Pregnancy related problems

Back pain during pregnancy

Most common Causes:

  • Hormones are softening ligaments causing the pelvic girdle to be less forgiving to asymmetrical movements - the pelvis falls out of alignment more readily.
    The muscles around the pelvic girdle are over worked because they are “holding” the pelvis in place. This causes the pain deep in the buttock from an overworked PIRIFORMIS muscle – which imitates “sciatica”
  • The feeling is one of sometimes sharp pain (with certain movements) and sometimes dull achy feeling

What should I do?

  1. Move bilaterally symmetrically – as if you are wearing a long pencil slim skirt – here are a few examples:
    1. Get in the car with the bottom on the seat first swinging the legs over
    2. Get out of the car with the legs out first, tighten the buttock muscles and push off the seat
    3. Put on your underwear and pants sitting down – stand up to pull them up from your knees to your waist
    4. Keep your knees facing forward when you are driving rather than in a V – this outward rotation of the hip may further tighten the piriformis muscle and cause it to hurt
    5. To bathe toddlers – get into the tub or shower with the child
  2. Footwear:
    1. Wear shoes with good support preferably with a cushioned sole
    2. No stiletto heels!
  3. Sleeping positions:
    1. Sleep with your spine aligned
    2. Pillow between your knees
    3. Small pillow under your belly for support (after 6 months)
    4. Hug a pillow to prevent your upper body from twisting
  4. Transitional movements: (from sit to stand, from bed to stand etc.)
    1. Out of bed: bend your knees with a pillow in between, roll to your side, drop your legs, push with your hands and sit up. Before you stand, squeeze your buttocks together, do a “kegels” exercise to stabilize your pelvis before you stand
    2. Out of the chair: Make your legs even (as you have on a pencil slim skirt), again make your own “corset” by squeezing your buttocks together, doing a “kegels” and push off the chair using your arms

Comfort Measures:

  • For achy muscles: use heat. Put 2 cups of uncooked rice in a white cotton sock. Knot the open end and heat in the microwave for a minute and place on the achy muscles
  • For acute pain: use a loose pack sac of frozen peas or corn over the painful area
  • Get a family member to massage your back
  • Do a “trigger point” release with a tennis ball or soft ball; stand up against a wall and place the ball on the muscle that is hurting and gently press the muscle up against the wall till you feel a “release” (it is best to seek the advice of a therapist before you try this)

Exercise: quality and accuracy with exercise is more important than quantity!

Exercises are directed towards stretching tight/tense muscles and stabilizing the pelvic girdle. Some common exercises are:

  • Buddha Stretch/child’s pose
  • On all fours, arch the back like an angry cat and relax till the spine is neutral
  • Pillow Squeeze – squeezing a pillow between your knees to stabilize the pelvis
  • Buttock Squeeze:
  • Walking with supportive, cushioned shoes. Get some help and try to walk a few feet backwards after you have been walking forward (to balance the sacroiliac joints)
  • Swimming as tolerated or water aerobics class
  • Be careful with the type of exercises you do in the gym
    STOP if any exercise causes pain!

What do I do to get help? How do I decide?

When is Physical Therapy the Right Choice?
If pain is causing you to have difficulty with ACTIVITIES OF DAILY LIVING (ADL’s) like sitting, sleeping, standing, housework, driving – we strongly recommend you come to physical therapy

When is Massage Therapy the Right Choice?
If you have achy, tired muscles but are able to do your daily routine without pain – massage therapy might be helpful. Please call 713-799-6193 to set up an appointment. The cost is $65 for one hour and $40 for half-hour massage. There is no tipping at the Hospital.
Massage therapy is not reimbursed by insurance.

What does Physical Theraphy do?

Our MAIN goal is to teach you what is causing your pain and how you can help yourself!
  • We will do an assessment to see if your pelvis in alignment and correct the misalignment if needed. We use gentle “muscle energy” techniques to realign your pelvis or tail bone
  • We will teach you how align your pelvis yourself at home
  • We will massage and release trigger points and stretch out muscles that are in spasm
  • We will teach you an exercise program tailored to your needs – to stretch tense muscles and to stabilize the pelvis, strengthen core muscles.
  • We may offer you a brace if needed or at least allow you to try one on and see if it is helpful
  • We may apply Kineseotape ® to certain muscles or joints to offer relief from pain
  • We will review and suggest modifications to the way you move in your daily life.

Most often patients come for 2-5 visits during their pregnancy. Even one visit will be helpful to evaluate if your pelvis is out of alignment and teach you a home program. To start in physical therapy, please get a referral from your physician and call 713-799-6193 for an appointment. We will verify and bill insurance for physical therapy

Other common problems in pregnancy for which Physical Therapy may be helpful

  • Rib Pain:
    Manual therapy, massage, mobilization, taping
  • Groin pain/pubic symphysis pain:
    Manual therapy, mobilization, massage, pregnancy brace,exercises and education on comfort measures
  • Carpal Tunnel Syndrome: massage, relief of swelling, exercise, wrist brace
  • Upper or Mid back pain: manual therapy, massage, exercise, taping, modifications in activities of daily living/sitting or work related posture
  • Round ligament pain:
    Appropriate footwear to minimize counterforces on the pelvis, “guarding” before and during cough, sneeze, gentle mobilization, brace if appropriate
  • Varicose Veins:
    Exercises to lessen swelling, modifications to daily activities to minimize swelling, comfort measures, suggestions on stockings/support
  • Physician recommended bed rest during pregnancy – physical therapy offers gentle exercises to minimize muscle weakness, aid in circulation and education on optimum bed positioning and relaxation training to help with the stress of bed rest.

For questions please call Physical Theraphy Department at 713-799-6193.