PELVIC GIRDLE PAIN
Pelvic girdle pain (PGP) is extremely common in pregnancy with 1 out of every 5 pregnant women experiencing it. Some women report pain that is nagging and dull and others describe severe sharp pain that can take your breath away. Personally, I experienced pubic pain in both my second and third pregnancies and it really was quite acute and sharp with some movements. I found it hampered my ability to take the dog for long walks, gave me pain when getting up from driving and pain turning in bed at night.
So, what is PGP? How do you recognise it? What can you do to treat or manage PGP, and will it harm you or your unborn baby? In this post I will answer those questions, and hopefully, reduce your worries about it.
Pelvic girdle pain is any pain felt around the joints and muscles of the pelvis, lower back, hips and bottom. Sometimes, if the pain is more central around the front of the pubis it may be called SPD (Symphysis Pubis Dysfunction). Health professions may also talk about Sacro-iliac joint pain which refers to the joints at the back of the pelvis between your hips and your sacrum.
If PGP is so common should I ignore it?
It may be considered common, but you should never accept that it is normal or inevitable. Pain in pregnancy can be scary and very wearing particularly if you are working, commuting or running after other children. Talk to your midwife or GP, and take advice from a physio if you are experiencing any pelvic pain.
PGP – Pelvic Pain Symptoms
- Pain in the pelvis, lower back, hips or bottom.
- Pain turning over in bed at night.
- Pain walking.
- Pain opening legs apart, for example getting out of a car.
- Pain during sex
- Pain loading one leg and lifting the other, for example putting on underwear or going up and down steps.
What causes PGP?
There is no definitive answer as to what causes PGP in pregnancy. Many sources attribute the pain to uneven motion in the joints of the pelvis, muscle imbalance and reduced stability of the joints. Using words such as “unstable” can be quite frightening and conjure up images of fragility and the pelvis falling apart. Genuine separation of the pelvic joints is incredibly rare, and most cases of PGP are more likely to result from small muscle changes that trigger the nervous system to be a little overprotective and cause muscles to become tense.
It may be that the rapid changes in weight and posture contribute to uneven load in the pelvis and a small contribution from pregnancy hormones that soften up the collagen allowing greater motion at the pelvic joints to enable the pelvis to open for birth.
Will the pain harm my baby?
There is no evidence to suggest that the baby is in any way affected by the mother’s pelvic pain. PGP will not increase your risk of miscarriage or early labour.
What can I do myself?
There are lots of helpful tips that can make you more comfortable if you have pelvic pain:
- Wear supportive shoes – generally high heels exacerbate the sway back position that often occurs in pregnancy.
- Keep active – often sitting or standing for long period will increase pain – so take movement breaks and do some light exercise.
- Rest and accept help when it is offered.
- Ask for help if it has not been offered – ask your partner or relatives to help with housework.
- Sit to get dressed and put your pants and trousers on.
- Keep knees together when getting in and out of a car or on and off the bed.
- Use a pillow between your knees at night.
- Do your pelvic floor and other body strengthening exercises that will be prescribed by your physio.
- Stand on one leg.
- Bend and twist when lifting.
- Cross your legs when sitting.
- Sit or stand for extended periods.
- Lift heavy shopping.
- Push heavy things with your foot (from personal experience this caused me the most pain – I’m obviously really lazy and often push things with my feet!)
Pregnancy Physiotherapist Assessment
Physiotherapy can make a real difference to pain in pregnancy.
A full assessment will look at how your move, and how you do things like getting in and out of a chair or standing on one leg. They will then feel all the different muscles and joints around your hips, back and pelvis. Recognising which particular areas are involved can help to direct the treatment more specifically to your individual symptoms.
Physio will be able to perform manual therapy techniques that can help to settle the muscular imbalance and reduce the sensitivity of the nervous system. Soft tissue massage, contract and relax techniques around the pelvis and hips, and gentle joint rocking motions (mobilisation) can really make a difference to your day to day discomfort.
Physio can also provide really tailored exercises to address any muscle weakness, tension or the interplay of the muscles as you move. Physio can offer advice on posture, and positions for comfort during the ongoing pregnancy.
Sometimes a support belt might be helpful, and the physio can work with you to decide when belt would be best. Finally, they can offer advice on positions for labour. In severe cases crutches may be required for pain relief.
Can physiotherapy treatment harm my baby?
Physiotherapy should not use any forceful motions or treat to a depth that could affect the baby. Physiotherapists have strict codes of conduct and regulation that keep our practice safe.
Please do feel free to check that your therapist is registered with the appropriate professional bodies (the Chartered Society of Physiotherapy is one such professional body).
The exercises will all be safe and appropriate and should help you feel better.
What about birth if I have PGP?
Most women manage a normal vaginal delivery even if they have had severe pelvic pain in pregnancy.
Birth positions that use gravity to assist with baby’s descent are advised such as kneeling and, on all fours, however squatting for long period might not be as comfortable. Lying back or propped lying tend to reduce the pelvic opening and can slow labour so would be much less helpful.
Will I still have pain after the birth?
A small minority of women who have PGP in pregnancy will continue to have pain after birth, most will be pain free almost immediately. If you do continue to have pain, please do contact your physio.
I hope I have manged to reassure you that PGP is common but should not be accepted as an inevitable part of pregnancy. I also hope I have given you some advice on management that you can do for yourself. If you would like more support, please do come and see me for a physiotherapy consultation at Jo Coulter Physiotherapy
This blog post was written by Jo Coulter BSc(Physio) Hons, MSc(Man Ther) MCSP, one of the certified and qualified Surrey Physiotherapists featured on our website.
You can view Jo’s profile and similar practitioners on our Surrey Physiotherapy search page.