Back or Pelvic pain during pregnancy? - Pelvic Girdle Pain explained.

Nov 27, 2015 - 5:46pm

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Many women experience pregnancy-related low back pain and/or pelvic pain. Pelvic Girdle Pain (PGP), also referred to as Pelvic Instability, is pain at the back of the pelvis, and/or pain over the pubic joint. It is important for pregnant women to understand this condition, and be aware of the treatment options, particularly if the pain is severe enough to interfere with their daily activities such as sitting, carrying and walking.

 

What is PGP?

PGP is inflammation of one or more of the pelvic joints. There are two joints at the back of the pelvis (sacroiliac joints) and one at the front (pubic symphysis). Sacroiliac joint (SIJ) pain is generally located between the top of the pelvis and the buttock creases. Pubic symphysis pain is usually located over the pubic bone, groin, inner thigh and/or vaginal area.

What causes PGP?

PGP is very common and

as many as 30% of all pregnant women experience PGP, which usually starts in the second trimester.

The combination of pregnancy hormones, and rapid changes in posture and body weight both contribute to PGP. Genetics and lifestyle factors such as occupation and exercise may play a role too.

Reduced pelvic stability during pregnancy

The pelvic joints are extremely stable before pregnancy and only move by about 2 degrees. During pregnancy your pelvic joints become more mobile and moves up to 4 degrees. The feeling of ‘instability’ during pregnancy comes from suboptimal muscle control or dysfunctional movement patterns.

How do I know if I could have PGP?

You may have pregnancy-related PGP if you experience pain during daily activities listed below:

• Pain in one or both sides of the lower back/pelvic area
• Pain over the pubic bone
• Pain with rolling in bed
• Pain with standing up from a chair
• Pain whilst standing on one leg

If you suspect that you may have PGP see your physiotherapist, who will test the stability, movement and pain of your pelvic joints and muscles.

How do I treat it?

RICE management: The use of the following acronym is a helpful tip to remember what may help to decrease your pain.

Rest – horizontal rest is the only way to offload the sore joints

Ice – ice is a natural anti-inflammatory, and has a cumulative effect, so use it a lot!

Compression – support garments such as tubigrip, a pelvic support belt or pregnancy shorts may help. Beware, in some cases these garments may make it worse. Seek advice from your women’s health physiotherapist first.

Education – Talk to your physiotherapist for advice on changing your daily activities, exercise and posture to help decrease your pain. For more information, Fitwise Physiotherapy have an e-book on: PGP during pregnancy and as a New Mum: Management and Solutions 

Additional techniques that may help:

• Manual therapy from your physiotherapist
• Decrease the amount of walking you are doing
• Avoid standing on one leg i.e. sit down to get dressed, avoid pushing things out of the way with your foot
• Clinical pilates to address your biomechanics

Can I still exercise?

YES! Exercise during pregnancy is good for you and your baby. Keep it low impact and pelvis friendly and your options could include:

• Pilates
• Stationary cycling
• Swimming (avoid breast stroke kick)
• Light weights sitting on a fitball or with weight even through both feet (avoid lunges or single leg movements)

Will it go away after I give birth?

Usually the pain improves when the cause (pregnancy) has been taken away. However, the higher the pain during pregnancy, the more likely the woman will have pain after pregnancy. Therefore, it is best to see a physiotherapist as soon as you can to help keep the pain at a low level during pregnancy. Research shows that functional rehabilitation (Pilates) after birth improves your post-natal outcomes, and decreases the change of PGP with subsequent pregnancies.

Credit image: onedollarphoto.com

Article written by: Caitlin Fris, Caitlin@fitwisephysio.com.au

Caitlin is a physiotherapist with post-graduate training in pelvic floor physiotherapy and exercise for women. She works with pregnant and post-natal women at Fitwise Physiotherapy in East Melbourne and Armadale where she loves to promote fun and safe exercise. Caitlin spends time on the maternity ward at Epworth Freemason's hospital, treats patients at Fitwise and runs exercise classes including pilates and pregnancy spin classes. Caitlin also works at the continence clinic at St Vincents public hospital. To keep fit, Caitlin enjoys yoga and running, so understands the importance getting back into exercise during and after pregnancy. For more information, visit: www.fitwise.com.au

What treatment measures have you found the most useful in the management of PGP?