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Pains of Pregnancy – Posterior Pelvic Pain

In this Pains of Pregnancy series, Principal Physiotherapist Sylvia Ho discusses the common issues faced by expectant mothers, how to identify them, and what physiotherapy can do to ease the symptoms and ultimately, pave the way to a more comfortable pregnancy and subsequent childbirth.

In this edition, we discuss posterior pelvic pain, why it arises, its causes and what you can do to alleviate the pain.

Transcript

We’re going to talk about Posterior Pelvic Pain. But before we can talk about posterior pelvic pain, we need to know what a pelvis is. The pelvis is made up of three bones held together by ligaments. You have illium and illium so two illium on each side and you have the sacrum.

The function of the pelvis is to act like a platform to transfer weight from one leg across the pelvis to the other in activities like walking. For this to happen efficiently and effectively, we need a very stable platform. This means a stable pelvis.These three parts must work together as one. When the joints become loose, the weight transfer cannot occur properly and therefore, pain results.

When does the pelvis become more loose? With pregnancy. Why? Because the ligaments become more relaxed as the body prepares itself for delivery.

How does that happen? It’s caused by the hormone relaxant. If the ligaments are lax, the platform is no longer stable. Therefore, that will lead to pain when transferring weight from one leg to the other.

We’re going to do the transfer abdominus exercise. It’s also called the core muscle exercise. What we need to do is we’re going fire it from the pelvic floor up just because it’s easier. Now, I want you to put your fingers here. Find your hipbone. This one here too, find your hipbone. You come back in and down about an inch where you stop between your soft belly there. Now, if you feel the belly, it’s nice and soft. Another way to think about it is your passage between your pelvic floor. You’re going to tighten up your pelvic floor so close that passage and you’re going to zip up all the way to your belly button. What you should feel is the waist pulling in very gently. Underneath your hands and your fingers, you should feel a gentle tension. What you should feel is actually a botch. Relax, one more time. Meredith, if you want to cough for me, just cough. Do you feel that bulging? We don’t want that bulging. That’s the wrong muscle. Try that again for me, your P muscle. Zip up towards your belly button. Feel your waist pulling in very gently and just tension underneath your fingers and relax.

We’re going to do the progression for the transverse abdominus exercise which we just did before. What do we have to is put your hands underneath the hollow of your back if you can. Now, find the neutral spine somewhere in the middle, not too flat, not too arched. P muscle on, zip up towards the belly button, switch on your core. Feel that waist pulling in. Keeping that back neutral, keeping that pressure in your hands even will increase the pressure or drop the pressure as you do this exercise. We’re going to pick this leg up and put it way back down. As you’re doing this nice and slow, keep your pelvic muscles on, keep your core on and keep your back stable. So, up and down for me. That’s good. Three times each side. Looking good.

Okay, the next one is what we call the leg extension. Again, same thing, find your neutral spine, P muscle on, zip up to your belly button, switch on your core. We’re going to get you lift this leg up for me.
From this position, what I want you to do is actually straighten the knee and back. Okay, two more. Good job. Keep your core in to your spine, neutral. And last one. Excellent. And this side now. Good, not too far though. If you find it too difficult, do that here. How does that feel? Alright? Okay.

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