If this is always true, why can we feel pain when we have not injured ourselves? 

For example, we feel neck or back pain after sitting for a prolonged periods or a trivial action like reaching for a towel causes severe back pain?
How is this possible if pain = damage? This is confusing.

What The Research Shows

The research tells a different story:

One study ( Brinjiki et al) showed a high rate of ‘pathology’ in lower back MRIs in over 3000 subjects without any pain or dysfunction – and this was in people ranging from 20 to 80 years old.

In the shoulder, many studies have painted a very similar picture. One study (Grisih et al) found that a remarkable 96% of subjects who reported no pain or issues had at least one identifiable ‘pathology’ on their ultrasound scan. 

So you can see that tissue damage does not lead to pain in many cases, and pain can arise without  evidence of tissue damage. This is precisely why we constantly remind our patients that ultrasound scans don’t tell the full story.

The general understanding of pain and injury needs to be updated so that people can overcome pain more easily and get back to living their (best) lives.

A New Understanding of Pain

The new understanding of pain is that it is an output signal created by the brain, as a warning sign. It can be out of proportion to the injury. This serves to change behaviour to prevent further damage, which is often required to fix the problem.

The issue is that most people don’t understand this, and remain stuck with a painful condition because they are fearful to move in case it causes more tissue damage. The problem with this is that people are thinking about local structures, not the whole body. There are compensations and protective mechanisms that can develop in other areas of the body that can contribute to your pain…. Where your pain is located is not necessarily where it comes from.

For example, someone can get knee pain because they had a recent back pain episode that affected the way they walked. The back pain improved, but the knee persisted because of secondary protective mechanisms that have not resolved.

A Whole Body Approach

This is why we look at the whole body and how it works together. We want be as thorough as we can and find all the contributors, both local and remote for your pain. This will enable you to get back to the things you love doing without the pain you have been suffering.

We use a 7 step process (the ridgway method) that will find the main drivers of your pain and fix them quickly. It is scientific, objective and based on the latest neuroscience research. 

If you’re not open to a new understanding of pain, you will remain stuck and restricted by your pain and fear of movement. Are you really willing to let your pain dictate your quality of life? 

Or are you looking for a new approach to regain your lifestyle, independence and get on top of your pain long term?

If you’re ready to take control of your life, book an initial consultation with us. We’d love to help you!

References

Brinjikji W et al; Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27.

Girish G et al; Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011 Oct;197(4):W713-9. doi: 10.2214/AJR.11.6971

“You have a 5cm DRAM.”

While it’s common to hear this from your nurse or physio after giving birth, what does it actually mean? And if you do have a separation, should you be worried? In this article, let’s demystify the meaning of having separated abdominal muscles – and what it means for you.

What is DRAM?

This condition has many names, but it essentially boils down to this:

Diastasis = separation of normally joined parts

Rectus Abdominis = the muscles that make up your abs (the part commonly called the “six-pack”!)

Between your abdominal muscles is a thin area of connective tissue called the linea alba. This tissue will be stretched during pregnancy by your growing baby, sometimes resulting in extra space between the two sections of your abdominal muscles. But this shouldn’t make you concerned – this is a normal part of the pregnancy process as your body makes room for your baby.

After giving birth, this distance in the abdominal muscles will often reduce and even disappear entirely for some women in the first six weeks. However, in 50% of cases, this separation can persist as a noticeable gap down the centre line of your abdominal region.

This can present in a number of ways. You might notice that when you tense your abdominal muscles, there’s a gap down the middle. Or even that your belly muscles can bulge out (also known as “tenting” or “coning”) or sink in through the centre when you sit up out of bed.

However, the most accurate way to get it assessed is to see a Women’s Health physiotherapist. They can measure where the separation is occurring, how wide it is, and most importantly, whether it’s a problem that needs to be addressed.

Should I be concerned?

Not necessarily! When it comes to DRAM, the most important thing to assess is, “is this separation affecting my core strength and daily life?” Smaller DRAMs less than 2cm don’t have an impact on your core strength or back function, which means that leaving it alone will have no long-term negative effects.

Larger DRAMs can mean your core is weaker and you will have more difficulty doing certain activities. If you are experiencing difficulty moving from lying to sitting up, lifting objects, or engaging your core muscles, then it is best to get yourself assessed. If a DRAM is found, it can often be easily addressed without invasive intervention.

What can be done to treat my DRAM?

Once your Women’s Health physiotherapist has assessed how your abdominal muscles are working, there are a range of treatment options.

Abdominal binding in combination with specific core strengthening have been shown to be effective in the recovery period after your baby’s birth, especially with caesarean deliveries.

Your Women’s Health physiotherapist can teach you are correct postures and lifting technique so your body remains protected and injury-free as you care for your newborn.

A physiotherapist prescribed regime of core stabilising exercises to regain strength and control in your abdominal muscles is the best solution. In particular, retraining your transversus abdominis (deep core) muscle has been shown to reduce bulging or tenting. The key is making sure the exercises are specific and set at the right level for you. If the exercises are too demanding, then it can lead to overloading and create pain in the back and elsewhere.

Key Takeaways

You might experience a lot of fear and uncertainty after being told you have a DRAM. You might feel concerned about long-term injuries or how your belly might look. Having a DRAM of any size is not a cause for concern. Smaller DRAMs often require no treatment at all and larger DRAMs can be improved with the right advice and treatment.

The team at NWPG can help you get on the right track. Call us at the clinic or book in online for a thorough assessment with our Women’s Health Physiotherapist today.

As your pregnancy progresses, your body will undergo significant physical changes. This is a natural part of the journey as your body prepares to deliver a newborn into the world. However, in up to 50% women, these body changes can result in a debilitating condition called Pregnancy Related Pelvic Girdle Pain.

The impact of Pelvic Girdle Pain can not only affect you physically, but emotionally and psychologically as well. You might struggle with everyday function and work. You might feel exhausted and powerless. You might rely on pain medication to get through the day.

Fortunately, there are things that can be done to treat this problem. The sooner you start treatment, the less likely the problem will persist following your baby’s birth and beyond.

How Do I Know If I Have Pelvic Girdle Pain?

Pelvic Girdle Pain is localised to the pelvic region, in the space between your lower back and hips. You might feel pain around your tailbone at the back or even around your pubic bone at the front.

If you have Pelvic Girdle Pain, you will commonly experience pain and restriction with the following:

• Standing on one leg
• Going up and down stairs
• Turning over in bed
• Walking on sand
• Wearing heels
• Squatting low to the ground
• Doing housework
• Caregiving

Why Am I Getting Pelvic Girdle Pain?

There are many factors that influence Pelvic Girdle Pain. The joints in the body naturally become looser during pregnancy to allow the pelvic bones to move and slide apart when it’s time to give birth. However, this extra joint mobility can lead to excessive stress and strain building up in the sacrum (tailbone) and pelvis when it normally wouldn’t.

Your natural body posture also changes during this time. As your baby and belly grows, your pelvis is drawn into an anterior tilt position.

This posture creates further tension on joints of the spine and sacrum. That, combined with the laxity in these joints, can lead to a feeling of instability, weakness, and pain around the sacrum and pelvis.

What Can I Do If I Have Pelvic Girdle Pain?

The first thing you can do straight away is to change any habits that may be aggravating the condition.

• Wear comfortable, supportive shoes when on your feet. Avoid wearing heels as this will further accentuate any anterior pelvic tilt position.
• Take the time to rest and be off your feet. Even that can help relax the tension that has built up in the joints and prevent the pain from getting worse.
• Avoid standing on one leg where possible – for example, sitting down to put on pants and shoes rather than standing. Keeping your weight even between both legs when you stand to prevent one side being overloaded and aggravating the problem.
• Learn how to stabilise the pelvis with specific exercises prescribed by a physiotherapist. Keeping your strength intact over the period of your pregnancy can not only reduce Pelvic Girdle Pain, but even lower the risk of injury and pain after your baby is born.
• Using support garments such as a belt or compression shorts can also help the recovery of this condition. Providing external support to the loose pelvic joints can create a feeling of comfort and stability and improve function. Our Women’s Health physiotherapist can help you fit these garments and advise what’s right for you.

Key Takeaways

Pelvic Girdle Pain is a common but treatable condition of pregnancy. If you notice pain in the pelvic region during your pregnancy, seek treatment with a Women’s Health Physiotherapist as soon as possible, as symptoms can often worsen as your due date approaches.

We can help you reduce pain and get you on track. Call us at the clinic or book in online for a thorough assessment today. The last thing you want is debilitating pain to be on your mind when your baby arrives!

But why is it so common? It all comes down to swelling. Pregnant women have a tendency to retain more fluid. This leads to generalised swelling across the body, meaning less space in the carpal tunnel, which then compresses the nerves in the forearm and hand. The result is numbness, tingling, and pain in the hands.

We have a complete Women’s health physiotherapy service here for you.

[An important note: Not all swelling in the hands is normal during pregnancy! If you have a sudden increase in hand and feet swelling, it’s important to check in with your midwife or obstetrician ASAP, as this can be an early sign of pre-eclampsia.]

Carpal tunnel syndrome usually starts in the 3^rd trimester and 85% of cases resolve within 2-4 weeks after the baby is born. Management during this time often involves soaking the hands in cold water before bed and wearing a soft splint overnight.

But what happens when it doesn’t resolve? Let’s explore an interesting example of this by looking at Ms X’s case.

When Carpal Tunnel Syndrome Doesn’t Go Away

Ms X presented to our clinic with carpal tunnel syndrome affecting her right and left hand. It had started several months ago during her 2^nd trimester. She had been told by her doctor at the time that it was related to her pregnancy and would resolve after her baby was born. Unfortunately for her, her baby was now two months old and the problem had not gone away – in fact, it was getting worse.

What did we find?

When I saw her, her symptoms were constant numbness, stiffness, and pain in both hands, especially on her right side. In addition to waking up to feed her newborn, she was waking up 1-2 times a night due to pain and numbness. Fine movements like doing up buttons and changing the nappy were difficult. Pushing the pram with her newborn for a walk made things even worse. As you can imagine, experiencing this painful condition on top of adjusting to life with a newborn was a lot to handle!

I assessed Ms X and found:

• Significant nerve tension in both arms
• Rounded shoulder posture
• Muscle tightness and joint stiffness across both shoulders
• Weakness in hands and arms, especially with gripping
• Overall weakness in her core muscles

Returning to full pain-free function

Ms X’s improvements were slow in the beginning. With disrupted sleep, having to constantly pick up her baby, and breastfeeding, getting the rest required for her carpal tunnel to settle was an uphill battle. But little by little, changes started happening!

The tingling gradually reduced – there was less spread, less intensity, and finally, less frequency. The left resolved first, then the right. We’re now at the point where the pain is much less severe and only occurring at night (usually when the baby sleeps on her right arm). She feels stronger overall and able to do many of her daily tasks without the weakness and pain that limited her before.

So what did we focus on to get this result?

First of all, most of the problem was coming from excessive tension around the neck and shoulders further upstream from where she was feeling her pain. This impacted the nerve pathways and led to the symptoms in the wrists and hands. We released this region in our sessions together as part of a whole body approach, which helped improve her flexibility and grip strength week by week.

Next, we made corrections to Ms X’s posture. Keeping her wrists in a neutral position while breastfeeding and carrying her baby were paramount. We also adjusted her posture while pushing the pram – keeping the pram closer to her body, lower the handle height, and squeezing her shoulder blades together helped support her hands and protect her nerves while walking.

We encouraged the use of ice and anti-inflammatory gel nightly over her forearms to reduce swelling and inflammation.

Lastly, the key thing that helped Ms X improve was a gentle program of strengthening her shoulder and core stabilising muscles. We started off with gentle holds and gradually progressed to resistance bands. This proved to be one of the most significant factors to her condition – the stronger she became, the less symptoms she had.

Why Was Strength So Important in Ms X’s Case?

Unfortunately, the advice she had been given regarding strengthening exercise during pregnancy had been unclear. Was it safe? What were the dos/don’ts? Without clear guidelines, she decided it was best to err on the side of caution and pause exercise until after the birth.

This is not an uncommon story, as many pregnant women receive conflicting or even no advice at all about exercise. Unfortunately, this meant she was much weaker following the birth of her child and the initial carpal tunnel problem was able to linger and become a chronic issue.

What Can We Learn From Ms X’s case?

If you experience any pain or problems during pregnancy, it is important to get a full assessment as soon as you can. There’s no reason you should suffer with persistent pain and discomfort during this special time in your life! A Women’s Health physio can help assess the factors contributing to your painful condition, fix them, and guide you in ways to stay well during your pregnancy.

Lastly, aerobic and strengthening exercise is encouraged in uncomplicated pregnancies! If you are pregnant and you’re not sure about what’s safe for you, arrange an appointment today to see our Women’s Health physio. Nicole can help demystify the dos/don’ts, treat areas contributing to your pain, and tailor your exercise to your specific needs. This will help you stay mobile, pain-free, and enjoy your pregnancy journey!