What is acupunctureWhen people ask ‘what is acupuncture’ they may already know that it comes from China and that it treats pain. What they may not know is that today it also forms part of a rational and evidence-based system of healthcare and that over a million healthcare practitioner use it worldwide. Furthermore practitioners use acupuncture to treat a wide range of physical and mental health illness. Acupuncture involves the insertion of fine sterile needles into acupuncture points and/or warming or massaging the points. Glass cups may also be used to create a vacuum over areas of the skin to dispel stagnation. In these ways the acupuncturist can stimulate the body’s own healing response in a completely natural way. What can it treatAcupuncture is increasingly recognised as a treatment option for a wide range of conditions and consequently many health professionals are happy to recommend acupuncture to their patients. Patients come for treatment for:
chronic and acute pain
arthritis, joint pain and stiffness
anxiety, depression, stress and insomnia
digstive disorders including IBS
chronic fatigue syndrome and ME
Skin conditions such as eczema and acne
migraines and headaches
PMT, fibroids and endometriosis
pregnancy and post-natal support
If you would like to know more about a specific health concern then please contact me. How it worksTraditionally acupuncturists explain its effects in relation to the flow of ‘qi’ in the body and the balancing of Yin and Yang – a framework of health which maps very closely to the Western concept of homeostasis. The way that we ingest, store and transform qi and the balance and harmony of its flow within the human body is the basis on which acupuncturists practise Chinese medicine. From a modern perspective acupuncture has been shown to stimulate nerves and connective tissue resulting in profound effects on the nervous system including regulation of key areas of the brain. Is it safeAll members of the British Acupuncture Council (BAcC) must observe a Code of Practice, which lays down stringent standards of hygiene and sterilisation for needles and other equipment. The Department of Health have approved these procedures which provide protection against the transmission of infectious diseases. Find out what to expect from an acupuncture treatment…
Going back to exercise after Pelvic Girdle Pain (PGP)Posted in Blog. Written by Claire, July 2018
Once upon a time, I used to cycle seven miles to work and go for long runs at the weekend. But after the birth of my first son, long-term Pelvic Girdle Pain (PGP) meant that exercise was off the agenda. Just getting to the corner shop could be a struggle. Five years and another baby later, my pelvic pain was well under control following successful manual therapy treatment, and I felt it was time to get more active. I could go about my day-to-day activities without problems, but doing something unusual could aggravate my pelvis. I wanted to get fit, and I was hoping that improving my core strength could help my pelvis and back problems. So when a new community gym opened in my town I decided to give it a try. My previous experience of gyms had not been very positive. Gym instructors had tended to be quite critical of my lack of flexibility and had left me feeling that gyms were for people who were already super fit. And that was before I had children and PGP, so what would they say now? Luckily the instructor at my new gym was fantastic. He listened as I explained my pelvis problems and he was positive about designing a programme that could accommodate my limitations. Warm up on the bike; no rowing machine, as too risky for my back; I can’t couldn’t run on the treadmill so I walked with it set on an incline, which turned out to be just as good for raising my heart rate. Then some simple exercises with (small) weights, most of which involved an exercise ball in some form, to get my core muscles working. Finally, some stretches – really important, as muscle tightness was one of the reasons my PGP took so long to treat. About twenty minutes after my first session I started to feel twinges in my sacroiliac joint. This gradually grew worse through the day. I iced my pelvis and later took a bath. But the next day my back went into spasm. The day after that, my pelvis was settling down but my back was worse and I was struggling to look after my toddler. My husband didn’t say anything but I knew he thought the gym was a bad Idea. I had to cancel my next gym session, and I felt really down. But I start rollering my hamstrings with a big spiky ball, and this seemed to help a bit. A week later, everything was settling down. I left it another week before venturing to the gym again. This time I was even more careful. I adjusted the bike seat to a lower position. But I noticed my pelvis rocking slightly from side to side as I pedalled. I decided the bike was just too big for me, so this would have to go from my programme. The instructor adapted my exercises to help my back: I was now lying on a raised step for some rather than on the gym ball. While I was on the treadmill I suddenly realised, I was actually enjoying this! Straight after the gym, I got the ice pack on my pelvis, in the hope of stopping problems before they started. Before I went to bed I repeated all my leg stretches, and put a hot water bottle on my back to try and relax it. The next day I had some slight niggles but it was manageable. I kept on with rollering and did stretches every day. Gym visits three and four went smoothly, no problems! I was feeling cautiously optimistic. I may have been imagining it, but I thought I was getting fitter. Three weeks later it is still going well, and I can really see a difference in my fitness now. Touch wood, I think this is working. I’m even thinking about running on the treadmill in a few sessions’ time. My advice to anyone thinking about going back to exercise after PGP would be to start slowly and aim for a gradual build-up of activity. Accept that you won’t be able to progress at the same pace as others. Take advice from your physiotherapist or whoever is treating your PGP. Be alert for anything that could aggravate your pelvis (bad shoes, too large an exercise bike, tight leg muscles). Be prepared for setbacks, and be ready to change your exercise programme to eliminate the things that might cause you problems. The journey of a thousand miles begins with one step.
After the birth of my first child, my Pelvic Girdle Pain (PGP) did not immediately go away as I had been told it would by numerous healthcare professionals. This was a pretty major blow as I had been looking forward to the birth of my baby so much, not just to see his beautiful face, but also to be free of the constant pain that disturbed both my waking and sleeping moments. Despite seeing a number of different physiotherapists, I wasn’t making any progress as I hadn’t yet found someone who actually knew what they were doing. With each fruitless session that passed, my mood sank a little lower. My baby was not a sleeper and I lived in a first storey flat and had no car. Mobility was a pretty big issue, but I sucked up the pain and just tried to get out as much as I could. Things were pretty bleak. I wasn’t enjoying my baby as social media kept telling me I ought to. My husband would work late and did not come through the door until 7.30, by which point I had endured at least 3 hours of griping. I used to throw the baby at him the minute he came through the door. This isn’t an unusual scene for young parents, but the difference between myself and the other mums at playgroup was that I was in pain all day as well. I could not put the baby in the pram and walk around the neighbourhood to distract him as others could. I could not even jiggle him for more than a minute without the pain becoming too bad.
I became more and more withdrawn. By nature I am a social creature; I like talking and listening to others and usually find it easy to connect with other people, especially women. But I used to sit in the playgroups and feel like a shadow of myself, plastering a grin on in places I thought were appropriate, usually trying to bite back tears as the dichotomy of who I was before and after motherhood stuck in my throat and threatened to choke me. Before pregnancy I would run for miles, getting lost and doing a few extra miles without breaking much of a sweat, but now I could barely make it down the street and had to catch a bus just to go into town half a mile away. Unfortunately, the bus stop was a block away from my house; on bad days this seemed like a marathon. I listened with ears that wanted to seal over to how the other mums were getting back to their exercise routines, and starting to extend their runs. I just wanted to get down the street. I remember one night, my first night out after the birth, myself and several other mums from our NCT group were in the car on the way back home. The analgesic effect of a few glasses of sauvignon blanc had loosened my tongue and I described to the other mums how I fantasised about running sometimes, just letting go and sprinting as fast as I could, how it would feel. A silence fell in the car. I think I had made them feel guilty about talking about their return to health. That wasn’t my intention. I was pleased with them, just sad for me. When I started work again I had hoped that not lifting a baby all day would improve my condition, but I was very wrong, and things just got worse. I was still breastfeeding and being apart from my baby took its toll. I was so low. In retrospect, I had not been myself since the PGP kicked in. I remember being paranoid that my work colleagues thought I was stupid, and that they didn’t like me. I thought I was weak for not being able to cope with pregnancy like all the other women seemed to. I hated myself for not loving being pregnant. The pain was like a consistent irritating noise that I could phase out to some extent most of the time but was always there driving me mad, causing loss of focus. Thoughts became like helium balloons on strings, slipping from my fingers, and flying up into the sky never to be caught again. Most of the time I struggled for clarity, and as my job was a research scientist it made life very difficult. I sunk lower and lower. I wasn’t living, I was just existing. Sleep was still an issue, my baby was not playing ball and I was falling apart at the seams. My worst point was trying to get home from a friend’s wedding in London. The Olympics were on at the time and getting a taxi was very difficult, so we got the tube home, which meant a lot of hobbling down and upstairs on my crutches. I was in so much pain and felt so terrible. I was standing on the platform with my husband, tears rolling down my cheeks, and I seriously contemplated jumping in front of the next train. I’d had enough. Enough of the pain, enough of the difficulty, just enough. I thought for a moment of my parents, and thought they’d understand in the end, they’d understand I just wanted it over. I thought of my husband and how he could get over it in the end eventually as well. But then I thought of my boy, five years old with no mum, and how I wanted to see what he would become growing up. I decided then I needed to do something. I went to the doctor for some anti-depressants and made a list of people who I needed to contact to find some help. It wasn’t long after that I found the Pelvic Partnership, who led me to a good physiotherapist and my PGP recovery began. The anti-depressants helped a great deal. I took them for about seven months and came off them with no problem. I was lucky that I got on quite well with the type preferred for breastfeeding mothers. I had access to good manual therapy in my second pregnancy so the impact of PGP on my life was far less intensive. Unfortunately, I had hyperemesis gravidarum to contend with instead, so I didn’t get the pleasant pregnancy experience and my mental health was strained once again. I didn’t mess around after the birth of my daughter. Six weeks after her birth I was still feeling very low so I went on anti-depressants again, which allowed me to enjoy life as a mum of two. At least this time around I had no problems with physical pain and immobility. I remember long, enjoyable walks in the autumn sunshine with my baby strapped to me in a sling.
PGP is such a difficult thing to contend with, especially when caring for a baby and the isolation that brings. I can’t imagine what it is like to have to care for a toddler as well as a baby when your pelvis is making your life miserable. It’s no wonder so many women with PGP end up with depression. Getting your pelvis back in good working order is so important, as is admitting to yourself that you need the help with your mental health. I would recommend letting your midwife, health visitor or GP know that you are struggling with low mood as soon as you can, as there is help out there. Charities such as Mind and Samaritans are also good. I found talking to PANDAs really helpful, as they specialise in pre and postnatal mental illnesses. Babies are small for such a short time, it’s important to try and enjoy this time as much as you can, without letting social stigma over mental illness get in the way.
The benefits of aqua natal workoutsPosted in Uncategorised. by Susie Murphy, BSc ( Hons ) RGN RM aquanatal professional level 3 specialist pre postnatal. Medical Acupuncturist. Keeping fit and active during pregnancy can help you to adjust to the changes your body is undergoing as you approach your due date. Staying healthy and active can also help you to cope with the demands of labour and to recover more quickly once your baby is born. Walking, dancing, yoga and pilates are all activities that can promote fitness but without causing too much stress during pregnancy. However, there are some sports that are not advised when expecting: perhaps the most obvious are contact sports such as judo or kickboxing where there’s a risk of being hit. Here, Susie Murphy offers aquanatal exercise as a perfect way to stay on the move in pregnancy whilst also offering release to women experiencing painful PGP symptoms. Aqua natal classes offer an holistic workout in water led by a specialist instructor. They can offer an enjoyable way to remain active in pregnancy and are really beneficial in the following ways to pregnant women who also experiencing PGP symptoms: Buoyancy. Uniquely, water can provide reliable support and stability for a pregnant woman to enable her to move freely where this ability may be compromised on dry land. Moving in water can strengthen the supporting muscles around the pelvis both above and below. All muscle movement in water is concentric (shortening) so post-exercise soreness doesn’t occur in the same way as it would on dry land. Pelvic Floor. A suitably experienced and trained teacher will include guidance during the gentle aerobic workout about how to maintain a healthy and strong pelvic floor. This will include movements to promote muscular strength and endurance of the pelvic floor which will help to keep the integrity of the muscles as well as maintain continence. Tummy muscles. Frontal resistance of the wall of water can help to strengthen tummy muscles and this occurs naturally as the woman moves through the water, carrying out the exercises included in the workout. The natural resistance of the water can also support the pelvis and strengthen the adductor and quadricep muscles. Pelvic rocking. A common movement within an aqua natal workout is pelvic rocking which is supported safely by the buoyancy of the water and can help to work both the back extensors and the abdominals. Wellbeing and stress relief. The aquatic environment can bring temporary but immense relief from stress and pain. Evidence suggests moving through water can release four times the endorphins (the body’s natural opiates, designed to relieve stress and pain while enhancing pleasure) than are normally released from movement on dry land. This is because movement in water causes the water molecules (which resemble a ‘v’ shape), to tumble over each other, sticking to the skin, the largest organ of the body, and stimulating it. Relieving trigger points. Women with PGP often experience painful trigger points (small contraction knots within muscle) in the gluteus muscles resulting from tension caused by pubic pain. In aqua natal sessions there is always a static stretching phase to prepare the muscles for the next exercise. This can be of great relief because the muscles benefit from moving rather than remaining in a jarring, tense state (acupuncture and manual therapy can be very useful in releasing these triggers or knots). Appropriate movements. Aqua natal workouts under the supervision of a properly trained teacher, will include only those exercises that are appropriate during pregnancy. For example, deep squats, wide leg side step, ply metric jumps and twists are not considered appropriate because they could cause strain or injury. NB Susie Murphy and colleague, Sue Baines have written a book on this topic which is aimed at healthcare professionals but would also be suitable for women interested in learning more. See: Aquatic Exercise for Pregnancy by Baines & Murphy S M&K publishing 2010.
Exercise and PGPExercise generally works best once your pelvic joints have been assessed and treated by an experienced manual therapist and when you feel little pain. If you have a lot of pain, it generally does not matter how much exercise you do, your pain will inhibit your muscles from working properly and you may put in a great deal of effort for little or no reward. It is best to start with manual therapy to sort out the joint function, and then discuss with your manual therapist which type of exercise is most likely to be beneficial for you.See our 'PGP is treatable' and 'What to expect from treatment' pages for more information.
Each woman’s experience of PGP differs slightly, so different exercises will suit different women. There is no one single exercise or exercise programme that will suit all women. The ultimate goal is for you to recover enough to be able to enjoy whichever sport/exercise you practised before you became pregnant and developed PGP. Our members have reported getting back to all of the following after receiving the correct treatment: marathon running, skiing, sailing, dancing, horse-riding, trampolining, hiking, jogging, kick boxing and ballet.
As a general rule, you should allow your pain to act as a guide to how much exercise you can do. It is helpful to keep as active as possible, within the limits of your pain. Before you start any exercise, we suggest that you talk to your manual therapist who should be able to give you a bespoke exercise plan as part of the course of treatment, and will update the exercises you need to do at each appointment. Often there are only a couple of strengthening and/or stretching exercises for you to focus on after each session. If your pain is reducing, you will be able to move normally which is the best sort of exercise and means that you are effectively exercising every time you do anything. If you follow the specific exercises you are given and they are regularly updated and progressed, you will stand the best chance of making a full recovery. Until you have recovered it may be best for you to avoid sports that involve a lot of asymmetric movement, for example, some aerobic exercises which require you to abduct your legs beyond the pain-free gap. Swimming breaststroke, some gym machines and yoga movements also do this. Once your pelvis is moving normally and your pain has reduced you might like to try the following to ease back into exercise:
Walking: a paced or graded walking programme can be beneficial, gradually building up the distances to be walked.
Pilates: Pilates is a gentle, low-impact form of exercise. It can help to maintain and improve the condition of both abdominal and pelvic floor muscles, which in turn stabilises the joints of the pelvis. Many women who have PGP have found that Pilates can help to manage their pelvic instability and therefore keep ‘the niggles’ at bay. For more information and class locations, see www.pilates.co.uk.
Swimming: when your manual therapist suggests you are ready to return to exercising in water it can be helpful to follow a graded programme similar to walking, as the resistance of the water and the buoyancy can often mask how difficult the exercise is, so it is easy to overdo it. Front or back crawl are often less of a strain on the pelvic joints; breaststroke can be quite a strong stress across the pelvic joints, so take care when you go back to this style of swimming. Many women find hydrotherapy and aquanatal exercise helpful, click here for more information about which exercises can be helpful and what to avoid with PGP.
Here are some suggestions to consider whilst exercising which can help you to avoid stressing the pelvic joints as you recover:
Make sure your instructor knows that you have PGP so that they can tailor the activity to your ability.
Try not to lift or push anything too heavy.
Try not to over-exert yourself.
Be careful of any large movement that causes one side of the pelvis to move against the other, for example, standing on one leg. This results in a vertical or up and down stress across the symphysis pubis and sacroiliac joints.
Any large movement that causes each side of the pelvis to move in opposite directions is unwise, for example, moving the legs far apart. This results in a ‘gapping’ movement of the symphysis pubis joint.
There is no need to panic if you do overdo it! You won't be back to square one but if you find your symptoms are worse after doing a particular exercise, it will be worth seeking advice from your manual therapist who may suggest further 'hands on' treatment and modify the exercises you are doing.
Practical suggestionsPGP presents many day-to-day challenges in looking after yourself, your family and your home, as well as managing work and leisure time. This section has been written by women with PGP to give some practical suggestions for making life easier. Some of the obstacles presented by PGP can be overcome by borrowing, hiring or buying equipment and, as with many things, it is easier to manage if you can afford to pay for help with housework, childcare etc. However, many people are not in a situation where they can do this, and the suggestions in this section reflect this, ranging from things that you can do if you can afford the extras, to places to go to borrow or hire equipment. Make use of anything that anyone offers in terms of help at home, doing some shopping, looking after older children etc, as it all helps. Accepting assistance can be difficult, as you may want to be as independent as possible. It can be useful to look at PGP as a short-term disability, which will get better faster the less physical activity you have to do. Therefore, accepting offers of assistance will really help in the longer term, as well as making daily life less painful and more manageable. Also, you may well be able to ‘give back’ later by helping someone else.
Recognise your limits and modify your expectations so that you are achieving what you want to do rather than failing to do what someone else can do. Occupational therapy (OT) assessmentAn OT assessment can be very helpful to help you to identify areas of your daily life you are finding particularly challenging and offer advice and equipment to enable you to live your life as independently as possible. Every area has a different referral process but you can often self-refer for a community OT assessment and your County Council website will often provide information on how to do this. Alternatively, speak to your GP and ask for a referral to an OT.
PGP (Pelvic Girdle Pain) is a condition which affects up to one in five pregnant women. It was commonly known as SPD (Symphysis Pubis Dysfunction), but this implies that only the symphysis pubis is affected, which is not usually the case.
There is a wide range of symptoms and the severity of the symptoms also varies between women. It is important to remember that PGP is a common and, in most cases, treatable condition. It can be safely treated at any stage during or after pregnancy. So if you have pelvic pain during or after a pregnancy, ask for manual therapy treatment.
Can PGP occur at any stage during or following pregnancy?PGP may come on suddenly, or start gradually. It usually starts during pregnancy, but it can occur during birth – usually this happens if you have a difficult birth or are in an awkward position for labour or birth. It may also start after giving birth, sometimes weeks or months later. PGP is assessed, managed and treated in the same way, whatever the cause and whenever it started. Is it hormonal or a joint problem?The pelvis is made up of a ring of three bones. They join together at the sacroiliac joints (at the back) and the symphysis pubis joint (at the front). These joints normally move a little bit to allow you to walk, turn over in bed, climb stairs, etc. PGP can cause pain in any or all of the three pelvic joints, causing difficulty moving and doing your usual activities. With PGP, often one joint becomes stiff and stops moving normally and causes irritation and pain in the other joints and surrounding muscles which have to compensate for its lack of movement. There is a subtle hormonal change during pregnancy which softens the ligaments throughout the body, though this is not the primary cause of PGP. The pain is caused by one or more of the following:
An underlying joint stiffness or previous pelvic or back problem or injury that is irritated by the hormonal changes or when the baby grows larger later in pregnancy.
A slip, fall or other accident during pregnancy at any stage.
Postural problems which irritate a joint – this may be a work-related or hobby-related repetitive movement or position.
Underlying joint hypermobility or a hypermobility syndrome which can make you more susceptible to PGP due to already less stable joints. Please see our 'Hypermobility and PGP' page for more information.
PGP is unlikely to go away without the right treatment, and manual therapy is effective because of the mechanical joint problem – if it were purely hormonal, manual therapy would have no effect on your pain. Traditionally, it was thought that PGP was caused by hormones such as relaxin during pregnancy, and many women are still told that it is a hormonal problem and “It will get better as soon as you have the baby”. However, the reason that the Pelvic Partnership exists is that many women have found out that this is not the case. They have missed out on effective treatment and experienced pain and mobility problems for much longer than necessary. Is it treatable?YES! It is important to remember that PGP is a common and, in most cases, treatable condition. PGP can usually be treated effectively by 'hands-on' manual therapy from a physiotherapist, osteopath or chiropractor with experience in treating the pelvis and back. The therapist gently uses their hands to release stiff or 'stuck' pelvic joints and relieve painful muscles to allow them to work normally again. An individual assessment is important to look at the position and symmetry of movement of your pelvic joints, to find out which joints are causing the problem and how this can be treated. Often the joint causing the problem is not particularly painful, so treating the painful point is unlikely to sort out the underlying problem. You may then be given some exercises specific to your own PGP to work on between treatment sessions when your pain has reduced. It is important to remember that pain stops your muscles from working correctly, so exercising when you are in a lot of pain is unlikely to help or make the muscles stronger, and often makes it worse. You should walk out of each treatment feeling some improvement in either pain or function and preferably in both. Please see our ‘Treatment section’ for more information. Other names for PGPPGP, formerly known as Symphysis Pubis Dysfunction (SPD), is also often called Osteitis Pubis, and Pelvic Girdle Relaxation. The name really depends on whom you talk to about it. In fact, the name is not very relevant. What matters most is that it is recognised as a mechanical joint problem and treated as early as possible, and that it can be safely treated in pregnancy. Diastasis Symphysis Pubis (DSP)DSP is a true separation at the symphysis pubis joint where the bones move more than 1 cm apart, either horizontally or vertically. It can happen if you have had a fall or another trauma to your pelvis (including a difficult birth or one where you have been asked to put your feet on a midwife’s hips or shoulders, something which they should never ask you to do). The majority of women with PGP do not have DSP. If your PGP symptoms do not get better with good manual therapy treatment from an experienced practitioner (remembering it can take time to find the right practitioner and you may need to try more than one to find the right person), it can be helpful to have further investigations to exclude DSP. The normal range of movement (vertical shift or horizontal gap) is 0-3 mm, and a moderately excessive gap is 3-10 mm. Women can usually still function very well with this amount of movement after treatment, but it may need to be taken more into account when looking at types of exercises in the rehabilitation phase of treatment. If the shift is over 10 mm this can be more difficult to manage, but if you have not yet had any manual treatment you should discuss the options with an experienced practitioner before deciding on further treatment, and it is usually worth trying this before exploring more invasive treatment such as steroid injections or surgery. Sports injuries PGP also occurs in sportsmen, such as rugby players, and they are treated quickly and effectively with the same range of techniques as those used for pregnancy-related PGP.
Symptoms of PGP
Symptoms of PGPThe main symptom that women report when they have PGP is pain while walking, bending, climbing stairs and turning over in bed. This means that it affects virtually everything you do in a day, which has a major impact on your life. This pain can be an ache, a sharp shooting pain or a deep muscle pain. You may also have a clicking or grinding feeling in your pelvic joints or in your hips. Common painful areas:
PGP is usually a mechanical joint problemYour pelvis is made up of three joints which work together in a ring-type system. In PGP these joints are not working normally. Often, one joint becomes stiff or stuck and this causes irritation in the other joints (you may not even feel pain in the stiff joint). By treating the stiff joint, a manual therapist can help the joints to function normally again, and allow the irritation at the painful joint to settle. PGP used to be known as Symphysis Pubis Dysfunction (SPD) but this title implies that it affects only the symphysis pubis joint at the front, which is not true, as any or all of the three pelvic joints can be affected, and commonly the two sacroiliac joints at the back of the pelvis are the cause. For information about how to treat PGP, please click here. Emotional symptomsIt is recognised that PGP can also have a big impact on how you feel emotionally, because coping with the physical challenges of day-to-day life can be difficult and leave you feeling low and isolated. One of the problems is that there is nothing to ‘see’ with PGP – you aren’t wearing a plaster cast and pain is not visible to others. Often, women feel cheated because they expect to be blooming and enjoying their pregnancy but, in fact, are struggling because they are experiencing pain that no-one can see. This can be compounded if you have other children at home already, and you are struggling to care for them too. See our Emotional impact of PGP section for more information.
For tips about how to manage day-to-day life, please click here.
For information on pain relief, please click here .
It is common to experience depression and/or post-traumatic stress disorder during and/or after having PGP. Please do not be afraid to ask for help from your GP or family and friends, to help you get through this difficult time. You are not alone and there is support available, so just ask! For information on where you can find support, please click here.