1 – What is Pelvic Girdle Pain?
Pelvic Girdle pain is a general term used to describe pain in the region of the pelvis.
For pelvic pain to be diagnosed as true ‘pelvic girdle pain’ it needs to be shown that it’s stemming from one or more of the pelvic joints – the two sacro-iliac joints at the back of the pelvis (near the ‘dimples’ on your lower back) or the pubic symphysis joint at the front.
Pain and discomfort in this area can obviously be from lots of different causes, like urinary tract infections or varicose veins or other joints like the hip or lower back.
2 – What are the most likely movements to cause Pelvic Girdle Pain and can they be modified?
Movements that are most likely to cause Pelvic Girdle Pain might include:
- Getting in and out of the car
- Getting up and down off the floor
- Getting dressed
- Single leg exercises at the gym and in classes like lunges and step ups
If you are experiencing pelvic girdle pain these are some movements to avoid where possible:
- Pushing Heavy trolleys
- Carrying a child, especially on one side
- Going for a walk as exercise
3 – Why does Pelvic Girdle Pain happen to some pregnant women and not others?
The rates are really variable in the literature and so we can’t say for sure what percentage of pregnant women get pelvic girdle pain, but we think it may be about 1 in 5 women. Put it this way – every week I run a Bump&Me exercise class with 8-10 pregnant women and without fail there are at least 2 of the women in the class with symptoms likely to be pelvic girdle pain. It’s really common!
So how do you know if you’re more likely to get PGP? Can you prevent it?
Studies show that pregnant women with these risk factors are more likely to develop pelvic girdle pain:
- if they have been pregnant multiple times
- if they have a history of lower back pain
- if they work in a job that is physically demanding (unsure if this study included being a Mum of a toddler as a physically demanding job!!)
- if they were experiencing emotional distress
That last one is interesting from a physio point of view. While we can’t help whether a woman has had multiple pregnancies, or a history of back pain, or a strenuous job – sometimes we can have an impact on someone’s emotional distress. Because experiencing pelvic girdle pain for some women can cause them to really worry and panic about it getting worse, and this is usually to do with their experiences and what has been told to them by others.
As a physio treating pelvic girdle pain, it’s really important for us to determine what the woman expects might happen as her pregnancy progresses – does she have a friend or sister who ended up unable to walk in her third trimester? Has someone told her that her pelvis is really ‘unstable’ or ‘out of alignment’ and how has she interpreted this? Because as I said – research shows that beliefs and distress about the pelvic girdle pain is actually one of the biggest driving factors for it persisting. Sometimes reassurance that the pelvic girdle joints are super strong and can’t dislocate is the most important piece of the puzzle.
4 – Is my pelvis ‘unstable’ in pregnancy?
Nope. Your pelvis is one of the most stable joints in your whole body, even in pregnancy.
There is less than 5mm of translational movement and less than 3 degrees of rotation that can happen in your sacroiliac joints. So while the pelvic joints can be ‘stiff’ or hypermobile’ – we are talking about tiny tiny variations, not large movements or dislocations.
More movement can occur in pregnancy in the pelvic joints (the body is very cleverly preparing for the baby to pass through the pelvis during birth) but studies have shown that increased movement, and increased levels of the hormone ‘relaxin’, don’t equal increased pain necessarily.
The pelvis can feel unstable and some women experience ‘clunks’ and ‘clicks’ that may feel like the pelvic joints moving. But in actual fact, this feeling is actually due to the muscle control around the joints and whether the muscles are tight, or aren’t working with an optimal pattern.
So in summary – yes, pain can definitely come from the pelvic girdle joints during pregnancy, with our posture and muscles and weights and hormones changing. But this is more to do with sensitivity of the ligaments, the way we adjust our movement patterns, and the way our muscles respond to our new postures, and less to do with the joints being ‘unstable’.
5 – Will my Pelvic Girdle Pain go away after pregnancy?
Yes, it is very likely that pelvic girdle pain will resolve soon after the baby is born, as your hormones, posture and weight change again!
The most likely reason for pelvic girdle pain persisting is a negative belief about the cause of the pain – mindset is really important.
If pelvic girdle pain does persist after the pregnancy, it is likely that it’s because of adaptations that you’ve inadvertently made to the way you move, and this can be picked up by the eagle eye of an experienced physiotherapist, who can help you to get back to pain free movement and exercise with an individual program and treatment.
6 – How will my Physio assess and manage my Pelvic Girdle Pain?
You should expect your physio to:
- do a variety of tests to check whether the pain is coming from the pelvic joints, or whether it’s coming from the lower back, hip, or somewhere else
- look at the way you move when you experience pain, and to give you some different movement patterns, breathing strategies, or cues to see if they decrease the pain
- determine if the muscles and fascia around the pelvis are too tight or too weak, and then to give you a management program to help your individual symptoms. So this might be muscle release and stretching, or it might be muscle strengthening exercises. The take home message here is that one size does not fit all.
Will your physio fit you with a support belt? Maybe, but not necessarily. These belts tend to help women who have the problem of not enough support around the pelvis – actually a lot of women are found to have the opposite problem, and they need to learn to relax their muscles more – these women are likely to experience more pain when wearing a tight belt or support shorts.
Do you think that you might be experiencing pelvic girdle pain? Our physios at FitRight HQ are very experienced in treating PGP and would love to help you. Click here to book.