Yes please!

by Aline Filipe Nunes, women’s health physiotherapist

Pregnancy is an event when many changes occur in a small period of time. The changes can affect your body, your mood, your fatigue levels as well as several psychological and social factors.  It is with no surprise that pregnancy can have an impact on your sex life and sexual routine.

Pregnancy is in its core a period of preparation: your body and your mind focus in building a baby but also prepare for the arrival of a new family member. The roles of parenthood start changing here. It is quite common that the future parents start feeling anxious or depressed during pregnancy in anticipation of the arrival of their baby. The anxiety in itself and the anticipation of the impact of the baby in the couple’s life, as well as the anticipation of the changes in the roles, can be enough to change how you feel as a “sexual being”.

I just don’t feel like sex now that I am pregnant

During pregnancy, many studies show that there is a decrease in sexual interest, decrease in sexual thoughts, decrease in the willingness to initiate sexual advancements and a decrease of the genital and non genital sensitivity. Physically, the hormonal changes can often lead to vaginal dryness too. 

Your pelvic floor muscles can also play an important part in the change. While dryness can become a problem in itself, during pregnancy your pelvic floor and the pelvic structures suffer some changes. Although some pelvic floors can become “tight” ( and therefore painful with sex) in response to the increased weight and body changes, others can become easily fatigued and problems such as prolapse and urinary incontinence can surge. Urinary incontinence and prolapse are two major factors that have a tremendous impact on body image.

Body image can also play a large part in the decrease in sexual interest. Many studies show a positive association between body image and sexual interest, meaning that the better you feel about your body, the more interested you become in engaging in sex.

On top of all of this, some studies point that about 80% of women during pregnancy feel some type of lower back discomfort. Pain in itself can be an important factor in the unwillingness to participate in sexual activity. It is important to treat the pain as soon as possible and to work with the mother-to-be and her partner, in order to bring function and movement back. This ideally will  promote mobility that will help towards sexuality.

Sex in pregnancy has wonderful benefits

Sex during pregnancy brings several benefits for the couple. On a physical level, sex and intimacy are fantastic methods for relaxation. Intimacy is also crucial as emotional support and as a way for the couple to feel sexually desired and hence, still see themselves as a “sexual beings”. Sexual activities can also be a great way to improve bonding, improve sleep, burn calories, improve mood and even improve your immunity.    

How can I become more sexual in pregnancy?

It is important to see this special period of time as a crucial event in the life of a couple.  There are many big changes that have a tremendous impact in their lives, including pregnancy and the arrival of a new baby. Women’s health physios are there to help any couple find balance again via offering several options.

• Exercise is known to improve body image, whilst also bringing many health benefits to you and your baby. Physio-taught pregnancy classes are a wonderful place to exercise safely, meet other pregnant mums and to hopefully make you feel great about yourself!
• Education and treatment sessions with a pelvic floor physiotherapist can help with the management of any pain with sex.
• Pelvic floor physiotherapy can help any woman for the treatment of pelvic floor dysfunction during pregnancy such as incontinence, pain or prolapse.
• Education regarding sexuality with advice regarding positions, intimacy and lubrication.

Your pelvis is not falling apart…debunking the myths around pregnancy pelvic pain

by Carrie Seow, women’s health physio

Pregnancy-related pelvic girdle pain (PRPGP) is a term that some women are all too familiar with. It can present in many different ways and impact your pregnant life when you sleep, change positions in bed, walk, climb stairs, get in or out of the car, get dressed or put on your shoes and socks. All those everyday tasks you previously never gave a second thought to may have become painful and difficult to do. It can be felt at the front of your pubic region, or across your tailbone and buttocks. It is often blamed on the lower back, but often is not. 

MYTH: “My unstable pelvis is causing my pelvic girdle pain.”

 Recent research from Prof. Sinead Dufour of McMaster University in Canada has noted that this concept of “pelvic instability” is unsubstantiated. Your pelvis is not falling apart! Rather, advanced pain science indicates that the pelvis is more sensitive during pregnancy. This sensitivity is increased by a range of lifestyle factors including the changing posture and load through the pelvis when pregnant, the differing ways in which you move with a belly bump, stress, sleep, and even gut health.

MYTH: :“I should just rest and avoid doing too much for the remainder of the pregnancy.”

Initial rest may be helpful to minimize a flare up of pain, however, we don’t want you to stay in this state! Exercise is the best medicine for pain. You may have heard the “motion is lotion” phrase. More importantly, you need to be strong in the hips, legs and upper body so that your body can carry you through the rest of the pregnancy. Yes, there may be some types of exercise which are not suitable for you during your pregnancy due to the nature of PRPGP but as clinicians we can help design appropriate and safe exercise programs to help you get stronger, which in turn help reduce your symptoms.

“But what if I can’t even get back to exercise because I’m in too much pain!”

 You may need some physio treatment by way of manual (yes, massage and ‘muscle love’!) and exercise therapy to help reduce the sensitivity of your back, hips and legs before gradually increasing your exercise load. For those with more severe symptoms, there are support garments available (e.g. pelvic belts, belly belts, SRC pregnancy shorts) that are available to help support your body in pregnancy to allow you to exercise rather than stopping all exercise. Your physio will retrain the better way of movement control and muscle activation around your pelvis to support and reduce the sensitivity, and all while keeping within those pain levels .  

**“How can I do all those everyday tasks such as sleeping, walking, sitting, putting on clothes and shoes without as much pain?”
**

It’s realistic to assume that you may need to change the way you do certain things when you’re pregnant. We can give you some ergonomic strategies to avoid irritating the sensitive structures in your body during activities of daily living. For starters, rather than balancing on 1 leg, try putting your pants, shoes and socks on while sitting down on a chair.

Catching and managing PRPGP early in pregnancy will help you the most!

Remember, it’s best to start dealing with PRPGP in the early stages rather than waiting until it gets really bad! Book an appointment for a thorough assessment and chat with your physio about the best management path for your pain. This could be manual therapy, home based exercise, or our pregnancy specific Pilates and group classes. Contact us for a chat.

References: Dufour, S. (2018) ‘Pregnancy-related Pelvic Girdle Pain: Embrace the Evidence and Move beyond Biomechanics’

The merits of a great video

We all picture ourselves to look like as graceful and effortless as the most famous of marathoners. However, how often do our bubbles burst when we see a photo or a video at the fun-run finish line?

Running ( and walking for the non-runners) biomechanics play an important role in the development of injuries in active individuals. When pain and the physical examination findings are in agreement with abnormalities observed in a biomechanics running analysis, it serves as a great tool for intervention. What exercises, what running cues, what change in shoes may allow for this person to walk and run injury free? 

Here are a few common issues we see in runners that really set up a risk of the body breaking down, being less efficient and potentially becoming injured. Perhaps you see yourself doing one of more of these when you run? Or perhaps you don’t!

Why not have a friend film you and have it looked at by our physio team? A short 30 second video from the side and from the rear would be all you need, so grab your phone and shoot away!

Excessive pelvic drop. Image B shows the dropping or dumping of a pelvis.

• The cause? Weakness across the glutes and pelvis.
• The effect? Outer hip pain, knee pain, glut tendonopathy, lower back overloading

Rear foot instability. Image A shows a normal, B abnormal degree of heel pronation and instability.

• The cause? Poor shoe choice with inappropriate hind foot guidance and control, tight calf and stiff foot joints.
• The effect? Where do we start? Foot, knee, Achilles, hip, lower back issues.

Over-striding. Image A shows good hip-ankle alignment while B shows the ankle too far forward from center of gravity.

• The cause? Poor trunk posture being too upright, tight hip flexors, poor running technique and awareness
• The effect? Higher ground reaction forces and poorer energy absorption, resulting in overloading of foot, knee, hip and back. 

Knee angle at foot fall. Image A shows a very extended knee, when images B and C show the preferred land on a soft or slightly flexed knee.

• The cause? Over-striding, trunk too upright and poor running awareness
• The effect? Load impact forces are greater on the knee, potentially causing pain and stress fractures

Foot strike pattern. Forefoot vs midfoot vs hindfoot.

The jury is till out and research still continues into this well discussed topic among runners. It is believed by many that injury risk is less in the forefoot striker (image A) as it brakes and absorbs the ground reaction force force more efficiently.

So grab a friend a get filming. We would love to see and help your analysis and share exercise/tips and shoe advice, so contact us to make an appointment.

Reference: Souza, R.B, An eveidence based videotaped running biomechanical analysis (2016)