9 Oct 2014

How to get rid of SI-joint pain in pregnancy!

I thought a little update on running might be interesting.
Yes, I'm still running at 26 weeks pragnant. Most importantly, I still enjoy running at 26 weeks pregnant! A few days ago I comfortably ran the 5 km city run and lost just 1.5 minutes as opposed to last year's time. Isn't that great? I certainly feel better about myself. Actually, it felt like having my own body back for almost 30 minutes. More about that in my next post.

The past month I couldn't run as often as I wanted. First of all, until a week ago the weather was too hot during the day, then around week 20 I caught a bad cold (though worked through it, I wasn't able to do much more after my work days) and I had a week of injuries: first SI-joint pain (=sacro-iliacal joint) and a few days into that I fell with my bike and luxated a finger on my left hand. It seemed like the end of the great pregnancy days but I'm happy to report it's all-right now! 

my story:
As a nurse I'm used to work hard: helping patients in and out of bed, lifting sometimes, we all have our own routines on how to do that. Up until the 20th week (the week when my bump 'suddenly' started to grow!) I didn't experienced any discomfort at work and I wasn't aware of the weakening of my joints and ligaments at all.
Sadly, because of this I didn't pay attention to my body and made quite a few wrong movements (like lifting heavy patients, not paying attention for my posture during activities and when standing still, doing to much bending movements...) which resulted in a terrible back-pain, with painful muscle cramps on the right side of my back (even while just sitting).

In the first few times I thought I just overstretched my back muscle and the pain would go away as usual. But the pain recurred and I've had those painful muscle cramps like 6-10 times a day. A few days later I've got lower back pain as well.
At a certain moment while I was biking home after my very last nightshift (at almost 21 weeks) I had a stabbing pain sensation on the right side of the lower back all the time. Honestly, I barely could make it home.
Because the pain was situated so high I thought that I had a kidney infection, rather than pregnancy-related pelvic problems. Another very typical thing was that I couldn't sit or lay down comfortably. Sitting on the kitchen chair was the most comfortable. This seems to be typical when having SI-joint pain (sacro-iliacal joint pain or posterior pelvic pain)

what is the SI-joint:
It is a strong and stable weight-bearing joint that permits very little movement due to its natural structure:

Hormones released during pregnancy relax the ligaments of the body to allow the pelvis to enlarge, in preparation for childbirth. As the physiotherapist explained to me, if you stretch the SI-joint too far, due to the relaxation it won't be able to retain it's original position and remains slightly overstretched, keeping the pelvic bones in the wrong position. As a nurse I know our bodies have the amazing, amazing ability to compensate everything that seems to be not normal in a natural way.
Our body tries to compensate the wrong position of the joint with muscle cramps above and below the joint, in an effort to pull the pelvic bones back to their normal position. (That was the reason of my returning back cramps!)

the diagnosis:
After an appointment with the doctor the diagnosis was easy: SI-joint pain, which is one type of PPGP or 'pregnancy-related pelvic girdle pain'. I haven't even thought about having that, especially so early in the pregnancy, with a relatively small bump! Of course, the size of the bump doesn't even matter that much if you do the wrong movements.

Getting diagnosed as early as possible can help keep pain to a minimum and avoid long-term discomfort. The doctor advised taking rest and painkillers. Well,  as we all know, the amount of painkillers which can be taken safely during pregnancy is very limited and after almost a week on Paracetamol for the flu that was the last thing I wanted to do. So I made an appointment with a physiotherapist, who is specialized in pelvic floor and pelvic support physiotherapy hoping for better advice and suggestions.

how to get rid of the pain:
I must say, after 4 appointments I was completely pain-free. I just wish I've had these suggestions much earlier in the pregnancy.
Here are the most important things:
  • alternate sitting-walking-standing positions often 
This way you reduce the stress on the pelvic bones and the back. You'll see, standing still is the least comfortable position. In the beginning when you still have pain you need to lay down for about 20 minutes every few hours. This was an advice that really helped me!
Actually, I've had a few days at work when I did this and could work comfortably for the remaining hours of my shift. By laying down on a bed or bench you allow the back muscles to rest and 'recharge'.
  • watch your posture when standing:
Squeeze your (remaining) stomach muscles to keep your back straight! This reduces the stress your bump puts on your back by pulling forward. I wasn;t conscious about this but such a simple thing helps a lot.
  • choose a brisk walk instead of waggling:
'Waggling' stresses the pelvic bones and ligaments because you completely relax the abdominal muscles. Also, you allow your heavy bump to pull everything forward. When walking faster you'll be surprised that you automatically squeeze the abdominal muscles more and keep a better position of the torso. Just try!
  • avoid the following activities:
bending too often, reaching over things in front of you, turning your torso too far to grab things, heavy lifting
  • do exercise your abdominal muscles!
In contrary to what they say, you really need to exercise your abdominal muscles during the pregnancy!!! Of course, don't think in terms of situps and leg lifts after the 12th week, but there are exercises you safely can do and need to do. Just think of it: the abdominal muscles are the only support for your bump! The two parts you can exercise are the lower and the side muscles.

Lower abdominal muscle exercise:
Try to squeeze them whenever you can, when standing and when laying in bed. Of course, your bump won't be able to move, but what helps is to concentrate on 'sucking in' the lower part as if you trying to pull the zipper of your jeans. Then you should feel the tightening and relaxing of the muscle on the inner side of your pelvic bone in the front.

Side muscles exercise:
Modified Standing oblique-twist or ab-twist. You need a simple rubber resistance band to do this.
1. Tie the band to a stable object (somewhere between bust and waist-height)
2. Stand with your feet shoulder-width apart and your knees slightly bent.
3. With the band on one side grab the band with both arms extended to one side, without turning your torso (this is the main difference with the original exercise!)
4. Tighten your abs.
5. Pull the band from one side to another in a horizontal line, until it is in front of you and then a bit further, keeping your head and hips facing forward (keep your torso in the same, straight  position at all times!)
6. do this slowly and try to do 3x10 repeats for both sides
  • sleep with a maternity supporting pillow
From the 20'th week I sleep with my diy supporting pillow and I love it! The only thing I changed past week in my own version (as expected) is to shorten it a bit as the filling (made out of cheap IKEA pillows) has got compacter.
  • wear a supporting (pelvic) belt from time to time
This is a controversial suggestion though. As my physiotherapist explained, wearing a supporting belt too often makes your abdominal muscles relax and by getting weaker they won't be able to perform their task anymore.
As long as you exercise your abdominal muscles you can wear a supporting belt occasionally if you need to do household activities or for fitness and running. Avoid wearing the belt too often or for longer time periods!
I have bought one and don't wear it really often.
  • you can keep up with other regular activities if they aren't painful
Like running! While running you make completely different movements than when walking and as an extra benefit you exercise your side muscles as well.

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