Pelvic Girdle Pain.

Pelvic girdle pain is pain felt between the top of the pelvis and the bottom of the buttocks, typically around the sacroiliac joints in the back of the pelvis, which may be present on one or both sides.

Some pain may radiate to the back of the thigh or the pubic symphysis joint (in the front of the pelvis) as well. The diagnosis can be reached with a positive finding on certain pelvic tests, and after the low back area has been excluded as causative.

Pregnancy-related pelvic girdle pain occurs about 20% of all pregnancies. It may commence at any point in pregnancy, but is more common in the second half of pregnancy, and may also be more common in second and subsequent pregnancies.

What Causes Pelvic Girdle Pain?

Pregnancy-related pelvic girdle pain is thought to be caused by a combination of hormonal factors, changes in posture and increased weight causing more load on the pelvic joints and supporting soft tissues.

The hormones relaxin and progesterone contribute to relaxation and increased laxity of the ligaments and muscles around the pelvis and low back region.

The growing foetus lengthens the supporting abdominal muscles by up to 60% and puts more load on the low back and pelvis.

The increased weight and size around the abdomen also contributes to postural changes, such as an increase in the normal lumbar curvature.

These factors in combination alter the usual support mechanisms around the pelvic joints, and place more load on the pelvis and low back, which may lead to pain.

Treatment

Whilst pelvic girdle pain is common in pregnancy, you can do things to help – you don’t have to suffer in silence!

It is also good to remember that for the majority of women, pelvic girdle pain will resolve very soon after you have had your baby.

The following suggestions are useful if you have pelvic girdle pain, and may also help to prevent it during pregnancy.

Avoid:

  • Asymmetrical activities – anything involving placing more load through one leg more than the other. For example, lunges, stairs, standing on one leg to dress.
  • If you have pelvic girdle painalready, you may need to avoid excessive walking and standing – especially standing with more weight on one leg than the other.
  • High impact activities, such as running and netball.
  • Lifting and carrying – including your toddler!

It may help to:

  • Keep the legs together when rolling in bed, getting out of the car and moving from sitting to standing
  • Engage your core muscles (deep abdominals and pelvic floor) to provide more support with activities such as getting out of bed, standing from a chair and lifting.
  • Wear tubigrip or a pelvic belt – this can be fitted by your physiotherapist, and may provide more support around the pelvis, making daily activities more comfortable.
  • Use ice (wrapped in a thin towel) over the pelvic joints to relieve pain and inflammation. This can be applied for 10 minutes every 1-2 hours during the day.
  • Exercise! Specific exercises prescribed by your physiotherapist, including appropriate core exercises and stretches for tight muscles, have been shown to be beneficial for easing pain. Hydrotherapy and Pilates-based exercises are often very helpful.
  • Spend time every day to REST – that means lying down! In some cases, you may need to use crutches or a walking frame briefly to unload your pelvis if the pain is severe.
  • Hands-on treatment, including joint mobilisation and soft tissue massage, can provide some relief temporarily, but should always be used in conjunction with other treatments, as recommended above.

Advice

Seek treatment early, as simple, early intervention, including modifying your daily activities and starting appropriate exercises, can make a big difference in most cases.

A Physiotherapist can provide helpful treatment, advice and exercise therapy – and it is the combination of these things that usually provide the most benefit.

Remember, your pelvic girdle pain may not last for the whole pregnancy, and for most women, it will resolve spontaneously soon after delivery.

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