Pelvic Girdle Pain (PGP) is one of the most common issues we see during pregnancy. PGP is any pain that comes from the joints between the pelvic bones:
Pubic Symphysis (PS) - typically felt in the pubic area, groins or inner thighs
Sacro-Iliac Joints (SIJ) - typically felt in one or both buttocks, and can radiate down the back of the thigh/s
Coccyx - typically felt as pain radiating from the tailbone, or as rectal pain
During pregnancy, hormonal changes cause the ligaments around the pelvis to soften and become more flexible, leading generally small increases in the amount of movement these joints can do. This is a normal part of pregnancy, and is important to allow the pelvic to stretch for childbirth. As pregnancy causes the body to change and grow, it can also lead to changes in the way muscles function as well as increasing pain sensitivity. These are all changes that are needed for your body to accommodate the growing baby, to keep your baby safe while they are developing and to prepare your body for childbirth. Despite these changes, a pregnant women's pelvis is generally very stable, however all of these changes can contribute to developing pain.
But in about 20% of pregnant mums, these changes can lead to pain. Why?
Research has suggested that other factors, in addition to the hormonal changes, could be why some mums develop pain and others don't. These factors include:
Having been pregnant before
You're actually more likely to have PGP in subsequent pregnancies
Muscle weakness and changes to how muscles turn on (including the pelvic floor muscles, gluteal muscles and tummy muscles)
Having a physical job - as some repetitive tasks of postures can overwork or over stress your pelvic area
Previous injury to the back or pelvis
A history of lower back or pelvic pain before pregnancy
Being inactive prior to pregnancy
Changes in the way you move. Women with PGP have been shown to have changes in the way they transfer weight from leg to leg in tasks such as walking or climbing stairs
If you have pain around the pelvis, lower back, buttocks or hips, it's best to have a thorough physical assessment from your physiotherapist to work out where the pain is coming from and help you to treat the pain. We strongly encourage getting help early, as research suggests that early intervention can delay or slow the progression of PGP in pregnancy, but it is difficult to completely remove it as your body will continue to grow and change rapidly. Starting as soon as you can is really important.
So I know I have PGP - Now what?
Minimise aggravating activities
Avoid putting more weight on one leg - try to keep weight 50/50
Swap lunging for squatting
Avoid standing "hanging on one hip" - instead stand with weight on both feet
Minimise trips up and down stairs
Sit down to dress yourself so you're avoiding standing on one leg to put on your undies and pants
Avoid sitting still for long periods
Takes regular breaks to get up and move
Try sitting on a gym ball instead of a desk chair if you can as it keeps your muscles active
If you have SIJ pain you may find sitting cross-legged makes things worse
Pace yourself by taking short breaks from long walks or repetitive activities
When walking try to stick to flatter paths or level ground
You could swap long walks on land for walking in a pool to support your pelvis
Keep your knees together when getting in/out of bed, a chair, and cars if you have pubic pain
Keeping knees together when rolling in bed
Support the pelvis
Wearing an abdominal tubigrip (compression) garment over the tummy may give you some relief from your symptoms, and is a fairly cheap and easy to access option. Your physiotherapist can advise or supply one to you that fits over your bump.
Wearing a pelvic support belt/garment can be very useful for some mums
It's good to have the correct type and size of brace/belt/garment fitted by your physiotherapist.
Some women will feel better for wearing a belt, and some women might feel worse. Your therapist can help you work out if a belt would be useful for you.
Wearing a belt sitting down is usually quite uncomfortable, so you may find you need to remove it to sit down.
Sleep with a pillow between your knees to off-load the pelvis while you sleep
If you get a deep aching in the sides of your hips at night, you may prefer to sleep with your hips less bent (so your legs are straight).
Your physiotherapist can advise you if sitting on a wedge pillow or a donut cushion would benefit you.
Exercise
Keeping active (gently!) is important while you're pregnant, but it can be tricky to know what to do with PGP. Exercise in a pool (so long as the temperature is below 34 degrees Celcius) can be a good way to move while your pelvis is supported. Pregnancy yoga or pregnancy pilates may be a good option as well. If in doubt, ask your physio!
Your physiotherapist can help you determine what muscles you may need to strengthen, or need to relax, to help your pain
Often you will have exercises for one or more of your glutes, abdominal muscles, pelvic floor, back or thigh muscles.
Research supports the use of low to moderate intensity exercise (where you can still maintain a conversation) and incorporating strengthening of the Pelvic Floor Muscles.
Look Outside the Pelvis
Sometimes pain in the pelvis can be made worse by other body areas putting stress through the pelvis. This might include your lower back, your upper back/ribcage posture or even your feet! We've seen quite a few mums experience relief from their pelvic pain from adding arch support into their shoes. This is because the way other body parts move creates stress or muscle pull on the pelvis and can alter how it moves as well.
Research also suggests that stress, fatigue and anxiety can be a risk factor for pain. Interestingly, even hating your job is an important risk factor for developing PGP! While we can't fix your job, we recommend finding ways to de-stress in your week and support good mental health.
Pain Relief
What gives relief can vary from person to person, so it may take some trial and error, and not everything on this list will work for you. Again, if in doubt ask your physio!
Don't push through the pain! Pain is usually a good sign that something needs to be modified or changed.
Try using a heat pack or a cold pack over the sore joints for 10-15 minutes at a time. Try both to see which one gives you the most relief, as women report finding comfort from both.
Heat can soothe and relax tight or sore muscles
(just don't apply heat directly over your tummy where the baby is)
Cold can relieve pain and "numb" the area
Have a gentle massage from someone trained in pregnancy massage such as your physiotherapist or a Myotherapist
Use a pregnancy-safe pain-relieving cream such as Fisiocrem, Arnica or magnesium oil
You may also find relief from using a massage ball around your gluteal muscles (your bum muscles). You can use a ball against a wall, rolling over any muscles that might be tight at the back of your hip.
Some women find relief from acupuncture or dry needling, and research shows this may be effective for some women. Make sure your therapist is trained in giving this treatment to pregnant women.
What about birth?
Great question! The good news is if you're planning a vaginal birth, having PGP does not increase your likelihood of being induced or having an emergency C-Section. It's good to speak with your Midwife about your pain and what makes it worse so that you can plan different labour positions that will be as kind as possible to your pelvis. Your physiotherapist can also give you some strategies and positions for early labour that will be a bit more friendly to your pelvis. These might include labouring on all fours, on your side with your leg supported, or leaning forwards over the bed. We aslo get asked if having PGP has any impact on the baby, which we are very happy to say that it doesn't. Having PGP does not affect your baby's development, health or safety in any way at all.
When will my pain go away?
We would love to be able to predict with 100% certainty for everyone. For some milder cases, you might be able to resolve your pain completely during your pregnancy. For most, we can reduce the pain with treatment, support and exercise or limit the progression of pain. The great news is that for 90% of women it will go away within the first 6 weeks after birth. Unfortunately for some women, the pain can persist for some time after birth. These women need ongoing support and strengthening to resolve their condition.
Our key message is to get help as early as you can so that you can achieve the best outcomes possible.
References:
de Groot, M., Pool-Goudzwaard, A. L., Spoor, C. W., & Snijders, C. J. (2008, Feb). The active straight leg raising test (ASLR) in pregnant women: differences in muscle activity and force between patients and healthy subjects. Man Ther, 13(1), 68-74. https://doi.org/10.1016/j.math.2006.08.006
Dumas, G. A., Leger, A., Plamondon, A., Charpentier, K. M., Pinti, A., & McGrath, M. (2010, Jan). Fatigability of back extensor muscles and low back pain during pregnancy. Clin Biomech (Bristol, Avon), 25(1), 1-5. https://doi.org/10.1016/j.clinbiomech.2009.09.011
Eichenseer, P. H., Sybert, D. R., & Cotton, J. R. (2011, Oct 15). A finite element analysis of sacroiliac joint ligaments in response to different loading conditions. Spine (Phila Pa 1976), 36(22), E1446-1452. https://doi.org/10.1097/BRS.0b013e31820bc705
Gutke, A., Betten, C., Degerskär, K., Pousette, S., & Olsén, M. F. (2015, Nov). Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand, 94(11), 1156-1167. https://doi.org/10.1111/aogs.12681
Snijders, C. J., Vleeming, A., & Stoeckart, R. (1993, Nov). Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech (Bristol, Avon), 8(6), 285-294. https://doi.org/10.1016/0268-0033(93)90002-y
Peng, Y.-C., & Chou, F.-H. (2019). Different Exercise Intensities for Relieving Lumbopelvic Pain in Pregnant Women. Journal for Nurse Practitioners, 15(3), 249-249. https://doi.org/10.1016/j.nurpra.2018.11.018
Vesentini, G., Prior, J., Ferreira, P. H., Hodges, P. W., Rudge, M., & Ferreira, M. L. (2020, Nov). Pelvic floor muscle training for women with lumbopelvic pain: A systematic review and meta-analysis. Eur J Pain, 24(10), 1865-1879. https://doi.org/10.1002/ejp.1636
Vleeming, A., Albert, H.B., Ostgaard, H.C., Sturesson, B., Stuge, B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal. 17(6). pp794–819. DOI 10.1007/s00586-008-0602-4