Round Ligament Pain
The Round Ligament is a structure in the body that does not make itself known until pregnancy. The ligament itself is a stabilizing structure that connects the uterus to the anterior aspect of the pelvis. Starting in about the second trimester of most pregnancies, it begins to lengthen and thicken rapidly in response to the growing fetus and subsequent enlargement of the muscular uterus.
Expectant mothers can sometimes experience sharp tugging pains or a prolonged cramping in the groin, abdomen, or at the ligaments attachment on the pelvis itself. These pains can be one sided or bilateral, last for seconds to hours, be consistent or intermittent, and vary widely from individual to individual. Later in pregnancy, Round Ligament pain can be mistaken for labor pains.
Oftentimes Round Ligament stress can be felt with certain movements. If that movement can be identified and somewhat isolated, the pregnant woman can attempt to avoid those stressful movements. In general, maintaining a relatively active body during pregnancy can be very helpful for the body to adjust to the rapid changes with more ease. Stretching and/or gentle yoga later in pregnancy can assist the body’s transformation.
If the Round Ligament pain becomes very dysfunctional and debilitating, a physical therapy appointment with a Pelvic Specialist can offer more specific stretches, manual mobilization techniques of the pelvis and ligament itself.
The therapist may also recommend a belly or sacral support in the form of a belt, band, or compression garment that can take excess stress off of the ligament and surrounding structures. Personally, my favorite garment for belly support is Spanx Maternity Mama Shaping Shorts. They offer a nice compressive lift of the abdomen, allowing the Round Ligament a bit of a break.
Low Back Pain
The most common complaint that I see in my clinic related to pregnancy is most definitely low back pain. I would include sacral in this very general definition of “low back”. Low back pain is incredibly consistent in pregnancy to one degree or another. I would dare say that every pregnant woman will experience some lower back or sacral change in the absorption of increased physical stress. The spine is required to change shape or alignment to some degree in order to accommodate the mothers growing abdomen and change in center of gravity.
At best, a woman may notice this change and adjust with very little “pain” and instead see or feel her body begin to move in an alternative manner. For example, she may feel her hips rotate out a bit more, or notice a wider stance, she may feel her bum begin to tuck under a bit more, or notice a decreased lumbar rotation without actual pain.
At worst, some women can experience very debilitating pain that may force a change in her ability to work, or require limited lifting, difficulty sleeping and changing positions, or even the need to medicate or supplement for pain control.
In all of the above cases, but especially the more uncomfortable situations, a physical therapist specializing in pregnancy can be so very helpful. Despite the common occurrence of low back and sacral discomfort, there is no reason that a person has to just suffer through it without support.
Within my own practice, I utilize a variety of techniques to help support my pregnant patients with low back pain including: Breathing techniques that encourage postural strength and stability, soft tissue and trigger point work including dry needling, manual therapy and mobilization of the spine and pelvis for improved structural alignment, and ongoing counseling of supportive recommendations that the client may use in their home and daily life.
Pelvic Girdle Pain
Pelvic Girdle Pain (PGP) also affects the majority of pregnant women at some point in their pregnancy. It is a very broad category of symptoms and pains in and around the pelvis. It can include but isn’t limited to:
- Vaginal pain
- Perianal pain
- Symphysis pubis pain
- Pelvic instability
- Hip pain and instability
- Pelvic pressure and swelling
- Labial Varicose vein swelling
- Hemorrhoids
- Coccygodynia
All of the above listed impairments may be treated slightly differently depending on the patient and the therapist, but all of the diagnosis can be helped in one way or another. Manual therapy to improve structure and alignment in the mother can reduce pain and pressure in the pelvis. Manual work can also help reposition the baby to a more ideal position in the pelvis, and remove the compression of structures and blood supply that may be contributing to the dysfunction.
In my clinic, I will also sometimes utilize trigger point work to reduce any soft tissue contributors in and around the pelvis. This can range from dry needling the glutes or low back to internal manual trigger point release to the vaginal vault musculature. A trigger point in the pelvic floor can sometimes be the cause of malalignment of the coccyx for example. Manual therapy and lymph drainage are also very helpful for any inflammation and excessive swelling that can pool in the pelvis.
The above are just three of the common pregnancy diagnoses that women may encounter in the 10 months of pregnancy. There are a variety of other changes and discomforts that can occur, and you don’t have to face them alone. A good therapist who works with pregnancy is the best tool you can have in your belt when it comes to navigating a healthy and comfortable pregnancy journey!
If you need support or have questions, schedule an appointment today.
