Pelvic Girdle Pain

Pelvic girdle pain (PGP) is a pregnancy discomfort that causes pain. This can be a consequence of instability and limitation of mobility and functioning in any of the three pelvic joints. PGP can affect your pubic symphysis joint around the front of your pelvis and/or the sacroiliac joints around the back. It can sometime effect both areas at the same time or your pain may move about to one area then the other. PGP can also be felt with pregnancy related lower back pain (PLBP).

As the body changes during pregnancy, your centre of gravity will alter which consequently impacts posture, biomechanics and muscle activity. Your muscles will need to work in different ways to try and support you. It is very importance not to forget your pelvic floor exercises during this time. Gentle exercise can still be achieved during pregnancy – for advice on this you can contact our Physiotherapy service or take a look at our website on Obstetrics & pelvic floor dysfunction.

Using management advice and coping strategies can help ease your symptoms. Learning how to perform functional tasks slightly differently during pregnancy can reduce the repetitive mechanical load on structures.

Pelvic, Obstetric Gynaecological Physiotherapy (POGP) highlight the following as common signs of PGP:

• Difficulty walking.

• Pain when putting weight on one leg, such as climbing the stairs/getting dressed.

• Pain and or difficulty in movements such as getting in and out of the bath or car.

• Clicking or grinding of the pelvic area.

• Difficult to lie on your effected side/sides.

• Pain during normal activities and/or pain/difficulty during sex.

Getting a diagnosis as early as possible can help minimise any pain and avoid long-term discomfort. If you pain is not managed, then you can contact a Woman’s Health Physiotherapist Specialist via your GP practice for an assessment.

Many women have found that making small changes to everyday activities can reduce their discomfort. POGP suggests trying the following:

• Remain active within the limits of what you find comfortable and can manage, avoid activities that you know makes the pain worse.

• Accept offers of help and involve your partner, family and friends day-to-day.

• Rest more frequently or sit down for activities that normally involve standing, e.g. ironing.

• Avoid standing on one leg so try dressing sitting down.

• Consider alternative sleeping positions, such as lying on one side with pillows between your knees to ankle. Turn over with knees together and squeeze your bum. You could try a pillow under your side.

• Try different ways to climb stairs. You could try going upstairs one leg at a time with the most pain-free leg first and the other leg joining it on the step.

• Plan the day by bringing everything you need downstairs in the morning and set up changing stations both up and downstairs. You might find a rucksack helpful to carry things around the house, especially if you have to use crutches.

• Avoid activities that involve asymmetrical positions of the pelvis, such as sitting cross-legged, reaching, pushing or pulling to one side, and bending and twisting to lift or carrying anything on one hip.

• Consider alternative positions for sex, such as lying on the side or kneeling on all fours.

• Organise hospital appointments for the same day if possible, such as combining appointments for antenatal care and Physiotherapy.

Many women can have a spontaneous vaginal delivery if they want to. Talk to your midwife about your pain relief options, as well as alternative positions for birth, such as supported kneeling or side lying with pillows/knees to chest. Using a birth pool may help you move around more freely without pain.

A cesarean section is not usually needed or recommended for women with PGP, as this might slow down your recovery.

Your healthcare provider will refer you to a Physiotherapist who will make an assessment and put together a treatment plan. This could include:

• Therapy that includes use of hot and cold packs, hydrotherapy, use of a TENS machine or acupuncture.

• Support belts can be effective if used regularly for short periods.

• Using crutches.

• If the pain is severe then regular pain relief medication might be needed. Your GP can discuss options with you.

While PGP in pregnancy is common, it isn’t normal. You should always seek help if you think you are suffering with it. It is a treatable condition that you can get support to manage. If however, you find that your symptoms are not easing with management advice or are more constant i.e at rest as much as with movement you should seek advice from your GP.