Pelvic Girdle Pain in Pregnancy: What It Is and How to Manage It
Pelvic girdle pain (PGP) is a common condition experienced by many women during pregnancy, affecting up to 1 in 5 women. It can make everyday activities like walking, standing, and sitting uncomfortable or even painful. While pregnancy brings significant changes to the body, PGP can be particularly frustrating as it limits mobility and contributes to physical discomfort. Understanding PGP, its causes, symptoms, and management techniques can help pregnant women maintain a better quality of life throughout their pregnancy.
What Is Pelvic Girdle Pain?
The pelvic girdle is made up of several bones, including the hip bones, sacrum, and pubic symphysis, which work together to support the weight of the upper body and provide stability. Pelvic girdle pain (PGP) refers to pain in or around these pelvic bones and joints, particularly around the sacroiliac joint (SIJ). It is often associated with pregnancy as hormonal changes, and biomechanical changes can place extra stress on these areas.
A closely related term is pubic symphysis dysfunction (PSD), which refers to pain in the pubic symphysis (the joint at the front of the pelvis). Additionally, sacroiliac joint pain is another term that refers to discomfort in the joints connecting the pelvis to the spine. Together, these conditions fall under the umbrella of PGP, which can range from mild discomfort to severe pain.
Symptoms of Pelvic Girdle Pain in Pregnancy
Pelvic girdle pain presents itself in various ways. Pregnant women experiencing PGP may describe the pain as:
Shooting, stabbing, throbbing sensation
Pain with activities: Pain particularly with asymmetrical movements in the legs like walking, stairs, getting out of the car, putting pants on, or getting out of bed.
Pain located around the pelvis: Pain in the back or front of the pelvis that might radiate to the hips, lower back, or thighs.
Common areas affected by PGP include:
Pelvic Girdle Pain Illustration
(PGP) can manifest in multiple areas of the pelvis, as highlighted in this diagram. The red circles represent common locations where PGP is felt, including the sacroiliac joints, the pubic symphysis, and the hip joints. PGP often occurs during pregnancy and can lead to discomfort in movement, sitting, or standing for extended periods. Pelvic floor physical therapy can help alleviate pain by addressing muscle imbalances and joint misalignments.
The front of the pelvis (pubic symphysis)
The back of the pelvis (sacroiliac joints)
Lower back
Hips and thighs
Who Gets Pelvic Girdle Pain in Pregnancy?
While PGP can affect any pregnant woman, several risk factors may increase the likelihood of developing this condition:
Previous pelvic, hip, or back pain: Women who have a history of pelvic or lower back pain, before pregnancy, are more susceptible.
Injuries: Previous injuries to the pelvic area can contribute to PGP.
Multiple pregnancies: Women who have had 2-3 pregnancies, or those carrying multiple babies (twins, triplets, etc.) experience increased pelvic strain, making them more prone to PGP.
High BMI: A higher body mass index can add extra pressure on the pelvic joints, leading to pain.
Joint hyper mobility: Those who have more flexibility in their body naturally, or those who have conditions such as Elhers Danlos Syndrome.
Causes of Pelvic Girdle Pain in Pregnancy
PGP during pregnancy can be caused by a few different factors. One of them is the body’s natural hormonal changes during pregnancy. The hormone progesterone causes muscles to relax more and another hormone relaxin impacts ligament support. While this is essential for pregnancy, it can lead to compromised support at the pelvis, thus resulting in PGP. Additionally, as the baby grows and the uterus expands, a woman’s center of gravity shifts, placing added pressure on the low back and pelvic region. This coupled with the muscular and ligamentous changes can also contribute to PGP.
Non-pregnancy-related factors can also play a role in PGP. Muscle imbalances, prior injuries, or underlying conditions like scoliosis can exacerbate pelvic pain during pregnancy.
How Pelvic Girdle Pain Affects Labor and Birth
For women experiencing PGP, labor and birth can be more challenging. The additional stress placed on the pelvic joints during labor may intensify PGP symptoms. However, many women with PGP can still have a vaginal delivery, although certain positions may need to be adjusted.
Recommended labor positions to reduce pelvic strain include those where the hips are in a symmetrical position, such as lying on your side or being on all fours. These positions help alleviate some pain from the pelvis and can make labor more manageable. It’s important to consult with your healthcare provider about labor positions that can ease PGP discomfort.
Managing Pelvic Girdle Pain in Pregnancy
There are several strategies for managing PGP during pregnancy, allowing women to reduce pain and stay active:
Daily activity modifications: Avoiding activities that create asymmetrical positions in the the pelvis, like standing on one leg or twisting movements, can help. It's also beneficial to sit down when getting dressed or use both legs together when getting out of bed.
Supportive footwear: Wearing comfortable, supportive shoes can help support your pelvis by reducing the impact on the joints through better foot, ankle and knee positioning.
Pelvic support garments and belts: SI belts can provide additional compression to the pelvic region, helping to better support the joints and reduce pain.
Gentle core activation exercises: Activating your deep core, to include your transversus abdominus and pelvic floor muscle, can help to provide extra support to the pelvis. Particularly doing this through a movement can be beneficial.
Use heat therapy: A warm compress or heating pad can help soothe sore back or hip muscles.
Pelvic Floor Physical Therapy and Exercises for Pelvic Girdle Pain
Working with a board certified pelvic floor physical therapist (PFPT) can be a game-changer for women with PGP. Pelvic PTs in particular are well versed in identifying muscle asymmetries and then providing manual therapy techniques such as soft tissue therapy to the relieve those muscles. They can also guide you on exercises that will best support your pelvis, as well as educate you on modifications for problematic movements.
Some common exercises might include:
Figure Four Stretch: This exercises stretches the hip muscles such as the piriformis.
Childs Pose Stretch: This exercises stretches to stretch tight back muscles muscles.
Deep Breathing: Diaphragmatic breathing helps to get our pelvic floor and deep core muscles activated for pelvic support and also helps to reduce tension in the surrounding muscles.
Transversus abdominus activation: This helps to activate the deep core system to provide stability and support to the pelvis.
Seated Pelvic Tilts: This helps to keep the pelvis moving and prevent further stiffness.
Future Pregnancies and Pelvic Girdle Pain
Women who have experienced PGP during pregnancy are more likely to encounter it again in future pregnancies. However, early treatment and consistent management strategies, such as strengthening and stabilization exercises, can help reduce the severity of symptoms.
FAQs
Can PGP go away after pregnancy? Yes, PGP symptoms improve after delivery. However, PGP is also common postpartum, thus it is important to start addressing this as early as you notice symptoms.
Is it safe to exercise with PGP? Yes, specific exercises that focus on gentle core activation and strengthening surrounding the pelvis are greatly beneficial at helping to manage symptoms. It is important to consult with a physical therapist to know what is best for your own body’s needs.
When should I see a doctor about PGP? If your PGP becomes unmanageable or significantly interferes with daily activities, it's important to seek medical advice. A doctor or physical therapist can offer guidance on managing pain and improving mobility. The sooner you can get help the better it will be at not allowing your symptoms to worsen.
Understanding and managing pelvic girdle pain during pregnancy can make a significant difference in a woman’s comfort and ability to stay active during pregnancy which is very important for the health of the baby and person. With the right strategies, including physical therapy, SI belt, stabilization exercises, and activity modifications, most women can successfully manage PGP and enjoy a healthier pregnancy.
Written By,
Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health
Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.
