Lots of my pregnancy Pilates participants in Epping find me because they're struggling with some sort of pelvic pain during pregnancy. It's really common and there's so much you can do to help with it (although there's also an element of 'luck of the draw').
I've helped lots of pregnant women with pelvic pain in my 15+ years specialising in pregnancy and exercise.
There are two distinct reasons for pelvic pain during pregnancy:
Symphisis Pubis Dysfunction (SPD) and Pregnancy Related Pelvic Girdle Pain (PRPGP)
I'm lumping them together because it can be hard to distinguish one from the other. That goes for me, you and potentially your health professional too.
What is SPD?
SPD is a painful condition which affects around one in five women during pregnancy (according to the NHS). It can vary in 'painfulness' from a dull, bruise-like ache in the front or back of your pelvis (which feels worse when walking, at the end of the day or in the morning) to full on, in a wheelchair or on crutches pain.
What is PRPGP?
PRPGP can be caused by different things to SPD but can also feel the same. Pain may start in the pelvis and radiate to the thighs or across the back.
The pelvis isn't a single bone. It's a collection of three main bones, connected by soft tissue.
Should you do Pilates in early pregnancy (first trimester)?
During pregnancy, your body’s hormonal changes include relaxing and softening hormones which enable your pelvis in particular to move around a bit (read more on that here: exercise safely during pregnancy). Your pelvis will need to accommodate your baby's little head before it descends (or ascends) into the world. And yes - it really is little - although when pressing against your pelvis and cervix it can be mistaken as a giant, watermelon like head.
The real magic happens during the birth process, when your pelvis will stretch and be manipulated by your baby.
The mechanics of birth
If you've ever stopped to wonder how your baby is actually going to get out of your front bottom, these are the basic mechanics of the process: Baby's skull is very soft, it needs to be to get squeezed out (and also to cope with knocks as a toddler) but your pelvis needs to respond to baby's head too. As with all things pregnancy and mother related, it's a two-way thing. Baby protests, you protest, then you find a way to work together but there's often a painful bit in the middle. Believe me - children who share your personality traits make for many painful moments - although less physically painful than childbirth (with the exception of treading on Lego).
I vividly remember during my first labour (which was assisted by drugs to get my contractions to do something other than just really hurt) feeling my insides opening up, like someone had a mechanical vice and was prizing me open. This was my hurty bit - but eventually (and it did feel like a very long time) Isaac and I worked out a little something to ensure he came out into the world.
What causes SPD and pelvic pain during pregancy?
In a fabulously, straightforward pregnancy and birth you have just enough of those hormones and your body responds in just the right way to ensure your pelvis will open up for a beautiful birth experience. You'll also have a fabulous posture and just the right amount of mobility in your hips and lower back to ensure your pelvis doesn't get shunted around before baby's time arrives. However, this isn't always the case (of course).
Some women are more sensitive to those hormones, others might have pre-existing imbalances which cause the pelvis to move before you'd like it to (this is more common if this isn’t your first pregnancy). I'm not going to go into physiological detail here. If you're interested and you have it, ask your physiotherapist, but for now, just know it hurts.
How to prevent pelvic pain during pregnancy?
I’d love to have the answers to prevent pelvis pain during pregnancy. Having a good level of strength and fitness before pregnancy can help but can’t affect your body’s reaction to hormones, the size of your baby, the way you carry your pregnancy or a host of other uncontrollables. Checking in a with a women’s health physiotherapist as standard after a pregnancy is also a good idea (standard practice in some other countries). Pilates and a good resistance programme are also fantastic ways to get your body ready for pregnancy and can help throughout pregnancy too.
During pregnancy there are some general recommendations for reducing your risk. I'm not one for absolutes - as in, I don't like saying 'don't do this' because often it's a case of do or don't do what's right for you once you have the facts - but there is an exception to this when it comes to SPD:
NEVER PUT ON YOUR KNICKERS WITHOUT SITTING DOWN.
Any kind of standing on one leg, outside of the stuff you absolutely have to do (like walking) can put more strain on your pelvis and could put you at greater risk of SPD.
I confess I get on my high horse a bit when I see fancy schmancy pregnancy yoga poses too. Yoga is great during pregnancy but your risk of SPD isn’t reduced just because you’ve done yoga before pregnancy.
Here are my top tips for minimising your risk of getting SPD during pregnancy and also how to stop it getting wors:
- Don't stand on one leg.
- Always sit down (or at least lean your butt against a wall) to put on your knickers, tights, leggings, socks etc.
- When getting in the car, sit on the seat first then swing your legs around, together. In other words, don't just throw yourself in (harder to do if this isn't your first baby and you are constantly in a hurry).
- Same applies for getting out of bed. Legs together please!
- Avoid breaststroke when you go swimming, try front crawl instead (more on swimming later).
If you do suffer with SPD (and I did during both pregnancies) then I'd thoroughly recommend keeping a kids’ size water bottle in your freezer. If you feel sore at the end of the
day you can ice your front bottom. Literally shove the water bottle down your trousers. It feels great and can help reduce inflammation.
Also, if your bump is quite big, shove a cushion under it when you sit down. It isn't glamorous but it helps to support the weight.
There are lots of ways to modify exercises in Pilates in order to make you more comfortable, like squatting with a balloon between your legs, or even performing a Pilates shoulder bridge which can really relieve your pelvis of the pressure.
Do tell your midwife or doctor if you think you might have SPD, it can affect delivery options. You may be referred for physiotherapy, in which case a physiotherapist might recommend a pelvis band, which helps to support your pelvis.
After pregnancy and birth
Most SPD will go after delivery, although it's worth noting your pelvis stays quite soft and malleable so I wouldn't advise much in the way of high impact exercise until you are sure you feel more yourself.
I've noticed that women who've suffered from SPD during pregnancy tend to notice pelvis pain when they do repetitive, high impact exercise (like running) for any length of time post pregnancy. So do take care.
I'd also recommend seeing a physiotherapist who specialises in pregnancy and post natal to check your pelvis has re-aligned post birth.