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Womens Health Physiotherapy

Phoenix Rehab Group’s Womens Health Physiotherapy Division is passionate and specialize in managing pre- and post-pregnancy/delivery related musculoskeletal conditions and pains.

Specificly, managing pelvic pains (which usually are experienced as low back pain, sacro-iliac pain or hip pain or pain around the hip/lower back area) for pregnant and post-pregnancy mummies.

So, musculoskeletal physiotherapy and management for pregnant and post-pregnancy women is a specialised branch of back and neck physiotherapy.

Assessing, diagnosing, treating and managing women's health/pregancy-related musculoskeletal conditions and pains is not the same as treating someone with the "common" musculoskeletal pain...

ie: treating a lady with hip pain when she is pregnant/post-delivery is very different from treating a lady with hip pain.

To start off with, many of the physiotherapy electro-therapy modalities such as ultrasound, shockwave machine or the transcutaneous electrical neuro-stimulation (TENS) machines, which are really commonly used...but they are not allowed to be used at all on a person who is pregnant.

Then of course there any many medications are not allowed in our physiotherapy clinics with pregnant mothers, and these are our basic protective processes to prevent any potential harm to the babies.

pelvic pains and sacro-iliac joint pains

Pelvic pains in a pregnant and post-pregnancy lady is usually attributed to pelvic and sacro-iliac dysfunction.

The sacro-iliac joint is located where our lower back portion of our spine connects with our pelvic bone, and it is a highly complex joint structure that will require very experienced expertise and accurate high level assessment and diagnostic skills to be able to pin-point conditions and pains accurately.

Please bear in mind that if one doesn't receive proper assessment and diagnosing to treat the main issue, you have a very high risk for the pain to not go away. In fact, it may become increasingly painful over time.

Pelvic Girdle Pain During Pregnancy

Pelvic girdle pain can occur in the following regions (may not be restricted to just one region):

• Lumbo-sacral joint pain (pain at the lumbar-sacrum area, or low back pain)
• Sacro-iliac joint pain (pain specificly at SIJ, more posterior of pelvis)
• Coccyx pain (pain at the bone at the very end of the spine, the tailbone)
• Pubic symphysis pain (pain at the pubis, in front)

That being said, pain in the pelvic girdle is usually connected to postural changes and in fact can be correlated to a person who has a waddling gait pattern. In most cases, 8 in 10 occurrences, the pains are very pin-point specific; but in the other 2 in 10, the pains experienced may be more vague and general.

There are 3 common areas where pelvic girdle pain usually show up as:

• symphysis pubis dysfunction (SPD)
• lumbo-sacral pain (low back pain)
• sacro-iliac joint pain (posterior pelvic pain)

The pelvic girdle is formed via 3 bones (see diagram above):

• 1 x sacrum (the bottom at the very bottom of the spine)
• 2 x iliums that both connect to the sacrum

So the pubis symphysis is a joint that is made of fibrocartilage, located in front of the pelvis and holds both sides of the ilium (pelvic bones) together.

The flip side of the pubis symphysis is where the sacrum and ilium joins together and this is called the sacro-iliac joint (SIJ). During pregnancy, the woman's body will release pregnancy-related hormones that will soften and allow ligaments to stretch and lengthen for childbirth and delivery...

...and this at times also causes pelvic ligamental laxity and instability.

It is this instability that causes pelvic pains.

women's health physiotherapy and what will my women's health physiotherapist do?

When there is pain, discomfort in the pelvic girdle, hips and lower back, women's health physiotherapy can be very helpful to treat them, provide pain relief for both the short and medium term, to ensure that your pregnancy is as comfortable as it can be.

As your pregnancy progresses day by day, week by week and month by month, you'd see, feel and realize that your body is also changing to accommodate the growing baby in your body - these changes may cause imbalances, stresses and discomforts to your body.

What specialist women's health physiotherapists do is to firstly, properly and accurately diagnose the exact issue, identify the body structure/location of problem, and correct them at the core.

The women's health physiotherapist will use a combination of the following to diagnose:

• range of motion tests
• clinical history taking and clinical interview
• special tests
• clinical palpations
• clinical observations

and these are done to understand and determine how mild or severe your condition is, and help treat the symptoms but more importantly, treat the core of the problem so that the pain doesn't recur (or takes longer to recur).

Our women's health physio will help you step by step, treat you and teach you how you can increase movement, range of motion, manage and decrease the pain and enjoy pregnancy as much as you can =)

They will also apply different clinical treatment approaches to help

• improve and restore the movement and stability of your spine,pelvic girdle, sacro-iliac crest and sacrum
• decrease pain experience and pain relief
  
• decrease muscle spasms
• improve strength, stamina

Our women's health physiotherapy treatments may include:

• gentle joint mobilizations
• gentle joint gliding
• myofascial trigger point release therapy
• muscle energy techniques (MET)
• core strengthening
  

Joint Glide and Mobilization for women's health physiotherapy

Gentle and careful accurate mobilizing and gliding of stiff joints will almost always help increase mobility and range of motion in the joints of the spine, sacro-iliac, and pelvic girdle.

Adding deep tissue release and myofascial trigger point of tight muscles will also help to further increase movement/mobility as well as strength of muscles.

Usually stiffness are near or around joints and muscles, sometimes also involving connective tissues.

When the women's health physiotherapists decrease and improve these range of movement restrictions using gentle joint mobilizations and gliding, patients may experience quick pain and discomfort relief.

Diastasis of the Rectus Abdominis Muscle (DRAM)

Unfortunately, diastasis of the rectus abdominis muscles (DRAM) is a very, very common post-pregnancy (post-natal) condition that many mother have...and it is also easily worsened by:

• weight gain (the more significant, the more it impacts)
• increased abdomen size (again, the larger the more it impacts)

DRAM is caused and continued to be aggravated by a combination of:

• hormonal changes due to pregnancy and post-pregnancy
• weakness and laxity of the stomach muscles (abdominals)
• weakness of the pelvic floor muscles
• increased demand of post-delivery

Usually there is a "window period" to help improve, reduce and treat your DRAM - after 4 months, it becomes very very hard to reduce your DRAM unless you do very specific anti-DRAM exercises to reduce your DRAM.

Anything greater than 2 fingers width for DRAM is already considered a problem because it increases risks of:

• back pains
• back and stomach muscles injuries
• potential abdominal prolapse

Your women's health physiotherapist will assess your diastasis of the rectus abdominis muscles (DRAM) and if it's in the very early stages, we may get you a supportive waist band/bandage to help support your stomach muscles between physiotherapy and recovery periods.

Pelvic Floor Education

Pregnancy and delivery/childbirth may damage your pelvic floor muscles as well as the connective tissues around it, and this will lead to a fair bit of painful and uncomfortable symptoms for mummies after delivery.

The pelvic floor muscles are connected between the pubic bone and tailbone, crading your bladder, bowel and uterus. It helps you

• control and hold your urine,
  
• control your bowel movements as well as
  
• sexual health and functioning.

To be specific, healthy and strong pelvic floor muscles allows you to keep your urine and bowels/faeces in, and control as and when you can/want to release them. The pelvic floor muscles also helps you to contract and relax your vagina during sexual intercourse.

If your pelvic floor muscles become/are weak, it can cause uncomfortable if not painful situations for you.

Our senior women's health physiotherapist will assess and evaluate your pelvic floor muscles to ascertain if weak pelvic floor muscles are the cause of your condition.

If they are, then what the senior women's health physiotherapists will do is to:

• design a treatment plan around treating the specific weakness, to strengthen them
• release any trigger points in the surrounding muscles
• teach you home exercises to complement clinical sessions

Myofascial and Trigger Point muscle Release

Often we develop tightness and shortness in our muscle fibres (sort of like very tight knots that cause discomfort and pain) due to postural habit, and they can cause difficulties in movement and even radiating pain.

Myofascial trigger point release is very specific muscle-release that releases, relaxes and restores length of shortened muscles and connecting tissues (but it may be tender during the session, because we're 'undoing a tight knot').

After that, the therapist may also incorporate deep stretches to lengthen the muscles that are treated/affected, and patients for sure will be given some home self-stretching exercises.

Of course we will also teach patients hip and pelvic girdle strengthening exercises to

• increase strength and stability and
• prevent hip, pelvic and sacro-iliac pains
  

Muscle Energy Technique (MET)

Muscle Energy Technique (MET) is a specialized pin-point technique that uses very precise body part positioning together with light muscle contractions.

When done right, it is used specificly to re-educate dysfunctional muscles. Dysfunctional muscle tone often causes imbalance of body symmetry; hence MET will be targeted on the pelvis and sacral girdle for women's health physiotherapy.

Muscle Energy Technique is a very gentle and yet very effective approach to help manage and relieve pain that's related to pregnancy-related musculoskeletal pains and disorders.

Manual Lymphatic Drainage

Manual Lymphatic Drainage (often shortened to MLD) is a very specific therapy where the expert MLD therapist will perform a series of very specialize gentle mobilization and pump technique to move lymphatic fluids towards your lymph flow.

What this does is that it will stimulate your lymph nodes and lymphatic vessels to increase the speed of waste/toxins/excess fluids removal from your body tissues, and most common outcomes are targeting at:

• decreasing fluid retention
• decreasing bloatedness/puffiness
• decreasing swelling/edema

This is helpful to help patients/mummies who have swelling in their lower limb due to pregnancy - our women's health physiotherapist will work closely with our manual lymphatic drainage therapist for this.

What should I expect when I see my women's health physio?

The first session with our senior women's health physiotherapist will last for about 45 minutes, and the session will comprise of:

• assessment and diagnosis to understand and pin-point accurately the core problem (clinical history taking, specialized testing, clinical palpations, clinical observations, testing with tools etc)
  
• treatment of the core problem, as well as for symptomatic relief

Follow up sessions will be 30 minutes, unless you have more than 1 condition.

How many women's health physio sessions will I need?

It's very hard for us to say for sure at a glance, how many physiotherapy sessions that one need.

The reason for this is because there are a few factors and variables that may influence the number of sessions, for example:

• type of condition you have
• how mild, moderate or severe your condition is
• how many conditions you have at a given time (the more one has, the more complex it becomes and the more time it takes)
• how compliant one can be to the clinic sessions and home exercises
• how your body responds
• how much time you have
  
• how one's pain response is
  
• etc

Hence it's hard to say - a 'safe' range will be between 6-12 sessions, but we have had patients who required less sessions and patients who needed a lot more than 20 sessions.

Upon assessment and a few sessions of treatment, once we have more data we can be more clear on your recovery rate and pattern, then we can tell more accurately.

Who should consult our women's health physiotherapist?

Any ladies, expecting mummies or even post-delivery mummies, if you are experiencing any of the following:

• Physical pains and discomfort such as:
  
  Back or neck pain
  Pelvic/sacral/iliac pains
  Wrist/hand/finger/thumb pains
  Foot swelling
  Etc
  
  
• Any other female- and age-related changes
  

Pelvic floor dysfunctions and women's health physiotherapy

Some of the symptoms and inconveniences of pelvic floor dysfunctions includes:

• Urinary incontinence - urine release with or without any activities (stress incontinence, urge incontinence of mixed incontinence)
• Physical pains or movement dysfunctions of the hip, lower back, pelvis
• Postural problems or pains
• Scoliosis or bent back concerns
• Any discomfort when working on table top activities or computer
  

expecting mummies or post-delivery mummies, please consider seeing our senior women's health physiotherapist for advice on:

• How to train, strengthen and stabilize your pelvic floor muscles
• Check if you have DRAM (diastasis of the rectus abdominis muscles) which basically means the muscles of the stomach are separated post delivery
• Clinical and women's health specific abdominal and core muscles retraining and restabilizing
• Blocked ducts in the breast, poor milk flow or even mastitis
• How to improve your posture when you carry your newborn, when you feed your new born, when bathing etc
• How to return back to strength, fitness and exercise safelly
  

our women's health physiotherapist can also help provide education and exercise programs for:

• Osteoporosis / osteopenia (weak and/or brittle bones)
• Returning to work post delivery
• Ante-natal and post-natal exercises
• How to manage chronic pain and chronic injuries
• Dry needling and acupuncture
• Treatment of postural-related musculoskeleral pains
• How to exercise safely during pregnancy
• How to improve core strength
• How to improve pelvic floor strength
• etc