Pregnancy and Postnatal Pelvic Girdle Pain

Pregnancy and Postnatal Pelvic Girdle Pain

This information is provided as a general information and a guide only and clients are advised to consult with their own Physiotherapist for further advice.

We estimate around 50% of our consultations involve assessment of the pelvic girdle. We recommend you check out any pain in pregnancy by consulting us at seasons of life Physiotherapy.  We are experienced in all forms of girdle pain and problems, small and big!

One in 5 women in pregnancy suffer from pain in the pelvic joints; that is the pubic bone at the front and/or one or both of the sacroiliac joints at the back of the pelvis in the buttock region. This is called Pelvic Girdle Pain (PGP).

PROGNOSIS

The pain can also be felt in the groin, lower back, pelvic floor, coccyx or other areas. Most women return to painfree function and have a 'normal' pelvis sometime after the birth. A very small number of women may have ongoing Pain that needs to be managed or further investigated. This is lessened by good management in pregnancy and ongoing follow up postnatally. Some women only begin to have pain after the baby has been born but this is less common. Just because the pain goes doesn't mean the problem is resolved and we recommend follow up postnatally to return to full function and strength. Many women become very anxious because they have been told incorrect information about PGP. Unfortunately many health professionals and well-meaning family or friends may inadvertently worry you about PGP. Having an episode of PGP does not mean you will have increased pain and end up in a wheelchair. However regular, good management is essential!

CAUSE 
The theories behind PGP are still under consideration. Because the pain is mostly specific to pregnancy (although it can occur in men and non-pregnant women,) hormones are thought to play a significant role. One of the common theories is that during pregnancy a hormone called relaxin is released in order to soften the joints and muscles/ tissues of the body in preparation for the birth of your baby. This is why the condition is sometimes called Pelvic Instability however the pelvis is one of the most stable joints in the body and doesn't actually become unstable although the joints may increase their usual range of movement. Also pregnant women are known to have higher responses to pain induced stimuli and the role pregnancy itself plays is not fully understood. We also know that women who have higher levels of distress generally are more likely to have ongoing problems through their pregnancy. But everyone is individual and we assess and manage YOUR pain and function.

The other theories are that some women are more likely to develop pain due to predisposing factors such as previous back pain, or trauma to the back/pelvis. Some women who are hypermobile are more likely to have pain or women who have had particular occupations or hobbies. Some research also indicates that it is a difference in joint movement that may be a risk factor in developing this condition but that is not something that women often know themselves! 

Strengthening and performing Pilates prior to pregnancy, during pregnancy and between pregnancies does tend to lessen severity of pain as well as recurrence in further pregnancies. Most women find regular Physiotherapy can help manage pain.

MANAGEMENT 
In pregnancy, guidelines that we follow for other times of our life may not be useful or even safe. Pelvic Girdle pain can be treated using hands on techniques such as massage or mobilisation of the spine, simple analgesic advice such as ice over the pubic joint or coccyx or heat over painful or tight muscles. Exercises for home and in a Funky Mama Pilates session or class as well as supportive braces in some women can be part of your management plan. Not all women benefit from braces. These do need to be properly fitted and are often not useful if bought without proper consultation or advice. Sometimes women are given crutches or other aids to use. This is similar to resting a joint that is injured. Think of an ankle that is sore after a sprain. You may need to use crutches in order to rest the ankle for a few days/weeks. Then the exercises and rehab begins:) 
 
Pelvic Girdle Pain can be aggravated by inappropriate exercises such as high impact, bouncing, wide legged exercise or poor stretching exercises or technique. At seasons of life and Funky Mama we are careful to screen pregnant women for possible pain, and only instruct safe exercise. Gentle water exercise is particularly suitable for women with pelvic instability however most women can also attend FM Pilates with modifications. We recommend Clinical Pilates sessions rather than our pregnancy classes if your pain is severe or acute. We also suggest you make an individual appointment so we can treat your PGP as well as attend classes. Attending exercise in itself is not going to improve pain as all of us are individuals and may need specific types of exercises or specific advise pertinent to our own situations.

BIRTH
Vaginal delivery is still best management for a woman with PGP as caesarean is not protective.  Caesareans is only necessary under our care givers recommendations for other medical or further reasons.

We look forward to assisting you in your journey through pregnancy and recovery with Physiotherapy and Pilates.