Where to find help for Pelvic Instability?
You should make an appointment as early as possible to see a physiotherapist who has experience treating Pelvic Instability or Pelvic Girdle Pain. This can usually be arranged through the maternity hospital where you are having your baby, or through a private physiotherapy clinic. If you have to wait a long time to see a physiotherapist at your maternity hospital, it may be worth making a sooner appointment at a private clinic.
Your physiotherapist may recommend an individual program for you, which includes specific exercises to strengthen the deep abdominal muscles and pelvic floor. You may also be fitted with a pelvic support belt and in some cases be fitted for mobility aids (i.e.crutches). They may also advise special considerations for delivery & postnatal treatment.
Finding time to attend physiotherapy can be a difficult task while also juggling the demands of a pregnancy or a young family. However, finding time to attend will improve your chances of recovering more quickly. Most women recover from Pelvic Instability within the first few months after delivery.
In rare cases, Pelvic Instability can last for a longer time and/or symptoms can be particularly disruptive or disabling. Women may find they need help from a team of health professionals (See below for more information).
Support from family and friends is crucial during this time.
Talking to another Pelvic Instability sufferer through the Pelvic Instability Association (PIA) can offer some relief and reassurance that you are not alone.
Treatment for Pelvic Instability
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Be guided by your physiotherapist as each woman's experience will be different.
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Stay as active as possible, participating in an exercise program designed for you by your physiotherapist. This may include an at home pilates program, clinical pilates, a water-based exercise class or an antenatal exercise class depending on what your physio suggests.
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Have a rest everyday where you put your feet up or lie down to take the weight off your pelvis .
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Listen to your body, and avoid movements which make your pain worse (This may include avoiding bending, twisting, straddling, standing on one leg).
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Take care of your back and posture by watching how you sit at work or complete tasks throughout the day.
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Talk to your GP about pain-relief medications and ask your physio about other pain-relieving methods such as ice and/or heat, massage or TENS. Research has shown that Acupuncture can help with pain-management for some women with Pelvic Instability.
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Ask for help in the home with tasks that may be causing difficulty- shopping, vacuuming, picking up toys, or caring for a toddler. You may need to organise a cleaner or child-care. See our practical self-help tips for more ideas.
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Sexual positions which may be more comfortable include side-lying positions and on all fours. Be guided by your pain.
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If you suffer incontinence or bowel problems discuss these with your GP and physiotherapist. Pelvic floor exercises are an important part of regaining control of these areas.
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Your obstetrician, midwife and physio should be able to give guidance on child-birth positions. Physiotherapists in the UK have recommendations for women with Pelvic Instability in labour. They recommend not spreading the legs too far apart during labour and birth. Positions which assist this are supported side-lying positions, supported forward leaning or all fours positions. They also recommend you avoid putting your feet on midwives hips or shoulders while pushing. For more information see the two documents by the Association of Chartered Physiotherapists in Women's Health, UK in the resources and references sections of this website.
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Postnatally, Pelvic Instability usually improves gradually over several months. Usually postnatal physiotherapy, Pilates, swimming / hydrotherapy and pain relief can help while the joints and muscles take time to heal and strengthen. Back care with your young family will still be very important. Trying to gradually improve your fitness for walking, lifting & bending with the guidance of your physio will help you regain your ability to enjoy an active life again.
Most importantly, support from your partner, family & friends will be vital at this time. It can be hard to ask for help, but it’s vital for your recovery. Once you’re better you may be able to repay the kindness in some way.
“Resting has been so important for my recovery. If I didn't feel rested enough I wasn't able to exercise my muscles effectively to stabilise my pelvis”
“I needed to make a commitment to my self to do my exercises for about an hour on most days in order to see results”
“In the early months , I arranged child care so that I could rest each day, do my exercises and have some quality time with my husband. It was well worth it”
“Sometimes I needed to have time just to do something fun which was not focussed on my body, and which took my mind off the pain. I started doing crosswords and art and crafts!”
“Talking to other women through PIA helped me a lot. I found out how others had coped and many useful tips”
Treatment for Pelvic Instability which needs extra help or doesn't seem to be improving
In some cases, women with Pelvic Instability can have symptoms which are particularly painful and or take longer to resolve. There mobility during pregnancy maybe very limited. Many women who have contacted PIA have required help from a variety of health professionals. These have included:
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General Practitioner
For pain management options, and link with resources such as home help of disabled pass.
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Occupational Practitioner
For aids and equipment to make life easier, based on your individual situation. This may include help with aids for getting out of bed, bathing or picking things up off the floor.
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Psychologist
To work through feelings of depression, grief and guilt associated with the condition. Some psychologists also specialise in helping people coping with pain.
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Social worker
For community resources and benefits.
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Maternal and Child health nurse
For connecting to local parenting resources.
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Multidisiplinary pain clinic
Is available in some public and private hospitals. It is where a team of health professionals work together to manage your pain condition. This is something you get a referral for from your GP. The services may include-Rehabilitation Physician, Physiotherapist, Psychologist, Occupational Therapist and Dietician.
You should feel like you are improving gradually after the baby is born. If you feel that you are not improving with your current treatment or your symptoms are worsening it may be worth seeking a second opinion.
If you feel that there might be something else going on with your body
Some women with Pelvic Instability may have an underlying cause for their symptoms continuing or not healing. They may have an underlying injury, or another condition in the pelvis area which is causing pain or adding to the pain felt in the pelvis region.
Some women who have contacted PIA have found benefit from being referred to the following specialists for further assistance: Musculoskeletal or Sport's physician; Gynaecologist; Rheumatologist; Gastroenterologist and in rare cases to an Orthopaedic Surgeon with experience dealing with Pelvic Girdles. Please be guided by your GP in what he/she may think would be useful.
Some sufferers have also found alternative therapies such as Osteopathy, Acupuncture, Chiropractic, Massage, Homeopathy & Bowen therapy to be helpful.
Always try to find someone who is qualified and experienced in treating this condition.
Treatment will depend on how severe your symptoms are, not all these resources will be needed by the majority of women who only have mild symptoms.
A new treatment for Pelvic Instability!
Real time ultrasound - muscle re-training
Research has shown that a few muscles deep in your abdomen and lower back are needed to contract to support your pelvis and spine correctly. When they are working well the pelvis and spine are more supported during activities and you are less likely to have pain. These are the 'Transversus Abdominis', 'Multifidus', 'Pelvic Floor' & 'Diaphragm'.
Unfortunately after an incident of pelvic instability or back pain these muscles switch off. This leads the pelvis and back to be at more risk of injury. This can then in turn switch off the muscles even further. These muscles have been shown to not automatically switch back on. Leaving your pelvis and back at further risk of injury. Exercises such as pilates, yoga & swimming may not necessarily switch these muscles back on.
Research has shown that Realtime ultrasound retraining is an effective way to learn to switch these muscles back on, and to keep them switched on in the future.
An ultrasound scanner allows your muscles to be seen on a TV monitor. You can watch specific muscles contract and relax as you retrain them. It is suggested that, patients who undertake ultrasound guided retraining improve their deep core muscle contractions quicker than those who don't use the scanner. This can result in a faster and more effective outcome.
After your initial scan, your physio may recommend a periodic review to compare the results against your first scan or to improve your contractions. Depending on your individual needs, a comprehensive rehabilitation program will be designed for you by your physiotherapist. It may include - core strengthening exercises, joint mobilisation / manipulation, massage, muscle releases and stretches, leg and arm strengthening exercise, and posture correction.
Real time ultrasound - muscle re-training - Is a new treatment available at some physiotherapy clinics in capital cities across Australia. To perform Real-Time Ultrasound Retraining, your physiotherapist requires special training.
“I had been doing clinical pilates for years, but kept getting pelvis & back pain if I stopped for one week. When I did the realtime ultrasound retraining, I was shocked to find that my deep abdominals were not as strong as I thought & lots of other muscles had taken over their job making it hard for me to use them correctly”
