In the last 6 months I have suffered with a nerve irritation in my neck, associated shoulder pain, a few back spasms and my wife has suffered with back ache and sciatica. For two healthy physiotherapists who have not suffered with these injuries before this could all just be a coincidence however the only metric that has changed in our lives (apart from ageing) is that we’ve recently become parents.

I would like to think that we live pretty healthy lives. We both have exercised for 30 years and have continued into parenthood with weight lifting, running and golf for me and yoga, running and weight lifting for my wife. Yet I have turned into the hundreds of patients I have treated over the years who have told me that they have just simply woken up with a bad neck or back leading to pain and frustration that you can’t go on about your normal daily life.

The scientist in me wants to look at the Bio-psycho-social factors for guidance.

Biologically my wife’s tissues have changed. For child birth we know that there is a hormonal change which leads to tendons and connective tissues to become more relaxed. This is why it is encouraged to avoid high impact or running for the first twelve weeks (Goom et al 2019). You can then include the increase in weight of carrying a child and repetitive flexion postpartum. Putting these together you can understand why it places mothers at a higher risk of suffering with neck and back pain.

I however, have no excuse. My tissues have not changed from a hormonal level. I have continued to train compound lifts like deadlifts and squats. Granted I haven’t been able to push myself due to sleep deprivation sticking with what I call ‘maintenance weights’ however, I have still been pretty regular attendee in the gym. The only change of behaviour is the repetitive daily lifting of a weight that has increased over time. In the initial phase of a babies life their nappies need changing 10-12 times per day. Then let’s add an extra 4 lifts for sleep cycles and in and out of the pram that means 16 lifts per day which is 112 per week. Now I know I only do a 1/3 of that but it’s every day. So combined with my weekly weight training session there has been a change of load.

There is a reason why they use sleep deprivation in the military as a form of torture. Unless you’re extremely lucky your baby wakes up 2-3 times per night to be settled/fed/changed. This means either one or both of you are getting up during the night. But it’s not like going to a festival where after four days of broken sleep you’re rewarding yourself with a cozy deep restorative sleep. This is relentless, night after night where I can genuinely count on one hand the amount of times both me and my wife have slept through the night in the past 6 months. For the parents that are looking after their child at home people encourage you to sleep when the baby sleeps. The reality of this is slim. Food, showering, cleaning or just watching a tiny bit of mindless tv to relax come way up the priority list.

The daily changing Rubik’s Cube that is keeping a baby healthy and happy is also a stressful. When your child is crying you feel like you’re up against the clock to solve the equation. This really puts pressure on your own personality and squeezes your relationship. There is no set text book, no ‘how to guide’ to follow and because every child is different what works for one baby doesn’t mean it will work for yours. The best advice I was given by my brother was, don’t accept any advice. Both these lifestyle changes have been suggested to influence pain (O’Sullivan et al 2016).

Socially there have also been changes. Parents who stay at home to look after their babies have to go through the monotony of the same routine, day after day with a reduced social interaction. Not having the daily stimulation from work colleagues or social activities can lead to change or loss of identity. Evidence suggests that this loss of identity can be linked with a persistent pain model (Bunzli et al 2013). Financially there is also added pressure. The cost of babies are not cheap. Formula, nappies, wipes and nursery all add up. Especially when statutory maternity pay is so little. This burden can weigh heavy on the parents.

So on reflection there are several explanations to why we have woken up with spontaneous neck, back, shoulder pain. However going through this personal experience has made me reevaluated my own practice as a physio. Here’s what I have learnt when treating people who are in similar situations to myself: 

1. Read the room! Spend time on your subjective understanding the person in front of you. If they have family support, nannies, supportive partners or they baby sleeps well then you know you can push them a little more. If they don’t then consider how much they have to do already and what’s reality to fit into their already busy schedule.
2. Empathise with them. Parents are often chronically fatigued and stressed so support them through caring. Be kind. Don’t tell them off if they haven’t had chance to action your plan. They are just trying to do their best.
3. Explain clearly the multi factorial causes of their none traumatic pain and provide a road map to recovery with options along the way.
4. Don’t bombard them with 6-8 exercises to be completed every day. The reality is they won’t do them or have the time to. Try to narrow it down to 1-3 exercises to be completed a couple of times per week.
5. For the fatigued mums and dad’s their tissues are often sensitised. Of course education and exercise are the mainstay of the treatment but that can be complemented with some hands on treatment. It’s probably the only 30 minutes they have in their day to themselves.

References:

Goom, T.,  Donnelly, G. and Brockwell, E. (2019) Returning to running postnatal – guideline for medical, health and fitness professionals managing this population. [https://mailchi.mp/38feb9423b2d/returning-to-running-postnatal-guideline]

O’Sullivan P et al, Unraveling the Complexity of Low Back Pain J Orthop Sports Phys Ther 2016;46(11):932-937. doi:10.2519/jospt.2016.0609

Bunzli, S., Watkins, R., Smith, A., Schütze, R., & O’Sullivan, P. (2013). Lives on hold: A qualitative synthesis exploring the experience of chronic low-back pain. Clinical Journal of Pain, 29(10), 907-916. https://doi.org/10.1097/AJP.0b013e31827a6dd8