Friday, 5 April 2013

Recovering from Pelvic Girdle Pain: some exercises to try.

Some women struggle to return to normal after suffering Pelvic Girdle Pain in pregnancy.
These exercises were recommended to me for stretching and strengthening the muscles so that I can achieve a normal range of movement again. An osteopath highlighted that I will have to teach my body how to walk normally again and these exercises need to continue regularly over a period of time. Essentially I need to teach my body to use the normal range of movement again and that this will take time. The nervous system, muscles and bones are relearning and reshaping to be used through the normal range of movement again.

Disclaimer: I am not a medical professional and the information below is not a substitute for seeing a trained physiotherapist, chiropractor or osteopath.  My post shares my experience with recovery and to give you options to explore and apply to your situation.
As with all exercise, if it is hurting then it is time to stop.

An osteopath gave me instructions 1-4 below.  These exercises helped the most with returning to nearly normal.  However your experience may be different from mine.

Exercises for the sacro iliac joint and muscles:
1. Pelvic rock

2. Lie in the same posture as for the pelvic rock. Press the ball of the right foot firmly into the floor and keeping the heel on the floor. While pressing the foot into the floor, ensure that the right knee stays over the toes and that the left hip presses lightly into the floor. This should cause the right knee to move forward over the toes and the right hip to rise off the floor. Repeat from the start on the alternate side. Start off slowly to ensure the correct movement.  Aim for alternating onto each leg in a smooth left right, left right succession. The hips, knees, and feet will move in a fashion reminiscent of walking.

3. Sit on a dining chair with feet firmly on the floor and knees at 90 degrees and about 12 inches apart. Aim to keep the right leg stationery and with your head over the right leg then rotate your torso to the left.  This should cause the right hip joint to ‘open’.  The left foot should remain at the same distance apart but the left leg will move due to the hip rotation. This move seems to require that you press onto the ball of your right foot while moving your torso to the left. Repeat on the opposite side. It is easier to do this exercise on a swivel chair or try it while sitting on a plastic shopping bag.

I have ‘designed’ this one myself and finds it works the same areas as no. 3 but it is simpler to do so some may find it easier to follow or start out with.
4.  Lie flat on your back on a firm surface, feet at least 6 inches apart.  Push one leg downwards as if you are pushing your heel into an imaginary floor.  That hip should move down with the leg.  Repeat on the other side.  You can add challenge to this by raising the opposite hip while pushing down.

Pelvic Floor Exercises

It may take time to actually ‘feel’ your pelvic floor if it is quite weak and the time you can squeeze may be mere seconds but overtime you will start to feel it and you will be able to squeeze for longer.
These exercises are all done lying flat on a firm surface.   I found I could do them lying in bed where I have a fairly firm mattress.

1. Tighten the pelvic floor as usual.  Inhale deeply, contract the abdominal muscles, imagining that the front of the abdomen is reaching right to the back of your spine. You ought to feel the vaginal muscles contract now. Exhale slowly and relax when you feel the muscles begin to tire. Repeat. The objective is to increase the length and number of repetitions.

2. Once you are comfortable with holding 5. for a while (5 - 10 secs I'd say), While doing #5, and lying flat on the floor or in bed, bend both knees to comfort and toes pointing up. Starting on the right (or left leg) slowly straighten leg. Slowly bend your knee once more keeping your heel on the floor or bed the whole time. You may need to rest the pelvic floor when your leg is fully straight. Simply tighten the pelvic floor again after a pause and continue the exercise. Repeat on the other side.

3. Tighten pelvic floor as #5 with knees bent, feet and knees together. Slowly move right knee to the right to a place of comfort. Move it back to the original position. Repeat on the left side. As the strength of your pelvic floor improves, you will be able to open the angle of your leg further and also to move both legs at the same time.

Because your pelvic floor is connected to muscles in your back and in your legs, it is important to work on other muscles which will also help you to bring back a good walking technique.  Back stretching exercise:

Stretching and strengthening the back

1. Start by lying with your body flat on the floor. Bend both knees deeply. Cross the right knee over the left knee, and rotate hips and legs to the left side while keeping the back flat on the floor. Increase the stretch further up the back by crossing the left harm over your chest and pushing the right shoulder into the floor.

2. For tight back muscles. Place two tennis balls into a thick sock. Tie it tightly at the top of the balls so that they can’t move around in the sock. Place them under your spine on the floor so that the balls rest on the tight muscles in your back. Hold stationery or make small shifting movements on the floor. It works for the neck and shoulder muscles too. I have been getting a pain in the outer part of my knee. Apparently it is due to the leg muscles spasming and pulling on the ligaments which are what is hurting. This tennis ball trick works a treat for that if I lie on my side and place the balls on the leg muscles, not the ligaments.

3. Sit on the floor with legs wide but comfortably apart. Lean forward slowly toward the left knee, the right knee and to the centre. Do not force it just stretch to comfort. Repeat a few times.

4. Stretch out the calf muscles by standing on a thick book and leaning gently forward. Repeat a few times.

No. 3 and 4 are useful due to the interconnectedness of the muscle groups and the aim to teach your hips and legs to walk again.

If you find any inconsistencies or ambiguities, please let me know. I have written this mostly so that I remember them but I've realised that others are coming up short when they look for information out there.

Also if it is helpful please let me know.   I am going to aim to add videos of the exercises my osteopath showed me.  There is one more that he’s shown me recently but I haven’t had the time to write it up yet.