Pelvic Girdle Pain
About 1 in 5 pregnant women will suffer with pelvic girdle pain during their pregnancy*. This is often a misunderstood and misdiagnosed condition which can leave women struggling with sometimes severe and disabling pain in the joints of the pelvis. The pain can force some women to use of crutches or even a wheelchair as even the simple task of walking can become too painful to bare.
Pelvic girdle pain (or PGP), which is also known as symphysis pubis dysfunction (or SPD), can come on at any point throughout a pregnancy or after you have given birth. It can develop during your first pregnancy or your third pregnancy and if you’ve had it before in a previous pregnancy you are more likely to develop it again in any subsequent pregnancies.
It is characterised by pain around the sacroiliac joints (located at the back of the pelvis where you find two dimples above the buttocks), the symphysis pubis (the joint at the front of the pelvis), the groin, the lower back or pain which radiates down the thighs. It can develop suddenly or gradually over a few days. Each women presents differently and with varying amounts of pain and immobility.
What causes it?
Women are often told that the pain is due to the pregnancy hormone Relaxin and that nothing can be done about it, but in fact it is as a result of a mechanical problem with the joints of the pelvis. This happens as a result of the abdominal muscles and pelvic floor muscles being stretched as the baby grows which means that these muscles are not as able to continue to support the joints of the pelvis and the lower spine. Asymmetrical movement can start to occur around the pelvic joints which results in inflammation of these joints, muscle spasm and pain. If the altered mechanics are not addressed then the pain will continue and may become more debilitating.
Signs and symptoms
The pain can come on suddenly or gradually around the joints of the pelvis. The severity and location of the pain varies from woman to woman. There may also be clunking or grinding felt or even heard around the pelvic joints.
Normally activities which place force or weight unevenly through the pelvic joints cause pain. This can be pain with:
- Walking, especially up or down stairs
- Standing on one leg such as when getting dressed
- Turning over in bed
- Getting in/out of the car or the bath
- Twisting movements such as pushing a shopping trolley or buggy.
How physiotherapy can help
It is important to remember that it is safe to receive physiotherapy during all stages of pregnancy. You will need to make sure that your physiotherapist has the necessary training to treat PGP. This can be a women’s health physiotherapist or a musculoskeletal physiotherapist who has had additional training to assess and treat women with PGP.
The physiotherapist will assess the joints of your pelvis and will then use a range of hands-on techniques to address any mechanical dysfunctions found. These techniques may include mobilisations of the pelvic joints, massage, muscle energy techniques, acupuncture, kinesiotaping and exercises to strengthen your pelvic floor muscles and core/deep tummy muscles.
You may also require the use of a sacroiliac belt which provides additional support to the joints around the pelvis whilst your muscles get stronger. Your physiotherapist will also be able to give you advice about exercising safely during pregnancy, managing your pain and planning for labour.