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Jerusalem physiotherapy by Tamara May

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Tamara May

Sciatica: Don’t Let It Get On Your Nerves

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This condition is so named as it is caused by your sciatic nerve. The course the nerve takes runs from your lower back travelling down the back of your legs and branching out into your feet. This is also where the pain is felt, following the course of this nerve. The job of this nerve is to help you feel sensation and move the muscles in your legs. 
Although seemingly quite common during pregnancy – especially in the third trimester – it is not necessarily directly caused by anything to do with pregnancy, although it can be aggravated by your posture during pregnancy. You can also suffer from sciatica without being pregnant. 
Sciatica happens when there is inflammation or pressure from your back on the nerve, often caused by a slipped or injured disc. It can also be caused by the growing uterus putting pressure onto the nerve. When suffering from sciatica you will feel a burning shooting pain, quite often in just one of the legs. It can be constant or it can come and go. Although coupled with inflammation, it is important to remember that while pregnant you cannot take Ibuprofen, even at over-the-counter strength.    
Treatment can include exercises to strengthen your pelvic floor, stomach and back muscles.  You may also be advised to wear a support belt. Flat shoes are also an essential. In bed it is important to support your bump using pillows. Keeping mobile is also very important as well as a sufficient amount of rest and getting off your feet.  One can also use heat and ice on the painful area for 10 minutes at a time.  
It is also important to discuss with your physiotherapist different birthing positions for labour as you may be more limited due to your sciatica. Labouring in water is often preferred in this case as moving in water can feel easier. 
If you suffer from any type of back pain or leg pain during 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 in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.  

Thoracic Pain and How to Avoid It

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The spine is split into different sections: cervical, thoracic and lumbar. This blog is going to focus on the thoracic spine, the middle bit of your spine but upper part of your back. Now technically thoracic pain can occur at any point during your pregnancy, but it tends to be more common during the third and final trimester. 
There can be many contributing factors to your pain. I have mentioned the hormone relaxin on this blog many times; the one that relaxes your ligaments and soft tissue. Unfortunately it is not a de-stress hormone. It can sometimes be the cause of muscle spasm, as it makes the muscles work harder. Other possible reasons for thoracic pain include:

  • As the size of the baby and uterus increase, your centre of gravity is shifted forward, placing more pressure on your back muscles
  • The extra weight gain can also put more stress on these muscles
  • The enlargement of breast tissue can alter your posture and place strain on the neck, shoulders and thoracic spine

There are ways to treat it once it has occurred, but as the saying goes, prevention is better then cure. Taking good care of your back is fundamental to hopefully preventing back pain ever occurring.
When looking after your back it is always important to keep it in a neutral position, when standing, sitting and even sleeping. When standing, stand straight and tall with shoulders back and relaxed, and don’t lock your knees. Use a wide stance and keep your weight evenly distributed between your sides. If you are standing still for a prolonged time rest one foot on a step stool and change feet regularly to change the weight distribution.
I often show my patients good sleeping positions. They can use a lot of pillows so I hope your partners don’t get too angry with you. It is recommended to sleep on your side especially in the second and third trimester. Place a pillow between your knees and another one under your bump to maintain a neutral spine. Also ensure you have a neutral neck or cervical spine position with an appropriate number of pillows under your head that is right and comfortable for you.
It is also important to wear a supportive bra and to ensure that it is not underwired. Make sure you wear comfortable shoes without a heel, to prevent and relieve back pain, by keeping the spine in a more neutral position.
Now the bit you probably won’t want me to say but I have written a lot about it the last two blogs, is exercise such as walking or swimming. This will keep your back muscles strong and help relieve discomfort. A few simple stretching and strengthening exercises can also make a big difference.
If you suffer from any type of back pain during 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 in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.  

Part II: Exercise after Birth

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Last week I wrote about the importance of exercise during pregnancy. But what about exercise after giving birth? Don’t lots of people from all walks of life say and keep reminding you mothers how important it is to rest? (Rest – wouldn’t that be nice with a new born around the house…).
Indeed, rest is extremely important after giving birth. I don’t need to tell you that birth is a major trauma on you body; you probably already know that. (There is a reason why men don’t give birth). However, exercise is also important. Pelvic floor exercises can start and should start within 24 hours of giving birth. Without even seeing your faces I can see some of you shouting at the screen, the tears, the stitches, the soreness; yes, I know. But in fact, exercise to this area will increase blood flow to this area and increase healing times.  
How about other forms of exercise? You have to let your body be your guide. You can exercise as soon as your body feels ready. (If you had a caesarean-section, recovery time will be longer and should wait until your check up with the doctor).
Your lower back and core abdominal muscles will be weaker then they used to be. Your ligaments and joints are also more supple and pliable, so it is easier to injure yourself from over-stretching and twisting too much. So make sure you include some strengthening exercises as well as an aerobic workout, such as a run.
If you are doing too much your body will let you know, and you should listen and slow down. You will experience extreme fatigue, feel run down and take longer to recover from exercise sessions. If your bleeding becomes heavier or changes colour to more pink or red this is also another sign.  
If you suffered with any musculoskeletal conditions such as SPD then your approach to exercise needs to be a little different. You should still exercise, but stick to specific exercises which are beyond the scope of this blog. 
If you suffer from any type of pain during or after pregnancy and are not sure if it’s safe to exercise 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 in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.  

Exercise During Pregnancy: The Correct Formula

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You may have heard the saying from your doctor or midwife that it is fine to carry on with exercise during pregnancy but don’t take on any new activities. You may have also heard the advice that pregnancy exercise classes are great and that general exercise and keeping fit is a great way to prepare your body for labour. So what happens when these two pieces of advice contradict each other?  
As a general rule, exercise that you were doing before pregnancy is usually safe during pregnancy – except of course for extreme sports and other dangerous activities such as horse riding. 
The benefits of exercise during pregnancy
Exercise is important during pregnancy, and has a number of benefits for you and your body:

  • It increases your energy levels  
  • It can help you sleep better (very important before the baby comes)
  • It reduces those pregnancy discomforts: As your bump gets bigger it pulls your body into a different posture, meaning that you are relying on different muscles from normal while carrying out your daily activities. Exercise helps stretch and strengthen your muscles, making them easier to use and therefore helping you cope better with the aches and pains.
  • Exercise helps prepare your body for labour; the better shape you’re in, the stronger your body will be when it comes to labour and delivery. Giving birth requires stamina, determination and focus, all skills used and practised while exercising.
  • There are medical articles that say that exercise makes for an easier labour and a shorter one too
  • Exercise can improve stress levels by increasing levels of serotonin, a chemical linked to mood; stress levels can often increase during pregnancy for many reasons
  • It can also improve your self-image and make it easier to get your body back into shape after giving birth  

Striking the right balance
Even if you don’t exercise regularly pre-pregnancy, taking on new classes specific to pregnancy or low impact exercises (e.g. regular walking or swimming) are not only going to do you no harm, but will do you the world of good, provided that you are not suffering with any specific pain and are having no complications. Pregnancy exercise classes are normally very good because they focus on core stability exercises related to the muscles that are put under extra stress with the change of posture that takes place during pregnancy. Walking and swimming also have many benefits, such as help your aerobic activity and stretching and strengthening your muscles. However, it is not advisable to take on high-impact or over-strenuous exercise, such as training for a marathon.
 If you are suffering from any type of pain during pregnancy and are not sure if it’s safe to exercise 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 in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.  

Coccydynia: A dislodged tail bone

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Well this one is often missed, put down to the trauma of delivery. However, come three months post delivery when the bleeding has stopped, the stitches have healed and you are starting to feel half human again there is still pain lingering in the tail bone.  You have spoken to your friends about it, and got all types of possible and probable reasons why you could still be in pain so long after giving birth. Most likely, none of these friends suggested coccydynia. 
Although you can suffer from coccydynia without going through childbirth, it is thought to be the most common cause. Once again the hormone relaxin plays a part in this condition, by relaxing your ligaments and soft tissue, including the tail bone. During child birth the tail one bone needs to move a little to give way for the baby, and in some cases the coccyx bone does not go back into its correct positions, leaving you in pain and with a condition called coccydynia. 
Quite often the main indicator of coccydynia is pain while moving from sitting to standing. Other symptoms can also include back ache, shooting pains down the leg, pain before or when you pass stools, pain during sex, painful buttocks and hips and increased pain during periods if they have started already. You may also have difficulty sleeping but often this goes unnoticed with a new baby round the house.  It is therefore not commonly suggested post partum as there could be pain anyway from the birth. 
How can it be treated?
Ibuprofen is very useful in this scenario as coccydynia always comes with swelling and inflammation. If the pain still persists then a physiotherapist can use a technique called spinal manipulations to put the bone back into its correct position, relieving the patient of pain.  
If you feel direct pain over your tail bone and you are in great discomfort, you do not need to wait three months before seeking help from a physiotherapist. It can be diagnosed and treated directly after giving birth.
If you are suffering from tail bone 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 in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.  

SIJ Dysfunction: Not to be Confused with SPD

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Sacroiliac joint dysfunction (SIJ) is a condition that one can suffer from during pregnancy which completely resolves itself after birth or shortly after.  Although it can be very painful during pregnancy, fortunately there is a lot a physiotherapist can do. 
Personally, I had never heard of SIJ until I started my training to become a women’s health physiotherapist. One of the reasons I and many others had not heard of it is because quite often if you suffers from SIJ, you also suffer from SPD.  Because patients often have the same symptoms from the two conditions, such as pain when using the stairs, the diagnosis of SIJ is missed.
What is SIJ? 
The sacroiliac joint is the joint at the back of your pelvis. When you have SIJ, pain is felt over the buttock and/or back of the thigh. Occasionally the pain is also felt over the groin and the entire back of the leg. SIJ is the misalignment of the sacroiliac joint.  The misalignment can take place in a few ways: it can be rotational in one of two different directions or the joint can slip upwards.  
The cause of this misalignment and the resulting pain is the hormone relaxin, which has come up a few times on this blog. Yes, the one that relaxes your ligaments and soft tissue. Relaxin has been the cause of most of the problems I have written about on this blog. But I promise you it is a useful hormone overall, as it prepares your body for birth and helps make room for the growing uterus. 
Can it be treated?
The job of the physiotherapist is this case is to diagnose the problem and then simply put the joint back in place. It sounds like it would be painful, but it is not.  This procedure will leave some patients completely cured and free of any more problems, while with others the misalignment can keep occurring and the physiotherapist will simply have to keep realigning the pelvis.  
In addition to this treatment, your physiotherapist will also advise you on stability exercises. This is because it is really important to strengthen the muscles around your pelvis and those that help with core stability. This helps to share the responsibility for your stability between your muscles and joints together, and not leaving it all to your joints. 
If you are suffering from groin and buttock 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 in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.