PELVIC GIRDLE PAIN

What is it?

Pelvic Girdle Pain (PGP) occurs when the joints within the pelvic girdle – sacroiliac joints (SIJ) and pubic symphysis joint (PSJ) become inflamed and sore. The SIJ are your dimple joints at the bottom of your spine where your left and right pelvic bone connect with your sacrum (triangle bone at the bottom of your spine). The SIJ are responsible for absorbing force between your legs, pelvis and spine. The PSJ is at the front of your pelvis where your left and right pelvic bones connect at your pubic joint. Like the SIJ, the PSJ is responsible for force absorption also however, the PSJ plays a vital role in childbirth as it gently stretches allowing the pelvis to open as the baby’s head passes through the pelvic outlet.

Causes

There can be multiple causes of PGP but most commonly, it occurs throughout pregnancy as a result of the culmination of multiple factors: 

  1. Increased weight into pelvic cavity – With a growing baby, increasing fluid and blood flow and general weight gain
  2. Relaxin hormone release from around 7-10 weeks creates inherent ligamentous laxity throughout the body. This increases the mobility and “instability” of joints especially within the pelvis
  3. Muscular overactivity – in order to provide support to the woman’s growing body and increasingly “stretchy” joints, the muscular system can go into overdrive. This can lead to tight and painful areas of overactivity which also contribute to pain
  4. Baby positional preferences – The position in which the baby is sitting can have a huge impact on the amount of pelvic pain felt and the location of pelvic pain – as if the baby is preferring one side, that side can start to become symptomatic as a result of the increased strain and pressure.

In the postnatal population, PGP most commonly is a result of:

  • Trauma – especially during childbirth – some women can injure their pubic symphysis especially if they deliver their baby in a highly asymmetrical position e.g. one leg up and one leg down
  • Overuse + poor posture – with bending, lifting and carrying a baby, there can be significant pressure and strain in the pelvic joints which can also contribute to PGP

Symptoms

  • Pain, tenderness and swelling around the pubic joint or sacroiliac joints
  • Typically movements that are provocative include:
      • Standing up, rolling in bed, getting out of the car, walking, navigating stairs
  • Low back pain 
  • Feeling as if one leg is longer than the other

Physiotherapy treatment options

  • Myofascial massage pelvic girdle pain pic 2
          • Massage is targeted towards releasing overactivity that could be contributing to pain and dysfunction however, if too much release is done, sometimes that can leave a pregnant woman feeling unstable and as if her joints are “falling apart”. With this in mind it is critical that you see a professional that has experience in treating obstetrics. 
  • Musculoskeletal mobilisation 
            • Sometimes the pelvis can be rotated or one side can be under strain if it is sitting in a certain way. This can place considerable strain on the ligaments throughout the pelvic joints and contribute to the pelvic pain experienced.   Gentle mobilisation techniques de-rotate and gently stretch the pelvic to sit in a more favourable, neutral position.
            • The exact effect of musculoskeletal mobilisation is unknown in terms of whether we are actually mobilising the joint itself or gently stretching the tight tissues around the joint which enables the joint to sit better. Regardless of the exact effect, the depth, pressure and intensity of mobilisation is very gentle and completely controlled by the patient
  • Compression – in lifting the weight of the glowing pregnant belly this can reduce the pressure into the pelvic cavity, hence reducing the strain on ligaments and joints and associated pain
  • Bracing – if the joint is deemed “lax” or “unstable” a specific brace may be prescribed to provide external support to the joint.
  • Ergonomic advice – This will form a large component of treatment and is highly tailored to the patients aggravating movements and pelvic pain. 
  • Ice / cold therapy – typically ice is recommended if a joint feels inflamed and sore. We recommend using the ice directly over the affected joint itself. 

The exact effect of ice / cold therapy is unknown especially in terms of time of application after the injury / pain has occurred. Despite this, there is considerable evidence to show no harm and if ice seems to reduce perceived pain or inflammation we strongly recommend it.

  • Heat therapy – typically it is recommended that you use heat over a tight muscle to “relax” the muscle. If the therapist recognises that there is marked overactivity in a particular area around the pelvis that could to contributing to altered mechanics, heat over that muscle would be indicated 
  • Mobility aid prescription – in severe cases, mobilising can become increasingly difficult and painful. In those instances, certain walking aids can be prescribed in order to reduce the strain into the pelvis and associated joints. 

Other treatment options

  • Anti-inflammatory medications – always consult your doctor or pharmacist prior to taking any medications to check if it is appropriate and safe for you to do so. In taking anti-inflammatory medications, inherent inflammation and irritation within the affected pelvic joints can reduce. 
  • Immobilisation – in severe cases bed rest may be the only option to reduce immediate irritation from the pelvic joints. This treatment option is rarely used as in most cases, physiotherapy can significantly reduce pelvic pain experienced. 
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