Pregnancy, bump & baby - Growing pains
Have you got aches, pains and uncomfortable niggles? Unfortunately pregnancy can be a time of bodily discomfort, with new and not-so-nice things to deal with. Pregnancy osteopath Sarah Boughtwood (sarahboughtwoodosteopath.co.nz) shares some of the more common aches and pains in pregnancy, and what you can do to help yourself.
Headaches & Migraines
Headaches are particularly common in the first trimester. This is largely due to change in your hormones. There are a variety of types of headaches; tension, cluster, cervicogenic and migraines (others too). Always tell your health professional if you are suffering from a headaches. Mostly they are not of concern but some headaches or migraines can be due to an underlying illness that needs addressing. Symptoms of headaches and migraines can include head pain – stabbing, dull, shooting pain, neck pain, nausea, sensitivity to light and changes in vision – aura, black spots, stars. Pre-eclampsia is a serious medical condition that can occur in pregnancy. It can present with swelling in the feet, legs, hands and face, elevation of blood pressure, protein in urine, changes in kidney function in blood tests and headaches. A headache relating to pre-eclampsia is often progressive, pulsating, worse with physical activity, doesn’t respond to medication. It needs medical attention, so please advise your health professional. To relieve and avoid headaches ensure you eat well, drink water, avoid stress, incorporate physical exercise & movement into your day, get adequate sleep and get some fresh air.
Round ligament pain
Often a sharp, stabbing pain, felt on one or both sides of the lower belly. The round ligament runs from the uterus to the pubic bone and naturally during pregnancy it expands in length and diameter. Some women experience this pain, typically in the second trimester when the ligament grows. It is considered a normal part of pregnancy as it is a growing pain. To help relieve the pain you can apply heat to the area, rest, avoid sudden movements, avoid heavy lifting and try stretching your hip.
Carpal tunnel syndrome (CTS)
There are many symptoms related to CTS, including; numbness, pins and needles, weakness, pain, tingling, throbbing sensation, swollen fingers, difficulty picking up small objects. The median nerve passes through the carpal tunnel in the palm of your hand. CTS is caused by compression on the median nerve through the carpal tunnel. Risk factors for developing CTS include; being over-weight, gestational diabetes, gestational hypertension (high blood pressure) and high bloods sugars. These all can cause fluid retention which can compress the nerve. To relieve the symptoms, you can try wear a compression bandage, stretching your wrist backwards, pumping your wrist backwards and forwards, stretching your forearm, elevate your wrists to help drain any fluid, avoid triggering activities eg typing.
Restless legs syndrome ‘Willis-Ekbom disease’
This is a sensory motor disorder, creating an uncomfortable, strong, irresistible urge to move your legs’ and an unpleasant sensation in the legs. It mostly commonly occurring during periods of rest, especially at night, when sleeping and is relieved by movement. There are potential links to low levels of iron and folate with restless legs syndrome and additional supplementation may be recommended. Please ask your health professional if this would suit you. To relieve the sensation a walk in the evening, followed by gentle stretching can help.
Symphysis pubis disorder ‘SPD’
This refers to the pubic joint that is in the front of the pelvis, where the left and right sides of the pelvis join. The pelvis is made up of a collection of bones- Ilium, Ischium, pubis, sacrum and coccyx. SPD refers to the pain felt in the joint between the left and right pubis bones. The cause of SPD relates to the hormonal changes in pregnancy as a normal part of the pregnancy. The relaxin hormone increases during pregnancy, allowing the pregnant body to expand and make room for the growing baby. Unfortunately, this rise in relaxin in some women can cause a variety of aches and pains as now the joints all become loose and unstable. During pregnancy the pubic joint widens around 3-7mm. Unfortunately, in some women the pubic joint becomes unstable and painful. Pain is typically worse with walking, weight bearing on one leg, rolling over in bed, putting on clothes and using stairs. To help minimise the pain keep your knee’s together when doing any activity that aggravates your pain eg putting pants on sitting down, rolling over in bed and so on. Ask your osteopath or physiotherapist for exercises to strengthen your pelvic muscles to help hold the joint together and whether a pregnancy belt may benefit you.
Lower back pain ‘LBP’
There are a vast amount of changes your lower back undergoes during pregnancy. Lower back pain refers to your lumbar spine, in your lower back. The curve in your lower back flattens, the change in your centre of gravity and the strain from the weight of your growing belly pulls from the front. All these, plus hormonal changes can cause LBP. A variety of symptoms are associated with LBP. There can be; sharp, dull, achey, stabbing, radiating pain. The pain can be isolated to your lower back of refer up to your thoracic spine/upper back or down in to your lower limbs/legs. Pain can be worse with movement or sitting still for extended periods. The easiest way to relieve LBP is gentle movement. Avoid extended periods of rest or sitting still and add gentle movement into your day. This might mean getting up from your desk more frequently or going for a walk. You do not need a gym membership to add gentle movement into your day or activewear, just simple walking.
Rib pain
Along with your pelvis, your rib cage expands during pregnancy, making more space for your expanding belly. Rib pain can be in the front (anteriorly) or in the back (posteriorly) where the ribs join your spine. The pain can be; sharp, dull, achey, ‘catch your breath’, refer around the entire rib cage. Pain is typically worse with sitting (as it compresses your rib cage), slouching and deep breaths. Rib pain can be worse in the third trimester as the baby is running out of space in your belly and often women experience kicking in their rib cage. To relieve the pain try gentle exercise, applying a heated wheat bag to the area, stretching, yoga, diaphragmatic breathing, the appropriate bra size and wear loose fitting clothes. Your bra is something that is often over looked.
Tip
A bra without underwire is the most comfortable during pregnancy, especially a soft padded bra, that is the correct size and doesn’t dig into your rib cage. Your breasts generally increase a few cup sizes over pregnancy and once your milk comes in. As they grow, invest in properly fitted bras, that are supportive and the correct size. This alone can eliminate rib pain.
Sciatica
A term often misunderstood but is very common in pregnancy. True sciatica refers to pain arising from compression of your sciatic nerve. The nerve arises in your lower back and passes through your buttocks region and into the back/posterior leg. The most cause of sciatica is disc (little ‘pillows’ between your spinal bones) herniation (disc slips or prolapses). Symptoms of sciatica include; burning or sharp pain that refers down the back of your leg, below your knee in the path of the sciatic nerve distribution. The pain is typically worse with sneezing, sitting, lifting or coughing. To relieve the pain include stretching your buttocks (glut and piriformis) muscles and moderate exercise.
Hip pain
The hip joint is where the head of the femur (thigh bone) attaches into the pelvis. There are a series of ligaments, muscles and the joint capsule that work together to create the hip function. In pregnancy the relaxin hormone can make the hip unstable and cause pain. The pain can be felt deep in the joint, or refer to the groin, thigh, outer hip or buttocks. Symptoms include; pain that can be described as sharp, achey, dull, stabbing, throbbing, sense of the hip giving way. To relieve the pain stretch the hip, gentle movement, walking to build strength, strengthening exercises prescribed by your osteopath or physiotherapist.
Tip
Another common compliant during pregnancy is pain in outer/lateral hip from sleeping on your sides. To relieve this pain at night, try sleeping with a pillow between your mattress and hip. This helps takes the pressure off your hip.
Reflux, constipation and UTI’s
Naturally during pregnancy the hormone progesterone rises. Unfortunately, this can cause reflux, constipation and being prone to UTI’s (urinary tract infections). Elevated levels of progesterone causes the smooth muscle and tissue to relax, therefore can create these issues. Reflux is caused by the spinchter at the top of the stomach becoming ‘floppy’ thus allowing stomach acid to come back up in your throat, creating the heartburn sensation. To help reduce symptoms of reflux, eat smaller meals more often, verse 3 large meals a day, also remain up right for a few hours after a meal, this also means having an earlier dinner and not immediately lying down on the couch. Constipation can occur as the progesterone hormone makes the smooth muscle of the intestines ‘slow’ so instead of your intestines moving digested food through your system it slows down, more water is absorbed making stools harder to pass. Make sure you are drinking plenty of water, eating lots of fibre and fruit and try adding in a walk everyday, as your bowels love gentle exercise. UTI’s are more common as progesterone makes the lower pelvis soft, thus allowing more bugs to travel back up the urinary track to the bladder and kidneys. Symptoms of a UTI include; increased frequency to urinate (this is also common in pregnancy) along with changes in the smell of urine, the urine becomes darker, burning sensation when urinating and pelvic discomfort. Back pain along with these symptoms can be a sign of a kidney infection. Please advise your health professional. To help avoid UTI’s be extra careful with hygiene, having a shower after sex, avoiding public pools as they can be full of bugs, drinking lots of water and not ignoring the symptoms of a UTI.
Osteopathy & Pregnancy
Pregnancy is a special time in a women’s life but it can bring a variety of unwanted aches and pains. Osteopathy is a safe and effective form of hands-on, physical therapy. Treatment is holistic, meaning the osteopath assesses the whole physical body and lifestyle elements that might be causing or adding to your aches and pains. The holistic nature of osteopathy means treatment is not only of the painful area, but rather addressing all areas that are not working well. Techniques used include; soft tissue massage, joint articulation, joint manipulation, muscle energy techniques and stretching. Treatment is tailored to the individual, with specific advice given. This may include stretches, exercises or lifestyle advice. For example, getting up more frequently at your desk, sleeping with a pillow between your knee’s or avoiding certain foods. Appointments are 30-60minutes long, giving the osteopath and mother plenty of time to discuss in depth what is relevant to her case, rather than being rushed and things being overlooked.
Treatment during pregnancy does not have to be limited to when the mother experiences pain. Due to the safe nature of osteopathy, treatment can be used as a preventative form of therapy, at any stage of pregnancy, rather than solely treating pain. The body undergoes a variety of changes in pregnancy and osteopathic treatment is aimed at guiding the body and mother through those changes making her as comfortable and as well adapted as possible. Leading up to delivery, treatment is especially important to make sure the pelvis, pelvic floor, surrounding joints and muscles are working as well as possible. Labour is very demanding on the body, so being in the best physical state is very important. There is a lot of advice given during pregnancy but your osteopath can give you the correct advice, based on latest research and generally first hand experience.
Sarah is a pregnancy osteopath, based in Milford, Auckland. She is ACC registered, with no referral required.