Sacroiliac joint instability treatment and prevention in pregnancy

By Dr. Alison Gault

Sacroiliac joint instability during pregnancy is a condition that tends to worsen.  It is vital to reduce straining the pelvis as much as possible even if you are not feeling pain at the time.    The majority of women have no pain after 3 months post delivery and have a very significant decrease in the pain in the days following birth. For more information of the symptoms and causes of sacroiliac joint instability in pregnancy, please click!

What to avoid with sacroiliac joint instability in pregnancy

Avoid standing on one leg, get dressed sitting down, the couple it underwear release system can help with this.  Avoid standing for long periods. Sit down wherever possible for tasks that require you to stand such as food preparation or ironing  Avoid squatting where possible  Avoid repetitive tasks   Avoid high intensity exercise  Avoid extreme ranges of movement in the hips and back

Health Practitioners for the treatment of sacroiliac joint instability

Hands on treatment with practitioners such an osteopath, physiotherapist, myotherapist, chiropractor or acupuncturist can assist in improving and managing your symptoms. Discuss your symptoms with your GP, midwife or obstetrician. Get an exercise program to strengthen pelvic musculature with a specialised personal trainer, physiotherapist or pilates instructor.   Be wary of stretching too much as this can reduce some of the much needed muscular support of the SIJ’s.  Exercise should be focused on strengthening not stretching. Pelvic floor and core strengthening can assist greatly especially learning to brace these muscles when you need to lift or bend.  Speak to your health practitioner about these. Some women experience feelings of depression, guilt, grief or anger associated with the condition.  Speaking to a psychologist, councillor or a support group can assist. A natural health practitioner such as a homeopath or Chinese medicine therapist may help.

Everyday tasks

If you have a severe case and have trouble walking, consider hiring a wheel chair or electric scooter if you need to go to a shopping centre or supermarket for a long period, many centers hire these out for free.  Listen to your body, pain is there for a reason. If it hurts, you are best to stop and avoid that activity. Commonly such tasks as shopping, vacuuming and sweeping can be a problem.  Ask for help with everything! The less you strain your pelvis, the better you will be. Tasks you may need to reduce are shopping, cleaning, childcare, work and lifting.  Consider a nanny or babysitter to give yourself a break and help get you through.   Avoid heavy lifting. Get older children to climb onto a stool or chair before lifting them up.  Reduce straining everyday activities as much as possible. Things to consider are buying groceries online, getting groceries delivered, getting a clothes and nappy washing service, getting a cleaner, getting meals delivered.  Set yourself up for what you will need for the day such as a big bottle of water, thermos of coffee/tea, snacks, phone, remote etc so that you don’t need to get up all the time.  Get a stool to sit on when doing tasks such as ironing, washing dishes and cooking that require longer periods of standing.  Play with children when seated where possible.  A claw can be of great assistance to help you pick things up off the floor.

Sleeping

Always sleep with something in between your knees such as a body pillow or leg spacer to help with pelvic alignment.  Try sleeping with silk or satin PJ’s as you can slide rather than pick yourself up to turn over.  You may find it easier to turn over in bed by going up on all 4s.   Consider hiring an electric recliner if your sleep is severely affected.  When turning over, keep your knees together where possible and contract your pelvic floor and core abdominal muscles to give you more support.

Movement

Reduce the strain on the pelvic joints when walking by taking shorter steps.  Don’t put asymmetrical strain through your pelvis:      avoid stairs where possible. You may find it less painful to walk up the stairs sidewards. If one side is less painful than the other, always step up with that leg first.       swing both of your legs onto the ground before getting out of the car.  You need to rest and avoid irritating the joints however you still need to remain active to avoid losing muscular strength. This is a delicate balancing act.  Towards the end of the pregnancy or earlier on if you have a severe case, you may need crutches, a walking stick or even a wheelchair to get around. This is vital if you are starting to experience pain with all movement and especially if you feel your back or legs are going to give way under you.  Keep your legs together as much as possible such as getting out of bed or your car and turning over in bed.

Sit

With your knees under the height of your hips  Without crossing your legs  With your knees together  With your weight evenly over both of your sitting bones  Change your position frequently from sitting, standing to lying

Tips

Ice packs over the SIJ’s can be beneficial in reducing the pain and inflammation.  Gently stretching your gluteal, hamstrings and quadriceps muscles can help to reduce pain but avoid over stretching as this will take away some of the remaining support of the pelvis.  Learning relaxation techniques such as meditation can help with pain tolerance and improving sleep.  Sitting or lying on tennis balls may help decrease tension and pain in your gluteal muscles. Getting your partner to gently put pressure on the gluteal muscles when you are lying on your side may also give you some relief.  Be careful not to slip, your pelvis is very vulnerable.

Prevention of pregnancy related sacroiliac joint instability

If you have had instability in prior pregnancies or a history of low back pain, it may be beneficial to:

Start training or do some rehabilitation with a physiotherapist, pilates instructor or personal trainer prior to getting pregnant to ensure your core and pelvic musculature is strong and functioning as best as possible.  Get treatment from a ‘hands on’ therapist such as a chiropractor, osteopath, myotherapist, acupuncturist or physiotherapist to ensure your pelvis and low back are in good working order before trying to get pregnant.  Act as soon as you start to experience symptoms as they tend to worsen as the pregnancy progresses.  It has been suggested having a 2 year gap between pregnancies enables the body to recover and decreases the chance of re occurrence.

Products that help your pregnancy related sacroiliac joint instability treatment?

The sacroiliac brace applies compression through the pelvic joints that may increase the stability, help reduce inflammation, increase speed of healing and decrease muscular spasm. The end result being a decrease in pain and an increase in your ability to function. It is especially beneficial to wear the belt in your more physically demanding times such as at work, doing housework or going shopping. A study showed that a belt decreased posterior pelvic pain in 82% of the women involved.

A pregnancy belly pillow  supports and lifts your growing bump when sleeping to take pressure off the joints and muscles of the pelvis by improving alignment and reducing drag.

The Leg spacer decreases tightness of your hip and pelvic muscles when lying on your side by slightly elevating your top leg. It also improves pelvic and spinal alignment to keep you in the optimal side lying position.

The couple it underwear release system  enables you to put your underwear on sitting down removing the need to stand on one leg.