Pelvic Girdle Pain in Pregnancy

Pregnancy related pelvic girdle pain (PRPGP) is estimated to affect 60-70% of women by the end of their 3rd trimester. But unfortunately research indicates only 25% of women are referred for treatment. Recognising the symptoms early and seeking appropriate treatment can make a huge difference to physical and emotional wellbeing throughout pregnancy and into the post partum period.

 

What are the symptoms of PRPGP?

Symptoms are usually felt in one or a combination of the following:

– Sacroiliac joints (SIJ’s)

– Pubic symphysis

– Referral to the buttocks and back of the thighs

– The lower back

Presentation usually results in discomfort when walking, sitting, and standing. Movements that involve single leg actions such as stairs or getting in and out of the car can also be difficult.

What causes PRPGP?

There is not one single cause of this condition, instead now clinicians believe  there is a multifactorial range of contributing factors. Some of these include:

– Hormonal changes

– Genetics

– Biomechanics

– Trauma

– Degenerative changes

– Fear avoidance

Is it due to the pregnancy hormone relaxin?

This was long thought to be the primary cause of “pelvic instability” as ligaments are affected by the presence of relaxin during pregnancy in preparation for labour. Despite this theory being very logical, there is insufficient evidence to support it and there is now more emerging evidence to contradict this theory. 

Does having PRPGP mean my pelvis is unstable?

Put simply, no. The pelvis as a structure is inherently stable and can safely carry increased load when pregnant. There is evidence to show that pelvic joint mobility increases during pregnancy, however it does not correlate with developing PRPGP. Furthermore, our muscle function actually counteracts a lot of this change so the belief of the pelvis being “unstable” is not anatomically or physically correct.

It is a normal part of pregnancy so I should just put up with it.

Although it may be common, there is a lot we can do to manage symptoms throughout pregnancy. In over 75% of cases it resolves within the first two months after birth, however it can be persistent in a small number of cases if it is not managed appropriately.

Should I stop activity to help my pain?

Being physically active during pregnancy has a huge number of physical, social and emotional health benefits. As discussed in an earlier blog, it is now actually recommended that women are physically active during their pregnancy. One of the factors that may contribute to developing PRPGP is a decrease in muscle function or a change in activity- this can include a reduction! Most of us assume pain results from doing too much but in some cases it is in fact the opposite. Therefore, instead of stopping activity all together, speak to a physiotherapist about what exercise is suitable for you, as every woman and every pregnancy is different.

How is PRPGP diagnosed?

Your physiotherapist will be able to identify PRPGP from your history and presentation of symptoms. They will also complete a range of tests to confirm the diagnosis and identify what factors may be contributing to your presentation. It is a relatively straight forward assessment that isn’t too uncomfortable, it also does not routinely require any further investigation or imaging.

What is the management of PRPGP?

There are many strategies and treatment options to reduce symptoms and improve function including:

– Advice and guidance to avoid aggravating activities

– Targeted stability and strength exercises to assist pelvic function

– Manual treatment to relieve compensatory muscle pain

– Strategies to reduce the load through the pelvis

– Compression garments to reduce pain

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If you need more information on this topic or some guidance, come in and see one of our Physiotherapists here at 13th Beach Health Services. In addition we offer individual and group pilates that are suitable for women at all stages of pregnancy.

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