Do SPD Belts Really Work?

In one word yes, but I will elaborate a bit further as it does need to be in conjunction with preventative measures.

I will start by quickly describing what SPD is. It is the symphysis pubic bone, the bone at the front, which is commonly a very stable joint and closed without a gap on a normal day. During pregnancy the hormone relaxin is released to relax your ligaments and soft tissue in order to make room for your growing baby and for giving birth. Due to this, in some cases the gap between the symphysis pubic joint can open causing instability and pain. Once this pain has started - if it is truly just SPD and no other joints are involved - will continue until after the baby is born. Physiotherapy in this case can only stop it getting worse and cannot stick the joint back together and get rid of the pain. In most cases the pain will go away as soon as the baby is born.

For some unlucky women the pain will linger after the baby is born, due to the hormone relaxin being mimicked in breastfeeding mums which will not exit your body until 3 months after you finish breastfeeding. Fortunately for many though SPD is coupled with a condition called sacroilliic joint dysfunction. This is anther joint that has been moved out of place due to your ligaments relaxing. This joint though can be manipulated back into place often creating an instant relief, and this can be done by your physiotherapist.

So where does the belt come into all of this. The belt will lie over the symphysis pubic joint holding it firmly in place. Now this will not stick it back together but every time you walk quickly or stretch your leg too far this causes more pain. The belt will hold the joint that little bit more in place and also acts as a reminder to keep your legs closer together at all times.

The belt will firmly hold the joint and every time you are regularly walking this will prevent the gap getting larger, causing a small relief taking the sting out of the pain. Again this will not ease the pain as the gap will still be there but it prevents it from getting worse and aggravating it.

I am a great advocate for the SPD belt, but, very importantly, it needs to be coupled with exercise and being aware of what aggravates the pain . For instance not running, doing the stairs one at a time and rolling over in bed with knees together are all important things to remember to not cause the joint any further opening and further pain.

If you want to purchase a belt or 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 privately or through Leumit in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Labouring with SPD: The Birth Plan

Making a birth plan is important in my opinion (even if you don't stick to it) and this is even more true if you suffer from SPD. In a midwife's ideal world there would be no pregnancy complications and everyone would deliver on their backs in stirrups, so that the midwife could maintain a good posture and control the baby easily. In many patients' ideal world they would deliver in a more upright position so gravity could help the labour and delivery along. By making a birth plan, you can consider all the different options and factors and work our what your preferred labour would look like.

If you suffer from SPD it is important before labour begins to measure how far you can open your legs in a pain free range. If your are very prepared you can buy a long piece of rope and tie it around your knees so you have the measurements of how far you are going to allow your legs to be open during the delivery, on hand. This is even more vital if you plan on having an epidural. This is because you will not feel pain while the epidural is in but will feel the pain afterwards if you have opened your legs into your pain range. With this in mind, a position that should definitely be avoided is a delivery in stirrups.

In the first stage of labour, movement and gravity play an important role. Most commonly, at this stage you are still at home, and timing your contractions. If you suffer from SPD it is still good to be walking around but not to be constantly climbing the stairs, which can often speed things along. Using the gym ball can also be good, by sitting on it and rolling your pelvis, but do ensure that your legs are not straddled too far open.

It is important to support your body in positions that are comfortable for you but to avoid straddling your legs, for example do not straddle a chair, however you can lean onto a chair or any other equipment.

In the final pushing stages there are many good options for positions. Being on your side is very good because the midwife can have good control and you can too. You can also be in a squatting position (as long as you are in pain free range). Any position where your legs are in your control and cannot be pushed open by someone else is a good position.

If you are suffering 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 Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

SPD After Labour

Symphysis pubis dysfunction (SPD) is a common condition found during pregnancy, presenting as pain around the pubic joint area. It is a separation by this joint that leads to pain, caused by the hormone relaxin that is produced in your body during pregnancy. Once the baby is born, the level of the hormone decreases (but is mimicked if you are breast feeding), and the pain will start to go away.

Well this is the scenario in most cases, however for some people this pain can linger or even start after labour itself. Due to the hormone relaxin, your ligaments are more soft and stretchy to enable your baby to be born. Due to this, labour itself (especially if it is a traumatic birth or you delivered in stirrups) can cause a separation at the symphysis pubic joint.

SPD after labour will get better but in some cases it can take time. The good news is there are things that can be done to speed this healing process along, one of those being physiotherapy. After your physiotherapist has assessed you they will give you lots of advice on movement techniques such as keeping your legs closer together during activities that you need to carry on with your daily living. They will help you find comfortable positions to carry out tasks that are important to you. They may also decide to give you crutches if they feel you will benefit from them, along with a specially designed SPD belt (this is different from a back support belt). They will also guide you on specific exercises and design you a personal home program exercise session. Of course this program will also include pelvic floor exercises that every woman should include into her daily routine.

If you feel you need to, you can also take pain killers and over the counter anti-inflammatories. It is important to remember that you can only take anti- inflammatories after labour once the baby is out and NOT if you are still pregnant and suffering from SPD. This is true even if you are breast feeding. If you are pregnant and suffering from SPD, you can only take over the counter pain killers such as Acamol and must go to your doctor if you need something stronger.

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If you are suffering 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 Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Part II: Exercise after Birth

Last week I wrote about the importance of exercise during pregnancy. But what about exercise after giving birth? Don’t lots of people from all walks of life say and keep reminding you mothers how important it is to rest? (Rest - wouldn’t that be nice with a new born around the house...).

Indeed, rest is extremely important after giving birth. I don’t need to tell you that birth is a major trauma on you body; you probably already know that. (There is a reason why men don’t give birth). However, exercise is also important. Pelvic floor exercises can start and should start within 24 hours of giving birth. Without even seeing your faces I can see some of you shouting at the screen, the tears, the stitches, the soreness; yes, I know. But in fact, exercise to this area will increase blood flow to this area and increase healing times.  

How about other forms of exercise? You have to let your body be your guide. You can exercise as soon as your body feels ready. (If you had a caesarean-section, recovery time will be longer and should wait until your check up with the doctor).

Your lower back and core abdominal muscles will be weaker then they used to be. Your ligaments and joints are also more supple and pliable, so it is easier to injure yourself from over-stretching and twisting too much. So make sure you include some strengthening exercises as well as an aerobic workout, such as a run.

If you are doing too much your body will let you know, and you should listen and slow down. You will experience extreme fatigue, feel run down and take longer to recover from exercise sessions. If your bleeding becomes heavier or changes colour to more pink or red this is also another sign.  

If you suffered with any musculoskeletal conditions such as SPD then your approach to exercise needs to be a little different. You should still exercise, but stick to specific exercises which are beyond the scope of this blog. 

If you suffer from any type of pain during or after pregnancy and are not sure if it’s safe to exercise 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.  

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.  

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.