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A Personal Account of Pelvic Girdle Pain
Moira Finlayson is a part time GP, wife and and mother to three children aged eight, five and 15 months. She was brought up in Kintyre and studied medicine at Glasgow University graduating in 1992. In 1995 she obtained the post graduate qualification MRCP after a two year medical rotation in Dundee. In 1998 she decided to change her career path into General Practice and moved to Beauly near Inverness for her GP registrar year. Her first pregnancy in this same year was also her first experience of Pelvic Girdle Pain(PGP)/Symphysis Pubis Dysfunction (SPD) and from 20 weeks into the pregnancy she experienced pelvic joint pain and worsening mobility problems that significantly limited her activities in the last 12 weeks of pregnancy. Her husband took over much of the housework and for periods of time her mobility difficulties restricted her to the house. A physiotherapist supplied a support belt and suggested doing some abdominal exercises but really none of the health professionals she saw seemed unduly concerned about her symptoms or her peculiar gait and she accepted this was part and parcel of pregnancy. Patients would however sometimes make comments such as “I’m a lot fitter than you are Doctor” as she hobbled back to the consulting room. On occasions she would go out to the shops but struggle to get back to the car having developed pain mainly in her left sacro iliac joint at the back of the pelvis and often felt she was “dragging her left leg” It was also painful to stand for more than a short period of time. There were a few paragraphs about 'Symphysis Pubis Dysfunction' in the 'Ready, Steady, Baby' pregnancy book which explained it was related to the pregnancy hormone relaxin but otherwise there was very little information available. Her symptoms resolved almost as soon as her baby was born in September 1999 and she enjoyed being out and about with her new baby returning to work part time on the GP retainer scheme.
A second pregnancy
In 2002 she moved to the Mull of Kintyre where her husband took up the post of a single handed GP there. Moira was delighted to be expecting her second baby later that year but only eight weeks into the pregnancy she developed pain in the sacro iliac joint at the back of the pelvis and started dragging her right leg while out playing golf. Within a few weeks her mobility became restricted mainly to the house and only very short distances outside and she experienced pain in all of her pelvic joints which persisted throughout the pregnancy. A few months after the birth of her second child in December 2002 Moira's mobility deteriorated to the point that she required a mobility scooter and sometimes a wheelchair to get around , she also found it increasingly difficult to lift and care for her new baby with even the most mundane everyday tasks becoming extremely difficult. She eventually had to admit defeat and had to accept full time help with caring for her two children, a decision which was hugely emotional for her as she had to watch while others bathed and cared for her baby and played with her toddler.
Her persisting symptoms after the birth were initially deemed to be due to the pregnancy hormones settling down and initially she was advised to wait six months and then eight months to see if they would settle on their own. She was also concerned that some form of “manipulation” might make her symptoms worse and this also led to a delay in seeking more active treatment. However the symptoms became so debilitating and painful that she started to research the condition and realised by this time that things were unlikely to resolve on their own.
She found the Pelvic Partnership, a support group based in Oxford after much searching on the internet one day. She phoned their helpline and spoke to to their Chair, Sarah Fishburn. Moira was relieved to find that she was not alone with the difficulties she was experiencing post natally and decided to seek more active treatment.
She requested an Occupational Therapy assessment and found the home assessment, done a few weeks later very useful and also arranged an appointment with a private physiotherapist with an interest in pelvic joint problems who had been recommended to her. She was relieved that for the first time someone understood why she was having such problems with walking and could only stand upright for literally seconds before experiencing severe pain. After one treatment session in which there was a fair amount of manipulation she was advised to commence an intensive regime of exercises which despite following religiously led to increased pain. After several telephone consultations in which she was advised only to return for another appointment when she had progressed the exercises further she eventually realized that that day would never come as she found it physically impossible to do the more difficult exercises. She had to abandon the exercises altogether due to increasing pain.
By this time sleep had become almost impossible and she was in an indescribable amount of pain. Her day consisted of sitting in the only chair in the house which was in any way comfortable. She continued to search for answers and obtained much support from women she contacted through a forum on the internet for Symphysis Pubis Dysfunction (SPD). She decided to try an osteopath specialising in the condition who had been recommended by many women with SPD and who was also on the list of practioners who had been recommended by members of the Pelvic Partnership.The treatment involved considerable travel away from home and expense but after the first few treatments she noticed a lessening of the pain and reduced muscle spasm and decided to persist with this line of treatment over gradually increasing intervals over a period of ten months. During this time she made a slow but steady improvement and started walking again, initially to her garden gate then to her neighbours house, gradually increasing by a minute a day, a target that she had set herself, until she was able to walk for a mile. She still felt very stiff and her walking still didn't feel "normal" but it was steadily improving. There were a few setbacks along the way ,each one accompanied by a sense of panic that she might be back at square one but each one either settled on its own or responded to treatment and she gradually started to gain in confidence. Some setbacks had a clearly identifiable reason such as when she decided to drive again before she was really ready but others seemed to happen 'out of the blue'
Ten months on, her pain had greatly reduced and her mobility had improved considerably but there were still occassional 'flare ups' of pain and she still found it difficult to lift or carry her' 'baby ' who was by now an active toddler. Her Osteopath recommended a specialist musculoskeletal physiotherapist who performed a thorough assessment. One thing that was particularly noticeable was that Moira was unable to perform an 'active straight leg raise' with her right leg and only with difficulty with her left leg. This is a test which looks at the function of the pelvis in transferring 'load'. The physiotherapist then applied pressure at different points on the pelvis in order to provide support and enable Moira to perform the test .Taping was then applied at various points across her lower back and down the back of one thigh. Moira was also shown how to breath correctly using her diaphragm and practised this at home.
The following week the physiotherapist showed Moira how to find the neutral spine position and began work on retraining the "core muscles" which to begin with proved to be extremely difficult. Any attempt to get the deep abdominal muscle (transversus abdominus) to work resulted in painful muscle spasms in other muscles often the thigh muscles. After some trial and error the physiotherapist devised ways of getting the muscles to work correctly and then attention focused on the larger muscle groups including the gluteal muscles which were weak and not acting effectively to support the pelvis and hips. Exercises which practiced day to day activities such as getting in and out of a chair and exercises to stretch her tight hamstring muscles were also included. Self help methods of trying to reduce activity in overactive muscles were extremely useful, for example imagining her leg lengthening when trying to reduce spasm in the quadriceps muscles.
Over another ten month period Moira,managed to induce spasm in one or another muscle group while trying to do the exercises. She had pain at times even in her upper back and arms and under her chin! There were times she despaired of ever getting her overactive muscles back under control but gradually she improved and particularly her ability to lift and carry her baby improved enormously. In the early days of treatment she had to ask her four year old son to pick up the tins of soup for her in the supermarket because they were so difficult to lift.
Gaining independence again
Moira continued to recover and gradually regained her independence. Throughout this whole time she was very grateful for the support she received from a couple of women in particular, with very similar experiences, with whom she had initially made contact through an forum on the internet for Symphysis Pubis Dysfunction(SPD). Many of the women on this forum had pain which persisted long after delivery of their baby but through the message boards they were able to offer support to each other.The help from this forum laid the seed of the idea for PINS.
She remembers with fondness the day, just before her son started school when she was able to take both children out for a trip on her own knowing that she was now able to lift her wee one in and out of the car seat and do everyday things like take them for a play in the park and to visit friends.
Almost three years to the day from when she first experienced problems with walking she returned to play to golf - a huge achievement and an emotional moment. A year later, after much consideration,and discussion with the professionals who had treated her previously she decided to embark upon another pregnancy.
Her third pregnancy in 2006 was an anxious time for the whole family as it was uncertain when and how pelvic girdle pain symptoms might develop. She developed an “aching” in her pelvic joints just before her pregnancy test was positive but this didn’t affect her mobility. She decided to keep as active as possible by doing plenty of walking but avoided heavy lifting which included her three year old daughter. She continued with her individual regime of exercises given to her previously as much as time and morning sickness allowed!
She saw the osteopath who had treated her previously at 20 weeks into the pregnancy for a check up and things continued to go well until 32 weeks when, over a few days walking became very difficult and she started using a stick to help her get about the house. Things quickly became a bit chaotic with her restricted mobility and two children to care for but she was grateful for the support of neighbours who helped her if she was on her own with practical things like housework and putting the children to bed. She managed to arrange an appointment with a physiotherapist who had been recommended for treating pelvic joint problems and who was closer to home – only 160 miles away this time. A week after the treatment she was amazed to discover that she was more mobile again and with one further treatment a month later she remained mobile and able to care for her children for the remainder of her pregnancy. Following the birth of her second son she was delighted to be able to care for him herself and enjoy walks with the pram and many other things that had been impossible after her second pregnancy.
A year on she has thoroughly enjoyed taking part in the Mull of Kintyre 10km event. Completed in a time of one hour 34 minutes 50 seconds, it was done at a brisk walk rather than a run but felt to Moira like a great achievement considering her mobility difficulties previously.
This story is a very personal one and Moira recognizes that people develop pelvic girdle pain for a variety of very individual reasons and therefore tailoring the treatment to the individual person is critical to its success. She hopes that by telling her story she will be able to offer hope and encouragement to people who are experiencing problems with pelvic girdle pain now.
Rhonda’s Personal Account of Pelvic Girdle Pain (SPD)
Hi my name is Rhonda and I am mum to Jack born on 16th March 2006 and my second baby Katie was born on 19th November 2008.
The first symptoms I experienced of PGP/SPD in my first pregnancy with Jack started at approximately 20 weeks. I have to be quite brutal when describing the pain as for me there is no other way to express it that can help someone understand the sheer agony and discomfort that is felt. At the very start it felt like someone had attached a heavy weight to my cervix and it was pulling down between my legs. I was referred to hospital straight away and, I was wired up to a machine to monitor the baby’s heartbeat and was then internally examined had tests and nothing untoward was found. Although one nurse mentioned that during pregnancy hormones loosen the ligaments in the pelvic area to prepare the body for birth, so it maybe my ligaments loosening. So I came away non the wiser but relieved all was fine with the baby. In the weeks to follow I was signed off sick from work until my maternity leave was due to start as I was unable to travel into London to work.
The only way I can describe the pain was that it felt like someone had smashed a baseball bat into my groin, hips, back and tops of my thighs about twenty times. I felt bruised, tender, shooting pains all round the areas on the slightest movement, I could feel bones clicking when sitting up or launching to move
I was bedridden and it was always touch and go whether I would make it to the loo on time, as the pain of manoevering out of bed to sitting position and then to standing position was like no other pain I had known. Then having to shuffle along the hallway holding onto anything I could to try and support my weight. My husband Nick was a star he fixed disabled handle bars in our loo so that I could lower and raise myself on and off of the loo. It made that part of my daily routine so much easier to manage.
On a few occasions when I had to leave my flat (to keep me from going insane) after all there is only so much daytime TV and pregnancy magazines and sitting there feeling sorry for myself – that you can do!!).I was loaned a wheelchair from the Red Cross and my husband took me out a couple of times which just ended up in an emotional disaster. I was struggling with anger at having to be in a wheelchair, when I didn’t have much of an understanding of what was happening to me and would I ever get better? Was I to be left disabled for the rest of my life? I hated people staring at me and getting the sympathy looks. I found it easier just to make excuses not to go out in the end.
When I think back to the depth of depression I sank into during my first pregnancy it was horrendous. You always see pregnant women blooming and looking fantastic and happy. I became insecure in my relationship with my husband because I was gaining a lot of weight and was just this useless “disabled” unsexy unattractive lump that was just moaning and eating chocolate all the time as that wonderful taste was my only comfort. So as you can imagine with my husband working long hours, doing all the housework, cooking and shopping it was putting an enormous strain on our relationship. But thankfully we have a fantastic relationship and due to the fact that we communicated our feelings to each other and are so deeply in love, we got through it.
I was terrified that I would never be able to walk again or care for my baby No-one could offer me a solution or advice or give me any reassurance. It was frightening. My midwife didn’t understand, my consultant just said to me that its not uncommon and symptoms should fade after the baby is born but that was not enough, I needed to speak to others who had this too and I went on all the baby forums and no-one could help me apart from hearing a few horror stories.
For weeks I was counting down the hours to the birth and finally the big day came – I had an early c-section, which I insisted on with the consultant the week before, and the birth went well. The hospital in question and the midwifes had no understanding or sympathy for my condition. After they insisted on removing my catheter (because I had to get out of bed and walk to the loo – like everybody else!) there was no-one there who could help me out of bed. I was made to feel like an inconvenience and a fraud. I was told by the senior midwife that until I had a shower and walked around a bit I could not go home. I struggled into the shower with help from Nick and told the midwifes that I had done as requested. I was then told “unless you get up and change your own baby’s nappy for a change you are not going anywhere”. I had enough and I basically told them that I was discharging myself and told my husband to come and collect me. Jack had been checked over the day before and had the all clear and it certainly was not helping me or doing me any good whatsoever staying in that place. A truly horrible experience when having your first baby taking in consideration you are already battling with hormones, post operative stress and pain with SPD!
I am happy to say that after tossing my crutches to one side and returning the wheelchair after four weeks, I pushed myself hard to walk to the local shop. A usual ten minute walk took about an hour but it was worth it. I still had the support belt on for what it was worth.
THE GREAT NEWS IS….After twelve weeks I was walking up to the doctors pushing the pram albeit very slowly and after seven months I was doing a postnatal exercise class and walking thirty minutes each way to do it!!!
My second pregnancy – (in a totally different county!)
A whole new ball game! (Because I have a mad toddler to cope with)
This time I was prepared and was not stressed or worried that I would be left disabled. Although I had heard of others that were immobile for quite sometime even though they recovered first time round. I remained positive throughout.
I had my first physio appointment when I was five weeks pregnant and I was surprised to find out even though I was not experiencing any pain at all with my pelvis, I thought I had fully recovered, but was told that it had not aligned properly since last time. I was given pelvic floor exercises to do and then was told to come back when I started to experience pain.
I was absolutely determined not to get this second time round. I started swimming (breast arms and crawl legs then eventually just arms) to get me into shape ready for the impending weight gain. My pains started about 23 weeks into my pregnancy and by week 26 I was on crutches again. I had a support belt but it was a waste of time. My son had to go into nursery full time as I was unable to look after him (he also decided he was ready for potty training) and he was deliberately playing me up because I couldn’t pick him up or hold him or cope with tantrums. I spent a lot of my time eating for comfort and sleeping again.
You may ask which pregnancy was worse? I would say the first one most definitely. Second time round I was confident that the SPD would improve which it has; I am ten weeks on now and walking around normally. Getting up from sitting down is still hard work and I have to take a few moments for the pain to subside before I start walking, also turning over and just moving about in bed really puts a strain on that area, I also regularly feel my pelvis click back into place.
I had my three year old bundle of mischief to focus on and making sure he was prepared for the new arrival. I also organised the little things that made my life easier to walk and function with on a daily basis. The medical care this time round was super had I had regular appointments with my physio.
My consultant recommended a fantastic Osteopath and I saw him twice a week for about three months prior to the birth. He relieved pressure in parts of my body that were overcompensating for my posture and lack of mobility during the pregnancy and also my recovery to walking unaided stage, which took four weeks. I will see him at six weekly intervals until I can do the “can can” with no problems!! I have total confidence in him and he really understands women, the sheer agony of the condition and he is very charming (George Clooney .. move over)!
Things that made my life easier that I recommend –
ü A raised toilet seat
ü Support bars or a frame to help lift yourself on and off loo
ü 2 carrier bags on the seat of your car to help you swivel the 90 degrees easier
ü A grabber (B&Q about £5)
ü Don’t wear pjs as this restricts movement against bedclothes when swinging legs out of bed. Someone told me that silk sheets work with silky pj’s.
ü Keep your knees together and squeeze in your pelvic whenever you move position
ü Enrol as a member to PINS, Moira and her team have spent a long time and focused their passion into creating this superb website which is very detailed and informative – they deserve your support too.
If you would like details of my osteopath please contact firstname.lastname@example.org and we will be happy to pass them on.
If you would like details of my osteopath please contact email@example.com and we will be happy to pass them on.
For anyone reading this who is currently suffering from this condition I have full heartfelt sympathy for you as no-one can possibly understand what you are going through unless you have been through it yourself. On a positive note I am feeling so much better and recovering quickly and I sincerely hope you do too. Please feel free to drop me an email Rhondadow@hotmail.co.uk if you need to talk as I know how desperately I needed to talk to someone when I was going through this first and second time round.
Stay positive and focus only on the outcome… a beautiful baby, and a speedy recovery afterwards. When you come out the other side, you will be able to offer support to others and hopefully we can all join ranks in making this condition more recognisable in the medical world and hopefully a proper structured medical and care plan will be put into place.
One last thing…… on a positive note also…. Considering the condition was so awful in the first pregnancy – I did go on to have another baby which means I was either a bit loopy OR I forgot how bad it was (which is a positive comfort).