It is not uncommon for women to experience musculoskeletal pain during pregnancy – relating to postural changes, increased weight and hormonal effects. Pain is typically experienced in the lower back, pelvis and pubic area – commonly caused Pelvic Girdle Pain (PGP) or Symphysis Pubis Dysfunction (SPD).
What is Pelvic Girdle Pain / Symphysis Pubis Dysfunction?
PGP or SPD is a condition, which causes pain in one or more joints of the pelvis and can result in difficulty walking. It is most commonly associated with pregnancy, but can also occur in women who are not pregnant and men, sometimes as a result of injury or trauma.
These joints are supported by strong ligaments and over 35 muscles which attach at various points to the pelvis and spine. It is important to remember that the pelvis is also closely linked to the spine and the hips and can therefore also be affected therefore also be affected by any previous injuries problem affecting these joints.
What are the symptoms of SPD, PGP?
Pain can start at any point through the pregnancy, and can range from an uncomfortable throb in the groin to severe pain and difficulty walking.
Symptoms can include:
- Pubic pain
- Pubic tenderness to the touch (and having the fundal height of the foetus measured may therefore be uncomfortable)
- Lower back pain, especially in the sacro-iliac area
- Difficulty/pain when turning over in bed
- Difficulty/pain with going up or downstairs, getting in and out of cars, sitting down or getting up, putting on clothes, bending, lifting, standing on one foot, lifting heavy objects, etc.
- Difficulty/pain on separating your legs
- Sciatica type symptoms (pain in buttocks and down the leg)
- “Clicking” in the pelvis when walking
- Waddling gait
- Difficulty getting started walking, especially after sleep.
- Feeling like your hip is out of place or has to pop into place before walking.
- Bladder dysfunction (temporary incontinence at change in position).
- Knee pain or pain in other areas can sometimes also be a side-effect of pelvis problems.
- Tightness in the upper back
- The pain is often much worse at night and can stop you getting much sleep. Getting up to go to the toilet in the middle of the night can be especially painful.
What causes Pelvic Girdle Pain/Symphysis Pubis Dysfunction?
No one knows the exact cause but a number of different factors have been identified which include:
- Differences in movement between the joints of the pelvis particularly the sacro iliac joints at the back of the pelvis can be associated with pain.
- Previous injury or restriction prior to pregnancy (which may not have caused pain or discomfort prior to pregnancy).
- In pregnancy there is an increase in the amount of the hormone Relaxin which causes softening of the ligaments throughout the whole body. As a result, the muscles around the lower back and pelvis have to work harder to support the body – and in some cases these muscles overwork resulting in pain.
- Postural changes occurring in pregnancy due to the growing size and weight of the baby
- The pelvic floor muscles which normally support the pelvis not working as effectively as normal because of the weight of the baby sitting on the pelvic floor.
- The abdominal muscles and the rib cage being stretched by the growing baby.
Why do some people get pelvic girdle pain in pregnancy and not others?
There is no clear answer as to why some women develop pelvic girdle pain and others don’t. It was traditionally thought that it was purely the pregnancy hormones especially Relaxin that were the cause of PGP/SPD. More recently other factors, such as differences in the way that the sacro iliac joints at the back of the pelvis move and differences in the way that the muscles are controlled have been shown to be important. Women who have previously had either pain in their lower back, an injury to their pelvis or pelvic girdle pain in a previous pregnancy are more likely to experience pain in subsequent pregnancies.
What is the cure for Pelvic GirdlePain/Symphysis Pubis Dysfunction?
There is no hard and fast cure for PGP or SPD.
Many women have reported improvement in their symptoms following a combination of manual or hands-on therapy to treat any underlying joint dysfunction, joint misalignment or overactive tight muscles followed by an exercise programme.
Research which studied postnatal women with pelvic girdle pain has shown that an individually designed programme of exercises to improve the stability of the pelvis is of benefit.
A pelvic support belt to provide support to the pelvis can also be useful as a temporary measure along with an exercise programme.
Is there anything I can do to ease the pain?
- Listen to your body, if something hurts, don’t do it, don’t be tempted to “push past the pain” as this can flare up your pain and it can take longer to settle down.
- Move little and often. Rest regularly; although you may not feel very sore now, it can be worse once you do relax
- Don’t push through the pain. Don’t be afraid to ask for help.
- Avoid heavy lifting or pushing (supermarket trolleys can be particularly painful).
- When dressing, sit down to put on clothing such as your knickers or trousers. Pull the clothing over your feet and then stand up to pull them up. Don’t try to put your legs into trousers, skirts or knickers whilst standing up.
- When sitting try not to sit on too low a seat as this can tilt your pelvis backwards and put more strain on the pelvic area and your lower back (increasing your pain).
- If you need to climb stairs, do so one step at a time, step up onto the step with your strongest, or least painful leg then bring your other leg up to meet it, repeat with each step.
- Sometimes, sleeping on a softer surface can help. Try placing a duvet under your sheet.
- When swimming avoid breaststroke, and take care with other strokes, ask your osteopath or physiotherapist for advice. Exercises in water can be helpful and sometimes just immersing in the water can give good pain relief.
- Ask your therapist for advice on ways to reduce pain during normal day to day activities.
- Acupuncture has also been shown to be useful for pain relief.
- Recently the Association of Chartered Physiotherapists in Women’s Health (ACPWH) has produced guidelines about the use of TENS machines during pregnancy. It is recommended that you discuss these with your midwife or doctor to find out whether using a TENS machine might be helpful for you.