How to cope with Pelvic Girdle Pain

Symphysis Pubis Dysfunction - now called Pregnancy- related pelvic girdle pain (PGP) - is a common pregnancy problem.

1 in 5 women in pregnancy experience some level of pelvic pain - either at the front or back of the pelvis. The severity of the symptoms varies and the pain is not always progressive. It can be actively treated with physiotherapy and exercises.

So what is it?

• PGP is pain from the joints that make up your pelvis - it includes: symphysis pubis joint (SPJ) at the front and or the sacroiliac joints (SIJ) at the back.
• Pain / discomfort is often felt over the pubic joint at the front, below your tummy, or across one side of your lower back or both sides.
• You may experience: difficulty walking, pain when standing on one leg e.g. climbing the stairs, dressing or getting in and out of the bath, difficulty getting in and out of the car, clicking within the pelvic joint, limited hip movements, painful to turn in bed and pain / difficulty during intercourse.

What causes PGP?

It is usually caused by a combination of factors: uneven movement within the pelvic joints, decreased muscular support due to the growing tummy and change of activity levels, a previous injury to the pelvis, or position of the baby. Also in pregnancy there is a natural increase in the width of the pelvic joints due to the laxity of connective tissue under hormonal influence.

Risk Factors

Not all women have any identifiable risk factors, but risk factors are thought to include - previous low back / pelvic pain, previous injury to the pelvis, multiple pregnancies, a hard physical job, PGP in previous pregnancy.

How to manage PGP

Follow the below advice and exercises. If it does not improve your symptoms seek a referral to a physiotherapist to assess if there is a mechanical reason for the pain which needs manual treatment.

Seek advice from your physiotherapist and midwife for labour
The important thing to remember is to keep equal weight through both legs, keep as good a posture as possible and try to keep you pelvis level.

Advice to follow in pregnancy

• Be as active as possible within pain free limits.
• Identify activities that increase your pain both at home and at work and see if you can avoid these activities, modify them or get someone to help.
• Listen to your body - rest when your body tells you to.
• Avoid prolonged standing.
• Make sure when you are standing that you put equal weight through both legs.
• Do take moderate exercise - walk with a shorter stride, avoid breaststroke leg kicks but continue with swimming.
• Don't take up a new sporting activity.
• Take the stairs one at a time. Going up, lead with your less painful leg and going down lead with the more painful leg.
• Pace your activities throughout the day.
• Try intercourse lying on your side. Sleep
• Sleep on your side with a pillow between your knees and under your bump.
• When turning in bed keep your knees together or gently hold a pillow between the knees.
• Try and roll out of bed keeping your knees together.

Avoid

• Activities that make your pain worse.
• Standing on one leg.
• Bending and twisting to lift, or carrying a toddler or baby on one hip.
• Crossing your legs.
• Sitting twisted.
• Lifting heavy objects / pushing heavy objects.
• Vacuuming.
• Carrying anything in only one hand.
• Impact exercises.

Exercises Keep good posture in all activities.

Posture - think about your posture throughout all your activities

• Stand evenly on both feet and avoid prolonged standing.
• Sit on both "cheeks", sitting upright and do not cross legs.
• Avoid heavy lifting.
• When rolling over in bed, bend knees, press them together, and tighten pelvic floor and tummy muscles and then roll.
• If you have young children try not to carry them on one hip instead hold them in front.
• Getting into a car by sitting on the seat and then bringing in both legs together - reverse to get out.
• When sleeping, put a pillow between your knees to keep your pelvis in a good position.
• Ensure your work surface is at the correct height both at work and at home.
• When carrying shopping ensure the weight is evenly distributed.

Focus on exercises to retrain and strengthen your stomach, back and pelvic floor and hip muscles.

Your tummy muscles will stretch greatly through pregnancy and will become weaker. It is therefore important to use these muscles correctly to provide support for your baby and for your back; and to encourage good posture.

The following tummy exercise is a good one to do throughout your pregnancy.

Exercising your abdominal 'support muscle'

• Place your hand on the lower part of your tummy, under your bump.
• Breathe in.
• Breathe out. Before your next breath gently draw in your lower tummy, away from your hand.
• Continue breathing and gently hold your tummy in for up to 10 seconds.
• Repeat up to 10 times.
• Repeat 3 times a day.

Try using this muscle during any activity requiring effort e.g. in and out of bed, shopping, and getting up from a chair. Pelvic floor muscles These are the main support muscles on the floor of the pelvis and are very important during pregnancy, labour and beyond. Pregnancy and delivery significantly weaken the pelvic floor, sometimes leading to bladder weakness. Exercising these muscles throughout pregnancy and beyond is essential.

• Sit on a firm chair with your knees slightly apart in good posture or in aside lying position. Tighten the ring of muscle around your back passage as though preventing a bowel movement or wind escaping. Then tighten the muscles around the front passage.
• Aiming to hold both front and back pelvic floor muscles tight for 5-10 seconds (without holding your breath) and then release.
• Followed by 5-10 quick squeezes (i.e. tighten back and front passages and relax) " The pelvic floor muscles work with your lower abdominal muscles. Therefore as you draw up your pelvic floor muscles, you should feel your lower abdomen draw in slightly.
• Aim to repeat 4 times a day.

About Fitback and Bumps

Fitback & Bumps www.fitbackandbumps.co.uk is a company providing nationwide fitness classes that combines exercise with education to help new and expectant mums prevent pregnancy related health issues that can affect them for life. Samantha Gillard is a Women's Health Clinical Specialist Physiotherapist (MSc HPC MCSP).

With over 17 years of experience in women's health and a mother to 3 boys, she knows the impact pregnancy and birth has on a woman's body. Samantha is lead tutor to the network of FitBack & Bumps physiotherapists around the UK.

By Samantha Gillard, chartered physiotherapist & women's health expert for www.fitbackandbumps.co.uk

Where to next?

• Talk to fellow SPD sufferers on our pelvic pain in pregnancy
• Got other health worries? Visit our pregnancy problems information
• For more details on the birth you want, click here
• Use our pregnancy timeline for advice throughout your 40 weeks