What is Pelvic Girdle Pain?
Pelvic Girdle Pain used to be lumped together in diagnosis of lower back pain. However, more recently Pelvic Girdle Pain (or PGP) has become it’s own ‘injury’. It refers to pain around the pelvis, usually focusing at your two sacroiliac joints, groin and your pubic symphysis.
The pain can sometimes refer down your legs into your thighs and also into your lower back. The most common areas are demonstrated in the diagram below.
Other than pain in the areas highlighted above the most common symptoms of PGP are pain with:
- Single legged activities, even as simple as walking or;
- Walking up stairs
- Rolling over in bed
- Getting in and out of the car
If you have PGP your endurance capacity for standing, walking and sitting is decreased.
PGP can occur for a number of reasons:
- Rapid weight gain
- High BMI
- Weak pelvic floor muscles
However, it occurs most commonly in pregnant women. It’s so common that 25% of pregnant women will suffer from some kind of PGP through their pregnancy. We call this pregnancy-related PGP.
Why Does Pelvic Girdle Pain Commonly Occur During Pregnancy?
Your pelvis has three joints – 2 sacroiliac joints (SIJ) and your pubic symphysis.
These three joints work together and usually only move very minimally (a couple of millimetres at best). When you become pregnant, certain factors cause these joints to become more mobile. This has to happen so you can push out a baby – pretty incredible right?
Firstly, the change in your weight (which is normal. I repeat, NORMAL) causes extra strain on your pelvis. As does the change in your gait and the way you sit and stand.
Secondly, the release of a lovely hormone known as relaxin softens all your ligaments and increases the flexibility of your pelvic muscles. Pregnant women have 10 times the relaxin in their body – not only softening your pelvic ligaments, but everywhere else in your body as well! Relaxin is at its’ peak throughout your first trimester and usually peaks around weeks 8-12. And interestingly enough – it’s at a similar time that pregnant women most often report the onset of PGP.
Relaxin will also peak again right before labour – to allow for the smoothest delivery possible.
So with weight changes, looser ligaments, altered gait and changed sitting positions the pelvis can start to move sub-optimally. This can lead to large amounts of pain and discomfort.
But – there are a lot of management strategies for PGP!
Ten tips for managing your Pelvic Girdle Pain:
Number One: Physiotherapy and exercise!
Each pregnancy is different and each person is different, so your exact exercises need to be tailored to you. It’s important to determine if you are suffering from PGP or lower back pain to tailor your program – and your physio can do this for you!
In general, while pregnant, you need to work on your pelvic stability. This includes your glutes, lower abdominals, obliques and adductors
The most simple exercise that will help strengthen these is squats. Start by squatting to a bed or chair. Ensure you stick your bottom right back to the chair and don’t let your knees come past your toes. Aim for 3 sets of 10 per day.
Other exercises can include pelvic tilts, bridges and supermans (or supermums)
What about pelvic floor exercises for Pelvic Girdle Pain?
It is certainly important to keep your pelvic floor strong as it supports or your pelvic organs. It has also been shown recently that there is a 50% reduction in urinary incontinence if you do pelvic floor exercises during pregnancy. One way to activate your pelvic floor is by imagining your cutting off your flow of wee (you can test this while actually going to the loo but don’t actually do this regularly).
But most importantly you need to RELAX your pelvic floor muscles (which is really hard to know if you’re doing or not). Another good imagery tool is to imagine a jellyfish swimming! Sounds ridiculous I know! But as you exhale lift through your pelvic floor and as you inhale relax and let go of your tentacles.
Practice holding for 10 seconds AND RELEASING.
I REPEAT – remember to relax and release your pelvic floor.
Related Article: 5 Tips for Pelvic Floor Health
Other tips that may also help:
Number 2: Take smaller steps when you’re walking
By taking smaller steps you will decrease the shearing forces through your pelvis. This can help manage your pain by decreasing the stress at your pelvic joints. Additionally, take your time when changing direction – slow and steady wins the race!
Number 3: Sit down whenever you need get dressed or changed
This will again decrease the shearing forces at your pelvis during single leg standing. If you stand on one leg to change you will have your full weight plus baby’s going through that leg. By sitting down you remove this pressure and the stress at your joints.
Number 4: Avoid heavy lifting
Always bend with your hips and knees whilst keeping the natural curve in your back. If possible stand near furniture for support as you bend down. Keep the objects your lifting close to your body.
Related Article: Exercise During Pregnancy
Number 5: Avoid sitting on the floor with crossed legs as well as standing for too long
Take regular sitting breaks if you have to stand for long periods.
If you have to sit on the floor (for example, to play with your kids) try sitting on a stool rather than cross legged.
Number 6: Correct Sitting Posture
Try using a small rolled up towel in the small of you back. Also try propping your feet up on a footstool and make sure your bottom us right back in the chair.
Number 7: Correct Standing Posture
Try slightly tucking your pelvis underneath your body more (i.e. don’t stick your bottom out).
Make sure you have even weight over both legs.
Number 8: Try sleeping with a pillow between your legs
This decreases pressure through the front of your pelvis and avoids twisting through the back of your pelvis.
Number 9: Cross your ankles when getting in and out of bed
Getting in: Sit with your bottom as far back as you can on the bed, cross your ankles, keep your legs bent and your knees a little apart as you lie down on your side, bringing your feet up with you.
Getting Out: starting on your side use your arms to push yourself up. Try to keep your knees and feet together or cross them over.
Number 10: Rolling Over
Move your body to one side of the bed to allow room without twisting.
With your legs bent up, roll bit by bit, keeping your knees and shoulders pointing in the same direction.
Will Pelvic Girdle Pain affect my baby or my labour?
No it will not affect your baby in any way. Unfortunately, all the pain is suffered by you!
It also shouldn’t affect your birth or labour at all. PGP does not mean you have to have a cesarean or be induced.
Will my pain persist after childbirth?
PGP can be managed throughout your pregnancy and most PGP recovers completely after childbirth. However, roughly 7% of cases can continue with pain. If this is the case for you, it’s really important that you continue with your treatment and management strategies. You can talk this over with both your physiotherapists and health care professionals.