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What is pregnancy-related Pelvic Girdle Pain?

Pelvic Girdle Pain or PGP is a term used to describe pain in the pubic bone region below the tummy, or pain across the low back or sacrum on one or both sides. It is a specific form of low back pain, and the term Symphysis Pubis Dysfunction, is included in the term PGP.

PGP can start around the 18th week, and reaches peak intensity between the 24th and 36th week of pregnancy. Usually in your first pregnancy it starts later into the third trimester but PGP occurs earlier in second and third pregnancies.

What are the symptoms?

Common complaints of PGP include difficulty in walking, pain when taking weight on one leg (for e.g. climbing stairs, dressing or getting into or out of the bath), turning over in bed and pain or difficulty during sexual intercourse. Some women with PGP can experience emotional problems, such as anxiety over the cause of pain, frustration and depression. In a study by Noren et al (1997), it was demonstrated that these women are three times more likely to suffer postpartum depressive symptoms

What causes PGP?

The exact cause of PGP is not understood. Initially it was thought that the cause of PGP was due to the release of the hormone Relaxin which allows the pelvic ligaments to stretch, leaving them more prone to stretch injuries. However the latest research by Damen et al (2002) shows that it may be due to asymmetric laxity of the pelvic ligaments. In other words, one side of the pelvis relaxes more than the other, so the pelvic girdle joints move unevenly.

How is PGP diagnosed?

The diagnosis of PGP is made once it is proven that the pain is not due to lower back pain. It is important to note that PGP must be reproduced by specific clinical tests, performed by a qualified physiotherapist.

How is it treated?

It is important to have a correct diagnosis of pregnancy-related PGP as opposed to pregnancy-related low back pain. Some treatments for low back pain may actually aggravate your pelvic girdle pain. The sooner it is assessed and identified, the better it can be managed

Pregnancy do’s

  • A pelvic belt is a good idea for a really painful PGP. It can be fitted to see if it gives some relief of your symptoms, but must only be worn for short periods – usually the last months of pregnancy.
  • Physiotherapy treatment can help to improve spinal and pelvic joint position and stability, relieve pain and improve muscle function
  • Regular exercise benefits the psychological state of mind and the mental health of pregnant women (Fetih et al, 2008)
  • Strengthen your stomach, back, pelvic floor and hip muscles - water aerobics is also proven to help PGP symptoms!

Good advice: A few simple tips!

  1. Sit down to get dressed or undressed
  2. Roll in and out of bed keeping your knees together
  3. Sleep in a comfortable position (for e.g. lie on your side with a  pillow between your knees
  4. Take the stairs one at a time (try going upstairs with your less painful leg and downstairs leading with the more painful one)
  5. Be as active as possible within your pain limits and avoid activities that make the pain worse!

A great website to look at is http://www.acpwh.co.uk. The UK chartered physiotherapy society, provide a leaflet specifically for Mothers-to-be and New moms who suffer from PGP. The leaflet provides more in-depth information on PGP and gives advice on how to adapt your lifestyle and how you can look after yourself.

References:

  • Vleeming, A et al, 2008. European Guidelines for the Diagnosis and treatment of pelvic girdle pain. European Spine Journal 17:794-8192.
  • Noren et al, 1997. Reduction of sick leave for low back and posterior pelvic pain in pregnancy. Spine 22:2157-21603.
  • Wu et al, 2004. Pregnancy related Pelvic Girdle Pain: Terminology, Clinical Presentation and Prevalence. European Spine Journal 13(6):460-54.
  • Damen et al, 2002.  Reliability of sacroiliac joint laxity measurement with Doppler imaging of vibrations. Ultrasound in Medicine & Biology 28:407-145.
  • Fetih et al, 2008. The state of mind of less physically active women in their second trimester of their pregnancies. Acta Univ. Palacki Olomuc. Gymnastika 38(3):37-43

Megyn Robertson, Broadacres Physiotherapy

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