Advice and Exercises for Postnatal Back and Pelvic Pain

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1 Information for patients Advice and Eercises for Postnatal Back and Pelvic Pain You can refer yourself to the department at any time during the si weeks after birth. After that, please ask your GP to refer you. Physiotherapy Department (FINN Clinic) Tel: DMI ref: indd(RP) Issue 1: December 2008 The Ipswich Hospital NHS Trust, All rights reserved. Not to be reproduced in whole, or in part, without the permission of the copyright owner.

2 Throughout pregnancy your body produces relain, a hormone which softens ligaments, joint capsules and the cervi. This allows increased movement at all joints. The pelvic joints are particularly affected by relain. The pelvis epands to accommodate the baby and allows the baby to pass through during delivery. The increased movement at the pelvis and back may cause pain or discomfort and can occur antenatally or postnatally. During pregnancy your posture changes. As your centre of gravity moves forward, you get an increased curve in the lower part of your spine. Your shoulders have a tendency to be rounder and your chin pokes forward. As the baby grows, the uterus enlarges and your tummy muscles become stretched and weaker. Your pelvic floor muscles are put under strain as they try to support the enlarged uterus and the baby inside it. Your body lays down fat in preparation for breast feeding and tends to retain fluid during pregnancy. Following the birth of your baby many of these changes will return to normal automatically. The uterus will be almost back to its pre-pregnancy size by 6 8 weeks. The ligaments will have tightened up by si months. However, you will have to work at correcting your posture and strengthening your tummy and pelvic floor muscles. Common conditions seen during and after pregnancy include pubic symphysitis, posterior pelvic pain, sacroiliac joint dysfunction, spinal instability or hypermobility. Your physiotherapist will eplain your relevant condition on assessment. Using ice packs wrapped in a damp tea towel can help reduce inflammation and pain. Apply to the affected area for 10 minutes 2 3 times a day. Heat can also help to reduce pain but make sure heat packs are also wrapped in a towel and are not too hot. Apply to the affected area for 10 minutes 2 3 times a day. Page 2

3 Massage can help with healing and pain relief. Try using deep circular motions to massage the affected area for 2 3 minutes at a time, 2 3 times a day. Eercises for pregnancy-related back and pelvic pain Eercise 1 inner range pelvic tilting Lie on your back with your knees bent and feet flat on the bed. Pull in your tummy and tilt your pelvis up, flattening out the lower back. Hold this position for 2 3 seconds and then slowly rela half way. Continue tilting your pelvis up and relaing to the half way position. Aim for the movement to be slow and smooth. Practice tilting your pelvis so you flatten the small of your back before and during changing position. Eercise 2 knee drop Lie on your back with your knees bent and feet flat on the bed. Draw in your pelvic floor and lower tummy muscles and hold. Take one knee slowly to the side without tilting your pelvis, then return the leg to the start position. with each leg Page 3

4 Do not eercise on all fours between 0 6 weeks postnatally. Eercise 3 pelvic tilting Kneel on all fours. Pull in your tummy towards your spine and tilt your pelvis so that your back becomes rounded. Hold this position for 2 3 seconds and slowly rela. Eercise 4 transversus abdominus Draw the lower part of your stomach (below the tummy button) in towards your spine, hold for 10 seconds (or as long as you can), and then rela. You may find it helps to pull in your pelvic floor before drawing in your stomach. Try to work at 30% of your maimum strength. Page 4

5 Eercise 5 gluteus maimus Kneel on all fours. Draw in the lower part of your stomach and squeeze your buttocks together. Raise one leg to straighten out the hip, with the knee at 90º, and the heel pointing towards the ceiling. From this position lift your heel towards the ceiling without arching your back. each leg Eercise 6 gluteus medius Lie on your side with your hips and knees comfortably bent. Draw in the lower part of your stomach and lift the top leg upwards, keeping the heels together. Hold for three seconds and then lower your knee slowly and smoothly. You may find a pillow between your knees more comfortable. each leg Page 5

6 Eercise 7 single leg raise Lie on your back with your knees bent and feet flat on the bed. Draw in your pelvic floor and hold. Raise one leg to the table top position, with hip and knee at 90º. Hold for three seconds and lower. alternate each leg Eercise 8 leg slide Lie on your back with your knees bent. Draw in your pelvic floor and hold. Keeping your pelvis and rib cage fied, slide one heel along the floor to lengthen the leg and then slide the leg back to the start position. each leg When you are able to do this without moving your pelvis you can take the opposite arm up above your head as you straighten your leg and then bring your arm down by your side as you bend your knee back up again. Page 6

7 Eercise 9 bridging Do not attempt during the first si weeks after birth. Lie on your back with your knees bent and feet flat on the floor. Place a rolled-up towel between your knees. Draw in the lower part of your tummy and hold. Squeeze your buttocks together and tilt your pelvis up. Continue curling up the spine from the floor, raising vertebra by vertebra. Take a breath in and as you breathe out curl the spine back down vertebra by vertebra. Eercise 10 diagonal bridging Do not attempt during the first si weeks after birth. Bridge as above. When in the bridge position allow one buttock to drop down toward the floor. Before allowing contact with the floor, squeeze the buttock muscle and return to the bridging position. Repeat with the other buttock. Finish the eercise by curling the spine back down vertebra by vertebra. Page 7

8 Progression eercises for women with pubic symphysitis Eercise 11 leg abduction Lie on your side with your legs straight. Draw in your lower tummy muscles and pull up your pelvic floor muscles. Slowly and smoothly raise your uppermost leg towards the ceiling and then slowly lower again. alternate each leg Eercise 12 leg adduction Lie on your side with your uppermost leg bent in front of your straight bottom leg. Draw in your lower tummy muscles or pull up your pelvic floor muscles. Slowly and smoothly raise your bottom leg towards the ceiling and then slowly lower again. alternate each leg Eercise 13 side leg lifts Lie on your side with your legs straight. Draw in your lower tummy muscles and pull up your pelvic floor muscles. Slowly and smoothly raise both your legs towards the ceiling and then slowly lower again. alternate each leg Page 8

9 Eercise 14 resisted abduction Lie on your back with your knees bent and feet flat. Place your hand on the outside of your thigh and resist your leg pushing out to the side. Work at 30% of your maimum strength. right left Eercise 15 resisted adduction Lie on your back with your knees bent and feet flat. Place your hand on the inside of your thigh and resist your leg pulling into the middle. Work at 30% of your maimum strength. right left Page 9

10 Eercise 16 resisted hip fleion Lie on your back with your knees bent and feet flat. Bend one knee towards your chest and resist by placing a hand on the front of your thigh. Work at 30% of your maimum strength. right left Eercise 17 resisted hip etension Lie on your back with your knees bent and feet flat. Bend one knee towards your chest and clasp your hands under your thigh. Resist trying to bring your leg down to the bed. Work at 30% of your maimum strength. right left Page 10

11 Stretches Hold each stretch for 15 seconds. Repeat Page 11

12 Pelvic floor muscles urethra vagina pelvic floor muscles perineal area anus The pelvic floor muscles form a hammock that attaches to the front of the pelvis on the pubic bone, and to the base of the spine. The pelvic floor muscles help support the abdominal contents and prevent them from dropping down (prolapsing). They help to control your bladder and bowel and help prevent you leaking urine, wind or faeces. They also have a role in seual arousal and performance. During pregnancy the pelvic floor is stretched and weakened by the weight of the baby in the uterus. During vaginal delivery the muscles are stretched a great deal as the baby comes down through the pelvis. A hormone called relain, which is released during pregnancy, also has an effect on the pelvic floor muscles, making them weaker. Page 12

13 Pelvic floor eercises should be done at least three times a day for life. Close your front passage as though to stop yourself passing urine. At the same time close your back passage as though to stop yourself passing wind. As you close and tighten you should feel a lifting inside you. Do not: hold your breath; use your abdominal muscles; or use your buttock muscles. These will increase your abdominal pressure, producing a bearing down force on the pelvic floor. This will weaken rather than strengthen the muscles. There are two types of pelvic floor eercises you should do. Quick squeezes. This is where you draw up the pelvic floor quickly and strongly then rela. Repeat five times. This will help prevent you leaking when you cough, sneeze, laugh etc. Holding. This is where you draw up the pelvic floor half way (not at your maimum contraction) and try to hold for 10 seconds (initially hold as long as possible). You must feel the pelvic floor muscles let go. Repeat five times. This will help prevent a prolapse. You can do your pelvic floor eercises lying down, sitting, kneeling, standing and walking. Try to do them while doing another activity such as feeding your baby, washing your hands or standing in a queue for eample. It is very common for the refle action of the pelvic floor muscles to be lost after pregnancy and delivery. This means your pelvic floor muscles can work but do so only if you tell them to. Try to pull up your pelvic floor before and during activities which may cause you to leak, such as coughing. Page 13

14 Changing and bathing Don t bend and stoop over the baby. Change and bathe your baby on a surface which is the right height for you. Never leave your baby unattended on a raised surface as they can roll off. Do not sit on the floor with your legs out straight when changing your baby kneel instead. Feeding Place a thin cushion behind your waist and a pillow on your lap so the baby is at the right height to feed without you having to slouch. Support the arm cradling your baby on the pillow. Sit well back into the chair and have a low stool for your feet. Lying on your side is often a very comfortable position to feed in. Page 14

15 Correct lifting technique Returning to sports after birth It is safe to walk as soon as you feel able to. You can swim again after your si-week check as your bleeding should have stopped, your cervi will be closed and you will no longer be at risk of infection. You can begin gentle cycling and horse riding after 6 8 weeks. More strenuous activities such as running, going to the gym, aerobics and competition horse riding can be restarted after 12 weeks returning to these sports earlier can increase your risk of developing a vaginal prolapse. Always start off gently and gradually increase the amount of eercise you do over a 3 6 week period. It is safe to have seual intercourse once your bleeding has stopped. Remember that it is possible to fall pregnant again two weeks after birth so consider contraception. Page 15

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