Octavio Gammara, General Manager
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Women’s Health Division
Core Concepts’ Women’s Health division is focused on musculoskeletal conditions arising as a result of pregnancy, specifically in treating pelvic pains (low back and hip region) for pregnant women. Musculoskeletal care for pregnant women with such pains is a very narrow sub-speciality of spinal pain management.
Treating pregnant pains is quite different from treating the more commons forms of low back pain in two aspects.
First, the common forms of treatment such as ultrasound, the use electro-therapy machines such as TENS machines. short-wave, NSAIDs drugs, pain-killers and traction are not available due to the potential harm to the unborn child.
Second, pelvic pain for pregnant women is usually a result of the dysfunction of the pelvic and sacroilliac joint. The Sacroilliac Joint (SIJ) is the where the low back portion of the spine meets the pelvic bone This very complex area requires a high level of diagnostic skills and experience to determine the fault amongst the numerous interactions between the various components of this area. In contrast, pre-natal massages treat the end result of the dysfunctions e.g. muscle strain. Without treating the underlying cause, you can expect the pain increase both in frequency and intensity.
These two aspects limit the choice of physiotherapy treatments to sub-set of therapy known as advanced manual therapy, an area of speciality for the Core Concepts group. This combined with the exclusive focus of the spinal division uniquely positions Core Concepts for this sub-speciality.
Peri-Partum Pelvic Pain
Between 50% to 80% of all pregnant women will experience pain in the pelvic region and lower back sometime during their pregnancy. This Peri-Partum Pelvic Pain (PPPP)this pain is most prevalent in the fifth and sixth month of pregnancy, but can begin as early as eight to twelve weeks into pregnancy. Several studies also reported the evening hours seem to be the most difficult.
Approximately 67% of pregnant women suffer from night discomfort or backache. While 36% have night backache so severe it wakes them from sleep. Women with history of low back pain are at higher risk for recurrence, and their back pain can occur earlier into the pregnancy.
Generally, peri-partum pelvic pain presents in the following areas:
- Lumbosacral joints (low back pain)
- Sacroiliac joints (posterior pelvic pain)
- Coccyx (pain in tailbone)
- Symphysis Pubis (pain in the front of the pubis)
- Groin area
PPPP tends to be influenced by posture and is associated with a waddling gait. Approximately 80% of these back pains are usually localized, but occasionally may vary. PPPP tend to increase in intensity towards the end of the 3rd trimesters and typically resolve 6 months after delivery.
There are 3 types of peripartum pelvic pain generally:
- Symphysis Pubis Dysfunction (SPD)
- Lumbosacral (low back) pain
- Posterior Pelvic Pain (Sacroiliac joint pain)
References
- Berg G, Hammar M, Moller-Nielsen J, Linden U, Thorblad J. Low back pain during pregnancy. Obstet Gynecol. 1988; 71:71-75.
- Fast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y. Low-back pain in pregnancy. Spine. 1987; 12:368-371.
- Fast A, Weiss L, Parikh S, Hertz G. Night backache in pregnancy. Hypothetical pathophysiological mechanisms. Am J Phys Med Rehabil.1989; 68:227-229.
- Jain S, Eedarapalli P, Jamjute P, Sawdy R. : pubis : a practical approach to management. The Obstetrician & Gynaecologist 2006;8:153-158
- Mantle MJ, Greenwood RM, Currey HL. Backache in pregnancy.Rheumatol Rehabil. 1977; 16:95-101.
- Svensson HO, Andersson GB, Hagstad A, Jansson PO. The relationship of low-back pain to pregnancy and gynecologic factors. Spine. 1990; 15:371-375.
- Wergeland E, Strand K. Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scand J Work Environ Health. 1998; 24:206-212.
The pelvic girdle is made up of 3 bones, the sacrum flanked by 2 innominate bones. The symphysis pubis is a fibrocartilaginous structure that sits at the front of the pelvis, connecting and holding the 2 innominate bones of the pelvis together.
The joints at the back of the pelvis are called the sacroiliac joints. During pregnancy, hormones soften supporting ligaments in these joints to prepare for labour, hence decreasing stability in the pelvis. This instability may cause peripartum pelvic pains.
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As your pregnancy progresses, there will be changes in your body to accommodate your baby. These changes sometimes can case stress and result in musculoskeletal dysfunction. These dysfunction often manifests as pain, especially in your pelvic girdle and back. Etonia’s approach to these symptoms involves analyzing the structure of the body to identify and correct these dysfunctions. Palpation, range of motion, and observation are used to reveal distortions of the pelvis, sacrum, and spine.
To reduce the stiffness, pain and discomfort brought about by these changes, Core Concepts’s physiotherapists apply various strategies in the restoration of spinal and pelvic girdle mobility and stability that often results in a reduction in the patient’s pain and spasm. Strategies include manual techniques, such as joint mobilization, muscle energy technique, myofascial release and pelvic girdle stabilization exercises.
Mobilisation
Mobilisation has always had its efficacy described in terms of improving mobility in areas of the spine that are restricted. Such restriction may be found in joints, connective tissues or muscles. By removing the restriction – by mobilisation – the source of pain is eliminated and the patient experiences symptomatic relief.
Muscle Energy Technique
Muscle Energy Technique (MET) uses precise positioning of the body in conjunction with very light muscle contractions to re-educate muscle whose dysfunctional tone distorts the body and causes asymmetry. Special emphasis is placed on the back and pelvic girdle, which control the functional core of the body. This technique is very gentle on the patient and can be very effective in relieving a variety of musculoskeletal dysfunctions, including symphysis pubis dysfunction (SPD).
Myofascial Release
Myofascial release uses manual, deep tissue release to lengthen shortened connective tissues. The release helps to induce a state of relaxation for the muscles that are tense due to the stresses of pregnancy. Manual stretching by the therapist and self stretching by the patient further this process. Lengthened and weakened muscles are then strengthened with gentle resistive exercises.
Pelvic girdle stabilization exercises will be incorporated in the management to help maintain stability and thus alleviate pains from pelvis, sacrum, and spine.
Manual Lymphatic Drainage
Manual Lymphatic Drainage (MLD) is an advanced therapy where a range of specialised and gentle rhythmic pumping techniques to move the skin in the direction of the lymph flow. This stimulates the lymphatic vessels and increase the rate of removal of waste products, toxins and excess fluid from the body’s tissues resulting in reduced fluid retention, swelling and puffiness such as of the ankles.
The rehabilitation specialists under this division are:
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