Specialist Rehab Group’s Womens Health Physiotherapy Singapore Division is dedicated to managing musculoskeletal conditions and pains and/or discomfort caused during pregnancy, specifically in managing pelvic pain (presented as low back pain or hip pain etc) for pregnant women.
care for pregnant women is a sub-specialty of
and managing aches and pains caused by pregnancy is very different from
treating common forms of musculoskeletal pain (e.g. low back pain during
treated very differently from other forms of low back pain).
First and foremost, many of the common treatment modalities, such as the ultrasound therapy and electrotherapy modalities such as the shockwave or TENS machines, which are commonly used in managing lower back pain, are definitely a strict no-no during pregnancy.
These as well as drugs such as pain-killers and NSAIDs and traction are not allowed in our clinic at all with pregnant mothers. This is to eliminate any potential harm to the baby in the pregnant women.
Secondly, pelvic pain in pregnant women is usually caused by a dysfunction of
the pelvis and sacroiliac joint (SIJ). The SIJ is located where the low back
portion of the spine meets the pelvic bone, and is a very complex area that
requires a very accurate and high level of diagnostic skills and
expertise to accurately diagnose the exact cause of pain.
Keep in mind that,
without properly and accurately assessing, diagnosing and treating the core issues, you
can almost expect the pain to return consistently and become more painful and unmanageable.
In our Womens Health Physiotherapy Singapore experience, around 7 out of 10 pregnant women will experience pain in the pelvic region and/or lower back during their pregnancy.
Pelvic Girdle Pain is most commonly experienced during the second trimester, however, with some women, it can begin as early as in the second or third month of pregnancy.
2 out of 3 pregnant women can experience backache at night or in bed…and 1 in 3 pregnant women have night backache that is so severe whcih can disrupt their sleep. Women who have had history of low back pain are at higher risk of exarcebation.
Generally, pelvic girdle pain can be present in the following areas:
Pelvic girdle pain is generally linked to the changes in posture and can be linked to the waddling walk pattern. 80% of the time, these pains are very localized, but in 20% of the time, the pains may be more wide spread and vague in nature.
Pelvic girdle pain has a tendency to intensify nearer the end of the third trimester and may continue for up to six months post delivery.
3 types of common areas where pelvic girdle pain can manifest as
Our pelvic girdle comprises of 3 bones – the sacrum (the bone at the bottom of the spine) and 2 iliums that both connect to the sacrum on each side and together at the pubis symphysis (see diagram).
The pubis symphysis is a fibrocartilaginous (means that it is made of fiber and cartilage), and is located at the front of the pelvis, and it holds both sides of the ilium (pelvic bones) together.
Physiotherapy can be very helpful in the management of these aches, pains and injuries, as well as for providing education for self management.
On the other hand, the joints at the back of the pelvis where the sacrum and ilium joins together is called the sacroiliac joints. During pregnancy, the expecting mother’s body naturally release hormone to relax and soften supporting ligaments to prepare the joints for childbirth/delivery, and one of the byproducts is that this causes progressive laxity and instability in the pelvis.
this instability that may lead to peri-partum pelvic pains.
As you progress in your pregnancy, your body will change to accommodate the growing baby. These changes usually will stress and cause imbalances, pain and discomfort to your body. The best physiotherapy approach to managing these problems are to firstly correctly diagnose the structure of the body and correct these problem areas.
Our physiotherapist will utilize a mix or all of the following clinical tools to pinpoint the causes:
to determine the severity and help you manage the symptoms. We will help you and educate you on how you can decrease the lack of movement (stiffness), manage your pain and/or discomfort.
Our women’s health physiotherapist will apply different approaches to restore the mobility and stability of your spine, sacrum and pelvic girdle, to decrease muscle spasms and ultimately, provide pain relief.
These may include gentle joint glide and mobilizations, myofascial / trigger point release, muscle energy technique (MET) and core strengthening exercises in our Womens Health Physiotherapy Singapore division.
Careful and gentle gliding and mobilizing stiff joints and relaxing tight muscles will cause an increase in the mobility and range of the spine-sacrum-pelvic girdle that is stiff.
These stiffness are usually concentrated around joints, muscles and even connective tissues. When we remove these restriction by gentle joint glides and mobilizations, as well as treating trigger points, often the sources of pain is removed and patient may experience quick symptomatic pain relief.
DRAM is most commonly occuring in post natal women and can be aggravated by significant weight gain and increased abdomen size during pregnancy.
A combination of hormonal changes, laxity of the muscles of the abdominals and pelvic floor muscles as well as the increase demands post-delivery can work together to cause further separation of the abdominals.
That's why it's vital to get your DRAM assessed. After 4 months there is rarely any further reduction of your DRAM unless you do specific exercises in an attempt to reduce the DRAM. Anything greater than 2 fingers width is considered problematic as it may predispose you to back pain, injury or possible abdominal prolapse.
Your physiotherapist will assess your DRAM and in the early stages may fit you with a supportive bandage which will help hold you together whilst you are recovering and regaining your strength.
Pregnancy and childbirth can damage the pelvic floor muscles and connective tissue, causing all kinds of inconvenient and uncomfortable symptoms for women after they give birth.
The pelvic floor muscles stretch between the pubic bone and the tailbone and cradle your bladder, bowel, and uterus, helping you control your urine, bowel movements, and sexual functioning.
More specifically, the pelvic floor muscles enable you to keep urine and feces in – and release them – when you need to. They also help you contract and relax your vagina during sex.
When the pelvic floor muscles are tight or weak, they can cause annoying symptoms or even pain.
What our women's health physiotherapist can do is to evaluate your pelvic floor muscles and determine if they're causing or aggravating to your conditions.
And if they are causing and aggravating pain, what our physiotherapists can do for you is to work on the muscles and connective tissue to release trigger points – areas where the tissues are stuck together instead of sliding easily around each other. They will also train you to do exercises at home to help relax muscles that are tight and strengthen muscles that are weak.
Myofascial release and trigger point release technique
uses purely hands-on deep tissue release techniques to release and restore
length of shortened muscles and connective tissues (these tissues may be tight due to poor positioning and overuse). The
release induces relaxation and symptomatic relief.
Manual stretching may be utilized by therapists and patient will be taught home self stretching exercises for self management between sessions.
We will also include pelvic girdle strengthening and stabilization exercises to improve and maintain pelvic stability and prevent pain from recurring in the pelvis, sacrum and spine.
Muscle Energy Technique involves accurate positioning of the body simultaneously with very precise and light muscle contractions.
It is used for the purpose of re-educating dysfunctional muscles. Dysfunctional muscle tone causes abnormal symmetry of the body, so special emphasis is placed on the pelvis-sacrum-spine girdle, as it controls the core of your body.
This technique is a very effective yet a gentle tool to relieve pain when managing pregnancy-related musculoskeletal disorders and dysfunctions.
Manual Lymphatic Drainage (abbreviated to MLD) is a very advanced therapy where the expert therapist will provide a range and series of specialized but gentle rhythmic mobilization and pump techniques to move fluids in the direction of your lymph flow.
This will encourage and stimulate the lymph nodes and lymphatic vessels to accelerate the rate and efficiency of removal of waste, toxins and excess fluid from your body’s tissues, to result in decreased fluid retention, puffiness and swelling.
This can be effective in managing swelling of ankles in patients with compromised circulatory problems face.
Urbanrehab Womens Health Physiotherapy Singapore works closely with our manual lymphatic drainage therapist.
The initial session with our Womens Health Physiotherapy Singapore division will last for about 60 minutes. During this time, the physiotherapist will conduct a thorough subjective clinical history (what happens is that we’ll have a guided talk to understand your symptoms, discomfort and pains). We then will follow with an objective assessments session, to confirm and ascertain specific conditions and diagnoses that is synchronous with the clinical history.
be several other assessment tools and treatment approaches that may be depending on the nature and severity of the condition.
Follow up sessions with the physiotherapist will be around 30 minutes.
It's a little hard to say, as there are variable factors that may influence the number of sessions required.
It depends on your condition, severity, compliance and response to women’s health physiotherapy treatments, hence the number of sessions will vary. A safe estimate is about 6 sessions, but we do have patients who require longer and more frequent number of intervention sessions.
Upon the initial session with our Womens Health Physiotherapy Singapore division can we have a rough
estimate of time required, but we will re-evaluate this as we go along, depending on your progress and your individualized management plan.
Any female at any any age, if you are experiencing any of the following symptoms:
Our Womens Health Physiotherapy Singapore division can also provides education and general exercise programmes for: