ObGyn/Pregnancy issues/Pelvic Girdle Pain (PGP) and Exercise
QUESTION: Dear Helene,
I am a semi-athlete now pregnant with baby no.2. When I was pregnant with baby no. 1, I was able to continue my high intensity training (including non-contact kickboxing, jumping jacks, plyometrics and spinning) until my 9th month when suddently I felt a pain in my gluteal area which I thought was a sprained muscle. At that point, I stopped my aerobic training. This time around, I started feeling this pain much earlier- at 18 weeks, and now realize that this is not muscle pain but PGP. I was wondering if you could advise what I can/cannot continue to do from my workout regimen, without inflicting damage to my pelvis. (I'd ask my orthopedic doctor as well, but he's out of the country for the next month). I'd appreciate any advice. Thanks!
ANSWER: PGP is usually felt right at one (or sometimes both) sacroiliac joints, on the side of the lower back, not so much glutes. (It's common for the quadratus lumbartum to spasm as a result of pelvic instability.) Or at the pubic bone, right on center.
Gluteal spasms can have various causes, included prirformis syndrome, or from a body torque pattern which creates a functional imbalance in opposing iliopsoas (hip flexors) and glutes, or even from a pinched nerve in the lower back.
18 weeks is a bit early to feel joint instability, but it could be that too.
People who spin a lot tend to have very tight hip flexors, and if you have an imbalance between sides, would indicate a body torque pattern.
I suggest that you consult a PT or Chiropractor who can diagnose exactly what your issue is, and then provide the proper therapeutic exercises.
In the mean time, try some of the deep glute stretches for piriformis syndrome to see if this helps. Don't perform any moves that might cause a spasm.
Swimming would be a great cross training activity for you, if you have access to a pool.
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QUESTION: Thanks Helene. Yes, the pain seems to be coming from the piriformis muscle, though when my husband massages the area where I feel pain, he says he feels bone, not muscle. The pain also jumps from side to side. I won't be able get a referral to a PT until next month, but do have access to a chiropractor. Is it worth looking into seeing an osteopath, or is a chiropractor fine for these kinds of muscular-skeletal issues?
ANSWER: The deep hip rotators, including the piriformis are near bone, so it makes sense the your DH would feel bone when he massages the painful area.
Start treating this as an acute injury flare-up, even though the root cause might be over-training. You want to nip this in the bud.
Fortunately, piriformis syndrome is one of the easier ones to self-treat, and there is a lot of good info on the web in how to stretch the muscle, and develop better functional balance to prevent the condition from becoming chronic. Start doing some of these basic moves since you won't see a PT until next month. Make sure that your PT is a specialist in piriformis syndrome. You don't want a young newbie trying out her "book learning" on your body.
For athletes, the hardest thing is to temporarily stop training regimes which might be contributing to the condition. Athletes are used to pushing through pain, and you don't want to do this and it delays healing.
Develop a cross training plan so that you have a safe athletic outlet. Since your currently pregnant, swimming, aqua-aerobics, and yoga would be good options. Swimming will be by far the best option for you.
Not sure about the benefits of an osteopath, but a Chiropractor might be helpful to get you out of the acute phase. But your belly is only going to get bigger, and this means that your functional stability will continue to decrease, so full PT might have to wait until after delivery.
Take a look at the core exercises Baby Hugs, and Baby Lifts on http://befitmom.com/diastasis_recti.html
. You should be able to do these safely throughout the rest of your pregnancy so that you preserve as much core strength and stability as possible as pregnancy progresses.
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QUESTION: Thank you for your fantastically thorough answer! I have one last question on the topic (I promise :)) I read online that many athletic pregnant women with this kind of pain had to cut out their high impact training but were able to do spinning- though I've read conflicting anecdotes. Based on your expertise, what is your view? Is it safe for me to go this route? Thanks again.
Spinning and other form of cycling are hip flexion intensive, and if the root cause of your pain is related to overly tight hip flexors, (either a cause or secondary effect) then spinning would not be a good option for you. If you do a lot of intense exercise in hip flexion w/o counterbalancing your training with a lot of hip extension, then this could lead to chronically tight hip flexors.
So spinning might, or might not be OK for you. You'll have to test this out.
I suggest that you start doing a lot more hip extension (along with prirformis stretching). If you find that one side is tighter than the other, work to obtain functional balance.
Certainly as your belly gets really big, recumbent bike will be another option.
Try out ellipitcal too, to see if this bothers you or not.