Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Pelvic girdle pain is a set of very commonly occurring symptoms in pregnancy and includes the conditions of sacroiliac joint dysfunction, sacroiliac joint instability, pubic symphysis dysfunction and diastasis symphysis pubis.

These conditions are all linked as they have a very similar set of symptoms but with differing intensities and primary source of pain. They can also occur together because the anatomy of the pelvis is like a ‘bowl’ with all of the bones connected in a circle. If one of the joints is affected or dysfunctional, the other joints are also likely to be affected and cannot function normally. For simplicity, the conditions are named according to where the majority of the pain is being experienced. In most cases, there will also be symptoms occurring at the other pelvic joints simultaneously.

Anatomy of the pelvis

The sacroiliac joints lie below the dimples in your low back. Each joint is between the Innominate bone (A) and the Sacrum (B). These joints are involved in movements of the low back and hips such as walking, moving between sitting and standing, climbing stairs, etc. The pubic symphysis is the joint (E) at the front of the pelvis between the two innominates (A) at the pubic ramus (D). This joint rotates and compresses, especially during the gait/walking cycle.

A: Innominate Bone
B: Sacrum
C: Acetabulum (‘cup’ of the hip joint)
D: Pubic Ramus
E: Pubic Symphysis or joint
F: Ischial Tuberosity or ‘sit’ bone

Sacroiliac Joint Dysfunction

Pain is primarily experienced at the sacroiliac joints and tends to be a deep ache with a sharp grabbing sensation with certain movements such as standing up from a seated position.
This condition tends to be a result of muscle imbalance within the pelvis due to tightness or weakness, which effects the joint’s ability to move freely and symmetrically. Sacroiliac joint dysfunction can occur in any person and is not specific to pregnancy.

Sacroiliac Joint Instability

Pain is primarily experienced in the sacroiliac joints but to a much greater intensity than with sacroiliac joint dysfunction. This is a condition largely associated with pregnancy and can become very debilitating, especially in the final few months, with a small percentage of women requiring a wheelchair or crutches to move around. For pregnant ladies this condition occurs due to the increased levels of relaxin, estrogen and progesterone hormones which act to soften the pelvic ligaments to enable birth. In some women, especially those with prior history of lower back pain, the ligament softening occurs more than normal and results in the sacroiliac joint not being stable enough.

Pubic Symphysis Dysfunction

Pain is primarily experienced at the pubic symphysis joint at the front of the pelvis with the joint widening (<9mm). Pain may also be experienced in the sacroiliac joints, gluteal muscles and the inner thigh muscles. This condition occurs due to muscular imbalance from weakness or tightness that prevents symmetrical and normal movement/functioning of the pelvic joints. This condition can occur in any person and is not specific to pregnancy.

Diastasis Symphysis Pubis

Pain is primarily experienced at the pubic symphysis joint at the front of the pelvis with the joint widening (>9mm). Pain and disability is much greater than with pubic symphysis dysfunction. As well as muscluar soreness, many women also experience a clicking or clunking sensation in the pelvis. For pregnant ladies this condition occurs due to the increased levels of relaxin, estrogen and progesterone hormones which act to soften the pelvic ligaments to enable birth. Some women however seem to be affected more by these hormones and the joint widening is greater than normal.

What can be done about these conditions?

If you, or someone you know, is suffering any of the above conditions or symptoms you/they may benefit from seeing a registered Osteopath like Dr. David Howard. Even if the conditions and/or symptoms cannot necessarily be ‘fixed’, they can be managed throughout the pregnancy – osteopathic treatment can reduce the intensity/severity of any pain being experienced. If you’re still unsure as to whether osteopathic treatment would be of benefit to you, please feel free to call the clinic – 9379 3888 – or send through your questions/queries via the Contact Us page.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

As most people spend about the same time sleeping as they do sitting at a desk, your sleeping posture is just as important  as your sitting posture. Research has indicated that 41% of people sleep in the foetal position. This posture, however, isn’t optimal in maintaining correct spinal alignment.

The best spinal alignment when sleeping is the same as when sitting, but obviously lying down – click onto this previous article for more detail. The triple C-curve of your spine is maintained and there is no excess pressure on any part of the spine. I know bad habits are hard to change but try going to sleep correctly and hopefully your sleeping body eventually gets the picture. We will start from the top…

*Neck straight with your chin away from your chest
*Good supportive pillow filling the gap between your head and shoulders - click onto this previous article for more detail
*Arms in front of you or hugging a pillow
*Maintain the curve in your low back or lumbar spine by having your knees below the level of your hips
*Both knees should be together so that the back is nice and straight. (Many people, especially women with larger hips will find this uncomfortable or impossible. Placing a pillow between your knees will remedy this).

Your bed may be the culprit…

Goldilocks wasn’t wrong… your bed shouldn’t be too hard or too soft, it should be just right. A bed that is too soft will not support your spine enough and a hard bed will not allow your pointy/bony bits to sink into the bed to enable correct spinal alignment.

A bed lasts 7-8 years before the internals start to fail – How old is yours?

Your bed should be at least 15 centimetres longer than you are

If you sleep with a partner, don’t settle for anything smaller than a queen size bed. The average sleeper turns 40-60 times a night – if there is not enough space, you will keep waking each other up.

Buy the best bed that you can afford - there seems to be a strong correlation between cost and quality.

If your current bed is too hard and not very old, consider buying a pillow top in latex or memory foam to save buying a whole new bed.

Some tips for sleeping posture when pregnant

Silk, or other shiny PJ’s, will allow you to slide when turning rather than having to lift your whole body weight

Invest in a pregnancy pillow. There are full length ones or those just for under the belly – and they really do make a difference!

If you are suffering from hip region pain at night or when you get up, your bed may be too hard with your change in weight distribution. Regular egg carton foam underlay can drastically improve your symptoms.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Although we all love the idea of having a 6 pack and a flat stomach, doing lots of stomach crunches isn’t the key to strengthening the mid section – focusing on the core is! Not only does having a strong core act like a corset tightening the midsection, it is also vital in preventing lower back pain and injury. Strong core muscles are your own internal back brace when lifting or going about your everyday activities. This type of exercise also trains you to be more conscious of your posture which further helps in preventing injury.

The Muscles

The function of the core muscles is to stabilise movement of the lumbar spine and pelvis before and during any movement. There are two types of muscle fibres in the body – fast and slow twitch fibres. Fast twitch fibres can be found in muscles like the biceps whose function predominantly involves short, fast and strong contractions (i.e. when lifting something).  Slow twitch fibres are your postural muscles like those of the core, whose function is to contract softly yet over a long period of time. The exercises therefore to strengthen the core are slow and controlled and initially require a lot of concentration to do correctly.

The key muscles of the core are the Transversus Abdominus, Multifidus, Internal Oblique and the pelvic floor. When all of these muscles contract together, they produce pressure within the abdomen which stabilises the lumbar spine. This core ‘protective system’ is very intelligent – as you think of performing a movement, the muscles contract ready for when you do the movement.

Since these muscles have a postural and stabilising function, they need to be strengthened when your spine and pelvis is in the correct alignment. These muscles don’t need great strength but instead need endurance. The key to training the core is doing it regularly, carefully and correctly.

The basic contraction

*Lie on your back with knees bent
*Your lower back should be neither arched nor flattened against the floor, but aligned normally with a small gap between the floor and your back. This is ‘neutral’ spine.
*Breath in deeply and relax all your stomach muscles
*Breath out and, as you do so, draw your abdomen below your belly button back towards your spine (i.e. like you are trying to zip up tight jeans)
*Breath in and out normally whilst holding this contraction for about 10 seconds
*Repeat 5-10 times
*It is vital that this is done correctly in order to get the most benefit.

Some points to keep in mind

*Visualise the deep abdominal muscles as a corset that wraps around the abdomen
*Place one hand above the belly button and one below
*Only the bottom hand should be feeling the abdominals tightening
*You shouldn’t be feeling much of a contraction in the 6 pack muscles (above the belly button)
*You should be able to breathe relatively normally during the ‘hold’ phase of the contraction. If not, you may be trying to contract the muscles too hard
*Don’t hold your breath
*Don’t brace too hard, you are aiming for endurance not strength
*Don’t bear down (i.e. as if you are going to the toilet). You should feel a lifting of your pelvic floor, not downward pressure.

Taking it up a notch

Now it’s time to further challenge the core. With these next exercises start with the basic contraction, then:
*Slide one leg along the ground and return to starting position
*Let one knee drop out to the side then return to starting position
*Lift one foot, then the other, off the ground with the knee joints at 90 degrees
*With both feet planted, slowly raise the hips off the floor and move your pelvis towards the ceiling

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Sciatica is a set of symptoms rather than a specific diagnosis. The symptoms are generally buttock pain and a sharp pain down the back of the thigh and sometimes into the calf.  Occasionally, when severe, there may be numbness, muscular weakness and tingling in the leg.

The sciatic nerve is the largest and longest nerve in the body. It originates from 5 smaller nerves from the spinal cord in the lumbar spine (lower back) and passes through the pelvis, buttock and into the leg.

The symptoms of sciatica are produced by pressure onto the nerve which decreases its ability to function and causes pain. There are many different causes of sciatica as there are many different parts of the body where it can become compressed.

Here I will outline a few of these causes:

Piriformis Syndrome

When the sciatic nerve passes through the pelvis, it travels through, under or over the piriformis muscle.  If this muscle gets tight, it can then compress the nerve. This is one the most common causes of sciatica and is easily treatable with osteopathic manual therapy and stretching.

Disc bulge or prolapse

This topic is also covered elsewhere on this website – click here for further detail. The spine discs are like shock absorbers between the vertebral bones. The disc can bulge and compress one of the 5 smaller nerves that make up the sciatic nerve as they exit the spine. This can be quite a serious condition causing severe pain, numbness, tingling and weakness in the legs.

Pregnancy

In the later stages of pregnancy, the uterus itself can compress the sciatic nerve causing the symptoms. Due to the change of posture and extra strain on the body, trigger points, piriformis syndrome and sacroiliac dysfunction are more likely to occur (these are described below).

Osteophytes (bone spurs)

As part of the process of arthritis, bone spurs can grow on the vertebrae.  These bone growths can press on nerves as the exit the vertebral canal, therefore causing the sciatica symptoms.

Here are some causes of Pseudo-sciatica. This is a condition that can have symptoms like sciatica but have nothing to do with the sciatic nerve at all.

Trigger points

The pain experienced is actually referred pain. This means that the pain is felt somewhere distant from its cause/origin. A trigger point occurs when a portion of the muscle becomes ischemic. This means that it hasn’t had enough blood supply. This can occur with injury or long term muscle tightness. Trigger points causing sciatic-like symptoms are most commonly found in the ‘glute’ (buttock) muscles or in the deep hip muscles.

Sacroilliac joint dysfunction

The sacroiliac joints are the two large joints at the back of the pelvis (either side). These quite commonly become inflamed or irritated and may cause referred pain in the lower back, around to the groin, or down the backs of the thighs.

So what can you do about it???

*Always sit with good posture and both your feet on the ground.
*Never sit with your wallet in your back pocket – you are just asking for piriformis syndrome!
*Lift properly. This means using your legs, not your back. The fastest way to get a disc bulge is to bend forward, twist then lift something.
*Keep your weight within the normal healthy range so you’re not putting extra pressure on your discs and pelvic joints.
*Get treatment and advice. Osteopathic treatment can assist with all causes of sciatica and pseudo-sciatica explained above.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.