Hello my name is Caroline, I am one of the obstetric physios, and I am going to go through the ‘Back and Pelvis’ advice session for pregnant ladies.
If you have any niggles or aches and pains in your lower back, your hips or your pelvis, I am going to go through some advice, looking at the anatomy of the pelvis and going through some equipment.
There are some leaflets that will be really helpful for you : so there is a Fit for pregnancy leaflet (that you should have all received in the post but you can ask your midwives for an advice pack), there is another leaflet with useful do’s and don’ts and a leaflet with tips and tools of equipment that may be helpful in pregnancy. We recommend that you ask your midwife for an advice pack of these leaflets, so you can phone our number, extension number 53741 and request an advice pack and we will send you one on the post. Alternatively, if you happen to be in the hospital anyway for a scan, you can ask at the maternity reception desk for a physio advice pack. The advice pack will contain all these leaflets and help you get through this pregnancy.
So, I am going to talk you through the anatomy of the pelvis and help you understand what’s happening during pregnancy. So this is your pelvis, with your big pelvic bones round the side and joining together at your pubic bones at the front. In the middle of your pubic bones is this cartilage, which is normally 4mm wide, when you’re not pregnant and this is normally a really strong joint in the body when you are not pregnant. However, when you are pregnant, your hormones are softening your ligaments. Your ligaments are like strong elastic bands that surround every joint and your hormones are starting to soften the ligaments, so you are now not as strong in the joints in the pelvis. So the front pubic bones are not as strong so you are more vulnerable at the front and you need to really be careful what you do with your legs. So your hips are here, and your legs are here, coming out of the pelvis. So please be careful that you are not doing big wide movements, in and out a car, standing on one leg getting dressed, shaving in the shower or pushing anything out of the way with your foot. You really need to look after the pubic bones in here. If you are getting aches and pains, the golden rule is to keep your legs together as much as you can and be more lady-like, so ideally get dressed sitting down.
Some other tips and tools would be, to use a silk bag for life on your car-seat, and then when you sit down, it’s going to help you get in and out the car a bit more smoothly, so it’s not jarring your joints as you are getting in and out of the car. Alternatively, you could buy a rotating car disc, that works really well on your car-seat, again, making it a lot smoother when you’re getting in and out of the car.
For the bed, it’s the same principle, so you can either use a silk sheet, silk pyjamas, silk pillowcase or you buy to some material from a shop, just make sure it’s really shiny, satin or silk. Just get 2 metres and sew it in a loop by sewing one seam, so it is like a glide sheet. Put that in the bed, under your bottom / hips and as you turn in the bed it’s a lot easier, to help you get in and out of the bed.
So if we look at the back of the pelvis, where the pelvic bones come round the back, your spine comes down and joins your sacrum with your coccyx. So your sacrum is a triangular bone with your coccyx at the bottom, and there is a lot of junction on here, so pelvic bones come together, meet the sacrum bone, form your dimples. So at the base of your spine are your dimples there.
Now, this sacrum does sit perfectly in the middle of your pelvis, but it does gently rock up, down, side to side, so that’s normal. Then you have your big ligaments which hold everything in place, but while you are pregnant, they have softened, so again you are not as strong around your pelvic area and your sacrum area, whilst you are pregnant, with your pregnancy hormones, so this bone does rock a little bit more in every direction while you are pregnant.
You need to be really aware and really careful of your back area and this back band here, especially as you are growing a bump at the front. So you need to be really careful if you are leaning forward that it’s gently opening those back joints a little bit more, and if you are leaning forward and twisting, to hoover, mop, do some housework, you are twisting one side a little bit more than the other. So make sure you are as symmetrical as you can, do light duties as much as you can, so light housework and really look after your posture.
So posture is really important, wherever you are sitting, so make sure you are sitting on an adult chair, preferably with a back on it, adult sized and with arms on it. You can use any sort of cushion, to pop it in your lower spine or lumber support, so it’s comfortable, shoulders back. So ideally knees and hips are level and you have a good spine and good support. So think of the car, house, sofa.. equally don’t sit for too long, so another Golden rule would be , every half an hour, shuffle yourself forward, make sure you roll your lower spine, have a good stretch both ways, maybe round off your shoulders and stretch your thoracic spine, keep everything moving, get your shoulders back, get your shoulders rolling, even a gentle twist , make sure you have moved everything regularly every half an hour, and every hour just stand up and do the opposite and have a good stretch.
Some alternative tools, would be to use a wobble cushion, you can buy this as an on-line purchase (but you don’t have to buy this make). This is really handy if you work a lot on an office chair, so I would say maybe every hour, on the hour, I would sit on this for 5-10 minutes. So you sit on the wobble cushion, which basically has some air in it, and it just helps you to do some pelvic tilts, so just move the pelvis forward / back, so switching the muscles on and off and getting some circulation into the joints.
Alternatively you could get a ball. The ball is one of the best tools we would recommend in pregnancy, so you can buy it in most of the shops now but the only thing is to make sure it is a 65cm ball and it says ‘anti-burst’ on the box. Make sure you have the right pump to go with the stopper and get someone else to blow the ball up. There are 3 different ways you can use this ball : so you can sit on it, and when you sit on it, same rules apply, so make sure your knees and hips are level and your knees are roughly shoulder width apart. On the ball you can gently rock and glide forwards and back, and again using your pelvis to glide forward and back, side to side, just rotate your hips, whatever feels comfortable. So just 10-15 minutes on the ball, to get everything moving and it should be more comfortable than your sofa.
Other uses for the ball, you can either put it on a table or a chair, and lean forward on it. So just hug forward, mind your chest out the way, and just stretch your back out. This is a really good position just to stretch your back out, you could then tuck your bottom in even more and have a really good stretch round the sacrum and coccyx. You can stick one hip out, just to stretch all the muscles in 3 your bottom, and the other side, or just simply rest. This is a good position for pregnancy but would also help you if you went into labour as well. Alternatively, you could put the ball against a wall, in your lower back, and you can just gently rock. Again this just helps rest your muscles, relax your muscles on the ball.
Ok, so because the ligaments are softening at the front and are not as strong around the pubic bones, and the same at the back, they are softening at the back and you have more movement at the back. Because of the vulnerable areas at the front and back of the pelvis, the muscles are generally working a lot harder around the back and front area, so they can get tired easily across this band and ladies are often saying to me they are quite achy around this band at the back, because the muscles are tired and achy.
Some good tips just to help relieve the muscle pain and relax the muscles, you can use a gentle or mild heat. You can use a wheat-bag in the microwave, as long as you only put in the microwave for a minute and it’s not too hot. A little tip is, just think to yourself ‘would I give this to a child? ’ …so it’s just a warm heat so it’s safe for you in pregnancy. You can also use a hot water bottle, as long as it’s got a cover on it, and not too hot. So just a warm, gentle heat on your back muscles, about 10-15 minutes, or in your pubic area, or over your hips.
So some gentle heat on your back area, then you can massage yourself, using the palm of your hand, around your dimples or down that triangle where your sacrum is or gently into your bottom. You can also use a tool or a massage stick, so you can hold it, then gently with the right pressure, give some massage and relief to the muscles.
Alternatively, the only gel you can use is Deep-Freeze gel (please do not use Deep-Heat or anything with Ibuprofen in) this is the only one we have found to be safe in pregnancy. You can use Deep–Freeze gel and put it in your lower back, your bottom and inner thigh, to just help relax those muscles and get circulation in there as well.
Ok, so I just want to mention sleeping positions, you probably all have about 5 pillows at home, or you might have bought a lovely maternity pillow, but I just want you to understand the principles. So when you are sleeping in bed, snuggled up on your side, just make sure your pelvis and hips are level, so you do need to ideally put something between your legs at night, so whether you put the duvet, pillow, long maternity pillow…that’s fine. You might want something under your bump and possibly something behind your back as well. So the cushion behind your back can be nice and thick, and if after a while you feel that hip has gone dead underneath, you can ease back a little towards your back, but as long as there is a cushion behind you and you are not flat on your back, that’s fine, that’s safe, but it just relieves some pressure from that underneath hip. Please do regularly turn as well, regularly change sides, to relieve the pressure and massage that hip.
Getting in and out of bed, you must not do a sit-up in any shape or form, so if you need the toilet in the middle of the night, do not do a sit-up to pull yourself up and cause stress and strain to your back and pelvis. So ideally, you need to bend your knees up, roll to your side, let your feet drop off, and push yourself up sideways. So the correct technique to get out of bed does not put stress and strain on your back or your pelvis.The next thing I would like to look at, is your core strength muscles. This is basic Pilates, if you have
ever done Pilates or heard of Pilates, great, that would be good practice.
So we don’t want you to use your ‘six-pack muscle’, we want you to use your underneath muscle, this is your core strength muscle running underneath your bump, this is a really important muscle. So simply put, and to simply use it, we often say ‘pretend you’ve got tight jeans on’ and all you are going to do is ‘zip your tight jeans on’ which also draws in your lower bump, but you still breathe, don’t hold your breath. Then we want to look at your pelvic floor, so all your muscles underneath… I want you to pretend ‘you’re stopping wind’, pretend ‘you’re stopping a wee’ , tuck everything up underneath and hold. Then ideally do them together, so ‘zip and tuck’ , hold everything together but still breathe. Then we want you to do them as you stand up, so shuffle forward, get everything moving, zip and tuck, use your hands, use your arm strength, lean forward and tuck everything in internally as you stand up. Give yourself a second, let everything settle, and then off you go.
Ok, so to summarise, please try get hold of these leaflets and have a really good read. So ask your midwife, maternity reception or phone us for a pack. Try and make sure you can get hold of a few of these tips and tools, just to make life a little bit easier. Try use good techniques, in and out of the car, sitting posture, in and out of the bed. Gentle stretching over the ball , gentle massage and look after yourself. Remember your ‘zips and tucks’ as well every time you stand up.
So other than that, you might find that you still need some sort of support. There are 2 different types of support : there is a softer support that you can just wear round your middle, that can help to boost your muscles and give them a little bit of a lift, which will help relax your muscles and they don’t work as hard. So we ideally have ‘tubigrip’ in the hospital, which is one of the largest tubigrip, and we put it on a bit like a mini-skirt. So you would step into it, pull it up, over bump, and it just gives you a little bit of support, and we might just tuck the bottom edge in, to just give a little bit of support under bump and round the back. So if you can find any sort of item equivalent on-line, that’s great, that’s fine, just to give you a little bit of a boost. If it’s nice and soft like this, you can still sit in it and it will really help your posture but remember the Golden rule : still regularly move and stretch as well and don’t sit too long. However, we don’t recommend that you wear it all day, so as a rough guideline : we 2-3hours in the morning, take it off for lunch, 2-3hours in the afternoon, take it off for dinner and a few hours in the evening but don’t sleep in it.
Then there is another alternative, which is the maternity belt. Now there are a lot of items on-line that you can buy, but we tend to recommend the simplest belt you can find, so ours is about 3” wide and has one layer of Velcro on the top. So the key points and the key areas, are your dimples, coming round your pelvis to your pubic bones. So if I just demonstrate how to put this one on : so ideally in your lower back dimples, (just loosten your Velcro to start with) scoop under your pubic bones, under your bump, on there and then just tug in a little bit tighter, with your extra layer of velcro . So it should be securely in place, round your dimples and coming under to your pubic bone.
It just gives you a little bit of support and strength round your pelvis. But, this belt is only for walking and standing, because it is quite strong and needs to be removed when you sit.So if you do find something equivalent on-line, that’s fine, but as long as you only know to only use this for standing and walking. So that is the end of the ‘back and pelvis’ advice session, so I hope you have found this helpful and some of the tips and tools have been useful to you, and take care.