Pelvic Girdle Pain in Pregnancy

Yvonne McKenny

There are so many wonderous changes that a woman’s body undergoes during pregnancy to accommodate, grow and deliver a child. Unfortunately, for many, pelvic girdle pain (PGP) can be a painful biproduct.

The prevalence of PGP and/or Lower Back Pain during pregnancy is estimated to be 50%, with as many as 20% of pregnant women experiencing PGP that is sufficiently serious to require medical help.

The pelvic girdle comprises of 3 joints –the 2 sacroiliac joints (SIJ) at the back and the pubic symphysis (PS) at the front. Pain can be experienced at any combination of these 3 sites.

To best understand why pain is common, it is important to appreciate the role of the pelvic girdle. These joints are unlike those in our shoulders and ankles that are renown for great amounts of mobility. These joints provide a shock absorbing role and help maintain stability across the pelvis while we transfer weight from one side of the body to the other. Throughout most of our lives, these joints stay relatively and intentionally stiff. They are held snug by design via multiple mechanisms –the congruous shape of the joint lines, muscular compression and by a dense set of ligaments.

However, when you consider the incredible phenomenon of pregnancy, growing a child in utero and subsequently giving childbirth, it stands to reason, that extra mobility will be required in this region. Therefore, in response to the influx of pregnancy hormones, a greater amount of laxity is introduced to the body that helps to accommodate more movement and stretch in preparation for childbirth. The tension of the ligamentous and muscular system previously compressing these joints, eases off. How wonderful, in theory. But herein is where the potential for pain arises.

With added laxity comes added movement and friction, as well as a reduction in stability across these pelvic joints, which can then cause irritation, inflammation and pain.

Where might you feel pain?

1. Two sacroiliac joints: At the very base of your back, either to the left, the right or both.

2. Pubic Symphysis: At the front of the pelvis, down low on the pubic bone itself.

3. Inner thighs, back and sides of the hip are areas that can also be accompanied by pain.

Tips on how to manage Pelvic Girdle

Pain:

1. The pelvis loves symmetry: Avoid unnecessary friction by encouraging symmetry.

• In bed use a pillow between the knees.

• Avoid single legged exercises.

• Push off and stand evenly on both feet where possible.

2. Wear pelvic girdle belt or compression tights: This gives back compressive support to the pelvis.

3. Exercise as if you were wearing a tight pencil skirt: Avoid activities with a wide stance. It is good to think about how close the knees would be if you were wearing a tight skirt and use this to limit how wide you squat, press, lunge etc.

4. Avoid sitting for extended periods of time.

5. Strengthening hips and back muscles: Encouraging good strength around the pelvis can reduce irritation and give added support.

6. Stretches and massage: May help relieve symptoms to an extent but should be coupled with a compression garment and strengthening for best effect.

7. Manage your morning for a more comfortable afternoon: Better management using the tips above throughout the day will determine how much irritation accumulates by the afternoon.

PGP can present in different areas and ways and severities. If you need help managing your pelvic girdle pain, seek the help of a Women’sHealthPhysio for customised advice and treatment.

Yvonne McKenny has B. App Sci (Physiotherapy) USYD and APPI Certified Pilates Instructor. She is a musculoskeletal and women’s health physiotherapist and a certified Pilates instructor who works at Evoker Premium Physiotherapy in Sydney’s CBD.