TENS and Pregnancy

Transcutaneous electrical nerve stimulation (TENS) is a common treatment used in all areas of physiotherapy to help relieve pain. During pregnancy we tend to stay away from electrotherapy treatments to protect the feutus. However TENS is the exception to the rule; it is safe for both mother and baby and can even help enhance the placental blood flow as well as acting like a pain reliever.

When patients present with musculoskeletal pain during pregnancy my first treatment options are normally advice on activities they are doing, exercise that is suitable for them and a hands on manual therapy when appropriate. However sometimes pain can still persist and then I would turn to TENS, especially if the alternative is medication.

There are things to be cautious about when using TENS, like increased uterine contractions when the probes are placed over specific accupuncture points. However, the reseach in this area also states that as soon as the accupuncture points are not stimulated the contractions will also stop, so if this happens you can stop using the TENS machine and this will stop this early onset of contractions. Note that if you are using TENS as a pain relief during labour, contractions are a good thing.

I always choose electrotherapy with caution as a treatment choice, as it is purely a pain releiver and will not correct the cause of the problem. My initial treatments are to treat the source of the pain, to correct alignments in joints, strengthen or stretch muscles, and rehabilitate. Sometimes pain can persist and then I prefer TENS over medication. Drugs can always have a side effect while with TENS all the research suggests it is safe if used correctly and the patient does not suffer from any of the contraindications that prevent the use of TENS.

TENS is also a good choice during labour as a pain relief. It can help avoid an epidural which can have side effects and it is a good way of avoiding unnecessary drugs for those that want a natural labour. There are organisations that you can rent these machines from for the duration of your labour.

If your are suffering from any aches or pains 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.

Losing the baby weight

After giving birth just over a week ago to my son, it might be appropriate to write about the extra baby weight and some realistic expectations and real medical facts. Although it may not be directly related to physiotherapy I still feel it is an important topic worth mentioning. 

Once the baby comes out, why o why does the tummy not go back to the way it was? Well first of all you have breast tissue, increased blood supply and for the first 6 weeks you still have an enlarged uterus. In fact, depending on the size of your baby you might not look that much skinnier than when the baby was inside you.

The most important thing to remember is slowly is the key to healthy weight loss, especially if you are breast feeding. Starving your self is not a responsible way to lose weight, especially as you are now responsible for not just your self but also your newborn, and your baby needs to grow (you don't want to put your baby on a diet with you) The body needs to heal and it does this with the right nutrients. You need to be drinking plenty of water and eating from all the different food types in a

balanced diet.

Exercise is also another key way to lose weight, finding the sport that you like and enjoy is always a good start to keep you focused, but don't over exert yourself. You need to listen to your body; rest post birth is important in your recovery. In fact the body takes 2 years to fully recover after birth, although most feel fine much much sooner than this time frame. Within the first 6 weeks post birth it is very important to listen to your body and go and take the mid-day nap when the baby is sleeping.

A healthy happy mummy is a healthy happy baby. But if your are suffering from any aches or pains 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.

Pain, Exercise and Pregnancy

I have written previously about how the benefits of exercise and how it can prevent pain. I have also written about listening to your body after birth to judge when it is time to restart exercise. Today I am going to discuss already being in pain but still starting to exercise.

Pain in pregnancy is often caused by the pure fact that your body has changed shaped quickly due to the growing bump and your muscles have not kept up to date with this change and are shortened and lengthened into a non-optimal position for the muscle to work functionally and support and hold up your body in a pain-free way. 

As your bump gets bigger it is pulled forward. Now, just as your biceps and triceps work together, as one lengthens, the other one shortens and vice versa, so too this is true with your back and stomach muscles. In pregnancy as the tummy is pulled forward these muscles shorten and the back muscles lengthen. They are not strong in this position as they are not used to supporting your body in this position and this is what causes pain. 

Now, as the pain is caused by weak muscles, even though you are in pain it is still a good idea to exercise and yes to even restart exercising. But it does need to be specific to the root of the problem; I am not suggesting you start taking up training for a marathon.

In this case I suggest - especially if you are more of a couch potato and have not really done any cardiac work out recently - regular walking, as this is not too strenuous but will start training your heart to become fitter. I also suggest some gentle back and stomach exercises to strengthen the muscles that are giving you the pain. Tucking your bottom and stomach in at the same time (posterior pelvic tilt) is always the best one to start with, and just gently repeat this action. Lying down with your knees bent and gently moving them from side to side is another great one that will gently stretch the side of your back. Another favourite is putting yourself in the all fours position and gently raising and lower your back.

If you are suffering from pregnancy-related 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 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.

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.

Is Walking Considered Enough Exercise in Pregnancy?

I have noticed a common reaction pattern when I am taking a patient's history during an appointment and I ask the question, 'Do you do any regular exercise?'. Often patients will shuffle in their seat, think for a bit then sheepishly say, 'Well I walk to work for 10 minutes'; there is usually a pause, and a look to the floor. To which my response is 'Great! Walking is exercise'.

If you already walk pre-pregnancy then it is perfectly safe to continue your regular walking program. If you are just getting started and pregnancy is the cause for starting a new exercise program then start with 20 to 30 minutes per day 3 days a week. This can be built up to 60 mins every day of the week. This type of exercise can continue right up to and including labour.

Now the reason many people get sheepish about walking as an exercise is because they don't consider it to be a cardio workout and building up a sweat. Now yes, a slow stroll will not achieve this but hills and power walking can. Moderation is the key in pregnancy so don't push yourself to the extreme, however don't be too lazy in your walking either; it is very easy to deceive yourself that you are getting the right balance, in either direction.

Now for the sciencey bit: the chemical byproducts raise your body temperature with overexertion and this can be bad for the fetus. But taking it too slow will have no real effects of exercise on your body. To get it right you can use the talk test to determine your exertion level. You should be able to complete sentences without having to puff and gasp. And if you're into more exact science, a pulse of more than 100 beats per minute five mins after your work out has ended also means you worked a little bit too hard.

Like all sports, doing the technique correctly is essential and can help prevent back pain. Stand up straight, do not arch your back, do not lean forward or back, keep your eyes ahead and not down; this also will help keeping your whole body straight. Keep your chin up, loose shoulders, suck in your stomach and tuck in your behind.

If your are having difficulty with constipation during pregnancy, walking is natural way to help tackle this. Along with eating plenty of fibre and prunes.

Like with any sport and pregnancy if you experience dizziness, pain or bleeding stop and go get yourself checked out.

Walking is also great for after the baby is born, you do not need to wait for your 6 week check up before you resume, you just need to listen to your body to know when you are ready to start and when it needs to rest.

Like with any sport, drink, drink and drink, water is key throughout your whole pregnancy.

Wishing you all chag sameach!

If you are suffering from pain during your 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 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.

Pelvic pain, not pelvic floor pain

Let's start off with a message of b'sha'a tova to Will & Kate (a.k.a the Duke and Duchess of Cambridge) - and all other expectant mothers out there. I'm reliably informed Kate is a regular reader of these blogs, but in case she misses this one, I have no doubt she's getting this advice from her own physiotherapist (By Royal Appointment).

I will address pelvic floor pain sometime in the near future as most of my pelvic floor blogs are more to do with incontinence. However today I am focusing on pelvic pain, the various causes and what is in the realms of normal-no-need-to-worry pain. 

Pregnancy is a very exciting time in one's life but it can also come with lots of fear and worry. The fear and worry is normal, as long as it's all about ensuring that this new life is safe and healthy and has everything it needs for the best start in there life.

As mentioned in previous blogs, two common causes of pelvic pain are relaxed joints and pressure from the weight of your growing baby. If the pain is constant or there is bleeding, unusual discharge, or strong cramping, it is time to see your doctor rather than visiting your physiotherapist.

With that in mind, it is very common to experience cramp-like pain that feels like your period is coming between weeks 8-12; this is your uterus expanding and as long as there is no bleeding this is within the normal realms of pregnancy.

Functional ovarian cysts, which form due to changes in the way your ovaries make or release eggs are also very common and and normally harmless. They can grow larger during pregnancy and the pressure that your growing uterus puts on your ovaries can cause persistent pain. If the cyst ruptures, the pain may suddenly get worse. It is therefore important to tell your doctor if you have a history of ovarian cysts so he can keep an eye on them or any potential growing ones. On very rare occasions a cyst can twist. This is called torsion, it is serious and needs immediate attention. It sometimes occurs after vigorous activity or having intercourse and is followed by very sharp pain, severe and constant and sometimes nausea, vomiting and sweating. 

As mentioned in a more recent post another common pain is round ligament pain. It is common to the second trimester and the pain is felt from your side, as the ligament that goes from the top of the uterus down to the groin stretches. It is felt more when walking or standing up from a chair. The uterus tilts and pulls on the ligament. Lying on the painful side can often help with this

Especially is the third trimester one can experience pain from the pressure on the baby in your pelvic region, often during movement when walking or in a moving car, because the baby bounces with your movements. Rest can ease this pain.

Braxton Hicks contractions is the pressure or tightening in the pelvis that comes and goes spontaneously. They are often described as practice contractions, often from week 20 onwards and triggered by dehydration (drink lots of water). If however they continue for more than 4 an hour for 2 hours and you are before week 37 it is good to check that it is not preterm labour and go and get checked out.

Relaxed pelvic joints also cause a lot of pain; this is one for the physiotherapist. Caused by the hormone relaxin which relaxes your joints a ligaments, it is common to feel pain over the pubic bone, and down your legs. There are many previous blogs on this.

Constipation is another common complaint and can cause pelvic pain; drink lots of water and eat fibre rich food. It is also important to assume a good position while on the toilet. Ensure your knees are higher than your hips and learn forward. This is the optimum position for the stool to come out with the least obstacles. 

There are many other reasons for pain, some of which are more serious than those mentioned above. For this reason, it is important to get regular check-ups throughout your pregnancy. If you experience any of the below list it is important to go to the doctor immediately

•  
• Pelvic pain that you can't walk or talk through
• Any bleeding
• Fever and/or chills
• Severe headache
• Dizziness
• Sudden swelling of the face, hands, and/or feet
• Persistent nausea and/or vomiting
• Less than 10 fetal kicks in one hour, from 28 weeks until delivery
• More than four contractions in an hour for two hours
• Watery, greenish, or bloody discharge

If you are suffering from pain during your 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 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.

When Massage Could Help Relieve Your Pregnancy Pain

Pregnancy is an exciting time period in one's life. However it can also be an extremely daunting time and high stress levels don't do you any favours. With rockets flying it is good to do everything you can to keep as calm and healthy as possible.

The body undergoes some big changes during pregnancy, including postural changes, change in hormone imbalance, weight gain, enlarged breasts, increased plasma and blood volume and the shifting of some of your organs. As a result of these changes many women suffer from pregnancy aches and pains.

Now some of these pains need addressing by a doctor or physiotherapist as they are beyond the realms of normal but some are completely normal and don't need addressing by a medical professional. So what do I advise to those patients that don't fit into the category of medical help but who are uncomfortable and want to do something about it? Firstly I suggest exercise, which has many benefits; if you are unsure what is safe you can read previous blogs or get in touch with a physiotherapist.

I also suggest pregnancy massage by a qualified professional. This is a safe, drug-free relaxing way to reduce and relieve the common discomforts that one can experience. It can improve not only your own physical and mental well being but also your baby's.

Back pain and sciatica are very common in pregnancy. As the posture of one's body changes during pregnancy so so does the centre of gravity, which in turn effects the musculoskeletal system. As the muscles adapt to the new posture they can compress the sciatic nerve, which in turn causes radiating pain from the lower back down to the leg. Massage loosens those muscles and releases the pressure on the nerve. It can also help increase range of motion and elasticity in the joints and muscles.

As the muscles begin to work harder due to the increased weight gain, there is an increase in the production of toxins that literally stick the individual muscle fibres together, which then aggravates nerve endings and causes pain. Massage releases that pain by breaking down the adhesion, releasing trigger points and pushing circulation into the area to increase oxygen and to stimulate the removal of toxins.

Let's move onto leg cramps. Although the reason is not known there are theories that the extra load on the leg muscles may well be a factor. Low levels of minerals and the lack of blood flow through the muscles during prolonged siting or lying could be a cause. As well as eating bananas, massage can also help by again stimulating blood flow and stretching the muscles

Muscle balance can be caused by the quick postural changes and sudden increase in breast size and are often the main cause of sudden upper back pain. Headaches are often caused by the surge of hormones along with an increase in the blood volume circulating the body. Massage relieves the muscle tension and stretches the shortened muscles in the head, neck and shoulders.

Massage can also reduce stress levels which reduces anxiety, improves mood and can increase sleep, which is very important to do before the baby comes and keeps you up at night.

The weight gain and increase in plasma and blood volume increase pressure on the hip, knee and ankle joints. Swelling is often caused by the decreased circulation and increased pressure on blood vessels. Massage helps stimulate soft tissue to reduce the collection of fluids in swollen joints, which also improves the removal of waste products carried by the lymph system. So massage can help flow of blood to the legs to reduce the chances of swelling, varicose veins and blood clots.

With all that being said it is important to determine whether your aches and pains are within normal range and therefore a massage will help or whether to go to a physiotherapist for a more long term treatment to treat the cause of a problem (with the option of a massage on the side). It is also best to discuss the options first with your doctor and if you still not sure what is the best treatment to call a physiotherapist to determine the most appropriate cause of treatment.

If you are suffering from pain during your 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 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.