Previously described as ‘pelvic instability’ pelvic girdle pain (PGP) is a condition affecting more than half of women during pregnancy to varying degrees. PGP refers to pregnancy related pain in the lumbosacral region, sacroiliac joints (SIJ) and symphysis pubis joint (SPJ). The change in terminology better reflects our current understanding of this condition where pain is likely due to increased sensitivity in the joints and ligaments rather than true instability.
The pelvic joints are inherently stable and we know that in most women the forces required for movement or disruption to occur would be similar to that of a high speed car accident! We know that language is vitally important when managing our clients and why it’s unhelpful to refer to women as ‘unstable’ when we have no biological evidence for this. It can promote fear and hypervigilance and result in more muscle dysfunction and pain.
The cause of PGP is difficult to establish and some women seem to suffer more than others while some have severe pain with one pregnancy but minor pain with the next.
With changes in centre of gravity PGP may be due to changes in biomechanics as pregnancy advances. 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 risk factors for PGP include:
- previous history of low back/pelvic girdle or hip joint pain or trauma
- previous episodes of PGP
- multiple pregnancies
- heavy workload
- high body mass index
- general joint hypermobility or Ehlers Danlos syndrome
However, PGP may develop insidiously without any obvious risk factors at all.
Common signs and symptoms of PGP include:
- Pain and difficulty standing, walking and with weight shift
- Pain when standing on one leg eg. to get dressed or when climbing stairs
- Pain turning over in bed, getting in/out of car or other changes in posture
PGP is better managed if diagnosed early, however, appropriate treatment can start at any stage of pregnancy and/or in the postnatal period. Physiotherapists are ideally placed to assist the support of PGP with the best available evidence for assessment and treatment techniques. Treatments for PGP may involve local release of muscles contributing to postural or mechanical imbalance, taping or bracing for improved proprioceptive support and dry needling or manual therapy to relieve pain.
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.
Jen Vardy is consulting both in clinic and via during the current COVID19 pandemic.