Pregnancy-related Pelvic Girdle Pain (PrPGP)
What is pregnancy-related pelvic girdle pain (PrPGP)?
PrPGP is a common pregnancy-related musculoskeletal condition, which results in pain around the joints of the pelvis. The common sites of pain include the sacroiliac joints (where the sacrum of the spine attaches to the iliac bones of the pelvis), and the pubic symphysis (where the two pubic bones meet at the front and centre of the pelvis).
It is a common misconception that “relaxin” causes PrPGP due to relaxing ligaments and causing the pelvis to be “unstable” - this is FALSE. The pelvis is a closed ring, and is therefore an inherently stable structure. These beliefs can perpetuate fear and lead to strategies like complete activity avoidance which can worsen the pain.
It is more helpful to think of the pelvis as being overloaded, due to increased weight in the pelvic bowl (a heavy uterus and placenta), and subsequent irritation to the joints of the pelvis. PrPGP is also common around 12, 20 and 27 weeks pregnant, when there is a larger growth of the foetus, causing a sudden increase in load on the pelvis.
Other things that may lead to pelvic girdle pain are just a bit unlucky - for some people, unfortunately their baby’s head is just in a bad position, and is pushing down into the pubic symphysis, causing significant pain and discomfort here.
Despite some contributing factors to PrPGP being unlucky, there are still ways to improve or even resolve PrPGP.
Management and resolution of pelvic girdle pain - will it ever go away?
Many pregnant women can become quite fearful of PGP, especially if they have had friends or relatives experience it quite severely. The question commonly pops up - will it ever go away?
The short answer is - YES!
A recent study by Pulsifer at al. (2022), found that ‘the strongest predictor of resolution of pregnancy-related pelvic girdle pain, is having the belief that it will go away.’
This finding shows how much our fear and unhelpful beliefs can negatively affect our bodies and our pain, but also, how much of an impact education and reassurance can have on resolving debilitating conditions such as PrPGP.
Pregnancy is common, and has been experienced by millions of people for centuries - people’s experiences of pregnancy are often shaped by what they are told by people they know; information which has been passed down for generations, and is highly biased and based on individual experiences. Every individual is different, and everyone will have their own unique experience of pregnancy, with their own individual triumphs and struggles which may be mental or physical.
So, apart from positive beliefs, how else can we improve, or prevent PrPGP?
As we said earlier, PrPGP occurs due to overload in the pelvis - so we can improve it by relatively unloading the pelvis. The two key factors I try to modify for my patients are:
Reducing single leg loading (this puts double the weight on one side of the pelvis!) and
Increasing glute strength! (especially gluteus medius)
I like to think of the glutes as muscles that “hug” the pelvis - they sit on the outside of the pelvis, and therefore provide support, particularly during single leg activities like climbing stairs. By strengthening the glutes during early pregnancy, we can reduce the risk of developing PrPGP down the track.
How can physiotherapy help?
As a Pelvic health physiotherapist, my biggest caseload is pre and post-natal women, so I am often seeing women who have experienced PrPGP, or who are worried about it.
Treatment for PrPGP can include soft tissue release such as massage or dry needling to reduce muscle tension which may be worsening symptoms, as well as education, and a home exercise program consisting mainly of glute strengthening exercises as mentioned above. My go-to glute exercises are:
Crab walks
Banded glute bridge
Clams/side lying leg lifts
For some women, teaching them how to activate their deep core muscles (transversus abdominus) can also significantly improve their pain.
Education is also a key component of treatment and resolution of PrPGP. I will highlight the main movements which may be provocative such as brisk walking, stairs, or single leg exercises they may be completing, and work with the patient to modify their activity to reduce irritation, but maintain function and exercise capacity.
For those that are pain-free and seeking preventative care, I will always educate them on PrPGP in strengths-based language, and prescribe preventative glute strengthening exercises to reduce risk of PrPGP.
Seeing a Pelvic health physiotherapist during pregnancy can help with treatment for PrPGP, advice and guidance for exercise prescription, as well as optimising pelvic floor function during pregnancy.
References:
Pulsifer J, Britnell S, Sim A, Adaszynski J, Dufour S. Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain. Br J Sports Med. 2022;56(22):1262-1265. doi:10.1136/bjsports-2022-105724