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Weighting and Expecting: Pelvic Girdle Pain During Pregnancy

Pregnancy is full of joy, wonder, and excitement. While it’s a beautiful journey, it’s common to experience challenges like exhaustion, anxiety, and pain. Let’s talk about one of the physical changes you may experience as a mum-to-be — Pelvic Girdle Pain (PGP), more specifically related to your pregnancy.

WHAT IS PREGNANCY-RELATED PELVIC GIRDLE PAIN?

Pregnancy-related pelvic girdle pain (PrPGP) is defined as any pain between the iliac crests and the gluteal fold, particularly in the vicinity of the sacroiliac joints. The pain can radiate down the posterior thigh and may also occur in conjunction with or separately in the pubic symphysis. The endurance capacity for standing, walking, and sitting is diminished (Vleeming et al. 2008). Up to 50% of women will experience PrPGP, and it is strongly associated with a negative impact on psychological and emotional well-being (Acharya et al. 2019). Unfortunately, women with PrPGP are three times more likely to experience postpartum depressive symptoms (Gutke et al. 2007).

WHAT DOES IT FEEL LIKE?

Women experiencing PrPGP may describe a sharp stabbing pain, and their leg may feel like it could give way. Some may also report a grinding or clicking sensation in the affected area. The following tasks aggravate their symptoms:

  • Turning over in bed
  • The first few steps in the morning
  • Getting in and out of the car
  • Climbing stairs
  • Getting dressed

WHAT CAUSES PRPGP?

It’s more than an issue in the tissues…

1. Hormonal

The increased levels of relaxin, progesterone, and oestrogen during pregnancy work together to soften the strong ligaments surrounding the pelvis. These ligaments absorb more water and become more elastic, allowing the pelvis to open up during childbirth to create space. Relaxin starts to peak at 10-12 weeks gestation, which may contribute to the early onset of PrPGP, but this hormonal influence does not make the pelvis unstable.

2. Biomechanics and load

Pregnancy is a phase of big change. Muscles and fascia, including the abdominal wall and linea alba (diastasis), undergo increased stretching. The pelvic floor muscles are also affected. Changes in posture are necessary to accommodate the growing foetus. These combined alterations contribute to the “pregnancy wobble” that some individuals may experience.

3. Poor movement patterns

During pregnancy, you may load your pelvis asymmetrically—such as when holding a toddler or carrying a heavy handbag on one arm. This can result in an asymmetry between the pelvis. No two sides are the same, but pregnancy introduces a unique dynamic where one side becomes stiffer and the other more mobile with each step you take.

4. The pregnancy factor

The Palsson et al. (2015) study showed that pregnant women experienced lower pain sensitivity thresholds compared to non-pregnant women. This phenomenon was attributed to the physical transformations, as well as changes in emotional well-being.

WHAT ARE THE RISK FACTORS FOR PPGP?

  • Previous history of lower back pain
  • Previous PGP
  • History of trauma such as fall, motor vehicle accident or sports injury
  • BMI > 25
  • Strenuous work during pregnancy
  • Depression
  • Hypermobile joints (no evidence for this one)
  • Multiparity (no evidence for this one either)

CAN I PREVENT PRPGP?

A study by Owe et al (2015) found that women who performed high-impact exercise three times a week were 14% less likely to suffer from severe PrPGP. Addressing other factors such as reducing BMI, improving mental health, and providing education to empower women may also have a positive impact.

WHAT’S THE LINK BETWEEN PRPGP AND PELVIC FLOOR FUNCTION?

Research indicates that up to 50% of women with PGP often report changes to their bladder, bowel, or sexual function. Pregnancy-related weight gain can lead to the stretching of pelvic floor muscles and sphincter relaxation, resulting in weakness. This may cause stress urinary incontinence. However, women with PrPGP often present with increased pelvic floor muscle tone (overactivity), so traditional pelvic floor exercises may not always be suitable.

WILL MY PRPGP BECOME CHRONIC?

There is a greater than 90% chance that you will be better in the postnatal period, and the “strongest predictor of PrPGP not becoming chronic after pregnancy is the belief that it won’t” (Vollestad and Stuge 2009).

WHAT IS THE TREATMENT?

“It is no longer acceptable to consider musculoskeletal pain solely as a peripheral phenomenon” (Pool-Goudzwaard et al 2020). Addressing the following factors is crucial to achieve your goals:

  • Biological: Hormones, central and/or peripheral sensitization, neuro-immune response, inflammation
  • Psychological: Sleep, stress, depression/anxiety, beliefs, active vs. passive coping strategies
  • Social: Work support, family support, life transitions, relationshipsThere is so much you can do, but the first step is education and understanding what is going on with your pelvis.

 

Here are some take-home points from today’s blog:

Schedule an appointment with a women’s health physiotherapist for an individual assessment and physiotherapy treatment, considering symmetry, biomechanics, and motor control.

Exercise is beneficial for all women, regardless of pain, to provide support for the pelvis. Focus on strengthening the glutes, pelvic floor, and deep core muscles. After the pain settles, continue exercising to maintain optimal muscle function and prevent future issues.

We would like to thank Angela James from the Sydney Pelvic Clinic for the amazing resources and knowledge provided during the recent pelvic pain course, from which the material in this blog is reflective.

If you feel like you could benefit from specialised guidance and treatment for your pelvic girdle pain recovery, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg to make an appointment.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as individual medical advice.

References:

  1. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819. doi:10.1007/s00586-008-0602-4
  2. Shijagurumayum Acharya, R., Tveter, A., Grotle, M. et al. Prevalence and severity of low back- and pelvic girdle pain in pregnant Nepalese women. BMC Pregnancy Childbirth 19, 247 (2019)
  3. Gutke A, Josefsson A, Oberg B. Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms. Spine (Phila Pa 1976). 2007 Jun 1;32(13):1430-6. doi: 10.1097/BRS.0b013e318060a673. PMID: 17545912.
  4. Vøllestad NK, Stuge B. Prognostic factors for recovery from postpartum pelvic girdle pain. Eur Spine J. 2009 May;18(5):718-26. doi: 10.1007/s00586-009-0911-2. Epub 2009 Feb 24. PMID: 19238458; PMCID: PMC3234007.
  5. Owe KM, Bjelland EK, Stuge B. Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women British Journal of Sports Medicine 2016;50:817-822.
  6. Palsson TS, Beales D, Slater H, O’Sullivan P, Graven-Nielsen T. Pregnancy is characterized by widespread deep-tissue hypersensitivity independent of lumbopelvic pain intensity, a facilitated response to manual orthopedic tests, and poorer self-reported health. J Pain. 2015 Mar;16(3):270-82.
  7. Pool-Goudzwaard A, Beales D, Bussey M. Introduction to the special issue on pelvic pain. Musculoskelet Sci Pract. 2020;48:102168.
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My experience with Embrace Physiotherapy has been very good. A very professional approach from the staff, right from the first call I made to seek appointments till the end of the therapy. A special note about my interaction with Alex, my consulting physiotherapist: Alex is very good at her work. She listens to her patients patiently to understand the issues being faced before exploring the solutions. She made me feel very comfortable and helped me to work with her to find the right solution to my needs. Her interactions have always been nice and with an added human touch, enabled me to feel comfortable working with her. She doesn't rush the treatment procedure and has helped me explore more than one solution keeping my condition and the history of complications in mind. She also keeps track of the progress and provides alternate solutions if the current approach isn't yielding the desired results. She is much more than a physiotherapist as she gave some great suggestions about lifestyle which helped me avoid the recurrence of issues.

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September 10, 2022

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Embrace physiotherapy was my first Physio experience. I had been having issues 3+ years postpartum and I had therapy from both Preet and Brenda. They were both fantastic therapists and helped me with separate issues such as alignment and my constant UTI's. I did my first ever Pilates class in their very well equipped studio in Joo Chiat as well which I loved! Was really pleased with the outcome of my sessions! Learnt some new moves and felt so much better!!

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