Pelvic pain during pregnancy, officially called Pregnancy related Pelvic Girdle Pain (PPGP), is pain felt anywhere across the top of the back part of the pelvis, into the glutes and sometimes wraps around the hips, and runs down the thighs. Often this also includes pubic bone pain, or pubic symphysis dysfunction (PSD). The pain can be felt in all of these spots, a few of them, or just one. It can be felt on one side, both sides, or can be very central.
PPGP usually arises during pregnancy, but can occur during delivery and extend into the post-pregnancy period. The pain can be continuous or intermittent; it can be sharp, burning, achy or tender and can also be inconsistent. Typically, pain occurs with walking, prolonged standing, bending, lifting, climbing stairs and rolling over in bed. However, sometimes you might get it with a certain activity (like getting up from a chair) and then the next day it will be gone…and then back again.
When I examine someone for PPGP, there are certain things that I look for. Sacro-iliac joint issues, asymmetry in the pelvis, overuse of certain muscles, underuse of others. Typically there is some strain in the pelvic ligaments. Often posture can play a large role. Not everyone has all of the signs, and some women have all of the signs but no pain at all. Additionally, just because a woman had pain with one pregnancy, does not necessarily mean she will have pain with a following pregnancy.
Physiotherapy treatment will generally include manual therapy (the use of the physiotherapists’ hands to help move joints), massage techniques, exercises to strengthen, stretches to lengthen and lots of education. Sometimes women need to relearn how to use their growing bodies, or need suggestions for better movement patterns.
I almost always recommend the Rost Moves Mamas app, for apple and android devices. This app demonstrates the do’s and don’ts of everyday activities. Pain with sitting? It demonstrates optimal positions. Difficulty bending? It will show you different techniques. I should add that I don’t receive any compensation for promoting this app – it’s just really useful! Occasionally I will suggest some sort of equipment – maternity support belts, Kinesiotape, compression socks, or body pillows, but this is on a case by case basis.
A large majority of women who experience PPGP get complete relief from their symptoms after delivery. Occasionally there are some who experience pain following pregnancy. For these women, I often continue treatment into the post-natal period. For the first 3 months after delivery (and I would argue up to 12 months after delivery) the body progressively return to its pre-baby form (kind of). The uterus lowers back into the pelvic bowl, the ribs descend, blood volumes reduce, the abdominal muscles strengthen and the pelvis comes back into place. However, some women will need a little help to make this happen. The focus of physiotherapy after delivery changes slightly, with the goal of rehabilitating all of the connective tissue and muscle changes that occurred during pregnancy and delivery.
What I really want women to know is this; there are many ways to treat and manage pregnancy related pelvic girdle pain. Often times, something can be done to lessen discomfort, improve pain levels, or get rid of symptoms all together. Talk to your doctor or obstetrician about finding a therapist who has experience working with pregnant women.
BSc., MSc. PT