SIJ Dysfunction: Not to be Confused with SPD

Sacroiliac joint dysfunction (SIJ) is a condition that one can suffer from during pregnancy which completely resolves itself after birth or shortly after.  Although it can be very painful during pregnancy, fortunately there is a lot a physiotherapist can do. 

Personally, I had never heard of SIJ until I started my training to become a women’s health physiotherapist. One of the reasons I and many others had not heard of it is because quite often if you suffers from SIJ, you also suffer from SPD.  Because patients often have the same symptoms from the two conditions, such as pain when using the stairs, the diagnosis of SIJ is missed.

What is SIJ? 

The sacroiliac joint is the joint at the back of your pelvis. When you have SIJ, pain is felt over the buttock and/or back of the thigh. Occasionally the pain is also felt over the groin and the entire back of the leg. SIJ is the misalignment of the sacroiliac joint.  The misalignment can take place in a few ways: it can be rotational in one of two different directions or the joint can slip upwards.  

The cause of this misalignment and the resulting pain is the hormone relaxin, which has come up a few times on this blog. Yes, the one that relaxes your ligaments and soft tissue. Relaxin has been the cause of most of the problems I have written about on this blog. But I promise you it is a useful hormone overall, as it prepares your body for birth and helps make room for the growing uterus. 

Can it be treated?

The job of the physiotherapist is this case is to diagnose the problem and then simply put the joint back in place. It sounds like it would be painful, but it is not.  This procedure will leave some patients completely cured and free of any more problems, while with others the misalignment can keep occurring and the physiotherapist will simply have to keep realigning the pelvis.  

In addition to this treatment, your physiotherapist will also advise you on stability exercises. This is because it is really important to strengthen the muscles around your pelvis and those that help with core stability. This helps to share the responsibility for your stability between your muscles and joints together, and not leaving it all to your joints. 

If you are suffering from groin and buttock pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com.  I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.  

Back Care Advice: The best head start for your body

First of all I would like to start off with a big mazal tov to Kate (aka HRH the Duchess of Cambridge) on the birth of a baby boy. Now although I don’t normally make personal announcements on my blog, I have decided this one is very fitting. I am sure Kate is getting the best treatment in town for her and her new royal son. It is not routine for a women’s health physiotherapist to visit a woman directly after birth if she is neither having any problems nor fits into a high risk category for having problems. There is still however a lot of advice that can keep you pain-free and let you focus on being a good mum.

As the well-known saying goes, prevention is better than cure. Looking after your back is imperative before back pain starts to kick in. It is easy to forget about looking after you with the mountains of washing loads that have come out of nowhere and the constant changing of the baby’s nappy and clothes, along with the feeding. You could just say to yourself “what harm will it really do to change the baby on the floor right here, after all it will save me a good minute which I can spend doing another chore around the house”. 

Bending, twisting and lifting are all bad for your back. These are probably the three actions that mothers or anyone really does the most and without even thinking about it. If you can take on board a few tips on how to improve certain actions it can save you a lot of back pain in the future. 

Babies need to be changed a lot throughout the day. It is therefore important to have a place in your house that is a suitable height for changing them. A chest of drawers is normally the correct height for most people. This will avoid bending or over stretching when doing this task throughout the day.  

Another action repeated many times after birth is feeding the baby. Whether by breast or bottle, make sure you are sitting in a comfortable position with your back properly supported. If you are breastfeeding make sure the baby is at the height of your breast instead of you bending towards your baby. You can buy fancy pillows for this or even just use a regular pillow to prop the baby to the right height. 

When you are lifting something heavy, whether it is the laundry or something else make sure you bend down on one knee with your back straight and hold the item close to you as you lift it up; this is much better than bending your back over to pick it up. 

I have only mentioned a few activities but the principles are the same for everything you do in life, so make sure you applythese principles to your lifestyle for a healthy, happy you. 

If you are suffering from back pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com.  I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.   

RAD: Getting Your Body Back After Birth

Rectus Abdominis Diastasis (RAD) can be quite common after giving birth. So, what exactly is RAD? How do I know if I have it? I hear many of my patients say “I have a gap of 2 fingers when I prod my tummy, I don’t really know what I am feeling for or what it even means.”

RAD is caused by the hormone relaxin, which I wrote about in my previous blog. The hormone relaxes your ligaments and soft tissue to make room for the growing uterus. It allows the abdominal muscles to stretch, permitting the uterus to move out into the abdominal space. The outer most abdominal muscle is called the rectus abdominis. It has two halves and is joined at the midline by a connective sheath called the linea alba. The two bands of recti muscle lay parallel but during pregnancy they can stretch away from the midline, and it is this separation that is called RAD. A significant RAD is a gap greater than 2 fingers in width, three days post-delivery.

Overall, 66% of pregnancies leave the mother with RAD at the end.  Scenarios in which RAD is most common include:    

• ·         If you have gained excess weight
• ·         If you are an older mother
• ·         If you have a larger baby (classified as above 4kg)
• ·         It is a multiple birth
• ·         It is your third, fourth etc. pregnancy
• ·         You have had pregnancies close together
• ·         You have carried out inappropriate exercise during pregnancy.

Are there any symptoms?

There are no obvious symptoms from RAD, which may leave you wondering why my patients should care about how many fingers worth of a gap they have.  In fact, although there are no obvious symptoms, it can alter your posture and contribute towards lower back and pelvic instability which in turn can lead to pain. It can also simply prevent you from gaining back your old figure.

What can I do about it?

Sit ups, which are a well-known exercise for toning your abdominal muscles, would be counterproductive for any patient that has RAD and should be avoided. Instead, focus on exercises that isolate the correct muscles. For instance, going on all fours or on your back doing posterior pelvic tilts would be more suitable.

It should only take one visit to your physiotherapist to measure RAD properly and show you how to do it yourself in future. They will also show you what exercises you should be doing at that stage, and advise you how to progress your exercises program. You cannot measure correctly simply by lying on your back prodding your tummy. The correct method, that should be demonstrated first, is lying on your back with your knees bent, drawing in your abdominal muscles, tilting your pelvis back, raising your head and shoulders off the floor and feeling 2cm below the umbilicus.

If you suspect you have RAD and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com.  I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or at your home if you live in Gush Etzion. 

SPD: Can it be self-diagnosed?

Symphysis pubis dysfunction, more commonly known as SPD, is a condition that is usually the first to be suggested as the diagnosis if you suffer pregnancy pain. My patients often tell me that when talking to their friends about the aches and pains during pregnancy, quite often the first response is “oh yes pain in the pubic area, I had that, my doctor told me it was SPD, there is not much that can be done about it.” You might even try to google your symptoms and will most likely end up with a self diagnosis of SPD. 

In fact, if you suffer from pubic pain you could very well have SPD – but it can only be diagnosed by a medical professional such as your physiotherapist or doctor. This is because there are many conditions with similar signs and symptoms to SPD. The good news is if you do suffer from SPD there is a lot your physiotherapist can do to help.

SPD is caused by the hormone relaxin, which is released during pregnancy. It does exactly what it says on the packet – it relaxes, it relaxes your ligaments and soft tissue. This hormone, although causing the pain of your SPD, is important as it helps your body make room for the growing baby inside you and prepares your body for birth.

If you are unfortunate enough to suffer from SPD you might find walking, stairs, turning in bed and getting in and out the car all very difficult activities, and you might find sex painful too. These are all activities that your physiotherapist can address and incorporate into treatment. Treatment can include certain exercises, yes exercise, as well as suggested techniques for carrying out the painful activities more comfortably. In some cases it may be helpful to wear a support belt, and crutches in severe cases.

Rest is important during pregnancy to an extent, but it is equally if not more important to stay physically active as much as possible.

If you suspect you may suffer from SPD and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com.  I can arrange to see you in Bishvilech health clinic in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Pelvic floor: laugh in confidence

There is a 1 in 3 chance that the person reading this blog has a secret: incontinence (either stress, frequency, urgency or a combination of the three types). Chances are if she has confided in a friend the response was “I do too, it's the price you pay for being a mum. There was this one time, it was so funny I laughed so hard I had to change my knickers.” 

Is it common to leak? Yes. Is it normal to leak? No.  Can something be done? Hell yes!  The easiest time to gain control over this problem is when leaking begins, and before it spirals out of control. Currently 50% of women in old age homes are incontinent and quite often that is the only reason they are in an old age home. However, these numbers can change if we do something about it at an earlier stage in our lives, when treatment is still possible.  

The pelvic floor muscles are a sling of muscles that form a figure of 8 that go around your front and back passage. They also support your bladder, bowel and uterus.

Initial leaking is called stress incontinence and caused by weakening of the muscles that keep urine stored in the bladder. It is no longer strong enough to withhold the pressure of the forces which push down from your abdomen when you laugh, sneeze, run or jump.

As the pelvic floor muscles have two different jobs of supporting and reacting to quick responses like a sneeze, they are made from two different fibres - slow twitch and fast twitch - and therefore it is important to exercise in two different ways.

Every woman should exercise three times a day for the rest of her life. This secret exercise should consist of two sets. This first set should be a quick contraction followed by a quick release and you should do 10 of these. The second set should be a contraction and holding it for 10 seconds followed by a slow release. This too should be repeated 10 times.

To test that you are doing this secret exercise correctly simply stop your urine mid flow. You should be able to stop your urine instantly, without tail-off. However, only use this test every other week. Do not use the toilet as a place to exercise.

If you are have problems and need additional help or you think you are doing these exercises incorrectly please contact me for an appointment at tamaramay.physio@gmail.com or call 0544485086.