Birthlight Forums

Hi all, happy New Year

I have a lady in my class who complians of hip pain left lateral side of the illiac crest when laying on her left side. I have offered different leg positions and suggested semi supine but she is keen to lay on the left due to it being "the best position". I have suggested she change sides if she is in pain and to not worry too much about laying on the left is it is causing her pain. She was unable to straingthen the arm when pressing hands into wall for a forward bend and said it was too much for her left shoulder. Perhaps there could be a connection here? Any suggestions would be appreciated...........thanks

Hi Sarah.  A couple of things spring to mind:

• Have you tried a side (not prone) lying version of  Flapping Fish Pose (Matsya Kridasana) using sufficient support under the top leg to keep the pelvis level and under the head and neck to keep them in line with the rest of the spine?  This is a restorative pose which frees up the SI joint.  It would be most beneficial to practice on both sides, then use the left side for relaxation.
• As your student mentions difficulty on the left side shoulder & hip I wonder if there is some shortening on this side such as would be found with a scoliosis, but only a qualified professional could diagnose this. 
  

I'd suggest she get some physio/chiro/osteo type assesment to see what's going on and take it from there.  You don't mention how many weeks pregnant she is but if she's not in the latter stages of pregnancy then lying on the left side isn't absolutely essential.  Doing lots of stuff on all fours would give you the 'baby's spine to mummy's tummy' OFP too.

I hope this helps.

Kind wishes, Liz Brown.  

Thank you liz. I appreciate your response and advise.The lady is  23 weeks pregnant. I've encouraged the flapping fish position (I never knew it was called that!). She said last week its more of an intense pressure rather than pain on the left hip/thigh when she lays on the left, the right side is fine when she lays on the right..  Does that change anything? She commented that flapping fish did not ease anything but having a soft cushion under her took the pressure off a tiny bit. Any more suggestions? thanks again.........

kind regards

Sarah B x 

Hi Sarah.  Does this cause the lady problems at any other time or it is just when she lies on the left side?  'Pelvic Girdle Pain' can be in any part of the pelvis.  It's not uncommon in pregnancy to experience intense pressure in the hips when you lie on that side for too long, or if you're very slim and more padding is required between your hips and the floor.  If it's coming on immediately, even with padding and/or if it's causing her distress or making everyday things difficult, I'd refer to her GP for referral to a women's physio.  In the meantime you can keep her calm and encourage her to lie however she is comfortable during relaxation.  It would be interesting to know what the Physio says and if Francoise has any advice...?  Kind wishes, Liz.

Hi Sarah,

I am a Women's health/Musculoskeletal physio who has started training through Birthlight. Over the years I have seen a number of women who have developed lateral hip pain around this stage. It often coincides with the significant change in lordosis as the belly really starts to show over 20 weeks and any pre-existing structural problems are exacerbated. She may not have had hip pain in the past but assymetry in the body can start to show as the centre of gravity is moved forwards and the weight of the growing baby changes the dynamics within and outside of the pelvis.  A number of muscles attach to the lateral bone of the hip - the greater trochanter- including the gluteus medius, and a fluid filled sack called a bursa sit between the muscles to provide further cushioning. The gluteus medius has a prime role in stabilising the pelvis and is being challenged as the changing centre of gravity pulls the body forwards. Both the gluteus tendon and bursa can become inflammed and do not like to be compressed, particularly at night.  This side lying position also places a lot of pressure through the sacroiliac joints so will also show up any issues there.

 It is important that she is fully assessed by a Women's Health/pregnany Physio or Osteo specialising in musculoskeletal problems as an individualised approach is important and the earlier it is addressed, the better as women can often become quite fearful of pain worsening with the pregnancy and often these pains are dismissed as 'normal' part of being pregnant (which I don't agree with). If treated and managed well, this problem can easily go away. It is really important that she becomes aware of her posture in all positions. It is highly likely that she weight bears more on one side than the other (and contrary to logic, it is often the painful side that is taking more weight - hence getting sore) - whether it be in standing or sitting. It is also important that her shoulders are aligned over the pelvis as shifts in the upper back can lead to assymetry in the pelvis and hips. She can also have tight gluts and piriformis - again this needs to be assessed but often these stretches can be incorporated through yoga poses. I find that a combination of gentle hands on release work, postural advice, functional training of movements (ie sit- stand, standing, walking, lie to sit, stairs etc), awareness of breathwork and acupuncture works really well to clear the pain and get women back on track and appropriate yoga reinforces the alignment, patterns, breathwork and movement. It is also important that she learns to listen to her body.

What she is doing by day will affect the pressure by night. Is she wearing high heels or appropriate comfortable footwear?  Is she carrying a toddler or heavy work back on one shoulder? Is she sitting with a twist at a desk etc. etc. Whilst you may not have time to go through all this in a yoga session if you have the chance it can be really helpful - people can often problem solve really well if you point them in the right direction. Awareness builds awareness and they become empowered that they can be in control of their symptoms and come out of the episode more aware of their bodies and strengthened.  At night, it is important that her left hip and left waist is given some support. Often rolling a normal sized bath towel into thirds and placing it lengthways across the bed so that her her waist rests on it helps to square the body and takes the pressure of the lateral hip. Hugging a pillow also gives the upper body support, and having a pillow between the knees can help spread the weight so it isn't all on the lateral side of the hip (over the greater trochanter). Sometimes placing the pillow behind the back can also help so that she is 1/4 off supine (her back) and not directly over the hip if she will only sleep on her left side at this point in time.

 I know this is sometime after the initial post but if she is still having issues, I hope this helps! 

Good luck, Wendy

HI Wendy

This was really useful, thanks.

Fortunately, the lady's symptoms have subsided somewhat but now, unfortunately, she is suffering with PGP instead. 

thanks again

Sarah B x 

Hi Sarah, PGP can sometimes start with lateral hip pain before moving more centrally to the pubis or sacroiliac joints/buttocks and sometimes the pain moves around depending on what has been done. The same alignment principles will still apply and the same sleep positions etc. mentioned above can sometimes give relief. It is important that she becomes aware of her posture and engages her different slings of muscular support - through the pelvic floor, lower abdominals. The yoga whole body breathwork can also be helpfulto encourage relaxation and an internal massage to the uterus/kidneys/pelvic floor and associated musculature as often there are patterns of two much tension in some muscles (such as the adductors and piriformis, hip flexors) and not enough support in other areas (such as the different parts of the pelvic floor, gluteals, deeper portions of the psoas and lower abdominals).  If you are Birthlight trained there is an excellent CPD article on PGP and the Birthlight approach in the member's section which you may find helpful if you haven't seen it already. 

 I find that sacroiliac belts can be helpful however I favour a particular style of belt where the support you add can be assymetrical, depending on assessment findings. Some people don't get along with the belts through, sometimes they aren't fitted appropriately and sometimes the general belts that give circumferential support without the assymetrical bias can provide compression in the wrong spots for that individual.  Also, the belts will only provide limited help if the daily postures, assymetries and movements aren't addressed. 

Gowri Motha has a good section on relaxation and massage techniques during pregnancy in her book 'The Gentle Birth Method'. Her creative healing massage technique which can easily be done by partners - it is very gentle, very soothing and good for stimulating lymphatic flow around the trunk and pelvis and can be very helpful for PGP. She also emphasises cutting down refined products etc. during pregnancy and anectodally I have found that helpful for a number of clients with PGP.

 I have found that PGP can be be managed well during pregnancy if all the pieces of the puzzle come together - treatment/self management/yoga/relaxation/nutrition etc. Many women become fearful that it will escalate  and restrict/prevent natural birth but in many cases, the opposite is true and they can birth really well so it is important to empower her with tools to manage it well.

Good luck!