Friday, 24 August 2018

My PGP Pregnancy Action Plan

I know Pelvic Girdle Pain well after suffering for around 20 weeks in my second pregnancy. This pregnancy I started to get twinges around my pelvis, groin and lower back from 11 weeks. I was (and still am) worried about how bad it will get throughout this pregnancy so it has been really important for me to create an action plan to reduce it's impact. 9 weeks after it started the pain is worse, but only slightly so my plan to reduce the impact seems to be working and I thought others might find it helpful too.

Pregnant me pointing at my pelvic region


What is Pelvic Girdle Pain (PGP)? 


Pelvic Girdle Pain used to be called SPD (symphasis pubis dysfunction). It's basically pain in pregnancy around the pelvic region including: lower back, hips, groin and pelvic area. It's caused by the uneven movement of the pelvic bones although it's not understood why some women get it and others don't.

Can Treatment Help Pelvic Girdle Pain?


Yes, but the effectiveness varies between individuals in part due to how early treatment is started. For some people PGP will go away, some will manage to stop it getting worse and for others the pain will progressively get worse until birth. The pain for most people will go away soon after birth.

My Action Plan To Tackle Pelvic Girdle Pain


My plan is based around getting treatment, preventing aggravating the PGP and strengthening my core muscles to better support my pelvic region.

Physiotherapy/ Osteopathy


I’ve heard people say that Physiotherapy has had little impact on their PGP and I suspect this is a combination of not being seen soon enough, there being too few specially trained Women’s Health physiotherapists and exercises not being completed adequately. While Physio might not make PGP go away manual therapy and exercises to strengthen the core muscles should help limit the deterioration.

Last time I had regular physiotherapy before and after birth so it was something I wanted to get early on this time, unfortunately due to the availability of my doctor and referral time for physiotherapy I am still waiting for an NHS appointment. Luckily I have the exercises I was given before and I aim to do those 2 to 3 times a day.

An alternative option is to have private treatment and after investigating private practitioners locally the most highly recommended person for PGP is an Osteopath with a special interest in Women's Health. The specialist knowledge appears to be of more importance than the field they work in.

Pelvic Floor Exercises


Kegal or pelvic floor exercises can help reduce the groin pain often experienced with PGP. As they also stop you peeing yourself when you sneeze they are pretty essential anyway (I don’t think women in their first pregnancy realise just how big an issue this is). 

I have previously reviewed a free app from Tena Lights, but I’ll admit that I have gone back to using Squeezy which is a paid for app supported by the NHS. I like how customisable this app is. I currently have it set for 3 repetitions a day and despite it reminding me multiple times I still only manage 2 sets most days. Better than none...

The most important thing about pelvic floor exercises (after actually doing them) is doing them correctly so it’s worth refreshing yourself on this and a midwife might be able to help if you are unsure.

Following Advice


There is too much useful advice about how to prevent antagonising PGP to include in the post so I have included some links at the bottom of this post. The most useful advice I got from my Physio was to not push myself. Continuing to do something which hurts will only make the pain worse and cause more damage so it's not worth it.

The other advice is mostly focused around keeping your knees together, trying to stay balanced (eg avoiding standing on one leg which is really difficult given you will inevitably need to walk and use stairs etc), keeping your pelvis straight (eg sit properly and with your knees lower than your bottom) and don’t lift anything heavy.

There are tricks to help with this like using a back pack instead of a shoulder bag, wearing flat shoes instead of heels, sitting down to dry yourself/ get dressed and taking one step at a time (rather than alternate steps) if you can’t avoid stairs, but it's well worth reading the Practical Suggestions from the Pelvic Partnership.

My favourite new gadget to prevent aggravating pain is this reaching aid. It allows me to pick up small items from the floor without having to bend over. Given how often I drop things and how little tidying up my children do it is super helpful (Affiliate Link).


Acupuncture 


I was dubious about acupuncture until I used it as a last resort to help with my migraines and it worked. There is scientific evidence that it can help relieve certain types of pain and it's even available on the NHS for PGP in some areas. I had it regularly when experiencing PGP last time and I’m planning to have it to manage pain this time too. 

Swimming 


I’m not really fit enough for most exercise and too much walking aggravates my PGP so I have started to go swimming regularly. The water soothes my painful body and provides support while allowing me to exercise strengthening my core.

I have to adapt my strokes for PGP including doing breaststroke legs instead of front crawl ones. When the pain was really bad last time I would hold a float between my thighs and just move my legs from the knees down.

Pregnancy Yoga/ Pilates


Through all my pregnancies I have experienced various aches as well as PGP and I have found pregnancy yoga a good way to stretch out my body. My favourite DVD by Tara Lee is available on Amazon, the updated version is also available on Amazon Prime video. What I like about this DVD is she tells you about the modifications you need to do for PGP.

This time I'm also going to try a Pregnancy Pilates class too. I'm a little nervous as I haven't done this sort of group class before, but there have been lots of recommendations.

Using A Support Band


Lots of people with PGP advocate support bands. When your bump is big they can definitely help spread the weight providing some relief, but the leading Women’s Health team I worked with didn’t recommend them for their patients. My understanding is that by using the band you are actually weakening the muscles which can make the pain worse when the band isn’t being worn. This makes sense to me, but their use is still widely recommended by health professionals. I don't intend to use one this time unless the pain gets severe and other approaches haven't worked.

Where to go to get more information about Pelvic Girdle Pain


More information about Pelvic Girdle Pain including the causes and treatments are available from the NHS Pelvic Pain in Pregnancy, the Pelvic Girdle Pain and Pregnancy factsheet from RCOG and there is a huge amount of information from the Pelvic Partnership charity website.

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