Pregnancy Related Pelvic Girdle Pain

Pregnancy related pelvic girdle pain (PR PGP) can be felt in the region of the sacroiliac joints (the dimples at the top of your buttocks) the gluteal muscles, back of the thighs and/or in the region of the pubic bone. It may also sometimes radiate into the perineal area and the hips.

What is the cause of PR PGP?

No one really knows exactly why some women experience PR PGP.

The main theories, which are logical include:

• Hormones that change the properties of ligaments that support the joints in the pelvis
• Changes in load distribution/forces going through the pelvic joints with the growing baby

Risk factors for PR PGP ⁽¹⁾

• Having ever had lower back pain or pelvic girdle pain before (either when pregnant or not)
• A family history of lower back or pelvic girdle pain
• Having been pregnant before
• Spending long hours in a standing position

It is often made worse by the following activities:

• Turning/rolling over in bed
• Going up and down stairs
• Getting in and out of a car
• Standing on one leg (for example when getting dressed; putting pants on)
• Walking

When will the pain go away? – Prognosis of PR PGP

It’s encouraging to know that most women who have experienced moderate to severe PR PGP report a significant reduction in pain in the first 2 weeks following birth (44%) and 83% recover at 6 weeks post-partum ⁽²⁾. It may take a little longer for a minority of women to recover.

How common is PRPGP?

The onset of pain can occur at any stage in pregnancy, even early on before there are other noticeable body changes. A recent well designed Australian study found PR PGP was common, affecting up to 44% of women at any one time during pregnancy ⁽¹⁾ . The level of pain is individual and variable, with many women having mild to moderate pain and occasionally severe pain. Although PR PGP is common, it is always advisable that you check in with a healthcare professional for individual assessment and care.

The impact of PR PGP

PR PGP is not dangerous to you or your baby and usually does not prevent you from having a vaginal birth.

Ceprnja and colleagues ⁽³⁾ examined the ‘lived experience’ of those with PR PGP. In this study, whether the individual’s experience with pain was mild, moderate, or severe they all reported significant difficulty with one or more daily tasks/activities. Many reported surprise that there would be pain with pregnancy, leading to frustration and the unexpected experience of not enjoying the pregnancy and having to rely more heavily on social support (ie partner, family and friends). In addition, when searching for education, assessment, and strategies to cope with the pain during pregnancy, many women found that healthcare professionals downplayed their pain as a normal part of being pregnant.

Physiotherapy of course was an exception to this finding!

Treatment options

Assessment:

Treatment must be individualised – there is no one size fits all. For this to occur an initial physical examination is important to diagnose PR PGP and to determine if there are other contributing factors (eg some of the pain may be coming from the low back as well). It’s good to know that there are health professional guidelines available to guide a specific cluster of tests for diagnosis and treatment guidelines for PR PGP ^(4).

Supportive Physiotherapy Treatment:

• Education regarding the condition
• Advice for coping with everyday practical activities that aggravate pain
• Assessment and if indicated, prescription of a pelvic belt
• Manual therapy to calm down painful joints
• Individualised gentle exercises to help strengthen and support pelvic joints.

Other treatment:

• Acupuncture is safe and effective for reducing PR PGP ⁽⁵⁾

 

In conclusion, don’t be put off by health professionals telling you “It’s normal, put up with it, it will get better once you give birth.” A caring Physiotherapist with a special interest in Women’s Health will listen to you, assess and validate your pain experience and provide education and individualised treatment options to support you through your pregnancy.

 

References:

1. Ceprnja D, Chipchase L, Fahey P, Liamputtong P, Gupta A. Prevalence and Factors Associated with Pelvic Girdle Pain During Pregnancy in Australian Women: A Cross-Sectional Study. Spine (Phila Pa 1976). 2021 Jul 15;46(14):944-949.
2. Gausel AM, Malmqvist S, Andersen K, Kjærmann I, Larsen JP, Dalen I, Økland I. Subjective recovery from pregnancy-related pelvic girdle pain the first 6 weeks after delivery: a prospective longitudinal cohort study. Eur Spine J. 2020 Mar;29(3):556-563. doi: 10.1007/s00586-020-06288-9. Epub 2020 Jan 16. PMID: 31950350.
3. Ceprnja D, Chipchase L, Liamputtong P, Gupta A. “This is hard to cope with”: the lived experience and coping strategies adopted amongst Australian women with pelvic girdle pain in pregnancy. BMC Pregnancy Childbirth. 2022 Feb 2;22(1):96.
4. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008 Jun;17(6):794-819.
5. Yang J, Wang Y, Xu J, Ou Z, Yue T, Mao Z, Lin Y, Wang T, Shen Z, Dong W. Acupuncture for low back and/or pelvic pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2022 Nov 21;12(12)