How to Treat Back or Pelvic Pain During Pregnancy – With Dr. Anuja Mathew

(uplifting upbeat music) – Welcome my friends, to
the Bob and Brad Podcast, produced by Bob and Brad, the two most famous physical
therapists on the internet. I am Bob, who is, and I'm exactly one half of the Bob and Brad team. Today, I'm going to be
joined by our guest, Dr. Anuja Mathew, she's
a physical therapist with a Doctorate in Physical Therapy and a Master's Degree in Physical Therapy. She also is certified
in orthopedics with an Orthopedic Clinical
Specialist certification and that's earned by the, by only 5% of the physical
therapists across the country.

She's also trained in women's
health and pelvic floor. She's been in a practice for 10 years. She's kind of an expert on
women's healthy conditions, such as urinary incontinence, pelvic pain, pubic synthesis dysfunction,
diastasis recti, prenatal and postnatal rehabilitation. So we'll get into a lot
of those subjects today. Please join me in
welcoming, Dr. Anuja Mathew. All right, Dr. Anuja. How do you pronounce
your last name, Anuja? – Matthew. – Matthew, just like it looks like. – Yes. So I'm talking to Anuja Mathew. Thank you so much for
being on our program today. – Thank you. – So we prepared some questions, thought we'd jump right into it and we gave your background already.

So everybody knows of your
impressive background. (soft laughing) – Very good, let's jump right into it. – Good, you see a fair
amount of women with, who are pregnant? – Yes, pregnant and postpartum… – Gotcha. – …after their delivery as well, yes. – Yeah, so do you see a lot of back pain? – Actually, a lot of them,
most of them would come in with back pain during pregnancy, some of them after pregnancy. And usually I've seen that
most women will get back pain either during their
pregnancy or afterwards.

– Sure, makes sense. – It depends, yeah. – So what, what would you
say is the most common, you know, type of back pain
you're seeing with pregnancy? – So most women actually come in with a diagnosis of sciatic pain, but when you evaluated them, I just, you know that
it's not sciatic pain. It's like a sharp shooting kind of pain that goes down your leg. But it is something that's
called a pelvic girdle pain or an SI joint pain that, kind of, refers down to your buttocks,
to your lateral thighs. Sometimes also going down to your calf. But very rarely does
it go down to your feet or your foot or the top of your foot. So that's the most common
type of pain presentation, that I see, the other type there's just general low back pain, mostly
later into the pregnancy when the whole biomechanics
of their body shifts.

You know, the belly is growing bigger, there's more strain on your back. And that's just the general low back pain which is not radiating to your leg. – So the pregnancy makes
it difficult to treat. – Yes. (soft laughing) – Lot of challenges. – A lot of challenges, yes. Your body's growing, all
the ligaments are relaxing, they're stretching out, your
muscles are stretching out. Doesn't make it easy for your body to maintain the stability it needs to. – Yeah, isn't the hormone
relaxing or something like that, it's actually… – I know, it's supposed to be relaxing – …yeah, yeah.

– But actually causes
the most problems there. – Right, right, exactly. – Yeah so, and a lot of women actually, even before they get into
their second trimester were experienced low back
pain or SI joint pain, just because of all these ligaments stretching out or just relaxing. There's been some the
correlation where they say that if you have gluteus medius weakness, you might end up having lower back pain because that's the main
stabilizer of your pelvis when you're walking or standing. – The gluteus medius, just
for the lay person out there, it's a muscle on the
side of your hip that… – Yes – …that helps to stabilize
the well, the femur too, right? – Yes.

– So what, what else do
you do for these people? I mean, for these women, what are some, can you describe some of the
things you try with them or? – Yeah, so most of it actually is, a lot of posture correction, the way they sit, they stand,
the way they're walking. The other thing is a
stabilization exercises and most of them will get better with hip stabilization exercises. Even if they do it for a couple of weeks, they're, they're much better later on in the pregnancy as well. – Nice. – And most of the exercises are
safe to do during pregnancy. And they're very comfortable, most of them include stretches, some amount of glute
stretches, hamstring stretches and the others will include strengthening of those glute muscles.

Also then some introduction
of your core stabilization or the awareness of your core muscles. And most people do it wrong, they're just, you know,
sucking in their belly, thinking that they're
activating their core, so a lot of it is also integrated
with breathing exercises or diaphragmatic breathing along
with relaxation techniques. – Do you, do you recommend
a belt or not, an SI belt? – So I do recommend an SI belt but it depends, like, the
evaluation is so important.

The patient should have a
side joint related symptoms. If it's someone with just
a regular low back pain which is located just in their lower back and radiating out in their lumbar area, they're not going to benefit
from the belt really. But if they do have a pain where it is on their buttock
or where your sacrum is radiating out on your buttocks or your pelvic area in the
front going down your thigh, if you give them the belt, you actually notice a
difference immediately, like, you give them the
belt, you make them walk, they should feel a difference, at least a reduction in the pain.

(crosstalk) – It's not something that
you grow into, I mean. – Yeah, yeah.
– It helps right away. – Yeah, it helps right away. And that's when you know that
it's the pelvic stabilization that they need, which will
help them with the pain. That being said, that's not
the only go-to thing there. You're not just gonna go get a belt and wear that and you're fine. You still have to activate those muscles that are needed to
stabilize your pelvis, so.

– You mentioned the walking. What is it that people do
wrong when they're walking that may cause the SI pain? – So even when you're walking,
your pelvis is rotating, right, left, right? So it's going into, so it's
rotating forward and backward as you take a step forward. With relaxation of your ligaments, there's not a lot of movement that happens between your sacrum and your ilium or the pelvic bone that is there. When your ligaments are relaxed, there could be a lot of movement that you don't want to happen.

– Sure. – And if these people have weak muscles in their pelvic floor or
in their hip or their core, that movement is going
to cause a lot of pain. – It does. – Not just with walking, in fact, most people notice it with stair climbing when their legs are actually
going in opposite direction, getting in and out of a car, even turning in bed or getting
out of bed will be painful just because of the amount
of movement that happens at the pelvis and the sacrum that's not supposed to happen.

– Yeah, kind of a micro movement going on. – Yeah, yeah. – So yeah, it's interesting, I was just watching a
video by Stuart McGill, I don't know if you know who he is but he wrote the 'Back Mechanic'. He's kind of a renown back expert. And he was talking about doing
split squats with weight. – Uh hum – How they're finding that
it's causing the SI problems.

– Yeah, because… – Fine to do split squats without weight, but with weight that actually brings on. – …irritates. – Yeah, irritates and
stretches out the SI, just like, you're kind of, so, I mean, some women too, just by
sitting incorrectly, correct? I mean, if they, kind
of, sit on one side more. – Yes, leaning on one side, yes. Even that could cause pain, even just prolonged sitting
could cause that kind of pain. – Yeah, it's a, a problem of society, I mean, lots, lots of
walking, correct, I mean? – Yes, yes, walking is always good. Even more than just walking, switching positions or changing positions. If you're standing for too long, sit down. If you're sitting for too
long, stand up and walk.

– Good, good point. – So to avoid something that's
sustained for a long time. – A static position,
you want to avoid that. – Yeah. – Yeah, so with the, with the belt, did you ever just squeeze on the ilium? – So it's usually, (laughs)
so the way it's worn, is you stand up upright and it's worn right above your trochanter or where you're you feel
your pelvic bone there and it's very low, it's not on your belly, it's right below where your belly ends. You stand with your feet
together, you put it on, you're not really squeezing it tight, it has to be comfortable. You should be able to
sit with it comfortably and you can take it off when
you're sleeping at night but you're supposed to
wear it throughout the day. – Gotcha, it makes sense. Now I'm, I'm assuming that you get to see the diagnosis of sciatica
a lot because people think as soon as it's, the pain is spreading out that it's, it's sciatica.

– Yes. – Is that what you think is going on? – Yeah, most of them, yes. Even people, they just
come in and they say, "I think I have sciatica." – Right, right. (crosstalk) – Even if it's just in their buttock, it's sciatica for them. – Exactly. (crosstalk) – The honesty to say, only
1% of pregnant patients with low back pain,
actually have sciatic pain and that could be related to something they even
had before pregnancy unless there's a real herniated disc there that is causing the sciatic pain because of the change
in your muscle strength and everything later on. – Any other common pain that
you see with pregnancy, that? – Yes, so there's also a
pubic synthesis dysfunction or the pubic bone pain, that
I've seen in a few patients.

This, it depends on the onset of it. Some patients have had it even in the, initially in the first trimester, but most of them will have
it later on in the trimester when it's actually stretched out more. And this pain is usually in the front of, it's right under your belly, it's on your pubic bone in the front and it could radiate. – Comes around and attaches
right at the front. – Yes, so it's right in the front, it could radiate into your groin
area, into your inner thigh or it could also radiate
to your lower back. So that also could cause
lower back pain for you. And these patients, you know immediately that it's a, it's a pubic synthesis pain. It's very specific. They'll say that they have
pain when they stand on one leg or they're climbing stairs.

It's like, they feel like they
clicking or something moving. That's another kind of pain that we see. (crosstalk) – They'll feel the pain, the
clicking in the front, I mean. – Yeah, front and also in the back, they also complain of clicking
in the front or the back and usually this pain
will go away postpartum. Only few women will actually
have this pain even postpartum. – Sure – But for these kinds of patients, yes, the stabilization works. But for them, it's also
avoiding a lot of things. And if it gets really, really severe then the only thing they can do is rest because it is that bad. And it is that painful and severe. – So really stop the cause. – Yeah, I have seen a few
patients with that kind of pain. Luckily, it hasn't been that severe that they had to go on complete rest. The belt helps all the
stabilization exercises, definitely help, also, if
you have a weak pelvic floor, it's one of the reasons
why it could also cause it.

(crosstalk) helping with pelvic floor. – We'll be talking a
little bit about that later but so you have them do
the pelvic floor exercises. – Yes. – And that often helps. – Yes. – Sure, but does it, when do you do the pelvic floor exercises, what length of time do you normally see, does it take for it, to see some benefit? – So during, during pregnancy we're actually not looking
to strengthen something a lot because everything is stretching out. During pregnancy, you're
just trying to maintain and prevent anything that
could happened later on. So we're not also, when we
do get a pregnant patient, very rarely would we do
an internal exam for them unless it is actually
advised by their OBGYN. So it's more to do with getting them an awareness of their
pelvic floor, where it is. And during pregnancy, more than actually doing the strengthening it's also important
for them to do relaxing 'cause that's what's gonna
help them during labor. So if you're just doing
strengthening and tightening and tightening and increasing the tone of the pelvic floor muscles so much and not relaxing it then you're not helping it during the labor.

– So hyper tonicity… – Yes. – … and the muscles get fired up and they won't relax and that
pain, that's pain itself, so. – Yes, so later on in the pregnancy, it's more about when
you contract the muscle to feel the contraction
but more than that, to also feel it come back
to the resting position or to feel it come back
into a relaxed position where you feel it stretched out or relaxed and not just contracting. – You may mention this later
or talk about this later but do you use any biofeedback with people who have pain like this? – So I, in my clinic, don't
use biofeedback at this moment. I used to initially in my practice, now I usually just use tactile feedback more of their own awareness which has actually helped
more than biofeedback. I used, I mean, I'm not saying that you shouldn't be using it.

There are practitioners who
use it very successfully. But with me, I felt that I
did better with the patient. The patients did better
with more tactile verbal or their own awareness
of all these things. – Well, makes sense to
me because then you can bring it to your own home. – Yes, yeah. – Where you can get feedback so. (uplifting upbeat music).