Pelvic Girdle Pain
Date issued: November 2012
For review: November 2014
Ref: B-258/Physio/AM/Pelvic girdle pain
Introduction
Pain in the pelvic region is common during pregnancy, sometimes significant enough to cause distress and upset your normal routine. Pelvic Girdle Pain (PGP) is a common recognised condition that can be safely treated at any stage during or after the pregnancy.
What is pelvic girdle pain?
Pelvic Girdle Pain is pain in any of the joints in the pelvis. PGP can develop at anytime during pregnancy, as a result of excessive ligament laxity. During pregnancy, hormones soften the ligaments that hold the joints in place. This is a natural occurrence that allows for the delivery of your baby. However, this greater availability of movement can lead to a lot of discomfort. This is a common problem during pregnancy, however, it does not occur in every woman, and should not be dismissed as a ‘normal’ part of pregnancy. Consult your midwife early so you can be directed to the correct course of treatment without delay.
Signs and symptoms
Strain of the pelvic joints may be felt as pain in the pubic region, groin and inner thigh, in your back and buttocks. Pain worsens with walking and all weight-bearing activities, especially those where the legs are parted e.g. using stairs, getting dressed, also rolling over in bed. Clicking or grinding may be heard or felt and you may feel the sensation of your pelvis giving way.
Management during pregnancy
- Listen to your body, rest when you can. Pain will only get worse if you push through it.
- Reduce non-essential weight bearing activities e.g. shopping, unnecessary climbing of stairs.
- Consider reducing hours at work or stopping earlier than planned, if able.
- Accept offers of help from family and friends
- Keep legs together (e.g. getting in/out bed, car, turning over in bed).
- Keep your body symmetrical when you move, sit, stand or lie down. Carry shopping equally in each hand, and carry babies in front, not on your hip.
- Avoid standing on one leg – sit to put on trousers and socks.
- Avoid breast-stroke if swimming.
- Plan ahead and consider positions for delivery (e.g. all-fours).
- Discuss this with your midwife or GP. They may feel you would benefit from physiotherapy and can refer you.
- Pain relief - discuss this with your doctor.
Physiotherapy may offer:
- Pelvic support belt, if tolerated, fitted by a physiotherapist.
- Elbow crutches.
- Exercises.
- ‘Hands on’ manual treatment.
Management during labour
- Inform your midwife of your PGP and write it in your birth plan.
- Record your measurement for the amount you can part your legs without pain (pain free gap) prior to your delivery and do not exceed this.
- Consider your most comfortable positions and try to adopt these during your delivery or when being examined
- Always be aware of the position of your legs, especially when using pain relief /epidural.
Management after delivery
- Inform staff of any discomfort you may be experiencing.
- A referral to a physiotherapist may be required.
- Rest and continue to accept help from family and friends if needed.
- mindful of your posture at all times
- Continue with the advice given during your pregnancy, even if the pain has reduced.
- The effects of the hormones can last up to six months.
Exercises
Transversus Abdominus Exercise
- Draw in your lower stomach muscles and hold in for 10 breaths. Brace this muscle whenever changing position e.g. rolling over in bed.
Pelvic Tilt Exercise
- When lying down flatten the hollow of your back into the bed to tilt your pelvis. Now practise this in standing.
Pelvic Floor Exercises
- Tighten the muscles around your back passage, and draw them forwards and in. Aim to hold for 10 breaths. Also try pulling your pelvic floor muscles in quickly.
These exercises can be done little and often through the day. Try to do 10 of each, holding for 10 seconds as often as you can. All these exercises will provide stability for your pelvis. They can be done in any positions (lying, sitting or standing). Your physiotherapist will show you more advanced exercises if necessary.
Will it get better?
You should find you are much more comfortable after delivery.
Will it come back?
There is a possibility of future recurrence in further pregnancies. The important thing is to be aware of your symptoms and seek advice early.
General Information
Physiotherapy department:
Level 7, Derriford Hospital, Plymouth.
Tel: 0845 155 8208
National organisations: www.pelvicpartnership.org.uk
Tel: 01235 820 921
British Red Cross for equipment hire:
60 Crownhill Road
Tel: 0845 331 3331
