How to ease pelvic pain with pilates

Pre-natal Pilates expert Ali Handley of BodyLove Pilates NYC shares her tips for easing pelvic pain during pregnancy

sciatica
Photo by Ali Handley

Your body goes through extensive changes over the course of your pregnancy – particularly the pelvis that houses, supports & eventually births your baby. During the the 40+ weeks of pregnancy your pelvis will experience structural, alignment & stability challenges – often creating a great deal of pain and discomfort. Here a few common conditions that flare up during pregnancy and tips on how you can workout to relieve the symptoms and prevent damage to the joints.

CAUTION: It’s extremely important that you listen to your body when you are pregnant – particularly when you are exercising. If something doesn’t feel right – stop immediately. Be sure to never work through pain & from the 2nd trimester onward make sure not to spend too much time on your back. If you are feeling breathless or dizzy in this position, roll to your side and take your time getting up again.

SI Joint Pain

The Sacro-Iliac (SI) joint is in fact two joints – one on each side of your sacrum where it meets the back of your pelvis. SI Joint pain presents itself locally on one or both sides of the sacrum/tailbone. SI Joint pain is the most common complaint during pregnancy, often flaring in the 3rd trimester. The pain often radiates along the hip crests and lower back.

Causes:

  1. The SI joint is a very vulnerable and unstable joint even before pregnancy
  2. The hormone ‘Relaxin’, which is produced by the body during pregnancy, causes ligaments and connective tissue to become extremely lax and as a result your pelvis becomes hypermobile and even more unstable, often this hyper-mobility is not symmetrical – so pain can present itself on one side more than the other
  3. The muscles of the butt can become tight, tonic and overworked during pregnancy as your pelvis changes to make room for the growing baby – pulling on one or both sides of the joints and causing pain.

Exercise:

SCI-Pilates

Squats: Squats are a wonderful exercises to help not only relieve SI Joint pain by working both side of the pelvis at the one time – creating balance – but it also strengthens the outer hips and lower body that help support the pelvis. There are loads of ways to squat – get creative! Against a wall, using the foam roller, toes up, heels up.

Set-up:

  1. Standing feet in parallel & hip distance apart.
  2. Inhale through your nose and sit back into the squat.
  3. Exhale out your mouth and first feel your belly button pull into your spine, keep this connection as you push through your feet and stand back up.
  4. REPS: 3 sets of 8
  5. Challenge: Wrap a stretch band around your knees and hold a low squat between each set for 8 breaths or 30 secs. These holds isometrically challenge the muscles of the outer hip to create a greater sense of force on the SI Joint.
  6. Tip: Make sure your feet remain in parallel and are only slightly wider than hip distance apart.  It can be damaging to the hip socket if the feet are too wide apart and make sure that your knees track over your second toes so to avoid knee pain and damage.

CAUTION: If you are experiencing SI Joint pain you should no longer do unilateral leg work – this means anything where you are only working one leg at a time, as it aggravates the condition. NO side-lying exercises such as Clamshell.

Pubic Symphysis Dysfunction (PSD)

Pubic Symphysis Dysfunction (PSD) occurs at the pubic symphysis, which is at the front of the pelvis where the two halves connect. This pain can feel like a pulling or tugging inside the vagina or sensitivity of the pubic bone area. This can occur when you are working out or simply walking around, and often flares up when your baby is experiencing a growth spurt.

Causes:

  1. Your body produces the hormone Relaxin to soften the pubic symphysis in preparation for birth, destabilizing this area where the two halves on the pelvis join
  2. The destabilizing and weakness of this area can cause pelvic misalignment – or pelvic shearing
  3. Pressure from the weight of the uterus and baby on the pelvis

Exercise:

Pilates-bridge1 Pilates-bridge2

Bridging: When it comes to PSD you want to avoid using the inner thighs which can tug and cause further strain on the pubic symphysis and instead want an exercise that uses both side of the pelvis at the same time (know as bilateral movement) and strengthens the outer hip to provide stability for the unstable joint. Bridging does all these things!

  1. Set-up: On your back, pelvis & spine in neutral. Knees are bent, feet are parallel and in line with the sitting bones.
  2. Inhale through your nose  and prepare for the movement.
  3. Exhale out your mouth and first feel your belly button pull into your spine, wrapping around your midsection, stabilizing your pelvis in neutral and then hinge the hips up into the air.
  4. Inhale again through your nose and maintain the hip lift and deep core wrapping.
  5. Exhale again out your mouth and lower your hips back down in one piece to the start position.
  6. REPS: 15

CAUTION: If you are experiencing PSD  you should no longer do unilateral leg work – this means anything where you are only working one leg at a time, as it aggravates the condition. NO side-lying exercises such as Clamshell. You should also avoid working the inner thighs as this tugs on the already vulnerable joint causing more pain.

Sciatica

Sciatic nerve pain and symptoms are very common during pregnancy. The sciatic nerve runs from the low back, through the butt and down the back of each leg. This pain can be described as an ache or pain on either side of the butt and leg, often worsening when you are sitting or even a burning, tingling or numbness down either leg.

Causes

  • The sciatic nerve originates from a vertebrae in the low back. As your belly gets bigger your pelvis can tilt forward (anterior) causing compression in the low back and impingement of the sciatic nerve.
  • As your pregnancy progresses the pelvis widens to make room for the growing baby. This causes your hips to externally rotate and muscles in the butt (a muscle called the ‘Piriformis’) to become very tight. The Sciatic nerve runs behind the piriformis and can become irritated and impinged by the tight muscle. This is called ‘Piriformis Syndrome’.

Exercise:

sciatica

Hug your baby: This exercise targets a muscle of the deep core called the Transverse Abdominis (TVA).  It wraps around your midsection like a corset – stabilizing your low back and pelvis, providing decompression and support for the lumbar vertebra & the sciatic nerve.

  1. Set-up: Seated in neutral spine and pelvis on a physioball, yoga block or bolster, a household chair.
  2. Inhale through your nose and allow your belly to fill up with air and muscles relax.
  3. Exhale a long, slow, even breath out your mouth and image pulling your belly button all the way to your spine, the TVA hugging your baby in toward your spine.
  4. Reps: 15
  5. Challenge: Do the exercise in all fours
  6. Tip: Stretching & releasing the muscles of butt and IT band can be hugely beneficial in relieving pressure of the sciatic nerve and symptoms of Piriformis Syndrome.