Physiotherapy Now

Jerusalem physiotherapy by Tamara May

pregnancy

Rib Flaring: Don’t Let It Flare Up During Your Pregnancy

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Rib flare is one of those less common conditions, found in pregnancy during the second and third trimester. Many pregnant women often complain of their growing baby poking and prodding them – “I feel a leg kicking through me.” Often you will place your hands over the bump just for the excitement of feeling your baby kick. Usually your husband is in the next room, he runs in to feel the baby kick and misses it each time. Well life would be simpler if they just carried the baby throughout the pregnancy, and then they could feel every kick along with the morning sickness, nausea and any other symptom that may occur….
This pain is a direct result of your baby and uterus getting bigger and poking and prodding into you. In pregnant women the demand for oxygen is increased. You will exhale more carbon dioxide which triggers the respiratory system to increase the respiratory rate slightly, and this is the reason you may find yourself more breathless during strenuous activity. Your diaphragm will have to work harder as well. 
You may find the baby beginning to press up and under your ribs and chest. This is the uterus ascending as the abdomen stretches upward and outward, so the baby can grow. The growing baby can obstruct the descent of the diaphragm, which is needed for deep breathing. Hence the pressure pushes the rib cage out sideways and forwards, known as rib flaring and causing a lot of pain. It can also lead to shoulder pain due to the nerves of the diaphragm referring pain there. 
Your growing breasts can also place added pressure onto your ribs, so a good supportive bra which is not underwired is really important.
Good posture can help relieve some of this pain as slouching will put added pressure onto your abdomen. So sitting up with shoulders back is a good start to relieving the pain.
Exercises that open your rib cage up are also really useful here. Stand facing a wall. With your feet 40cm from the wall, cross your arms in front of your face. Then lean your crossed arms on the wall sliding them up the wall above your head and stretching yourself up as far as possible. Hold the position for as long as comfortable. This lifts the diaphragm and rib cage up off the uterus. Practicing doorway chest stretches can also be helpful because they, too, will help rotate the shoulders up and back, which can also help lift the ribs away from the uterus.
Breathing and relaxation exercises can also help. There are also several hands-on techniques that your physiotherapist can do to gently stretch and lift your ribs away from the uterus. 
If you are suffering from rib flaring 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.  

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.