Our Personal Experience;
Our lead practitioners have always had an interest in paediatrics and pregnancy. Our lead chiropractor Donna Strachan undertook additional courses in paediatrics in addition to her undergraduate training in paediatrics and pregnancy as early as 2001. Or lead Physiotherapist Leigh Halfteck has a particular interest in Visceral Manipulation for over 12 years and is explicitly interested in how visceral problems can impact women who are struggling to conceive. However nothing focusses the mind like having a child yourself, and when Donna and Leigh were delighted to become pregnant with their little bundle of joy, they embraced the experience as fabulous experience to gain professional insight as well as personal experience. Donna tells us more;
“When we became pregnant, I sent Leigh on the “Steve Williams Paediatrics” courses which are not usually open to Physiotherapists – only to Chiropractors and Osteopaths. I was fortunate enough to be taught by Steve at an undergrad level, and as I know him, he agreed to allow Leigh onto the course after seeing all the Osteopathic, Visceral and Neural Techniques that Leigh has completed. I wanted to be well looked after during pregnancy!!” she explains. Although Donna has completed a number of chiropractic post-graduate training courses in pregnancy and paediatrics, this is the one she found most valuable. With a full complement of Physiotherapy, Osteopathy and Chiropractic perspectives and techniques, Leigh was fully equipped to treat Donna throughout her pregnancy. “Of course I was in such a fortunate position to have Leigh looking after me, but I was delighted not to need a lot of treatment on my back. From my perspective, looking after my back and becoming strong before pregnancy was a big factor. So, of course, I would advocate this for anyone as a first step. During pregnancy I worked till 38 weeks and had no back issues, I did my pelvic floor exercises throughout and stayed active, I even rode up to 36 weeks but then I was banned!” she laughs. However, she can appreciate fully how back pain occurs – especially after multiple births. Donna goes on to explain “It was such an interesting time for me, from my perspective with pregnancy, birth and postpartum; it is just incredible how much your body changes and no one experience is the same! After birth you may have so many issues with your core muscles and pelvic floor and these of course have an impact on your back and the strength of your pelvis. Having second or third children whilst this is the case will predispose you to have pain – we know this from the research – and I can certainly appreciate why. This is when we will always assess you as a whole person, not just an area of pain. We look at treating and addressing causes as well as symptoms, and we want the best results for you.”
Although Donna was fortunate not to experience back pain with pregnancy, she did require the expertise of Leigh’s treatment. What for? Heartburn or Reflux as it is sometimes known. This is common in pregnancy as the lower ribcage has to stretch to accommodate your growing bump. from also places a strain on the diaphragm where your oesophagus passes thought, which is why food can be restricted and cause symptoms. Thankfully Leigh was on hand with effective treatment. “Treatment from Leigh for this was amazing and helped me so much. Even I was so relieved and thankful that I would experience immediate relief with treatment. Leigh also gave me stretches daily which helped and I undertook advice changes such as eating at the table only in a good position, avoiding reclined positions in the evening after food, eating little and often and avoiding high pregnancy pants when sitting and eating.”
Why Back Pain in Pregnancy?
So what are the mechanisms behind pain during pregnancy? One of the significant factors is that your body releases a hormone called Relaxin. This hormone is essential in allowing the pelvis to cope with the growing baby. It causes ligaments to elongate and gain much-needed space. However, this elongation then requires more help from the muscles surrounding the area to increase the stability of the joints. Where your muscles are not strong enough, this can increase strain to your muscles, ligaments and joints resulting in pain. In addition to the relaxin, pregnancy will, of course, change the mechanics of your low back and pelvis which inherently increases stress. The combination of these factors makes this problem a common one that we see.
The two main causes of pain are
Pubic Symphysis Dysfunction (PSD) and Pelvic Girdle Pain (PGP)
Often the area of symptoms for the patient is not also the cause. Those patients suffering with PGP can experience pain into the sacroiliac joint (two joints at the back of the hips just below your spine). The cause in our experience is often how tight the structures at the front of the hips have become. Therefore treatment is aimed at releasing tension in the front of the hips and increasing strength in the back. Addressing mismatching of function gains more sustained relief as opposed to isolated treatment to the painful structures alone.
The opposite is then often true if you are experiencing pain in the groin, specifically the symphysis pubis. This can be caused by increased tension posteriorly that then raises the tension at the front of the hips. Treatment is then aimed at releasing structures in the back of the pelvis and increasing strength in the front. Please read below as we have a real account from one of our patients who felt relief from this type of treatment;
Case Example of PSD
“Starting my second pregnancy I was excited but filled with dread. My first pregnancy was fine up until 24 weeks when my hips started getting sore. By 30 weeks I was struggling to walk & using crutches. I went to physio via my midwife but sadly they had a very hands-off approach and basically said I have to put up with it until the baby arrived. I had really severe Pubic Symphysis Dysfunction (PSD) and felt like my hips were literally going to fall apart at times.
Once the baby arrived (at 42 weeks) it did relieve a huge amount of the pain but sadly a lot of damage had already been done. Over the next 6-12 months, i attempted strengthening with physio (via GP) and could start to see a little progress but was still on lots of painkillers, support belts & crutches ad-hoc.
I found out I was pregnant again and the physio instantly referred me back to the GP saying they had a completely hands-off approach with pregnant people. This was heart sinking as by my first scan at 12 weeks I could already feel the instability starting again in my pelvis.
Several family members had been to The Chiro & Physio Clinic and whilst chatting in their appointments mentioned about my issues and asked their opinions on physiotherapy whilst pregnant. The joy of joys came when they said yes tell her to get booked in.
I had my first assessment with Leigh & straight away felt relief, primarily because someone was willing to see me, talk to me & treat me. I didn’t care whether it worked at this point, to be honest, I was just glad for someone confirming the pain I was feeling was real & shouldn’t be accepted just because I’m pregnant.
The big turn around came in our second session where we realised there was an issue with one of my nerves. I shuffled almost in tears into the appointment in agony & honestly walked out not quite believing what had happened. Literally, it was like someone had flicked a switched. That nerve pain has never returned (6 weeks later) but if it does i now know how to deal with it quickly.
There are still other issues with my pelvis & with a growing baby inside of me it will come under strain but considering we were anticipating me being on crutches by now & certainly a wheelchair towards the end I am blown away by the progress made.
I am beyond grateful for the treatment i have received from Leigh & the staff. I was dreading this pregnancy so much but I can actually start enjoying it now & playing with my 18 month old. I just wish more pregnant women wouldn’t suffer in silence and accept being told its just part of pregnancy. Its not!!”
Leigh explains how treatment helped in this case;
“The big turn around moment was when we mobilised the pudendal nerve into the back of the pelvis. Its path starts in a place very similar to the sciatic nerve but instead of going down the back of the leg, it passes under the groin and into the front.
With the relaxin present, the Sacroiliac joints now have greater mobility which can then cause an irritation to the nerve. Freeing it allows mobility without irritation.” Please see below on how the nerve is mobilised. The picture is taken from Leigh’s course entitled Neural Interface Technique.
If you are suffering from pain during pregnancy, call our Liverpool Clinic on 0151 4275000 or Wirral Clinic on 0151 6485000 to book an appointment or speak to a practitioner. Alternatively, email us at firstname.lastname@example.org