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