Pelvic Girdle Pain or ‘PGP’ occurs in pregnancy and usually develops between 14-24 weeks gestation. PGP is said to develop with varying degrees of severity in 33% of the pregnant population. There is a strong correlation between PGP and pelvic floor dysfunction with up to 50% of women with PGP also experiencing continence issues.
Pain is experienced in the pubic joint (pubic symphysis) and/or the joint between the tailbone and the pelvis, known as the Sacroiliac joint (SIJ) on one or both sides. Pain may also radiate down the back of the thighs.
PGP is typically caused by movements which cause ‘shearing’ through the pelvis. These may include:
• standing on one leg - like when putting pants on
• getting up from a chair or getting out of the car with one leg
• walking - particularly up hills or if wearing high heels
• going up or down stairs
• rolling in bed
PGP is the result of a few causative factors. The first being inflammation of the pelvic joint due to increasing levels of the hormone relaxin. The hormone relaxin is often blamed for a lot of pregnancy related issues but it is really important in preparing your body for labour and to allow the pelvis to stretch for delivery. Secondly, as your pregnancy continues and the weight of the baby increases additional pressure is put on the muscles, bones and fascia around the pelvis. Thirdly, the changing body shape often causes weakening of the gluteal (butt) muscles, pelvic floor and deep abdominal muscles which mean that the pelvis has less support from these important structures.
Risk factors for developing PGP during pregnancy include a prior history of back pain and prior trauma to the pelvis. There is mixed evidence to suggest that those women with more physically demanding jobs, who have hyper mobile joints, are obese or have had more that 1 baby are at an increased risk.
In order to treat PGP is it important to minimise shearing forces through the pelvis. A good motto is to ‘live life in a mini skirt’! This means that you sit down to get dressed, keep your knees close together when you get in and out of the car or roll in bed. Minimising stairs and reducing the length of your stride when walking can also help to reduce pain.
Physiotherapists play a vital role in the diagnosis, education and rehabilitation of PGP. Specialised physiotherapists can help by:
• providing an individualised exercise program to help strengthen weakened muscles which may include the gluteals, deep abdominals and pelvis floor muscles
• applying hands on techniques to reduce the muscle tension and land through the pelvic joints
• in some cases support belts or support shorts may provide relief
• providing education and reassurance as to where the pain is coming from and why
Lastly, as someone who experienced quite severe PGP during pregnancy its important to remember that there are many steps which you can take to help reduce your pain and that in most cases the pain is only temporary.