Let's Talk Pelvic Girdle Pain: Who Gets It, Causes, Symptoms And How To Address It
Let's talk PGP. Knowing what it is could lead to earlier treatment and a better quality of life.
What is it?
It used to be thought that pelvic girdle pain (PGP) was hormonal, the ‘normal aches and pains’ of pregnancy, and would go away as soon as the baby was born. However, research into sacroiliac joint function has now found that asymmetry is linked to pelvic dysfunction.
The pelvis is made up of a ring of three bones. They join together at the sacroiliac joints (at the back) and the symphysis pubis joint (at the front). These joints normally move a little bit to allow you to walk, turn over in bed, climb stairs, etc.
PGP can cause pain in any or all of the three pelvic joints, causing difficulty moving and doing your usual activities. With PGP, often one joint becomes stiff and stops moving normally and causes irritation and pain in the other joints and surrounding muscles which have to compensate for its lack of movement. There is a subtle hormonal change during pregnancy which softens the ligaments throughout the body, though this is not the primary cause of PGP.
Symptoms
Women experience different symptoms and these are more severe in some women than others. If you understand how PGP may be caused, what treatment is available, and how you can help yourself, this may help to speed up your recovery, reducing the impact of PGP on your life.
The main symptom that women report is pain;
> walking
> bending
> climbing stairs
> turning over in bed
> standing on one leg i.e. getting in and out of the bath, getting dressed
> during sexual intercourse
This means that it affects virtually everything you do in a day, which has a major impact on your life. This pain can be an ache, a sharp shooting pain or a deep muscle pain. You may also have a clicking or grinding feeling in your pelvic joints or in your hips.
The pain is caused by one or more of the following:
Stiffness, back problems or injury irritated by the the growing baby
A slip, fall or accident during pregnancy at any stage
Repetitive movement or position at work or hobby
Hypermobility
Who?
Around 1 in 5 pregnant women experiences mild discomfort in the back or front of the pelvis during pregnancy. If you have symptoms that do not improve within a week or two, or interfere with your normal day-to-day life, you may have PGP and should ask for help from your midwife, GP, physiotherapist or other health carer.
What can I do to help?
Exercise
Once you have had manual therapy and the pain is less severe. Pain inhibits muscle activity so exercise prior to this would not be beneficial. The main goal is to return to the sport/ activity that you did prior to pregnancy. Allow pain to guide how much exercise you do. Stay as active as you can within the limits of pain.
Try walking (gently build up distance and speed), pilates (great for abdominals, pelvic floor and hip stability in a gentle low impact way), swimming (Using resistance and buoyancy/ anti-gravity of the water. Front or back crawl rather than breaststroke as to not put pelvis under strain.)
Do:
Walk in supportive footwear, swing arms and use a rucksack rather than a handbag for symmetry and ease of movement
If walking is difficult and painful, try altering your stride length and speed
Accept help when you need it
Sit down to get dressed and undressed; avoid standing on one leg
Try to keep your knees together when getting in and out of the car
Place a pillow between your knees when sleeping on your side and when turning over, keep your knees together as much as possible
Try getting into bed or turning over in bed via hands and knees
Do your pelvic floor exercises and low abdominal exercises
Move from sitting to standing symmetrically
Take the stairs one at a time (lead with your less painful leg when going upstairs, and downstairs, lead with the more painful leg)
Use a small rucksack to carry things if you need to use crutches
Consider alternative positions for sexual intercourse such as side-lying or kneeling on all fours
Consider alignment- hips, knee, feet- during exercises, sitting and sleeping
Equal weight bearing
Make sure the PT knows you have PGP so that we can tailor the exercises accordingly
Train stabilising muscles- have a chat to any of our antenatally trained PTs for guidance with this
Avoid:
> Crossing legs
> Twists
> Lunges
> Single leg loading as this causes vertical stress across the joints
> Heavy lifting i.e. toddler, hoover, shopping
> Pushing trolley
> Carrying shopping in on hand
> Over-exerting
> Moving legs far apart
> Bending to lift, or carrying a toddler or baby on one hip
> Activities that aggravate pain
> Sitting on the floor
> Sitting or standing for long periods
Labour and beyond
Before labour:
• Think about and practice moving between positions that are comfortable for you
• Record them in your birth plan and discuss with your birthing partner and/or midwife
• Labour and birth in water may be appropriate and comfortable for you
• Discuss coping strategies with your physiotherapist
During labour:
• Use gravity to help the baby to move downwards by staying as upright as possible:
• Kneeling
• On all-fours
• Standing
These positions can help labour to progress and avoid further strain on your pelvis.
• Try to avoid lying on your back or sitting propped up on the bed - these positions reduce the pelvic opening and may slow labour
• The squatting position and birthing stool may be uncomfortable positions for labour
• Moving between positions, and positions of symmetry are often most comfortable
Discuss with your midwife and try these gravity-assisted positions instead of lying on your back or sitting.
After your baby is born
Feeding:
• When possible, sit in a firm but comfortable chair to feed your baby
• Make sure your back is well supported; placing a small, rolled towel behind your lower back helps
• Ensure your feet are supported and fl at on the floor
• Stopping breastfeeding will not speed up recovery of PGP
• Make sure your back is well supported; placing a small, rolled towel
Looking after your baby and yourself
• Change nappies on a surface at waist height.
• Carry your baby in front of you; do not carry your baby on one hip.
• Kneel at the bath side rather than leaning over
• Lower the cot side when lifting or lowering your baby
• Keep your baby close to you when moving him/her in and out of a car seat
• If you have to carry your baby in the car seat, hold it in front of you, not on your hip, or put it on a wheeled frame/buggy
• Do not lift your baby in and out of high shopping trolleys
• Do your pelvic floor muscle exercises daily