Pregnancy related pelvic girdle pain (PRPGP) is a term to describe pain in the back of the pelvis, sacroiliac joints (SIJ) and symphysis pubis joint (SPJ), sometimes referring into the back of the leg, groin and front of the hips. This condition is known to affect approximately 44% of women throughout their pregnancy and in some cases continuing post natal.
Women with PGP commonly experience pain with movements such as sit to stand, rolling in bed, standing on one leg (eg putting undies on), getting out of bed, climbing stairs and lunges.
Our current understanding of this condition suggests the pain is likely due to increased sensitivity in the tissues around the pelvis and a change in motor control. Hormonal changes may induce pain in the pelvic girdle region and sometimes the position of the baby may be the main driver for pain.
Some factors that can increase a women’s risk for PGP are:
- Multiple pregnancies
- Smoking history
- History of low back pain or PGP in a previous pregnancy
- Previous pelvic trauma
- Increased BMI
- Work dissatisfaction
- Lack of belief of improvement in the prognosis of PRPGP
- Those exposed to heavy lifting and postural load (eg prolonged standing) may be at increased risk of PRPGP and increase leave/employment cessation
- General joint hypermobility or Ehlers Danlos syndrome
Some common misconceptions around PGP are..
- PGP is caused by an ‘unstable’ pelvis and that the hormone relaxin can cause this
- Pelvic pain is a normal part of pregnancy
- Lactation will worsen and prolong the symptoms of PRPGP
- Birthing vaginally will make the pelvic pain worse
- Pelvic pain is a normal part of pregnancy
- Moving less and keeping the legs closed with reduce the pain
What we do know is the pelvic joints are inherently stable. Women’s bodies are adaptable and resilient to the changes in the pelvis that are required during pregnancy. These structural changes are normal and safe to occur.
The positive news is PGP can be self managed by the women by addressing some key lifestyle factors including optimising sleep, improving emotional wellbeing, external supports to promote independence and most importantly understanding the pain.
Manual therapies from your physiotherapist (massage, dry needling, taping) can help to provide increased sensation and proprioception which may increase motor control and confidence with movement.
Clinical exercise/ pilates classes supervised by our experienced physiotherapists or an individualised home exercise program are another important part of PGP management to support women to keep fit and active throughout pregnancy, to improve posture and alignment and increase muscle strength and control.
Sometimes pain eases very quickly after the birth of your baby but occasionally it is worsened postnatally and can take time to improve. Individual assessment is key to guide each woman in their recovery as many factors can contribute to pain after birth including slow or fast pushing/second stage, forceps delivery, large birth-weight baby, posterior presentation of baby, labour or birthing position and so on. Remember the pelvis is unlikely to actually be unstable even though the pain presents that way.
Having a thorough assessment and getting the correct advice, reassurance and management is key to improving your symptoms. For an assessment of your pelvic girdle pain contact us today on 97510400 or book online.
Jen Vardy is consulting at Olinda on Tuesday and Paris Houeix is consulting at Olinda and Mount Evelyn throughout the whole week.