(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.
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