Managing pain in pregnancy

So the last few weeks, aside from being fairly excruciating, have been a fascinating learning curve into managing pain. So I’m writing this in the hope of offering some ideas to anyone else who (like me) might be scouring the Internet for answers to a very specific question: are there any simple, secret or simply lesser-known things you can do to relieve ongoing hip/back pain in pregnancy?

(Just a big fat disclaimer: I am not a doctor or a scientist. Everything here is purely anecdotal, based on my own experience. This is NOT medical information or research – it’s just my opinion, experience and some stuff I’ve tried. I’m not an authority on this stuff, and before you try any of this, you might want to check with [whoever it is you trust to advise you on this stuff].)

PS. If you want to skip to the quickest and coolest fixes, scroll down to #6 below. Though I’m hoping the rest is helpful too. I’d love to hear what worked for you – please leave comments and suggestions if you have any!

1. Figure out what’s causing it
In pregnancy, working out what exactly is causing your aches and pains is one big blind guessing game. The main culprits are a) relaxin, a hormone that’s busy causing your joints and ligaments to stretch and loosen, and b) your growing uterus – and baby – who are taking up an increasing amount of space, and pressing on bits of your anatomy from the inside in all sorts of ways. It may be just the way the baby is lying. Apparently, your tissues also retain more water during pregnancy, which means all the fine passages in your joint areas (wrists, hips, knees, elbows) get crowded with swollen tissue. This can cause rubbing against tendons and ligaments. 

If you have any pre-existing hip or back issues, these can be exacerbated by all these changes too. And, just to add to all this, no one can really look inside and see what’s going on, as it’s not recommended to x-ray pregnant women. So it’s all guesswork.

Still, it’s worth taking note of some obvious things: was there an injury? When did the pain start – was it sudden or gradual? What kind of pain is it – sharp or achy, throbby or stabbing? Is it continuous, or does it improve and worse at different times? Do different temperatures make a difference  – what happens when you apply heat or cold? Which movements are painful, and which offer relief? Are there particular positions that are particularly relieving or particularly painful? This kind of stuff will help you (and your doctor/physio/chiropractor/sympathetic friend) figure out where it’s coming from and what to do to help.

Common ones in pregnancy are pelvic girdle pain, round ligament pain and sciatica. Each are fairly different and respond to different kinds of things. Look them up on the internet and work out if one of those apply to you – how you deal with your pain will depend a lot on what kind of pain it is.

2. Go to a good chiropractor
Knowing what I do now, I think I might have gone to the chiropractor BEFORE I was pregnant, in order to get any spinal/skeletal misalignments adjusted. (If you’re planning to fall pregnant, I’d say it’s a pretty smart thing to do.) If your spine isn’t out of kilter to start with, you’re less likely to cause painful flare-ups in your joints, ligaments and tendons.

OK, but you (like me) didn’t have such far-ranging precognition so you didn’t do that. (It’s ok, who knew anyway?) So  now you’re pregnant and sitting/standing/walking/lying down is some sort of gruesome torture. Find a good chiropractor, preferably one recommended by a midwife. (I know, you don’t have a midwife, you have a gynae. Ask your gynae. If they don’t know one, Google a midwife in your area and phone and ask her advice. Midwives are about the most helpful people in the universe.)

The chiro will do some (possibly) scary tapping, twisting and adjusting of your spine, hips and neck. A good one will explain to you exactly which vertebrae, bones and muscles you’re working with at each point in the session. Your chiro may also give you some useful exercises to gently mobilise the sore areas, ease the pressure and encourage your frame to keep itself properly aligned.

I’d love to tell you that you’ll walk out of there like someone has removed all the daggers from your hips/back. Apparently some people do. For me, sometimes it felt better, sometimes it felt worse – before it felt better. Either way, if your pelvis is torqued or twisted, or your spine or neck, that’s going to continue to pressure your nerves, ligaments, tendons and muscles. You want to start by getting your skeleton more or less as decently aligned as it can be, so you’re not causing more pressure on the soft tissue.

3. Now go to a good physiotherapist
I know, I’m costing you a fortune here. I’ll get to some DIY pain-relief in a minute or two (you can scroll down; you probably already have. But bear with me here…) The physio does soft tissue work. That means incredibly skilled massage of the sore areas. Possibly taping of the sore areas. The physio may also give you some exercises to do at home. Don’t tune out and ignore this part… actually go and do those, even though they hurt like mad. Even if you can only do 30 seconds at a time.

4. Ice it
OK, I know it’s probably 9pm on a Friday night and you need relief RIGHT NOW, and your odds of finding an available chiro and physio are about zero until next Tuesday. Your secret weapon here is ice. Wrap some ice in a damp tea-towel, grit your teeth, and ice that sore area. I know that is the last thing you feel like doing. I promise it will help. Start there.

5. Bath with epsom salts
But actually you’re freezing and you don’t feel like ice. OK, amazingly, heat can also help. A hot bath will be a whole 20 to 30 minutes of relief. (Every minute counts, right?) There are also things you can add to your bath to help. Epsom salts contain magnesium which gets absorbed through your skin (yup, it’s fine for pregnancy). Magnesium regulates the way your muscles deal with inflammation and swelling. OK, truth is, I don’t really know what it does. You can look up the science and fill me in in the comments section. I just know that the chiropractor and sports massage people I’ve spoken to all say that it helps regulate what muscles are doing. I found it very soothing. It also does nice stuff for your skin.

6. Go shopping for some supplies!
You’re off to the pharmacy/health shop and you want the very satisfying thrill of Getting Stuff That Will Help. I feel you on this. Retail is a considerable part of healing. The tough part here will be getting your doctor or pharmacist to admit that there’s anything that is allowed for pregnant ladies. But you’ve done your Internet research, so you’ve found out about some of the secret weapons in this particular battle.

PEPPERMINT OIL
This was a gem from my marvelous neighbour, Julia. A little bottle of peppermint essential oil, plus a bigger bottle of a ‘carrier oil’ (that’s a neutral oil that you can add essential oils to – I got sweet almond oil, but you can also use grapeseed or even just olive oil from your cupboard.) Peppermint is the big secret here – it does amazing things for relieving inflammation. It stimulates circulation and cools the skin. Don’t make the mistake I did and leave it on your hands before putting moisturiser on your face – you will suddenly feel like you’ve been slapped in the face with some sort of peppermint flavoured deep heat. (Unless you like that kind of thing, in which case go for it.)

ARNICA ICE GEL
This was another recommendation from the chiropractor. It’s a blue gel with arnica, camphor, menthol and spearmint. It is AMAZING for any kind of sore muscles, bursitis, tendonitis. They use it for horses, and the jar I bought has a picture of a horse on the front. The common wisdom about arnica seems to be that you shouldn’t really ingest (swallow) it while pregnant, but topical application (ie on the skin cream/ointment/gel) is ok – just not over the uterus area.

TRAUMEEL homeopathic tablets
These are a homeopathic anti-inflammatory. The pharmacist was adamant that they’re ok for use in pregnancy, and I found several sites on the Internet endorsing that view. That said, they do contain arnica as an active ingredient, so perhaps you should check with your midwife before you make the call to take them. My gynae was suggesting a short course of more hardcore anti-inflammatories (Voltaren/Myprodol), so I figured I’d rather go with the lighter, homeopathic option.

PANADO (paracetamol)
I’ve been avoiding painkillers, as my issue with painkillers is that pain is fairly important to track – if something is very hurty, it’s maybe telling you not to step quite so heavily on that side, or not to use that muscle lest you make it worse. But. Pain can also be debilitating, so I’ve gone with a conservative approach of using as little as I can get away with, but as much as I need to remain a functional human being (and family member). If all I can do is sit in a chair and grimace and cry, I’d rather ease things up with paracetamol. I also think it’s worth taking enough of it to make sleep possible. Sleep is your biggest healing ally, and waking up repeatedly because of pain in a hip or leg is much less damaging than masking that symptom and getting the benefit of some hours of rest.

EPSOM SALTS
for your bath (see #5 above)

A HOT WATER BOTTLE
If you don’t already have one, get yourself a hot water bottle. Sleep with this thing propped against your lower back or hip or wherever it’s sore. Bizarrely, heat can soothe and relieve as much as ice (depending on the kind of pain you’re in). A word of warning here – when I went into labour with Molly, a hot water bottle against my lower back caused labour to speed up very fast. So if you’re in early labour and dealing with pain, bear in mind that hot water bottles can have some weird interactions with oxytocin. (Again, not science, purely anecdotal!!)

SLOW-RELEASE MAGNESIUM TABLETS
Again, magnesium does some mysteriously useful things to sore and inflamed muscle tissue. As far as I understand, slow-release magnesium is a useful thing to take as a pregnancy supplement (though definitely check this with your health provider and also take into account if you’re taking a pregnancy multi-vitamin that contains any considerable dosages of Mg.)

FRESH GINGER and PEPPERMINT TEA
Drink lots of water. Oddly, it seems water retention is worse when you don’t drink enough fluids. I find hot water with fresh ginger, some peppermint tea and honey has mysteriously soothing properties. I don’t know that much about the medicinal benefits of ginger, but I find there’s nearly nothing it can’t help. Sore throats, sore tummies, nausea and even muscle pain…. some sliced up ginger in hot water is up there with homemade chicken soup as one of the great panaceas. At the moment, I’m loving mixing it into fresh peppermint tea, maybe because of the whole peppermint anti-inflammatory connection. With some honey in because honey improves everything.

7. Acupuncture
People rave about acupuncture. I’ve had it recommended by midwives and doulas, and friends who swear by it. It hasn’t worked for me, but it does for many people (and it’s one of the few alternative healing practices that has surprisingly copious quantities of positive research findings backing it up.

8. Yoga, swimming, stretching
Admittedly, whilst barely able to cough, sneeze or walk, I haven’t been particularly inclined to leap into sweat pants and a tank top for a yoga class. Somewhere I do have a two-piece swimming costume that theoretically will fit over my bump, but since I’m barely able to get my socks on, I haven’t gotten there either. That said, some simple yoga stretches have helped enormously (child pose; simple mountain pose with upward arms; simplest warrior 1). And when this whole thing started, we were on holiday, and floating in the pool was about the most pain-free time of the whole trip. I think that’s because swimming takes any pressure off your joints – you’re gravity-free for a bit. Heaven. Stretches can make more space around the squished-up tendons and ligaments, and loosen things up fantastically. If you’re really lucky something will shift and the pain will subside – at least for a bit.

9. A last word on your mind, sleep and the placebo effect
When you’re paying close attention to pain management, you also have to do some very close and attentive listening to your body, and to what feels better and what feels worse. Your mood has a huge impact on this, and when you think you’re feeling better, then you are… and vice versa.

Getting enough sleep helps a LOT; without sleep I get weepy and self-pitying and everything gets harder to bear. Pain is worse too without sleep. It’s worth resorting to painkillers if that’s going to spare you a sleepless night.

Eating light – fruit, soups, wholesome stuff, drinking lots of water – it just FEELS better for your body, and suddenly things can feel lighter. That may or may not be a placebo effect, but the placebo effect is a super-powerful mind tool, and the reason that so many homeopathic and alternative techniques really do work. And if milky tea and chocolate biscuits are your comfort and soothing moment of choice, they can do just as much as a bitter medicinal brew. Do what works for you.

It’s also worth thinking in time frames, and which tactics work best for you at each time of day. For example, I do more of the cooling stuff (ice packs and arnica gel) in the mid-morning, whereas later in the evening as the temperature drops and the pain has a more ‘frozen’, seized-up feeling, I definitely need more warmth – hot water bottles, peppermint oil in warm sweet almond oil.

As I said, these are just the bits and pieces that have helped me along the way… I’d love to hear your suggestions and insights. To anyone who’s found their way here because they’re going through anything similar, thanks for reading and I wish you a blissful, painfree time. L x

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About Lisa

I live in South Africa with my husband and two small children, doing things, thinking about things and sometimes writing about them.
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