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Mar 25

Pregnancy pelvic girdle pain

by physio Olivia

At Vital Core Physiotherapy we are passionate about looking after mums during and after their pregnancies. Therefore it’s no surprise that one of the most common conditions we treat is Pregnancy related pelvic girdle pain (PPGP). 

So what is PPGP and how can we help you?

PPGP affect up to 70% of women sometime during their pregnancies and for some it may persist post-delivery. It is a complaint of pain around the pelvis which commonly occurs between 14 and 30 weeks of pregnancy. The pain can be in the sacro- iliac (pelvis) joints, buttocks, inner thighs, tail bone, pubic bones or in a combination of those areas. The pain may also be felt in the lower back. However, if minimal pelvis symptoms are present this is instead diagnosed as pregnancy lower back pain. PPGP can present on one side or both and sometimes radiates into the back of the leg/s which cause mums to think they have “sciatica”. 

PGPP can make sleeping difficult

If you are experiencing PPGP you may have pain as you move from sit to stand and the first few steps of walking. Pain is often present after sitting for prolonged periods or prolonged walking. Most mums with PPGP find it hard to turn in bed and to get comfortable in bed, reducing their much needed sleep. Getting in and out of the car and going up and down stairs may be bothersome, not to mention getting a toddler in and out of the car! The nature of the pain can range from a constant dull ache to a sudden sharp pain and the sense of the pelvis “giving way” that stops all activity.

You may have heard or read somewhere that the pelvis becomes “unstable” or “goes out of joint”. In the past the hormone relaxin was incorrectly to blame for all our pregnancy related aches and pains. This hormone, which is present from about 9 weeks of pregnancy, helps to soften our ligaments around the pelvis and the rest of our bodies to allow the pelvis to accommodate a growing baby and to prepare for labour. So if it literally “relaxes” joints, it must cause pelvic instability right? Wrong! Contrary to belief, the pelvis cannot become unstable unless you have had a traumatic injury e.g. a motor vehicle accident or fracture. Instead, during pregnancy, there may be some very minimal movement in the pelvic joints (due to relaxin and other factors) which can cause these joints to be sensitised and painful. The normal increase in progesterone during pregnancy further increases the sensitivity of the tissues to pain, especially those ligaments that are already under more load than usual.

It is common in severe PGPP for the pelvis feel ‘unstable’ but rest assured it is not.

If the pelvis is not unstable then what causes the discomfort and pain around the pelvis?

Usually it is not one thing that is causing your PPGP. Factors which may increase a mum’s risk of developing PPGP include increased BMI, high levels of stress and worry, previous pregnancies, orthopaedic problems such as fractures (leg, hip or back) and smoking. Additionally, inappropriate exercise, not enough exercise, weak or stiff muscles (buttocks, abdominal, pelvic floor) and poor postures (exaggerated slump pregnancy posture) can all contribute to the development of PPGP.

How can physio help?

At Vital Core Physiotherapy your posture, joint range of movement and painful movements will be assessed. It is also important to assess the muscle groups around the pelvis for weakness or excessive stiffness/ spasm.

Evidence suggest that mums will benefit from a pelvis support brace or garment (SRC shorts/ tubigrip) to take the load off the sensitised structures. You may need some hands on treatment to help with pain relief. Most mums remain comfortable during pregnancy with the right exercises, education and advice unique to their PPGP. You may just need a few subtle changes to improve how you move.

Exercise in pregnancy is safe and can make all the difference to PGPP

The first thing mums tend to do to manage PPGP is to avoid certain exercises or stop exercising altogether which we advise against. There are safe alternatives and modifications including an individualised home exercise program, hydrotherapy and the mummycise classes offered here at Vital Core Physiotherapy. Recent recommendations for exercise during pregnancy confirmed the many benefits of exercise. You can read more about exercise in pregnancy here.

The good news is that there is strong evidence that Physiotherapy can help with your PPGP and prevent persistent pain. So, instead of suffering from PPGP through your pregnancy or borrowing a friend’s pregnancy belt which may offer little relief if not fitted correctly, why don’t you come and see one of our experienced Physiotherapists as soon as you notice symptoms. We are here to help!

References:

https://journals.lww.com/jwhpt/Fulltext/2017/05000/Pelvic_Girdle_Pain_in_the_Antepartum_Population__.7.aspx