Lila Abbate, PT, DPT, MS, OCS, WCS
Pelvic Girdle Pain (PGP) During Pregnancy
Pelvic Girdle Pain during pregnancy can be quite debilitating for many pregnant women. In the United States, roughly 33-50% of women experience pelvic girdle pain before 20 weeks of gestation and 60-70% by late pregnancy. PGP is defined as the pain experienced between iliac crest and gluteal fold, either at the front or back.
The pain may range from a mild ache to severe pain which limits your daily activities. This pain may start at any time during pregnancy, labor or during the postpartum period.
What causes Pelvic Girdle Pain (PGP)?
It is hard to pinpoint what causes the PGP in some women and not others; however, the main risk factors found from the studies include history of previous pregnancy, joint hypermobility, prior history of low back pain, pelvic girdle pain, and/or previous trauma to the pelvis. Research also has found that factors such as early onset of pelvic girdle pain in the beginning of the pregnancy and multiple pain locations are related to persisting pelvic girdle pain after the delivery and severe pain and disability throughout the pregnancy.
Symptoms of Pelvic Girdle Pain
Pain is most commonly occurring at one side of sacroiliac (SI joint) or pain may be felt in both sides of the SI joint, in the buttock, radiating to the back of the thigh or in the pubic area. Patients commonly experience sharp pain when rolling over in bed, getting in and out of the car, using stairs or standing with one leg. Symptoms can be aggravated by the increasing weight of the baby, changes in the body’s center of gravity and posture.
During the pregnancy, a woman’s body goes through significant changes which predispose her body to pelvic girdle pain.
Hormones (relaxin) released during pregnancy relax the ligaments of the body to allow the pelvis to enlarge, in preparation for childbirth.
The growing uterus ‘stretches’ thereby weakening some of the core muscles around the pelvis.
Increased body weight due to the weight of the growing fetus, uterus and breasts, places increased demand on pelvic floor muscles and connective tissue.
Changes in posture may lead to faulty biomechanics of body and non-ideal loading of pelvis
Coping with pelvic girdle pain during the pregnancy
Physical therapy with a qualified PT can be helpful in diagnosing and treating women with PGP. Diagnosis is usually made by symptoms and by the thorough assessment of the spine and pelvis. Through the assessment, your physical therapist may be able to find the source of the problem. Various manual treatments will be provided to restore normal movement in pelvis joints and to release myofascial restrictions. Therapeutic exercises will also be prescribed to help with stabilization of the pelvic joints and address muscle imbalance throughout the body. External stabilization from a support belt may be necessary depending on physical impairments. The use of taping can also be useful for some women. In addition, your physical therapist will discuss proper body mechanics to minimize symptoms including the appropriate way to sleep, sit, stand, walk and lift. Good compliance with the physical therapy regimen along with early initiation of treatments can significantly help to keep the pain to a minimum and prevent long-term discomfort.
1. Clinton S, LaCross J, Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health. Journal of Women’s Health Physical Therapy: May 2017 - Volume 41 - Issue 2 - p 100–101
2. Fitzgerald CM, Le J. Back pain in pregnancy requires practitioner creativity. Biomechanics. 2007 November
3. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991; 16:549-552.
4. Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B. Reduction of pelvic pain in pregnancy. Spine. 1994; 19:894-900.