Rib Flaring: Don't Let It Flare Up During Your Pregnancy

Rib flare is one of those less common conditions, found in pregnancy during the second and third trimester. Many pregnant women often complain of their growing baby poking and prodding them - “I feel a leg kicking through me.” Often you will place your hands over the bump just for the excitement of feeling your baby kick. Usually your husband is in the next room, he runs in to feel the baby kick and misses it each time. Well life would be simpler if they just carried the baby throughout the pregnancy, and then they could feel every kick along with the morning sickness, nausea and any other symptom that may occur....

This pain is a direct result of your baby and uterus getting bigger and poking and prodding into you. In pregnant women the demand for oxygen is increased. You will exhale more carbon dioxide which triggers the respiratory system to increase the respiratory rate slightly, and this is the reason you may find yourself more breathless during strenuous activity. Your diaphragm will have to work harder as well. 

You may find the baby beginning to press up and under your ribs and chest. This is the uterus ascending as the abdomen stretches upward and outward, so the baby can grow. The growing baby can obstruct the descent of the diaphragm, which is needed for deep breathing. Hence the pressure pushes the rib cage out sideways and forwards, known as rib flaring and causing a lot of pain. It can also lead to shoulder pain due to the nerves of the diaphragm referring pain there. 

Your growing breasts can also place added pressure onto your ribs, so a good supportive bra which is not underwired is really important.

Good posture can help relieve some of this pain as slouching will put added pressure onto your abdomen. So sitting up with shoulders back is a good start to relieving the pain.

Exercises that open your rib cage up are also really useful here. Stand facing a wall. With your feet 40cm from the wall, cross your arms in front of your face. Then lean your crossed arms on the wall sliding them up the wall above your head and stretching yourself up as far as possible. Hold the position for as long as comfortable. This lifts the diaphragm and rib cage up off the uterus. Practicing doorway chest stretches can also be helpful because they, too, will help rotate the shoulders up and back, which can also help lift the ribs away from the uterus.

Breathing and relaxation exercises can also help. There are also several hands-on techniques that your physiotherapist can do to gently stretch and lift your ribs away from the uterus. 

If you are suffering from rib flaring 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.  

Useful tips after birth

Now many of you may think that this topic is not physiotherapy-related, but the job of a women’s health physio sometimes involves treating patients within hours of them giving birth. In these cases, we provide general advice on advisable body positions, as well as treating the patient for the uncommon discomforts post-labour.

My number one tip of the day would be to keep drinking water, and lots of it. You may quite often hear many of the different medical professionals say this, but this is because it affects so many systems in the body that it is an all round good substance for the body. Many might recall the soreness down below when urinating. Now the water can change the pH of your urine making it sting less. If you find it very painful when you urinate then you can pour water on yourself, down the toilet whilst urinating. I might also add that doing your pelvic floor exercise can also increase the healing time as it increases blood flow. (There is just no escaping those pelvic floor exercises).

While on the topic of soreness, some patients have told me they have difficulties in sitting on a hard chair. So here is another piece of DIY make it yourself equipment advice. Take a towel and roll it up into a sausage shape. Then place the towel in a horse shoe shape on the chair and sit on the chair, thus relieving you of putting pressure on the pain. 

While you are not in company or even if you are you can put some ice on the sore area. The recommended method would be to use a bag of frozen peas wrapped in a tea towel. It is best to do this 10 minutes at a time, giving yourself a 10 minute brake before repeating. 

One of the less talked about problems that can follow is constipation. Whilst on the toilet, put a foot stool (mind the pun) under your feet to raise your legs, knees bent hips flexed above 90. This creates a smoother route for the stool to exit your body.  

I don’t talk about it much, as physiotherapists are very much advocates for exercise, but do remember to rest after giving birth. Birth is a wonderful and traumatic event on your body and rest will help improve healing times.

If you suffer from any type of muscle pain during or after pregnancy 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.

Breastfeeding: Don't Let it be a Pain in the Back(side)

There are many advantages for both you and your baby to breastfeeding. I am personally very much in favour and breastfed all 3 of my babies. However, this is not the place to go into the pros and cons of bottle and breastfeeding; there are many sites that have detailed discussions on that to help you make informed decisions.   

However, I do notice that some women that breastfeed tend to complain of back pain. Now this does not have to be the case. I do sympathise, especially with those middle of the night feeds that all you want to do is feed the baby and put them back to bed. But if you do one extra thing every time you feed it can spare you a lot of pain in the future.

It is very common to pick up the baby, let the baby latch on and for you to be in a sitting position with your back titled towards one side with your baby resting on your lap whilst feeding. However if you place a pillow on your lap and the baby on top of the pillow then there is no need to bend down towards the baby as the baby is at the right height to feed from you. 

The next question you are probably wondering is, am I asking you to go out and buy those fancy feeding pillows that cost a lot of money. No I certainly am not. The breastfeeding pillows that look like 3/5 of a circle are very beneficial and if you have one I strongly encourage you to use it. That is because it gives a lot of extra support to your back as well as preventing you from leaning down. I also would recommending purchasing one of those pillows if you are prone to back ache or already suffering from back ache. 

If you do not suffer from back ache and this is merely preventative then any old pillow (or two if needed) will do the job of raising your baby higher up to you to prevent you leaning and twisting your back in positions that can cause pain. 

Another important thing to remember is to ensure that you are wearing a bra that fits your properly - not just when you are breastfeeding but at any stage of your life. This is another tip that can help prevent back pain.

If you suffer from antenatal or postnatal 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.  

Pelvic Floor: Key Questions to Ask Yourself

Due to my short break from writing because of the chagim, I thought I would go back to the pelvic floor muscles before I move on to a host of different topics that some of you may not have heard of.

The onset of incontinence is gradual but never unnoticed. It is the body’s way of telling us that things are not quite as they should be. Leaking urine can bring on a downward spiral with loss of self respect as well as anxiety and depression. 

The initial leaking is called stress incontinence, caused by weakening of the muscles that keep urine stored inside the bladder. These muscles, called the pelvic floor muscles, fail to fight forces which push down from the abdomen when you laugh, sneeze, run or jump.

If left untreated, stress incontinence can lead to urgency and frequency. An example of this could be when running to the bank before closing time you suddenly feel dampness between your legs. You take a quick diversion to the toilet to check that this is not obvious to the outside world, you don’t really feel the need to go but as your mother probably told you better to be safe than sorry and you go to the toilet. Anxiety can begin to set in out of fear of a re-occurrence, causing you to take a trip to the toilet just in case, to really make sure your bladder is empty, thus establishing a pattern of frequency. 

Before you know it you are a confirmed toilet hopper, you know all the ladies toilets in town and which petrol stations along your driving route have conveniences too. You will then start to cut down your fluid intake (don’t ever do this) and before you know it you are laughing this situation off with all your friends, they are laughing in a supporting sympathetic way or are laughing because they have these same problems.

The three main symptoms are stress incontinence, urgency and frequency.  Stress is when leaking from a high impact movement. Urgency is the really strong need to pass urine that if ignored you feel you will probably end up with wet knickers. Finally frequency, which is how frequent you are going to the toilet. A combination of any of these three can be present.

Most people consider their toilet habits normal, however if the answer to any of the following questions is no, then your habits are not normal and it is time to really step up your exercises to your pelvic floor muscles to more than 3 times a day, which is the prescribed amount for people who do not suffer from this. It might also be the time to seek physiotherapy help as there are much higher success rates when treatment is started earlier on.

• Do you go to the toilet 4 to 6 times each day only?

• Do you sleep through or get up only once through the night?

• Do you have dry knickers all the time?

• Do you pass 300-400mls each time? 1 mug is approx 250mls

• Do you pass water easily, without straining or stopping and starting?

• Do you find urinating is painless and quite a comfortable thing to do?

If you suffer from any type of incontinence 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.  

Sciatica: Don’t Let It Get On Your Nerves

This condition is so named as it is caused by your sciatic nerve. The course the nerve takes runs from your lower back travelling down the back of your legs and branching out into your feet. This is also where the pain is felt, following the course of this nerve. The job of this nerve is to help you feel sensation and move the muscles in your legs. 

Although seemingly quite common during pregnancy – especially in the third trimester – it is not necessarily directly caused by anything to do with pregnancy, although it can be aggravated by your posture during pregnancy. You can also suffer from sciatica without being pregnant. 

Sciatica happens when there is inflammation or pressure from your back on the nerve, often caused by a slipped or injured disc. It can also be caused by the growing uterus putting pressure onto the nerve. When suffering from sciatica you will feel a burning shooting pain, quite often in just one of the legs. It can be constant or it can come and go. Although coupled with inflammation, it is important to remember that while pregnant you cannot take Ibuprofen, even at over-the-counter strength.    

Treatment can include exercises to strengthen your pelvic floor, stomach and back muscles.  You may also be advised to wear a support belt. Flat shoes are also an essential. In bed it is important to support your bump using pillows. Keeping mobile is also very important as well as a sufficient amount of rest and getting off your feet.  One can also use heat and ice on the painful area for 10 minutes at a time.  

It is also important to discuss with your physiotherapist different birthing positions for labour as you may be more limited due to your sciatica. Labouring in water is often preferred in this case as moving in water can feel easier. 

If you suffer from any type of back pain or leg pain during pregnancy 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.