Pelvic girdle pain (PGP) is the general term for all pelvic pain. It includes pubic pain – previously called symphysis pubis dysfunction (SPD). PGP includes pain anywhere from the lower back down to the thigh, either at the front or back.
The pain may range from a mild ache to severe pain that limits your daily activities. This may start at any time during pregnancy, labour or in the weeks after giving birth.
Women often feel that PGP affects their daily life, and that their emotional and mental health can suffer.
PGP in pregnancy and through the first 12 months postpartum is common and combined with low back pain is estimated to occur in 56%–72% of pregnancies with 20% reporting severe symptoms during 20–30 weeks’ gestation and 33%–50% reporting symptoms before 20 weeks’ gestation.
PGP is a significant cause of disability, reduced quality of life and early medical leave from work. People who experience more persistent symptoms in pregnancy can be at risk for poorer long-term outcomes.
Lack of belief in that it will get better, increased emotional distress and pain severity have potential for persistent PGP after pregnancy.
Early intervention in pregnancy and instilling the belief that it can improve will create improved long-term outcomes.
Unhelpful stories about Pregnancy Related PGP from experiences and interactions with women and well-intended health professionals may perpetuate unhelpful beliefs regarding pregnancy PGP.
Common narratives with unhelpful beliefs are:
- Pelvic pain is a normal part of pregnancy.
- Pelvic pain will go away as soon as the baby is born.
- The hormone relaxin makes the pelvis unstable.
- Pelvic pain is worse because of poor posture and alignment.
- Pelvic pain is caused by unstable pelvic ligaments and joints.
- Moving less and keeping the legs closed will reduce pelvic pain.
- Breastfeeding hormones will prolong pelvic pain and instability.
- Birthing vaginally will worsen pelvic pain.
- Support belts should be worn to help stabilise the pelvis.
When training athletes with pain in the absence of acute trauma or injury, current practices are targeted towards creating more freedom, flexibility, strength and diversity of movement that ultimately allow for more comfort and resiliency.
These same concepts must be applied to pregnant and postpartum women to broaden their capacity for movement and adaptability. Pregnancy PGP is now more broadly under-stood to be a reflection of sensitivity of tissues, and not tissue instability, injury or harm.
By addressing the associated beliefs and fears around movement, women are able to resume activities with a greater understanding of their body, diversify patterns and reduce pain and discomfort.
New ways to look at Pregnancy PGP:
Three key terms have been developed to re-frame Pregnancy PGP care and these are known as Stable, Safe and Self Manageable.
These terms were chosen to help dispel the unhelpful beliefs that certain activities are unsafe, that the pelvis is unstable and that there is no management available for this condition.
Due to more research and understanding of pain science, these are some fabulous science-backed recommendations which are summarised them below:
STABLE
- Hormones: The Pelvis remains robust despite changing hormone levels. Increased sensations can occur
- Joints: Adaptive changes at the pelvis in-terms of pelvic tilt and joints widening occurs in preparation for birth. No scientific evidence to link relaxin with PGP
- Varied Movements: Advising ladies to keep legs together and contract the core can lead to more muscle guarding and fear.
SAFE
- Postural adaptations: No correlation between postural changes and pain intensity
- Lactation: No proven link between lactating and continuation of PPGP
- Vaginal birth: Lower risk of severity and persistence of PPGP
SELF MANAGEMENT
- Lifestyle and education: Beliefs, stress and sleep education can all improve pain and empower people to self-manage
- Physical Activity: Exercise can reduce Pregnancy PGP in pregnancy, encourage women to exercise for their own health and benefits to baby
- External supports: such as belts/ physiotherapy/osteopathy/massage can be used to create altered sensory input to reduce fear of movement, but primary interventions should be to encourage behaviour modifications.
Health care providers can achieve this by approaching care from holistic perspective, using approaches including education, counselling, massage therapies and exercise that foster trust and confidence rather than dependence and disability.
Early intervention for Pregnancy PGP is essential to help pregnant women make sense of their pain experience, believe in the possibility of change and adopt positive lifestyle habits throughout their pregnancy for improved health and birth outcomes.
Having time to address your health needs in pregnancy is paramount. Taking time out to focus on breathing, relaxation, exercise, and gaining support from your health care providers, colleagues, friends and family is vital to receiving positive outcomes.
I teach Aqua Bump for pregnancy every Wednesday at 7.15pm. Water is a great and supportive environment for women to move in.
I will be starting a new weekly class in January 2023 called Preparation for Birth which incorporates movement, stretches and mindfulness relaxation to support women through their pregnancy.
I also offer pregnancy massage therapies and include exercises and techniques to help reduce discomfort for PGP.
