How Pelvic girdle pain is caused during pregnancy

Pelvic girdle pain refers to musculoskeletal conditions affecting the sacroiliac joints, symphysis pubis and surrounding ligaments and muscles. It will affect about 1 in 5 Northern Beaches mothers but can also develop outside of pregnancy.[1]

The pelvic girdle is a ring of bones around your body at the base of your spine and when the three joints in your pelvis work together normally, they move slightly. Pelvic girdle pain is usually caused by the joints moving unevenly, which can lead to the pelvic girdle becoming less stable and more painful.

What does pelvic girdle pain feel like?

“I’m normally like a socially active person. It has made me the most miserable anti-social person. . .cos I’m in too much pain”

 “Constantly feeling like your pelvis is going to fall off.[2]

Pelvic girdle pain used to be known as symphysis pubis dysfunction (SPD), but it still causes the same high level of pain it always did.

Pelvic girdle pain can affect your mobility and sharp pain when you are walking, climbing stairs and turning over in bed are common symptoms.

What are the symptoms of PGP?

Symptoms include:

  • pain in the pubic region, lower back, hips, groin, thighs or knees
  • clicking or grinding in the pelvic area
  • pain made worse by movement

However, early diagnosis and treatment can relieve your pain. Treatment is safe at any stage during or after pregnancy.

What causes Pelvic girdle pain?

As your baby grows in the womb, the extra weight and the change in the way you sit or stand can put more strain on your pelvis. You are more likely to have pelvic girdle pain if you have had a previous back or pelvis condition or have hypermobility syndrome; a condition in which your joints stretch more than normal.

What are my treatment options?

Your Fixio physio will be able to suggest the right treatment for your needs. This may include:

  • advice on avoiding movements that may be aggravating the pain
  • exercises that strengthen your abdominal and pelvic floor muscles and can help relieve your pain and allow you to move around more easily.
  • manual therapy to gently mobilise the joints and help them move normally again. This should not be painful.
  • warm baths, or heat or ice packs
  • acupuncture or dry needling. Women receiving acupuncture or physiotherapy reported less intense pain in the morning or evening than women receiving usual antenatal care[3]

Pelvis girdle pain is not something you just have to put up with until your baby is born. The outcomes for women with pelvic girdle pain during pregnancy are good, with 9 out of 10 of women reporting most symptoms subside after about 3 months of giving birth. However, pelvic girdle pain frequently recurs in subsequent pregnancies, with the painful symptoms no less painful.


[1] Chou LH, Slipman CW, Bhagia SM, Tsaur L, Bhat AL, Isaac Z, et al. Inciting events initiating injection-proven sacroiliac joint syndrome. Pain Med 2004;5(1): 26e32.

[2] Clarkson, C. E., & Adams, N. (2018). A qualitative exploration of the views and experiences of women with Pregnancy related Pelvic Girdle Pain. Physiotherapy, 104(3), 338–346.

[3] Pennick V & Young G (2007) Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Sys Rev 2007 Issue 2. Art. No.: CD001139.


What is a Bankart lesion?

Shoulder instability and recurrent shoulder dislocations are the cause of a lot of visits to Dee Why physiotherapists and shoulder surgeons.

The root cause of shoulder instability can be a number of different conditions, and the most commonly injured structure following a shoulder dislocation is the anterior labrum, AKA Bankart lesion.[1]

What is a bankart lesion?

The Bankart lesion is named after English orthopaedic surgeon Arthur Sydney Blundell Bankart.

The shoulder socket, or glenoid is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilise the joint. During anterior shoulder dislocations (when the humeral head is displaced towards the front) the labrum may be torn. Labral tears and other lesions are also common in athletes and workers that use repetitive overhead activities.

After a dislocation in young patients, instability recurrence rate has been reported to be up to 90%.[2]

Occasionally a bony piece of the socket will fracture off with the labrum; this is imaginatively called a “bony Bankart” lesion.

Symptoms of a Bankart lesion can include:

  • Pain when reaching overhead, to put the seatbelt on and daily activities.
  • Instability and weakness that causes apprehension about moving the shoulder into certain positions away from the body. Low energy movements, like rolling over in bed commonly mentioned as times when their shoulders can ‘slip’.
  • Limited range of motion.
  • Grinding, catching, locking in place, or popping

Bankart lesions are commonly treated using conservative methods such as rest, immobilisation, and a physiotherapy program, particularly in older patients.

However, many cases require surgery to reattach the torn labrum to the socket of the shoulder performed through arthroscopy.

As with any surgical procedure, there are risks associated with arthroscopic Bankart repair that may include:

  • Bleeding
  • Infection
  • Blood clots
  • Shoulder stiffness
  • Blood vessel or nerve injury
  • Post traumatic arthritis.

Early physio rehab goals after bankart repair surgery

After arthroscopic Bankart repair, you will generally be required to keep your arm immobilized in a sling for approximately one month but physio will usually start within the week.

Once you have had surgery to repair your bankart lesion, Early goals for your surgery rehab will be to:

  • Protect surgical repair
  • Reduce swelling, minimise pain
  • Maintain range of motion in the elbow, hand and wrist
  • Minimise muscle inhibition
  • Educate you on your injury and ways to minimise recurrence

After surgery it is important to

  • Not overstress healing tissue
  • Gradually return to full functional activities
  • Do your rehab exercises
  • Listen to your physio

Be sure to follow your bespoke treatment plan. Although recovering from shoulder surgery can be a slow process, your commitment to physiotherapy is the most important factor in returning to all the activities you enjoy without pain or fear of instability.

[1] Bankart ASB. Recurrent or habitual dislocation of the shoulder- joint. Br Med J. 1923;2(3285):1132-1133. doi:10.1136/bmj.2.3285.1132.

[2] Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first- time, traumatic anterior dislocations. Am J Sports Med. 1997;25(3):306-311. doi:10.1177/036354659702500306.


How to take care of Rheumatoid Arthritis

Osteoarthritis and rheumatoid arthritis are very different diseases managed very differently, but are often confused when people come in to my Northern Beaches office to talk about their sore joints.

Although both cause pain and damage to joints, the damage occurs for different reasons.

How are rheumatoid and osteoarthritis different?

Rheumatoid arthritis differs from osteoarthritis because in rheumatoid arthritis it is the faulty immune system that causes inflammation, while in osteoarthritis the joints become damaged through wear and tear.

Your immune system is an intricate mechanism that enables your body to defend itself against bacteria, viruses and other organisms that want to invade it. A healthy immune system knows which of these are foreign to the body and which ones belong, the rheumatoid arthritis sufferer’s does not. If you have rheumatoid arthritis, your immune system sends antibodies to the lining of your joints, where instead of attacking harmful bacteria, they attack the tissue surrounding the joint.

Osteoarthritis normally starts later in life than rheumatoid arthritis and along with joint pain, some rheumatoid arthritis sufferers feel tired or generally unwell when inflammation occurs. In rheumatoid arthritis it is also possible to have inflammation in other organs as well as the joints, for example, the lungs and blood vessels, but usually it is the joints that are affected.

Having rheumatoid arthritis means that your joints are much more vulnerable to damage than other people’s joints are.

If you have been diagnosed, it is important to start rheumatoid arthritis treatment ASAP

The word pain is derived from the word poena, which means punishment. And that’s exactly how many rheumatoid arthritis sufferers describe their pain.

Even though rheumatoid arthritis can’t be prevented, there are a number of strategies that can minimise its impact on your life. Early treatment of Rheumatoid arthritis has been shown to slow the progression of joint damage in most patients, helping to prevent irreversible disability.

Before starting treatment, your Fixio physio will determine your needs based on any current incapacity, disability, and handicaps.

One of the key issues for anyone who has rheumatoid arthritis is dealing with pain, stiffness and discomfort. Many people with rheumatoid arthritis rank pain as the most important symptom to be treated.

Your physio will ask you a number of questions about your:

  • limitations in daily functioning,
  • pain,
  • morning stiffness,
  • muscle strength,
  • joint range of motion,
  • joint stability,
  • limitations in leisure activities,
  • aerobic capacity and
  • limitations in work situations

Your joints will likely be checked for the presence of swelling, tenderness, loss of motion, and deformity.

Your physiotherapy treatment may include:

  • The application of heat or cold to relieve pain
  • Rest and splinting during rest to reduce pain and improve function
  • Education on safe exercising for your needs
  • Relaxation techniques to relieve secondary muscle spasm

Staying active with rheumatoid arthritis is a balancing act

Too much heavy weight bearing exercise such as jogging, jumping, lifting can overload already painful eroded joints. But people who have rheumatoid arthritis need strong muscles to support their joints, particularly if they are damaged due to cartilage erosion.

Pain and stiffness from not keeping active can often lead patients to avoid using the affected joints. This lack of use can result in loss of joint motion and muscle atrophy, decreasing joint stability and producing a further increase in fatigue and weaker muscles.

This is where an expert physio can guide you through a bespoke exercise program.

Objectives of physio treatment of rheumatoid arthritis are to

  • prevent disability,
  • to increase functional capacity,
  • to provide pain relief,
  • and to provide patient education.

If you have been diagnosed with rheumatoid arthritis or would like more information regarding your specific pain, give us a call to book an appointment with one of our Fixio experts.


How physiotherapy helps in recovering stroke

Your brain is fed by blood carrying oxygen and nutrients through blood vessels called arteries.

Stroke is the term doctors use when blood cannot get to your brain because of a blocked or burst artery, causing your brain cells to die due to a lack of oxygen and nutrients.

Up to 1.9 million brain cells may die every minute when they do not get enough blood.

What is a stroke?

There are two main types of stroke:

Ischemic strokes are caused by a blockage in one of the blood vessels that supply oxygen and other important nutrients to the brain. The majority of strokes are ischemic.

Haemorrhagic strokes occur when blood vessels in the brain leak or rupture, causing bleeding in or around the brain. This can lead to pressure within the head, which can cause damage to the brain.

Strokes can cause long-lasting disability or even death. However, early treatment and preventive measures can reduce the brain damage that occurs because of stroke.

What are the symptoms of stroke?

Every stroke is different. How a stroke affects someone depends on where it happens in the brain, and on how big the stroke is. Signs and symptoms of a stroke may be similar to other conditions; the only way to know for sure is to be seen as soon as possible by an experienced doctor or nurse.

The symptoms of a stroke usually begin suddenly but sometimes develop over hours or days, depending upon the type of stroke.

In both ischemic and haemorrhagic stroke, depending upon the area affected, a person may lose the ability to move one side of their body, the ability to speak, or a number of other functions.

Knowing the signs and symptoms of a stroke can be lifesaving.

Classic stroke symptoms can be recalled with the acronym FAST, or BE-FAST with each letter standing for one of the things you should watch for:

  • Balance – Is the person having trouble standing or walking?
  • Eyes – Is the person having trouble with their vision?
  • Face – Sudden weakness or droopiness of the face, or problems with vision
  • Arm – Sudden weakness or numbness of one or both arms
  • Speech – Difficulty speaking, slurred speech
  • Time – Time is very important in stroke treatment. The sooner treatment begins, the better the chances are for recovery. Call an ambulance right away.

What are the risk factors for stroke?

There are a number of risk factors for stroke; some of these factors increase the risk of one type of stroke, while others increase the risk of both types.

Ischemic stroke risk factors include the following:

  • Heart disease
  • High blood pressure
  • Smoking
  • Diabetes
  • High blood cholesterol levels
  • Inactive lifestyle and lack of exercise
  • Obesity
  • Current or past history of blood clots
  • Family history of cardiac disease and/or stroke

Haemorrhagic stroke risk factors include the following:

  • High blood pressure
  • Smoking
  • Illegal drug use
  • Use of warfarin or other blood thinning medicines

Following a stroke, you should be assessed by a physiotherapist as soon as possible

After a stroke, our brains cannot grow new cells to replace the ones that have been damaged, but the brain has the ability to reorganise its undamaged cells and make up for what has been lost. This is called neuroplasticity. This process can be guided by the rehabilitation you receive following your stroke, and your physio will provide expert guidance on how to relearn movement and regain function.

Physiotherapists specialise in treating issues related to motor and sensory impairments; helping to restore physical functioning by evaluating and treating problems with movement, balance, and coordination exercises.

A physiotherapy program for stroke rehabilitation may include exercises to strengthen muscles, improve coordination, and regain range of motion.

During physiotherapy you may do exercises to strengthen weak muscles and build up your stamina. Stretching exercises can reduce muscle and joint stiffness. You may also work on specific skills that you need to improve. For example, if you are having difficulty keeping your balance, you may be asked to stand up a lot. If you have difficulty lifting your arm, you will need to do activities that make you lift and use your arm. If you are having difficulty walking you need to walk as much as possible.

You may work on a one-to-one basis with a physiotherapist, particularly on the tasks and the movements you are re-learning to do. You will also have home-based activities to do on your own outside of therapy sessions.

Most people recover quickly in the first weeks after their stroke and when you start physiotherapy, your physio will plan and set goals and exercises with you.

You should have physiotherapy for as long as you need it, ending when you have reached your goals, such as walking or improving your balance.

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