing pelvic girdle pain, but we do know one of the major reasons for developing back pain in pregnancy and having difficulties during labour is poor musculoskeletal health in the mother. Why? Well, a job that involves a lot of sitting down and little exercise out of work can mean that the tone and activity in the muscles that stabilise the pelvis (such as the abdominals, pelvic floor muscles and the gluteal muscles in the buttocks) is reduced, and they struggle to tolerate additional stress during pregnancy which can lead to ongoing discomfort.
Around 20% of pregnant women will develop some form of pelvic girdle pain during pregnancy and we know that other risk factors include a history of pelvic or lower back pain (both during pregnancy and when not pregnant). The good news is that whilst 1-2 % of patients may have persistent pain one year after giving birth, in 93% of cases, the symptoms of PGP settle within the first 3 months post delivery.
What can be done to help pelvic girdle pain and symphysis pubis dysfunction?
Pregnant patients require a gentle, drug-free alternative for treating their discomfort and so seeking chiropractic care is a logical choice as it is a safe and effective treatment option, not only for treatment of pelvic girdle pain but also other musculoskeletal problems that may arise during pregnancy. Not only that, but it can help avoid a difficult labour, may mean you can stay at work longer and can reduce long-term disability.
Chiropractic treatment doesn’t just involve manual adjustments of the spine (chiropractic care is SO much more than that). We use numerous gentle techniques during treatments including soft tissue work, fascial release, acupuncture, exercises, postural advice (including optimal foetal positioning) and perhaps most importantly, we work with you to ensure you understand your condition and know how to manage it. Chiropractic treatment is recommended for pelvic girdle pain by the Pelvic Obstetric and Gynaecological Physiotherapy- you can read their guidance on PGP here.
In the case of our patient, we adjusted the sacroiliac joints and pubic symphysis, but in addition we also adjusted the thoracic and lumbar spine, and released the diaphragm and psoas muscles in the abdomen as we know that these abdominal muscles are key contributors to pelvic pain. Remember- only a fool treats where the pain is, so as chiropractors we have to make sure that all factors contributing to the pain have been addressed! Our patient also went away with some kinesiology tape on her pelvis for support- more about that here.
Is there anything else I can do to help?
Yes- there are some simple exercises that you can do at home to help alleviate discomfort. In addition to giving you exercises we also advise you on ways to move that will help protect your pelvis and avoid aggravating the condition. Always speak to your practitioner to determine if an exercise is appropriate before attempting it. All the exercises we provide our patients are bespoke to them based on the results of their examination.
Sometimes a pelvic belt can offer relief, particularly when you’re up and moving around. We prefer to use kinesiology tape to help our pregnant patients as this provides support to the structures without limiting movement.
Aas-Jacobsen E. and Miller J. (2010) Chiropractic care during pregnancy: survey of 100 patients presented to a private clinic in Oslo, Norway. JCCP. Vol. 11. No.2. 771-774.
Andrew C. and Dorey G. (2008) Pelvic girdle pain in three pregnant women choosing chiropractic management: a pilot study using a respondent generated instrument and chiropractor’s assessment tool. Journal of the Association of chartered physiotherapists in women’s health. 102. p.12-24.
Andrew. C and Pedersen P. (2003) A study into the effectiveness of chiropractic treatment for pre- and post partum women with symphysis pubis dysfunction. European Journal of chiropractic. 48. P. 77-95
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Vleeming, A., Albert, H.B., Östgaard, H.C., Sturesson, B., Stuge, B. (2008) European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 17 (6) 794-819