Yes! The research shows that nearly all pregnancy related pelvic girdle pain resolves after labour. Every woman is different.

It may take a few weeks to months.

It may disappear immediately you walk out of the birthing rooms.

You may require the expert guidance of a physio to get everything well aligned in your hips and pelvic region after the pregnancy changes, and muscles working again in the appropriate way to support the pelvis.

You may need short term activity modification or taping around the pelvis as you return to gentle exercise.

You will need to start your exercise journey post bub by reconnecting with your deep abdominals, pelvic floor and breath.

You will need to find this inner strength before adding impact like running, jumping, or loads such as weight lifting.

But do know that your pelvis will be alright after the miracle of pregnancy and birth!

#pelvicgirldepain #pelvicpain #pregnancypain #pregnancypelvicpain #pregnancybackpain #sijpain #spd #psd #pubicsymphysis #postnatalbackpain #postnatalpelvicpain #thefixprogram #thefixprogramonline #pregnancyphysio

Pelvic girdle pain is as common as 7 out of every 10 pregnancies. That’s a whopping 70% of pregnant women going about their day with anything from mild intermittent troubles, to barely being able to walk.

Pelvic girdle pain is often confused as back pain in pregnancy. If your pain is located more across your buttocks or over your tailbone/sacrum, or at the front of your pubic area, you are one of the stats. Pelvic girdle pain refers to the changes that occur in the 3 large pelvic joints due to pregnant postures, weaker support muscles for the pelvis in pregnancy, changing hormones and increasing weights in the pelvis that come with growing a little human.

Here are the facts:

👉 The sacro-iliac joints (SIJs) and pubic symphysis (PS) are the 3 joints of the pelvis. None, 1, 2 or all 3 of these joints can give a woman problem during her pregnancy. Yes, all at the same time!

👉 Most pelvic girdle pain experienced in pregnancy resolves after birth and the early weeks of the postpartum period. Hooray! YO will not be left with this pain for your whole life.

👉 If you are unlucky with 2 or more pelvic joints painful in your pregnancy, you are more likely to need physio and a longer time to recover after having your baby from pelvic pain. Never fear, things will settle with the right exercises and targeted physio treatments.

👉 Simple strategies when you’re pregnant can make a huge difference to your pain levels if you feel you have pelvic girdle pain. These include targeted safe exercise in your pregnancy to build muscle support about the pelvic region. This is balanced with rest, avoiding standing on one leg, sleeping with a pillow between your legs and using 2 legs to get out of your car.

👉 Pelvic support or compression belts and tights work for almost all women suffering from pelvic girdle pain. For a few, belts can make the pain worse. So, see your pregnancy physio as she knows all the tricks and can prescribe the right exercise, belts and advice for you!

👉 So, yes! Your pelvis can feel the same after your pregnancy and labour.

#pelvicgirldepain #pelvicpain #pregnancypain #pregnancypelvicpain #pregnancybackpain #sijpain #spd #psd #pubicsymphysis #postnatalbackpain #postnatalpelvicpain #thefixprogram #thefixprogramonline #pregnancyphysio

We love the way our compression shorts feel, but do they ease pregnancy back and pelvic pain?

Our physio team are often asked about the benefits of external compression garments for pregnancy and post-natal wear. Usually a lovely bike-short or legging with compression panels  around the belly and perineum - easy to wear under your normal clothes, much like the ‘skins’ range of sportswear you see about.

As physios, we know the importance of a balanced strength of muscles about the pelvis and spine for optimal postural support. And this is the case even more so in pregnancy and in early post natal days. After all, your bodies are facing their greatest ever biomechanical challenge in movement and posture. These shorts offer a subtle compression about the pelvis, lower back and pelvic floor areas of our body, increasing the stability of your pelvic joints. They also are claimed to increase the activity of the all important muscles about the pelvic floor and abdomen

So what evidence is out there that they even work? I thought I would take a look to see what research there is out there, combined with the anecdotal evidence about how terrific and supportive these shorts are.

What is pelvic girdle pain?

Not all women will suffer from pelvic girdle pain (PGP) in pregnancy and early motherhood, but those that do, more than 70% will return to a pain-free lifestyle within a few months of delivery. Hormone changes to joint laxity, an inefficient network of supporting muscles and carrying heavier weight within the pelvis can create sensitive and painful pelvic joints. These pelvic joints are the pubic symphysis (PS) and the sacro-iliac joints (SIJs), at both the front and back of the pelvic ring.

Compression garments do work well for most women with mild to moderate PGP, but it is best to seek advice from your physiotherapist, because for some women, pelvic compression can actually make their pain worse.

A quick review of the research.

I reviewed a paper published 2008 in the European Journal of Spine* and found some interesting comments and conclusions on the diagnoses and management of PGP in both pregnant and non-pregnant populations. Here is what I found most interesting about the treatment of PGP in pregnancy:

• Individualised exercises in pregnancy are recommended, based on pelvic stabilising muscles – the pelvic floor, the deep abdominals and deep spinal muscles. These act like am internal compression belt, much like a corset to support your pelvic ring and the 3 joints involved.

• Specific focus on movement control and stability about the pelvis needs to be an integral part of a the management of PGP in pregnancy.

• There is no evidence to recommend the use of a pelvic belt as a single ‘stand alone’ treatment for PGP. A pelvic belt may be fitted to test for symptomatic relief, but should only be applied for short periods.

• It has been shown that transfer of weight through the pelvic joints ( often the source of pain here) is better by application of a pelvic belt (in most women).

• One pilot study showed a positive effect in pain scores and on daily activities after using a maternity support binder for relief of pregnancy-related back pain^

So, how does the compression of a belt or garment work?

Muscles in the body will work their best in a particular alignment or position. As muscles become over stretched (like your tummy muscles over your growing baby belly), or too tight, muscles can’t contract and activate optimally. They need to work harder and for all their extra effort, they still don’t support or move you as well. The optimal and most efficient contraction for a muscle is with the muscle somewhere in the middle of its stretch – not too tight or not too loose.

The compression garments offer a subtle compression force about the abdominal, back and pelvic floor muscles, bringing them into more of a ‘middle supportive range’ ( OK still not the best over your baby belly, but much better than when not wearing them). This ‘better position’ for the muscles means that they can contract better to support and hold your pelvic joints, thereby reducing your discomfort.

Anecdotally, wearing a compression garment around your belly is also a gentle reminder about posture, and I believe this is a further reason for their success in controlling pain. Other research shows that working gently on keeping your waists tall and your ribs stacked automatically keeps your ‘core ’ activated. And in doing so, your internal compression belt is humming away in there too to support your changing pelvis.

*Andry Vleeming, Hanne B. Albert, Hans Christian Östgaard, Bengt Sturesson, and Britt Stuge. European guidelines for the diagnosis and treatment of pelvic girdle pain (Eur Spine J. Jun 2008; 17(6): 794–819.)

^Carr CA. Use of a maternity support binder for relief of pregnancy-related back pain. J Obstet Gynecol Neonatal Nurs. 2003;32:495–502

Holding our posture up all day can be quite a tiring feat. Our bodies are so terribly good at adapting for the needs we place on it. Often these adaptations are great strategies, but often, they are not. We ‘cheat’ and often begin to use muscles and strategies not quite ideal and often a cause of tension, poor alignment and pain. 

Every single one of us has our little ‘strategies’ to cope and respond with the loads and stresses we put on our body all day, no matter how small. You would be lying if you didn’t fall into some non-ideal postures and habits in your day. Young children are possibly the only ones who can boast good posture. This is at least before long days sitting at school and carrying big backpacks begin to change things.

Awareness is half the battle here when it comes to posture cheats. When you begin to recognise your daily postures more, it is easy to then make small changes to ‘unlearn’ or to find other ways to hold your posture all day. Butt gripping is a very common one of these. Perhaps these below are you?

😮 Can you sense your self holding your buttocks clenched?

😮 Do you sit on clenched buttocks when you are at work all day?

😮 Do you butt ‘wink’ or tuck when you squat, or go to sit down on a chair?

😮 Do you clench your buttocks actively on squat to stand?

😮 Do you often ‘lose’ or dig out your knickers or pants that have found their way up your bottom?

Butt gripping as a long term ‘strategy’ that can cause your hip joint to be more compressed in the pelvis, preventing freedom of movement in the hip socket. Hip pain can develop. Butt gripping can also cause pelvic pain, a tight pelvic floor, and even back pain. Hips and butts are often a part of a well rounded back pain rehab program of exercises. 

Are you a ‘butt gripper’? Begin by determining if you are and see if you can soften across your buttocks whenever you feel the tension.

Visit a physio (at The Fix Program even) who can use manual techniques and awareness exercises to help you learn to let that butt gripping go!

 Did you know that there are other posture cheats? Perhaps you tend to back grip or chest grip too? Intrigued? Check out our other posts and make a healthy change to your posture habits.

#posture #posturalawareness #buttgripping #buttwink #squatting #hippain #backpain #pelvicpain #dianeleephysio #thefixprogram #thefixprogramonline #thefixprogramsydney

Understanding and managing sore ribs in pregnancy

Are you pregnant, and suffering from pain in and around your rib cage? Well you are definitely not alone – it is probably the second most common pregnancy-related complaint that we receive in our clinic, The Fix Program. If you’re wondering what the most common is, it is pelvic girdle pain.

Why do my ribs hurt in pregnancy?

During your pregnancy your body produces high levels of the hormone relaxin. This makes your ligaments stretchy, flexible, and pliable, and this very important to help allow your body to expand with the growth of your baby and get ready for the stretching required for giving birth in your pelvis. However, unfortunately there is increased laxity in ALL your ligaments, including those between each rib, and between your spine and breast bones. The ribs can easily be pushed into extreme and uncomfortable postures as the ligaments and tissues surrounding them stretch out and become painful.

Once you enter your third trimester, and as your baby becomes ever larger, the uterus expands right up beneath your rib cage. The lowest few ribs expand and flare out in response to your growing baby, putting them into a position they have never been before, dragging your soft tissues with them. This can definitely be a recipe for discomfort! This added stretching can place stress in between the ribs, or at their attachments to the spine at your back or breastbone at your front.

What does pregnancy rib pain feel like?

• Pain in the ribs on one side more than the other
• Tenderness to the touch
• Pain in sitting, bending forward, or slouching
• A deep ache or burn around the rib or upper back that makes sustained sitting difficult.
• Painful coughing, sneezing, laughing, or deep breathing

How can I manage the pain and discomfort associated with pregnancy rib pain?

Often in pregnancy, many aches are short term as the resilient body adjusts and gets used to its new postures and physical stresses. This is also the case with rib pain. If you do suffer from rib pain, consider trying any or the following common treatment strategies.

• Keep your posture straight and tall as often as you can – avoid sitting for long periods, especially in a slouched posture pulling on those ribs and ligaments even more.
• Use heat or cold packs for 20mins at a time, whatever eases your pain more.
• Move and stretch regularly! Remind yourself with a half hourly alarm, or even use the red dot postural reminders to make sure you do it often.
• In some cases some gentle sports taping of the ribs may be helpful.
• When sleeping, support yourself with pillows to get as comfortable as possible.
• When stretching, target your thoracic spine, shoulders, and rib cage – just like we do in our pre-natal Pilates classes. Try the standing wall twist, or the Feldenkrais ‘bow and arrow’ for gentle free flowing movement of the upper trunk.
• In a physiotherapy appointment we can provide massage that can relieve the pain from tight muscles while realigning your ribs and spinal joints as needed. Book in to see us, and we will also tailor an effective home exercise plan just for you.
• Join an online class from the comfort of your home - Katrina the principle physio at The Fix Program has designed a series of pregnancy exercise programs that will help you immensely.  

When am I likely to feel better?

Each of the above measures should provide some relief almost straight away – the more you do, and the more often you do them, the better. However, some women may find that the pain will continue or return very quickly, especially in the third trimester. The good news is that this won’t last forever! At the 36-week mark the baby will start to drop lower into your pelvis, meaning some of the pressure will ease and often the rib discomfort along with it. For the minority who feel pain all the way through to delivery, it should completely disappear soon afterwards as your relaxin levels return to normal and your body doesn’t have to make room for a whole new person any longer!

For those who experience it, this rib pain is all part and parcel of growing your new child. We always want to know if you are struggling with this all too common pregnancy symptom, so please do not hesitate to call and book in with one of our Physios here at The Fix Program.

by Mariam Middleton,  Founder of Sydney City Mums and social worker

Mothers, know that you are your daughters very first female role model. What is important for you to show your daughter about motherhood? Are you a mother who does everything for everyone else and does not prioritise herself. Or, a mother who values herself, she is an individual with her own needs, values, and interests.

Children observe what we say and what we do, even when it’s not directed at them. They pick up on a lot more than what we as adults may give them credit for, especially emotions. According to a 2008 study, by Shannon and Shaw, daughters “learn about leisure, leisure values and attitudes, and make leisure choices based on the behaviours they observed in their mothers.”  Daughters are learning from their mothers that having some “me-time” and taking part in fulfilling activities is great and terribly important.

However we all know that there are hurdles often in the way here to being a great role model for our children.  Probably the biggest hurdle with self-care or fitting in “me-time” for mums is time. However, self-care is not always about major life changes, it can also be little things. Self-care is not always about doing something; it could mean practicing self-compassion. Self-compassion involves acknowledging the struggle and being kind to oneself.

How can we be a better conscious role model?  Try the following easily applied behaviours to demonstrate healthy self-care, mindset and attitudes to your young women ( and boys too!) in training.

• Tip 1. Demonstrate that you value yourself by prioritising your needs, the messy house can be wait.

• Tip 2. Demonstrate that you are an individual with your own hobbies and interests, in addition to your caring role. If your interests are in fitness, involve the kids and exercise together.

• Tip 3. Deliberately use language that demonstrates you value yourself.

• Tip 4. Role model positive self-talk.

• Tip 5. Share the mother-load by asking for help. You are modelling to your children that asking for help is not a weakness but an insightful strength.

Reference: Shannon, C. S., & Shaw, S. M. (2008). Mothers and daughters: Teaching and learning about leisure. Leisure Sciences, 30(1), 1–16

Draft ‘Term 2 2021’ Pilates timetable is subject to change.

These classes will run for 10 WEEKS in our BRAND NEW Dymocks Building studio.

Classes will commence from **Tuesday 13th April 2021.
**

Classes for this term are recommended and scheduled for:

• Beginners Pilates for those new to postural strength and awareness.

• Intermediate/advanced level Pilates for challenging and functional postural control.

• Pregnancy specific Pilates

Classes will be mixed for all client types as listed above, and kept to a maximum of 4 per class.

Contact us for further information.

I often share this story to my pregnant clients in the middle of a pregnancy Pilates class or within our physio sessions. My experience is always met with many inquisitive and ears and many questions afterwards. Pre-eclampsia is not talked about much, or enough in my experience, but yet it affects 1 in 10 pregnant mothers. I know that I knew nothing of it until it happened to me

This is my story.  

For me, my first pregnancy was relatively easy and uncomplicated. Lots of exercise, no morning sickness, quick ante natal visits at Royal Women’s Hospital at Randwick. A dream pregnancy really and a plan to work as a physio right up to the end of my 38th week. But, this all changed when at my 38 week visit there was some commotion over my blood pressure and its steep rise from the last visit. An early 8am appointment and then straight to work was the plan on this particular day. However I was suddenly admitted for the day for further testing and I had to cancel my entire day of clients and classes. I was not impressed! I had been feeling perfectly fine. No symptoms whatsoever. What was all the fuss about?

In the day unit, I was to have blood tests for liver and clotting function, another urgent ultrasound assessment for the health of baby and constant blood pressure checks almost on the half hour.  I still felt fine, not a sign or feeling of illness to speak of.

However, later that afternoon, I was met by the endocrine specialist OB (‘the Prof’). According to him, I was apparently gravely unwell - I was showing signs of severe liver failure, and my baby was distressed with less than than the usual amniotic fluid measured around him. I was for immediate admission to the hospital to be monitored and for probable induction into early labour in the coming days.  I couldn’t believe it! Hubbie joined me for dinner- he bought in take away and all my belongings. I had not packed my maternity bag as yet. I know now that I should have been better prepared! We spent the night sorting out my early exit from my physio clinic- things to do, ends to tie up, people to notify. 

Pre-eclampsia, formally called toxemia, is when a pregnant woman shows high blood pressure and high protein in their urine. It can range from mild to severe. It usually happens late in pregnancy, but can happen as early as 20 weeks, or even after delivery. Pre-eclampsia can lead to eclampsia, a serious condition that can have health risks for mum and baby and, in rare cases, cause death. The only cure for pre-eclampsia is to give birth. Even after delivery, symptoms of pre-eclampsia can last 1 to 6 weeks or more.

It is uncertain why this occurs for 1 in 10 pregnant women. It is thought to be related to the placenta not working the way it should. Some experts think high body fat might contribute, or a lack of blood flow to the uterus. Genes are also a factor.

For me, I had an uneventful first night after admission and Thai take away, and I was up early for brekkie. I was allowed to walk around the hospital, but to stay close. At lunch time, I started to feel quite strange. Poor hearing, almost as if I were inside a bubble. I had started to develop a headache, one of the common signs of pre-eclampsia, but what startled and scared me the most was the loss of vision. I began to lose peripheral vision to the right, with a blackout in this visual field. It came on all so quickly, within the hour, and after a quick response visit from ‘the Prof’ at my bedside, I was in for a C section within the hour.  I don’t think I really ever felt in danger until the rush to theatre to give birth and to get the placenta out. The urgency in the staff, the sudden calls to my husband made it all very real.

Baby Oliver was born via C section at 38+4, all OK but with breathing difficulties. He spent an hour or so on oxygen and perked up quickly. And yes, hubbie made it just in time to get on the gowns and be with me during the birth. Oliver was checked regularly for that first night- I think they were more concerned about him than me.  I do recall not much sleep that night as my blood pressures were checked every hour. Apparently all settling down without any further todo after the birth, which I understand now was lucky for me. I did not have to take any meds for my blood pressure, went home at day 4 and needed no medical intervention until the usual 6 week post natal check-up with my GP.   

All in all, everything worked out OK, however I do often think I was a lucky girl to have had this picked up on the day of my ante-natal visit. I often wonder,  if my appointment was a few days after, would I have just soldiered on, thinking that these mild symptoms were a part of pregnancy in the final weeks? How long would I have waited before thinking a hospital trip to A&E was warranted? Would could have happened to me or Oliver if I were slow to act?

Watch for the signs of possible pre-eclampsia and act on them immediately. I could not believe the speed at which I suddenly felt unwell after such an easy pregnancy. It can happen to any of us. Watch for

• sudden weight gain due to a large increase in bodily fluid
• belly pain, especially in the upper right side
• headaches
• dizziness
• peeing less or not at all
• sudden vomiting and nausea
• visual changes like flashing lights, floaties and blurred or greyed vision

Remember also, that some women with pre-eclampsia don’t even have any symptoms, so it’s important to see your doctor for regular blood pressure checks and urine tests.

by Samah Elomari,  Women’s health physiotherapist 

We women, with our moods and energy levels will often find ourselves blaming our menstrual cycle for most things! At the same time, driving our housemates or partners mad!

Ladies, let’s turn it all around and use our changing hormone levels every month for the better! Here are women’s health physiotherapist Samah’s top 6 tips for exercising and training throughout your month.

Tip 1. At the end of your period and the week after, you are building more and faster muscle mass. This is due to the rise in oestrogen. Use these weeks to work on your strength training and lifting.

Tip 2. Around ovulation, your testosterone levels go up. Testosterone makes you feel competitive, powerful and energetic. This is perfect for competition day and running. At this time, you also have better coordination and faster reaction times – great for if you’re trying to learn dance or gymnastics routines. Book those dance classes and attend  Zumba classes at this time i the middle of your cycle. Find your feet if you are usually tripping over them!

**Tip 3.**If looking to lose fat, you’ll burn up to 30% more fat during aerobic exercise in those 7 days after ovulation. This is due to the rising combination of estrogen and progesterone, which fires up your body’s ability to burn fat.

Tip 4. If you exercise according to heart rate zones, expect higher heart rates to be more of a challenge to reach during your period. Try shorter workouts or shorter runs and swims during this time too, because you’re more likely to experience a drop in endurance. Leave you endurance workouts alone during your period.

 **Tip 5.**When training at higher intensities, you might experience more of a challenge during those 7-10 days after ovulation. Your heart is working slightly harder than normal, especially if you’re training in hotter climates…so you’ll reach a higher heart rate more quickly. Go back to those  dance and Zumba classes perhaps!

Tip 6. Here is comes, the most important tip.  Listen to your body and please  be kind to yourself. Only you know how your body is feeling. If you’re experiencing premenstrual syndrome (PMS) – that irritability, fatigue and a down mood – maybe what you need is some R&R, meditation and Yoga. Leave that big weights session or run to another day.

How true is the beloved old myth that when you are pregnant, you can eat for 2?

Jennifer May, Nutritionist and owner of Sydney City Nutritionist cannot disagree more. While pregnancy may make you feel that hungry, you cannot double your food intake each day. You may, however, may wish to double your nutrient intake with healthy eating habits.

If you put on too much weight during pregnancy, you increase your risk of gestational diabetes, backache, higher blood pressures, and C-section birth. Conversely, gaining too little weight during pregnancy can lead to low birth weight, premature delivery, and, later, developmental delays, or chronic health problems in your baby.

Here’s Jennifer’s guide throughout pregnancy when it comes to calorie intake:

• During the first trimester of pregnancy no additional calories are needed, however you may feel hungrier due to the high requirement of nutrients.
• In the second trimester an extra 334 calories on average are needed.
• In the third trimester an extra 475 calories are needed per day.
• It is important to meet those needs with foods that are highly nutritious and which promote optimum health and balanced blood sugar such as healthy protein, healthy fats and high fibre carbohydrates.

If you need further guidance on healthy eating habits and menus for pregnancy, contact Jennifer She would love to help and can consult with you through telehealth or face to face!