Pelvic Girdle Pain - A real pain in the butt, back and groin
Pelvic girdle pain, pelvic instability, symphysis pubis dysfunction. Similar names for the same problems.
I’ve seen many pregnant women seeking treatment for their pain, and they usually preface the appointment with 'It's probably just pregnancy pains' or 'I know there's probably nothing you can do because I'm pregnant'. My response is always 'just because you're pregnant, doesn't mean you have to be sore!' Sure, as pregnancy progresses, you'll probably get uncomfortable and sometimes being preggers can really suck balls. But there are things that can be done about pain that’s interfering with your life! The most common musculoskeletal pain during pregnancy is pelvic girdle pain (PGP).
What is pelvic girdle pain?
PGP was previously known as pelvic instability, but, most medical professionals don’t use this term anymore, as the word 'instability' tends to reinforce chronicity and cause poorer outcomes. PGP is very common. About 30% of all pregnant women experience it and it presents anywhere from a small niggle of pain, to severe pain requiring crutches or a wheel chair. PGP is an inflammation of one or more pelvic joints. We have three pelvic joints; your pubic symphysis (the bony bit at the front of your pelvis - think Michael Jackson's crotch grab dance move), and two sacroiliac joints at the back (found on either side of the top of the bum crack, just below the two dimples on your lower back). These three joints move just a teeny tiny bit when we are not pregnant, to allow ease of movement and force transfer when we do things like walk or change positions. When we fall pregnant, the pregnancy hormone, relaxin, causes a softening of the ligaments surrounding those joints and, if supporting muscles can't keep up with the changes, these ligaments can become sprained, much like an ankle sprain. When you add the weight of your boobs, the baby and uterus, plus the rapid changes in posture, you may experience PGP symptoms:
Pain over the pubic bone or the feeling of being kicked in the vagina
Pain in the butt/lower back on one or both sides, often with referral down the thigh, causing the tell tale 'pregnancy waddle'
Pain whilst walking, standing up from a chair, rolling in bed or standing on one leg
Note: you are not 'unstable' but may feel slightly unstable due to suboptimal muscle control and movement patterns. These symptoms usually present in the second trimester and left untreated, can get worse during pregnancy. The good thing is, the earlier you seek treatment from your women's health physio, the easier it is to manage!
What are my treatment options for pelvic girdle pain?
It is important to realise that all women present differently and need individualised treatment to address the cause of their pain. For example, some women will need to strengthen their pelvic floor, others will need to down train their overactive pelvic floor and gluts. Therefore, it is crucial to be assessed by a women's health physio to receive treatment that is tailored to your body.
Nevertheless there are some things that all women with pelvic girdle pain can do to limit the pain. First up, what would you do for an ankle sprain? You would RICE:
R- rest daily; horizontal rest is the only way offload the pelvic joints
I- ice is a natural anti-inflammatory. It has a cumulative effect, so put ice on your sore joints at least 4-5 x a day
C- compression. A pelvic support belt, pregnancy shorts or abdominal tubigrip can help. Beware, these garments may make some cases worse, so see your women's health physio for advice first.
E- education and exercise. Talk to your physio about changing your daily activities, exercise and posture. Things that may help:
Avoid standing on one leg (sit down to get dressed, stand with weight even on both feed)
Avoid walking for exercise
Ditch the heels and unsupportive flats and invest in some supportive shoes for work (see Bared shoes for good shoes that don't make you look like your teacher from 1987)
Keep your legs together (I hear some of you saying 'too late, that's what got me into this predicament!'). Press your knees together lightly when getting out of the car or rolling in bed. Think Lady Di, not Britney Spears.
Avoid lifting more than 5kg (yep that means your toddler, time to teach your toddler some independence, as you will be advised against lifting them after you deliver anyway right?)
Manual therapy and clinical Pilates from your physiotherapist
The most chocolate filled ice cream you can find. Just kidding. Or am I?
If you're really struggling to walk, you may require some time on crutches, to settle the inflammation down
It is important to recognise that if you are not getting better, no matter how many health professionals you see, if you are not modifying your daily activities or doing your individualised exercises, you won't improve. The hardest thing to do in this day and age is stop. Really stop and take it easy. Especially when there is work to do and kids to look after and dinner to sort out. I hear ya sista! But you have to get resourceful, ask for help, and learn to say no. Put yourself first, woman!
Can I still exercise?
YES, please do! I know all you want to do is sit on the couch and eat dirty Doritos and maybe you feel like your body is going to disintegrate into a pile of dust and crumbs. However, exercise is good for you and your baby. Some forms of exercise can flare up your PGP (i.e. breaststroke legs whilst swimming, running, walking, stairs, yoga poses that encourage legs wide or single leg stand) so keep it pelvic friendly:
- Stationary cycling (stay seated, avoid coming up off the seat)
- Swimming (mostly arms, light kicking)
- Clinical Pilates
- Light weights sitting on a Swissball
Will it go away when I deliver my baby and will I get it again in subsequent pregnancies?
In most cases the pain goes away when the cause goes away (the cause being pregnancy). However, approximately 10% of those who had PGP during pregnancy will experience it after pregnancy and often flare up around the time of menstruation, due to hormonal changes. The worse your pain when going into labour, the more likely you will experience postnatal PGP. So, see your women's health physio sooner in pregnancy, rather than later.
If you had PGP in previous pregnancy, you are more likely to get it with subsequent pregnancies. Similarly, a history of low back pain, trauma to the pelvis, physically strenuous work, high stress levels and having an immediate relative that had PGP are all risk factors for developing PGP in pregnancy. Recent research shows that performing individualised exercise with a health professional (i.e. clinical Pilates) improves your pain if you have post natal PGP and decreases the chance of getting PGP when you fall pregnant again.
So yes, pregnancy can be a pain in the butt, back and groin sometimes, but you don’t need to tough it out! Seek help earlier rather than later.
- the vagina physio
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