Antenatal Lesson 2 - Physiotherapy

I've done so much the last few days, I feel somewhat accomplished! With so much on my plate, it's really important to pace myself.

The massive amount of prep work done on Sunday! 4 full hours. Felt so drained at the end of it but looked forward to comedy date with the hub at 1030pm. Had a really good night's sleep that day.

Session two was on Physio..something which I really look forward to. Unfortunately, the massage bit was a tad disappointing. They emphasized more on touch. A sensual aspect between couples. The hub and I aren't exactly sensual when it comes to hardcore massage and the fact that I'm really aching, I really don't appreciate such techniques. Thankfully the hub knows me best and exerted the right pressure and skill on me :)

As a reminder to self, I've posted the notes given by the hospital:







At the end of the session, I asked if there's any cure for upper backpain which has been nagging me insanely every night. Seems like upper back is not as common as lower back thus there isn't much one can do. The gynae attributed this to poor posture. Yes, I'm guilty of it, but seriously I just need to slouch at times. Carrying a basketball, walking and driving myself around isn't exactly the most luxurious thing. I'm also suspecting that i'm having mild Pelvic Girdle Pain. Pregnancy related Pelvic Girdle Pain (PGP) causes pain, instability and limitation of mobility and functioning in any of the three pelvic joints.The affection appears to consist of relaxation of the pelvic articulations, becoming apparent suddenly after parturition or gradually during pregnancy and permitting a degree of mobility of the pelvic bones which effectively hinders locomotion and gives rise to the most peculiar and alarming sensations.

A combination of postural changes, the growing baby, unstable pelvic joints under the influence of pregnancy hormones and changes in the centre of gravity can all add to the varying degrees of pain or discomfort.

PGP can begin as early as the first trimester of pregnancy. Pain is usually felt low down over the symphyseal joint, this area may be extremely tender to the touch. Pain may also be felt in the hips, groin and lower abdomen and can radiate down the inner thighs. You may waddle or shuffle, and may be aware of an audible clicking sound coming from the pelvis. PGP can develop slowly during pregnancy, gradually gaining in severity as the pregnancy progresses.

During pregnancy and postpartum, the symphyseal gap can be felt moving and/or straining when walking, climbing stairs and turning over in bed. These activities can be difficult or even impossible. Pain may remain static, i.e. in one place such as the front of the pelvis producing the feeling of having been kicked, in other cases it may start in one area and move to other areas, you may even experience a combination of symptoms. Any weight bearing activity has the potential of aggravating an already unstable pelvis producing symptoms that may limit the ability for the woman to carry out many daily activities. She will experience pain involving movements such as dressing, getting in and out of the bath, rolling in bed, climbing the stairs and sexual activity. Pain will also be present when lifting, carrying, pushing or pulling.

Severity

The severity and instability of the pelvis can be measured on a three level scale.

Pelvic type 1:The pelvic ligaments support the pelvis sufficiently. Even when the muscles are used incorrectly, no complaints will occur when performing everyday activities. This is the most common situation in persons who have never been pregnant, who have never been in an accident, and who are not hyperactive.

Pelvic type 2:The ligaments alone do not support the joint sufficiently. A coordinated use of muscles around the joint will compensate for ligament weakness. In case the muscles around the joint do not function, the patient will experience pain and weakness when performing everyday activities. This kind of pelvic often occurs after giving birth to a child weighing 3000 grams or more, in case of hyperactivity, and sometimes after an accident involving the pelvis. Type 2 is the most common form of pelvic instability. Treatment is based on learning how to use the muscles around the pelvis more efficiently.

Pelvic type 3:The ligaments do not support the joint sufficiently. This is a serious situation whereby the muscles around the joint are unable to compensate for ligament weakness. This type of pelvic instability usually only occurs after an accident, or occasionally after a (small) accident in combination with giving birth. Sometimes a small accident occurring long before giving birth is forgotten so that the pelvic instability is attributed only to the childbirth. Although the difference between Type 2 and 3 is often difficult to establish, in case of doubt an exercise program may help the patient. However, if Pelvic Type 3 has been diagnosed then invasive treatment is the only option: in this case parts of the pelvis are screwed together.

Causes

Sometimes there is no obvious explanation for the cause of PGP but usually there is a combination of factors such as:

1. The pelvic joints moving unevenly.
2. A change in the activity of the muscles in the pelvis, hip, abdomen, back and pelvic floor.
3. A history of pelvic trauma.
4. The position of the baby altering the loading stresses on the pelvic ligaments and joints.
5. Strenuous work.
6. Previous lower back pain.
7. Previous pelvic girdle pain during pregnancy.
8. Hypermobility, genetical ability to stretch joints beyond normal range.
9. An event during the pregnancy or birth that caused injury or strain to the pelvic joints or rupture of the fibrocartilage.
10. The occurrence of PGP is associated with twin pregnancy, first pregnancy and a higher age at first pregnancy.

Treatment

Once a diagnosis of pgp has been made there are various treatments that can be applied. One of the main factors in helping women cope with the condition is with education, information and support. Other coping strategies include physical medicine and rehabilitation, physiotherapy, osteopathy, chiropractic, psychologist, prolo therapy or platelet-rich plasma therapy, massage therapy, acupuncture and alternative medicine. Mobility aids such as a wheelchair, walker, elbow crutches and walking stick can be very useful. Medication dispensed by a qualified health care provider can also be used to manage:

• Chronic pain
• Anxiety
• Depression
• Post Traumatic Stress Disorder(resulting from birth trauma/ pregnancy)
• Musculo-skeletal disorders.

Some pelvic joint trauma will not respond to conservative type treatments and orthopedic surgery might become the only option to stabilize the joints.

Self help management

Self help management techniques include:

• When getting into bed sit on the edge keeping knees close together, lie down on your side, lifting both legs at the same time. Reverse this to get up.
• Try not to attempt to pull yourself up from lying on your back.
• Keep knees together when rolling over in bed.
• Sleep with a pillow between the legs; add more in other areas for support.
• When getting into a car: Sit down first and then swing legs keeping them together.
• Avoid sofas and chairs that are too low or too soft.
• Try to reduce the stress on the joint.
• Avoid any movement with your knees apart.
• Take smaller steps when walking.
• Avoid stairs if possible.
• Take breaks.
• Move within the limits of pain.
• Avoid twisting, bending or squatting.

Many women find floating in a heated pool relieves the pain.

I should seriously and consciously do more stretches. The walking from house to house doesn't amount to a significant amount of exercise it seems. But given my current energy level, all I want is to veg out on the bed and sleep! Sleep-- a luxury it seems! Note to self: not to eat too much durians! For the last 6 mths I hadn't touched any, but last Saturday, I feasted on durians! Wrong move! That very night, my lungs felt extremely compressed and I was sweating in profusion despite the fan being blasted at me. Frustration really mounted when I tossed and turned from 2-6am and finally getting an eye shut for about 2hrs whilst sitting upright.