Pregnancy and Pelvic Girdle Pain

You have just gotten through your first trimester, the nausea has eased and some of your energy is returning.  You are looking forward to the “pregnancy glow” everyone is talking about and are ready to get back to all your regular activities before the big day at the end of your last trimester.  Wait…what is this…all of a sudden you have pain in your back, your groin and even turning in bed is difficult.  You may have Pelvic Girdle Pain or PGP.

What is Pelvic Girdle pain?

PGP describes pain in the joints that make up your pelvic girdle; this includes the symphysis pubis joint (SPJ) at the front and/or the sacroiliac joints (SIJ) at the back.   The discomfort is often felt over the pubic bone at the front, below your stomach, or across one or both sides of your lower back.  PGP is diagnosed by certain signs and symptoms which you may experience during pregnancy or afterwards.  Having one or more of these symptoms may indicate the need for a physiotherapy assessment.

Common PGP Symptoms include:

• Pain over the pelvis area, into the buttocks and thighs or pain in the lower back.
• Difficulty walking.
• Pain when standing on one leg e.g. climbing the stairs, getting dressed, getting in or out of the bath
• Pain and/or difficulty moving your legs apart e.g. getting in and out of the car.
• Clicking or grinding in the pelvic area – you may hear or feel this.
• Limited or painful hip movements e.g. turning over in bed.
• Difficulty lying in some positions e.g. on your back or side.
• Pain during normal activities of daily life.
• Pain and difficulty during sexual intercourse.

With PGP the degree of discomfort you are feeling may vary from being intermittent and irritating to being constant and disruptive.

What causes PGP?

Sometimes there is no obvious explanation for the cause of PGP, however there is usually a combinations of factors involved, including:

• The pelvic girdle joints moving unevenly
• A change in the activity of the muscles of your stomach, pelvic girdle, hip and pelvic floor which can lead to the pelvic girdle becoming less stable and therefore painful
• A previous fall or accident that has damaged your pelvis
• A small number of women may have pain in the pelvic joints caused by hormones. Occasionally the position of the baby may produce symptoms related to PGP

Risk factors for PGP

Not all women have identifiable risk factors but for some the following physical risks may apply:

• A history of previous low-back and pelvic girdle pain
• A previous injury to the pelvis
• More than one pregnancy
• A hard physical job or workload
• PGP in a previous pregnancy
• Increased body weight and body mass index before and/or by the end of pregnancy
• Increased mobility of other joints in the body

Managing Pelvic Girdle Pain during Pregnancy

Pregnancy related pelvic girdle pain (PGP) is common, around 1 in 5 pregnant women experience mild discomfort in the back or front of the pelvis during pregnancy.  If you have symptoms that do not improve within a couple of days, or interfere with your normal day to day life you may have PGP and should ask for help from your physiotherapist, midwife or doctor.

There is a wide range of symptoms and in some women it is much worse than in others.  Having some symptoms does not mean you are automatically going to get worse.  If you get the appropriate treatment soon after onset of symptoms, PGP can usually be managed well, and in some cases, the symptoms resolve completely.  However in a small percentage of women, PGP may persist after birth, particularly if left untreated.

Treatment

Management of PGP should include early assessment of your condition by a physiotherapist.  This assessment should include a careful examination of your pelvic, back and hip joints and the muscles around them, looking at how the joints are moving and whether the muscles are strong enough to support your pelvis and spine.

Physiotherapy treatment aims to improve your spinal and pelvic joint position and stability, relieve pain and improve muscle function. Treatment may include:

• Manual therapy to make sure your spinal, pelvic and hip joints are moving normally or to correct their movement
• Exercises to retrain and strengthen your stomach, back, pelvic floor and hip muscles
• Education on back care, proper lifting/carrying technique, and suggested positions for labour
• Education on symptom management strategies such as the use of heat/ice and/or support belts

All of the above can be very helpful in not only managing the symptoms of PGP during pregnancy but also in preventing further problems with the pelvis and back post partum and in future pregnancies.