Pelvic girdle pain (PGP) is an umbrella term for pain at the joints in the pelvis, mainly in one or both of the sacroiliac joints (two joints in the back of your hips) as well as the pubic symphysis (where the pubic bone is).  You’ll often hear the terms  “SIJ Dysfunction” or “Pubic Symphysis Dysfunction” used. 

While PGP can happen to anyone, it’s a common complaint during pregnancy.  Up to 45% of pregnant women experience pelvic girdle pain, typically with transitions such as rolling in bed or getting out of the car, as well as during one-legged weight bearing like walking, stair climbing, or putting on pants. The nature of symptoms during these activities or others can range from bothersome to debilitating. Across the spectrum, pelvic girdle pain can limit women’s ability to work, exercise, and live daily life. And as a result it can contribute to increasing anxiety, frustration, fear, and suffering.

The common culprit blamed for pelvic girdle pain is the hormone, relaxin, which, as the name suggests, loosens ligaments as the body prepares for birth. However, current research is demonstrating that there is low evidence for the association between the level of relaxin and the level of joint looseness.  There is also low evidence for the association between the level of joint looseness and the amount of pain experienced by women.

In fact, a certain amount of widening of the joints during pregnancy can be considered normal and is asymptomatic. These conclusions mean that if you are experiencing pelvic girdle pain, the causes are not completely out of your control and thus, something can be done! 

While research on this issue does connect factors such as genetics, number of children, hormonal make-up before pregnancy to the occurrence of pelvic girdle pain, one of the primary contributing factors is mechanical in nature—involving the coordination and control of muscles that contribute to optimal pelvic function during activities. These muscles include those in the abdomen, back, butt, pelvic floor, hip, and thigh, essentially any muscle that attaches to the pelvis.

The coordination and control of these muscles can either be reduced (under working) or excessive (over working).  Either way, muscles in these states are inefficient and ultimately contribute to pain.  Some of your health care providers may mention that your pelvis is out of alignment, which is clinically observed as a result of torsion or strain from muscles more often than from a pure positional fault.

Another significant contributing factor to pelvic girdle pain is fear.  Our bodies have well programmed physiological responses to the experience of fear involving our brain, nerves, and chemical and hormonal signals. During pregnancy specifically, our nervous system is more sensitized, meaning that our inner alarm system is on high alert. Thus, anything that contributes to danger signals being sent out by our nervous system, including fear, is more acutely felt during pregnancy.

Beliefs about pelvic girdle pain that can contribute to a physiological fear response are that your pelvis is unstable, that nothing can be done, that it will not improve, or that you are making it worse. Contrary to these beliefs, your pelvis is relatively very stable, it just may not have sufficient control and coordination during movement. In addition, pelvic girdle pain very often improves or resolves with the right treatment, and there are lots of things you can do to make it better. In fact, avoiding lots of activities out of fear or tensing up and becoming rigid during certain activities can make things feel worse.

What you can do to help pelvic girdle pain depends on whether you have reduced or excessive control and coordination of muscles contributing to optimal pelvic function. While the distinction is best assessed by a pelvic health physio, you can generally get an idea of where you are at based off your experience. (Please note the following statements are generalizations, thus may not be true for everyone).

For instance, if you are highly active, have high muscle tone, don’t like to stretch, carry stress in certain areas of your body, or catch yourself clenching up, you probably fall on the excessive side of the spectrum and need help getting muscles firing at the optimal times rather than all the time.

On the other hand, if you tend to be flexible, you feel weaker in your core or hips, you’ve had a previous injury in the area, or you haven’t been able to be as active as usual due to nausea, fatigue, work, etc during pregnancy, you may fall on the reduced side of the spectrum, and need help getting muscles firing better and stronger. 

A specific test can be trying a pelvic support belt. Assuming it’s on correctly, if having a belt on makes things feel worse, you are probably experiencing excessive control of the pelvis. The belt provides more compression, which your muscles are already giving you too much of, so it causes more discomfort.

If the belt is helpful to have on, you likely are dealing with reduced control, as it is providing more compression around the pelvis, which your muscles aren’t giving you enough of. If it makes no difference, you would likely benefit from a more in-depth clinical assessment. Important to note is that pelvic girdle pain can be referred from other areas of the body, like the low back or hip joints, so differentiating the primary source of the issue is crucial, otherwise treatment can be unsuccessful or misleading. 

Pelvic health physiotherapy can help pelvic girdle pain by:

• Assessing the source of the issue (low back, hips, pelvic joints, etc)
• Assessing on which end of the spectrum you fall between excessive control and reduced control
• Providing exercises that improve muscular control and coordination related to the pelvis, whether for abdominal, back, hip, leg, or pelvic floor muscles
• Providing suggestions for movement strategies during your day to day life, regardless of your activity level, to improve your experience
• Providing suggestions related to labor and delivery to reduce risk of pain or injury
• Providing strategies to manage fear, anxiety, or stress related to pain, pregnancy, and/or labor and delivery
• Providing information on use of products like pelvic belts or ab wraps and whether or not they are right for you

We at The Mama’s Physio hope that this information is helpful and empowering, and we’d love to use our skills and expertise to help you have a better pregnancy experience.

By Sophia McLean – PT, DPT

Sources:

Clinton, Susan C, Alaina Newell, Patricia Downey, and Kimberly Ferreira. “Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Section on Women’s Health and the Orthopaedic Section of the American Physical Therapy Association.” Journal of Women’s Health Physical Therapy 41, no. 2 (2017): 102–25.

Dufour, Sinead. “Pelvic Health Solutions: Pregnancy, Pelvic Girdle Pain, & The Pelvic Floor.” Abbotsford, BC, January 2019.

O’Sullivan, Peter B., and Darren J. Beales. “Diagnosis and Classification of Pelvic Girdle Pain Disorders—Part 1: A Mechanism Based Approach within a Biopsychosocial Framework.” Manual Therapy 12, no. 2 (2007): 86–97.

O’Sullivan, Peter B., and Darren J. Beales. “Diagnosis and Classification of Pelvic Girdle Pain Disorders, Part 2: Illustration of the Utility of a Classification System via Case Studies.” Manual Therapy 12, no. 2 (2007): e1–12.

Palsson, Thorvaldur Skuli, Darren J. Beales, Helen Slater, Peter B. O’Sullivan, and Thomas Graven-Nielsen. “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.” The Journal of Pain 16, no. 3 (2015): 270–82.

Rost, Cecile M. Relieving Pelvic Pain During and After Pregnancy: How Women Can Heal Chronic Pelvic Instability. Berkeley: Hunter House, 2006.