2020/21 working mums-to-be
2020 was a year many people experienced sudden changes to their working practices. Many started working from home having to adjust to changes in their technology, environment and how they worked, all in a relatively short period of time.
I work both privately and for the NHS as a Specialist Physiotherapist looking after women during and after pregnancy and women with gynaecological or pelvic floor problems. 2020 saw an increase in women suffering pregnancy related musculoskeletal disorders which may well have been exacerbated by changes in working environment. Many women suddenly found themselves working at the dining room table or in a cramped spare room, and not having to leave the house to go to work, meant they also had a less active lifestyle.
What would be my simple advice to pregnant women finding themselves in this situation?
The first thing to do is make sure your employer is aware you are pregnant. There is no legal requirement to conduct a separate risk assessment for pregnant women, however, employers have a responsibility under Health and Safety Law to provide a safe working environment and a risk assessment would ensure this. It should consider your health and wellbeing and identify and mitigate any potential risks. Some women worry about using computer screens during pregnancy, but the most recent research shows no evidence of any risk to your baby from visual display units or computers. (“Scientific studies have not shown any link between miscarriages or birth defects and working with DSE”. HSE 2020)
The first most common problem I see women referred for are pain in the lower back and pelvis. 50 - 70% of women experience lumbo-pelvic pain or Pelvic Girdle Pain (PGP) during pregnancy.
There are many factors that may contribute to the development of PGP, including; heavy workload, poor workplace ergonomics and awkward working conditions. This may be due to altered biomechanics causing the pelvic girdle joints to move asymmetrically. Other factors include: multiple pregnancies, hormonal changes, the position of the baby, high body mass index, general joint hypermobility or previous injury to the pelvis. If it is not your first pregnancy and you have experienced PGP in the past, then you may be at a higher risk of experiencing similar pain in subsequent pregnancies.
When presenting with PGP, women can report difficulty walking and pain when putting weight through one leg, such as when climbing stairs and dressing, as well as difficulty getting in and out of the bath and turning in bed. Some women may experience a clicking or grinding in the pelvic area. Often, the level of pain experienced is made worse by the activities done earlier in the day. These activities may not have been painful at the time, but after rest, discomfort can occur when activity is resumed.
So, what can be done during the working day to reduce pain and help women continue to work for as long as possible?
- Adapting activities throughout the day as well as when working is a good place to start. Trying to remain active within the limits of pain and avoid any activities which aggravate pain. It may be helpful to discuss pain relief with your GP or midwife.
- Taking regular breaks away from your computer to rest.
- Changing your working hours if morning sickness or afternoon fatigue are a problem, perhaps taking a longer break in the middle of the day.
- Accepting any offers of help with daily chores from a partner or support bubble.
- Sitting down for activities that normally involve standing and avoiding standing on one leg, for example, sitting down when getting dressed.
- Sleeping on your side, with a pillow between your legs, can be more comfortable.
Turning “under” in bed, or “over” with your knees together, squeezing your buttocks to control the movement.
- Climbing stairs one leg at a time, with the most pain-free leg leading. Planning the day and bringing everything you need downstairs in the morning to avoid unnecessary trips upstairs.
- Avoiding any activities that involve asymmetrical positions of the pelvis, such as sitting cross-legged, reaching, pushing or pulling to one side, bending and twisting whilst lifting or carrying anything on one hip. Using a rucksack inside and outside the house can also help to keep your pelvis more level.
How can the office space be adjusted to help reduce pain?
Pregnant women often find themselves moving further away from the desk as their belly expands, with the distance between their knees getting wider. Their lower back often becomes more arched and upper back more rounded. Aching shoulders and wrists are not uncommon. An existing chair may feel less supportive and it can become increasingly difficult to find a comfortable position. I advise women to try the following adjustments:
Spending time making sure there is enough room under the desk to accommodate your altered knee position.
Checking the whole of your back is in contact with your chair. If you are unable to adjust the lower part of your chair to meet your increasing curves, then a small rolled up towel or cushion can be used instead.
As with general DSE advice, ensure your hips and knees are at a 90 degree angle. Bring the chair as close to the desk as your tummy allows and position the keyboard in a central position.
Do you spend more time typing or are you generally using the mouse more? Position the most used device as centrally as possible. Overreaching for your mouse or the keyboard can strain your neck and shoulders.
Keep the top of the screen in line with your eyes.
Frequent changes in activity can also help. Limit desk-based activity to 20 minutes, then try making any phone-calls whilst standing, adding movement from side to side or gentle pelvic tilts. Taking time to complete seated or standing stretches can also prevent the aches and pains that may result from prolonged sedentary postures.
The second most common problem I see women referred for is joint and wrist pain, including Carpal Tunnel Syndrome (CTS). As many as 62% of women experience CTS during pregnancy, (R.Ablove and T. Ablove 2009 Jul;108(4):194-6 Prevalence of carpal tunnel syndrome in pregnant women) . Hormone-related swelling is thought to be the main contributing factor. The swelling narrows the space where the median nerve travels through a small tunnel on the underside of the wrist, causing pain and ‘pins and needles’ in the thumb, index finger, middle finger and the side of the ring finger. Pain can also radiate up the affected arm.
What can you do if you suffer from CTS?
CTS can be exacerbated by poor positions increasing pressure on the structures in the wrist, such as holding your wrist in an extended position when holding a computer mouse, or putting pressure on your wrists by resting them on the desk when using a keyboard. Your elbows should be relaxed at your sides and your forearms should be able to hover above the desk. As a rough guide, the desk height should be approximately 3cm below elbow height.
When using the mouse, your arm should be clear of the desk with the hand free to move around. To limit stress to wrist structures, your wrist should be relaxed in a neutral position with no skin creases.
There are many devices that can be used to improve alignment if your symptoms are not improving with simple changes. For example, an adaptive mouse is designed to keep the wrist and arm in a neutral position.
In conclusion:
Many of the aches and pains you experience can be improved with simple adjustments, but if your symptoms do not resolve quickly following adjustment, then it is important to seek further advice and support. It may be that you need individualised, more specific DSE advice. This can be accessed via your health and well-being department. You may also need to see a Specialist
Physiotherapist, who can offer you individualised treatment. They may advise you on possible support belts, wrist splints or other devices that you might find beneficial. You should be able to access a Specialist Physiotherapist via your GP or Midwife. Alternatively, you may be able to use online services to self-refer.
Useful Information:
The NHS website has lots of helpful information: NHS-keeping well in pregnancy and this leaflet from the Chartered Society of Physiotherapist about pregnancy related Pelvic Girdle Pain is a great resource Pregnancy-related Pelvic Girdle Pain