Core Stability

 There has been much research and interest in this area in recent years and many health professionals are now trained in and using core stability work in their day to day practice when treating people with pelvic girdle pain.

There are essentially two types of muscle:

Muscles which stabilise your joints before any movement actually occurs - the "core muscles" or "deep spinal stabilising muscles"

Muscles which actually move joints

Under normal circumstances there is a small amount of movement between the joints of the pelvic girdle.  Before you undertake any day to day activitiy, such as walking, standing or sitting these muscles act to keep your spine and pelvis in a stable position.

Within the low back and the pelvis the stabilising muscles are:

Transversus abdominis - the deepest abdominal muscle

Pelvic floor

Multifidus - the deepest back muscle

The respiratory diaphragm - breathing muscle

These muscles work together to act as a special "corset" for your back and provide support and protection for your spine and pelvis during the most minor activities. Every time you stand, sit, walk, or run they anticipate that you are going to do something and activate before the movement actually takes place.

In people with pelvic girdle pain there is often asymmetry in how the pelvic joints move with one joint having become stiffer or more mobile than the others.  The body will try to compensate for this by getting some muscles to work harder than usual (become overactive) to try to stabilise the pelvis. The over activity in these muscles can result in some other muscle groups becoming less active than usual. A vicious cycle then develops with over activity in some groups of muscles and under activity in others, often the "core or "deep stabilising" muscles. The order in which these muscles normally activate to stabilise the pelvis may also be faulty.

In treating pelvic girdle pain,  the challenge is in  getting these core muscles to work in the correct order  and  and this may take considerable time and patience under the expert guidance of an appropriately trained therapist.  

 In the early stages of treatment your physiotherapist may apply taping or fit you with a pelvic belt to encourage your muscles to start working in the correct pattern again.

Ultrasound Retraining

Some practioners use ultrasound imaging as a useful tool in retraining the core muscles. 

The patient  is able to see the muscles working live in action on the screen and to learn the correct pattern of muscle activation.

Clinical studies have proven that people who specifically re-train these control muscles can significantly reduce the risk of recurring back pain and some physiotherapists have also used this technique to retrain the pelvic floor.

Hints and Tips:

Based on our own experiences and those of others:

Before starting on retraining the "core muscles" it is firstly important to deal with any other problems. As mentioned above there is often asymmetry in the way that the sacro iliac joints at the back of the pelvis move and certain muscles often become tight and overactive to compensate.  What is required will depend on your own individual circumstances and you may require a lot of work on the "soft tissues" first before starting on "core stability" work. Beware of a therapist who launches you straight into an intensive "core stability” programme without addressing these other areas first.

 To begin with it can be very tricky to get these muscles to work properly. Learning proper breathing techniques is important. For activating the "core muscles" some people find visualisation techniques helpful, for others exercises on a gym ball can be a good method of getting these muscles to work properly- your therapist will work out which technique is best for you and check that you are doing the exercises correctly. It can be very frustrating to start with but it is well worth persevering.

Unlike many other muscle groups in the body, these muscles work at a low level most of the time and getting them to work at the right time and in the right order is what is critical here not muscle strength. The exercises are often very subtle - you are not looking to contract the muscles strongly.

 Research has shown that an individualised programme of exercises works best.

 You may pick up the exercises quickly or it might take a great deal of trial and error and a lot of time and patience with many doubts along the way.  Controlling over active muscles in other areas may well be a bigger challenge than getting your tummy muscles to work.  Don't compare yourself to others with similar problems - you will get there!

Once you have got the hang of activating your "core muscles" correctly your therapist will give you further exercises to do to stengthen other muscle groups which are not working as effectively as they should be.  For example the gluteal (bottom) muscles are an important group of muscles which help stabilise the hips and they  are often weak in people with pelvic girdle pain.Also  the hamstrings muscles at the back of your thighs are often tight. Again the exercises are tailored to the individual.

Exercises which incorporate functional activities of daily living  will also be included. e.g getting in and out of a chair etc

 If you have previously tried and failed with these types of exercises you are not alone but it would be well worth seeking treatment from a specialised musculoskeletal physiotherapist. Personal recommendation can be a good way of finding a physiotherapist with a special interest in this area.

Pilates can also be helpful in managing Pelvic Girdle Pain but ask  the therapist who is treating you for advice about this in your own particular circumstances. Many people find it difficult to do the exercises properly and as  this is crucial to their success  we would personally recommend pilates on and one to one basis at least until you are confident in the techniques used. Many physiotherapists are now trained in pilates and this would be a good option to consider.

A personal Account of core stability and pelvic girdle pain

Click here if you would like to view  a personal account of pelvic girdle pain written by our Chair Moira Finlayson in which she describes her experiences of pelvic girdle pain and core stability work.

Find or recommend a physiotherapist

If you would like to recommend a physiotherapist, please contact us at the email address below  and we will  pass on the details to others in your area who are looking for a physiotherapist to treat them. Likewise if you are experiencing difficulty in finding a physiotherapist to treat you please contact us.

Contact us at info@pelvicinstability.org.uk

 Reference:

Stuge B, Laerum E, Kirkesola G, Vollestad N 2004 The efficacy of a treatment program focusing on specific stabilising exercises for Pelvic Girdle Pain after pregnancy. Spine 29 (4) : 351