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Pregnancy, pelvic pain & safely returning to running

Pregnancy, pelvic pain & safely returning to running

Pregnancy is an exciting and special time but it can also come with a lot of questions. Whilst Google gives us access to a wonderful world of information, it can lead to more questions and sometimes concerns. This article will discuss the effect of pregnancy on the mother in terms of pelvic pain and the pelvic floor and returning to running after pregnancy, backed up by evidence and research. It is important to remember that not any one pregnancy is exactly the same!

Pelvic Pain & Exercise during Pregnancy

Based on various studies, approximately 50% of women experience low back pain or pelvic girdle pain (pubic, buttock, tailbone, pelvic floor regions) during pregnancy and 25% continue to have this pain 12 months after delivery (Davenport MH, et. al., 2019).

A panel of experts looked at 32 studies, which included a total of 52,297 women without absolute or relative contraindications to exercise (Davenport MH, et. al., 2019). For the absolute and relative contraindications, please click here. From this, it was found that physical activity during pregnancy decreased the severity of low back, pelvic and lumbopelvic pain. (Davenport MH, et. al., 2019). This is both during the pregnancy and in the early postpartum period. The exercise components of these studies included yoga, aerobic exercise, general muscle strengthening and a combination of resistance and aerobic training (Davenport MH, et. al., 2019).

Another study by Owe et. Al (2016) looked at 39, 184 pregnant women who had not previously given birth. This study found that exercising up to five times weekly prior to pregnancy was protective against pelvic girdle pain and also those women who reported participating in high impact exercises prior to pregnancy had the lowest risk of pelvic girdle pain during pregnancy. (Owe KM, et. al, 2016).

The most current guidelines state that an accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications (Mottola MF, et al., 2018).

Pregnancy & the Pelvic Floor

In relation to the pelvic floor, the main recommendation part of the most current guidelines state that pelvic floor muscle training is associated with a reduction in prenatal and postnatal urinary incontinence (Mottola MF, et al., 2018). These exercises can be performed daily HOWEVER, it is crucial that women seek instruction from a trained health professional (such as a women’s health physiotherapist) to ensure proper technique in order to obtain the best outcomes/benefits from performing these exercises. This is especially the case for women who have never trained these muscles.

Returning to Running after Pregnancy
More recently (March 2019), three highly experienced physiotherapists – Tom Goom, Gráinne Donnelly & Emma Brockwell combined their areas of expertise to release a paper on returning to running postnatal and the guidelines for this population. The main findings that were included in the paper were that women in the post-natal period benefit from an individualised assessment and guided pelvic floor rehabilitation in order to prevent and manage pelvic organ prolapse (bladder, bowel or uterus descending into the vagina) (Hagen, S et al., 2014), manage urinary continence (Bø, 2003) (Dumoulin, C et al., 2018) (Price, N et al., 2010) and improve sexual function.

Based on expert opinion only, the following suggestions were made:

• Return to running is NOT recommended at all prior to 3 months post-natal OR beyond this time point if any symptoms of pelvic floor dysfunction are identified before or after attempting return to running
• Pelvic health, load impact management and strength testing should be assessed in order to establish if a patient is ready to return to running in the post-natal period
• Additional factors that should be considered in the postnatal evaluation are weight, fitness, breathing, psychological wellbeing/status, abdominal separation, breast support and feeding, running with a buggy and relative energy deficiency in sport (RED-S)

How we can help you at Physiotec:

It is imperative to see your physiotherapist before commencing physical activity, especially if planning a pregnancy, already pregnant or in the post-natal period.

Here at Physiotec, your women’s health physiotherapist can:
1. assess your pelvic floor muscles to ensure you are using them correctly
2. assess and address other areas of concern such as low back pain or pelvic pain
3. advise you on the safest exercises during pregnancy as well as into the post-natal period
4. perform a physical assessment to determine whether you are ready to return to running or other exercise after pregnancy 
5. perform a running assessment to ensure that your technique places minimal loads on your pelvic floor and joints following pregnancy

You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Bibliography

Bø, K. (2003). Is there still a place for physiotherapy in the treatment of female incontinence? EAU , 145-153.
Davenport MH, et. al. (2019). Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine, 53, 90-98.
Dumoulin, C., Cacciari, L. and Hay-Smith, EC. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews(10).
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., Frawley, H, Galea, MP, Logan, J., McDonald, A., McPherson G., Moore KH, Norrie, J., Walker, A., Wilson, D. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicenter randomised controlled trial. 282(9919), 796-806.
Mottola MF, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52, 1339-1346.
Owe KM, et. al. (2016). Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women. British Journal of Sports Medicine, 50, 817-822.
Price, N., Dawood, R. and Jackson SR. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315.

Physical Activity & Pregnancy

Physical Activity & Pregnancy

Physical Activity & Pregnancy

The Facts, the Figures & the False Conceptions

If you are pregnant or planning a pregnancy and you are unsure about the current guidelines for physical activity and what is safe, this is a must read! An excellent team of experts have appraised over 27,000 manuscripts and abstracts (Davies G & Artal R., 2019) in order to bring us the most up to date information and guidelines on physical activity during pregnancy.

THE FACTS:

Physical activity during pregnancy:

  • DOES NOT increase the risks of structural or functional birth defects which stem from in the womb (Davenport MH, et al., 2019)
  • Has a significant effect on reducing the severity of low back pain, pelvic girdle pain and lumbopelvic pain. (Davenport MH, et al., 2019)
  • Decreases the chances of using instruments during delivery (Davenport MH, et al., 2019)
  • Reduces the chances of depression during pregnancy as well as the severity of symptoms. Unfortunately, this does not apply to the post-natal period. (Davenport MH, et al., 2018)
  • Reduces the risk of excessive weight gain during pregnancy as well as weight retention postpartum. (Ruchat S, et al., 2018)
  • Results in a small increase in the mother’s body temperature which is safe for the baby. (Davenport MH, et al, 2019)
  • Effectively reduces the risk of developing gestational diabetes mellitus, gestational hypertension and pre-eclampsia. (Davenport MH, et al., 2018)
  • Reduces the odds of having abnormally large babies (Davenport MH, et al., 2018)

Additionally…

  • There is no association between physical activity during pregnancy and increased risk of miscarriage or perinatal mortality (stillbirth or deaths in the first week of life) (Davenport MH, et al., 2019)
  • There is not enough evidence to inform us if lying on our back to exercise is safe or if it should be avoided altogether during pregnancy (Mottola MF, et al., 2019)
  • There was no association found between exercise during pregnancy and complications with the newborn baby or harmful childhood outcomes (Davenport MH, et al., 2018)

THE FIGURES & RECOMMENDATIONS

(Mottola MF, et al., 2018)

  • An accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications
  • Exercise over a minimum of 3 days per week, however daily exercise is encouraged
  • Variety is key in order to achieve greater benefits
  • Pelvic floor muscle training can be performed daily in order to reduce risk of urinary incontinence
  • Exercising flat on the back should be modified if the pregnant women is experiencing light headedness, nausea or feeling unwell
  • TAKE HOME MESSAGE: All women WITHOUT contraindications should be participating in physical activity during pregnancy

THE FALSE CONCEPTIONS

  • Exercise will harm the baby. The evidence has shown that there are no increased risks of miscarriage or a small baby when undertaking physical activity during pregnancy
  • Heart rate should be below 140 beats per minute. This is an outdated guideline from the 80s and there was no evidence to even support this guideline, it was based on expert opinion.
  • Exercise needs to be at a gym or with group fitness. Lots of studies that were looked at were walking programmes. Additionally, moderate intensity physical activity can include gardening, mowing the lawns and some household chores.

Other considerations for physical activity & pregnancy

There are other considerations specific to the mother during pregnancy and physical activity. These include, but are not limited to, the pelvic floor and risk of overload/prolapse as well as pelvic pain. If you are planning a pregnancy/already pregnant and have a history of pelvic pain or pelvic floor concerns, it is important to see your physiotherapist before commencing physical activity. Here at Physiotec, your women’s health physiotherapist can assess your pelvic floor muscles to ensure you are using them correctly, assess and address other areas of concern such as low back pain or pelvic pain and advise you on the safest exercises during pregnancy as well as into the post-natal period. You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Download more information on Physical Activity during Pregnancy here

Why should I exercise during and after Pregnancy

Why should I exercise during and after Pregnancy

For Mums and Mums to be…

Have you ever experienced some pain in the pelvis  or in the hips during or after pregnacy?

Poor pelvic control or instability is a condition more common in women and is most likely to occur during or post –pregnancy.  During pregnancy, a hormone called relaxin is released in the body to allow the ligaments to stretch to accommodate the fast growing baby. With another human being growing rapidly, the pelvis does undergo an increase in loading, which some women cope with a little better than others – this can be due to genetic factors such as natural pelvic and ligamentous structure, or the background muscle conditioning you had prior to the pregnancy.

DON’T WORRY THOUGH…. remember that “instability” does not mean your pelvis is physically out of place but rather your muscles around the pelvis are not providing adequate’ force closure’ or mechanical compression or support around the pelvis while the ligaments are lax.

Who is more at risk of developing Pelvic pain due to pelvic instability?

Research has shown that  women who are involved in strenous work, or have a previous history of low back pain and a history of lumbo-pelvic (lower back and pelvis) pain during previous pregnancies are at risk. Although, direct trauma to the pelvis such as a fall can also result in pelvic instability.

How can Physiotherapy Help?

Use of Physical Aids

Physiotherapy can help by identifying the cause of the pain around the pelvis, whether it is originating from the lumbar spine or from pelvic instability. Off loading the pelvis may be important in reducing the symptoms such as using crutches or walking sticks. Tape or pelvic/abdominal belts  can also provide some compression around the pelvis, assisting with stability in the shorter term.

Postural and Movement Education

Being aware of movements or postures that may overload the pelvis, and optimising muscles support around the lumbar spine and pelvis are the most  important factors in managing this condition. Some specific advice on what movements or positions you may need to avoid or adjust can make a big difference in avoiding pain aggravation.

Specific and Appropriate Strengthening Exercises

Improving activation of the deep supporting muscles around the pelvis is also extremely important for providing dynamic control, so

despite laxity in the ligaments, your muscles can assist in compensating for the reduced support that ligaments can give during your pregnancy. Using real time ultrasound to train deep abdominals and pelvic floor muscles, and some of the deep hip/pelvic muscles are beneficial to someone who has pelvic instability. This is followed by a progressive strengthening program matched to the needs of the individual. Your physiotherapist can recommend appropriate Pilates and Pilates-based exercises as well as monitor your progress throughout your pregnancy and even after your pregnancy.

Transversus Abdominis Ultrasound At Rest
Ultrasound retraining of the abdominal wall – Transversus abdominis

If you are suffering from pelvic pain due to instability, see a Women’s Health Physiotherapist and get some good advice on pain management, training in deep muscle activation and an appropriate exercise program.

Image Courtesy of keerati of freedigitalphotos.net

References:

Vleeming et al. (1992). An integrated therapy for peripartum pelvic instability. A study of the Biomechanical effects of Pelvic Belts. American Journal  of Obstetrics. 166 (4): 1243-1247

Wu et al. (2004). Pregnancy-Related Pelvic Girdle Pain (PPP)I: Terminology, Clinical Presentation and Prevalence. European Spine Journal. 13:575-589