What is PGP?
Pelvic Girdle Pain (PGP) is an umbrella term used to describe pain felt in the lower back or pelvic joints. Pain may also be felt in the hips or thighs. PGP used to be known as symphysis pubis dysfunction (SPD)
It is a common complaint with around 1 in 5 pregnant women experiencing PGP. PGP is best managed with prompt identification and can be treated at any point during pregnancy as soon as symptoms arise. The sooner it is treated, the more likely you are to feel better.
What are the symptoms of PGP?
Identifying the symptoms of PGP early is important so that you can seek treatment. Symptoms may be mild to severe, but can include:
- Pain in the pubic region, lower back, hips, groins, or thighs
- Clicking or grinding in the pelvic area
- Pain made worse by movement such as walking on uneven surfaces or for long distances, moving your knees apart (e.g. getting in/out of car), standing on one leg (e.g. climbing stairs, dressing), or rolling over in bed.
What causes PGP?
The causes of PGP are multi-factorial and often there is no obvious explanation. PGP is more likely to be a combination of factors that include:
- the pelvic girdle joints moving asymmetrically.
- abnormal pelvic girdle biomechanics from altered activity in the spinal, abdominal, pelvic girdle, hip and/or pelvic floor muscles
- a small number of women may have hormonally induced pain in the pelvic girdle.
- occasionally the position of the baby may produce symptoms allied to PGP.
Am I at risk of developing PGP?
PGP may develop in women with no identifiable risk factors. The evidence for risk factors is inconclusive and some evidence is contradictory. The main risk factor appears to be a history of previous low-back/pelvic girdle pain and/or previous trauma to the pelvis.
Other risk factors may include:
- pelvic girdle pain in a previous pregnancy
- high BMI and weight pre-pregnancy
- poor muscle function in the back/pelvis pre-pregnancy
- heavy workload
- poor workplace ergonomics and awkward working conditions
- general joint hypermobility
Management of PGP
What can I do to ease my pain?
This will vary based on the individual needs of each woman. PGP symptoms can vary greatly between pregnant women. Some helpful tips may include:
- Try to remain as active as possible within the limits of pain – if an activity does not cause pain it does not necessarily need to be restricted.
- Avoid activities which you know will make the pain worse – ask for help with activities or chores as needed.
- Rest is important – you may find you need to rest more frequently. It is also useful to sit down for activities that normally involve standing e.g. ironing, chopping vegetables.
- Avoid standing on one leg e.g. get dressed while sitting down.
- Avoid positions that involve asymmetrical position of the pelvis – avoid sitting cross-legged, avoid bending and twisting to lift, avoid carrying anything on one hip e.g. toddlers.
- Consider alternative sleeping positions – sleep on your side with pillow between knees, turn over keeping the knees together and squeezing the buttock.
- If stairs are causing pain try going up one step at a time, leading with the most pain-free leg first. Plan your day so that to bring everything you need downstairs in the morning.
- Seek the help of a Chartered Physiotherapist with experience in treating PGP, as soon as symptoms start.
Is Physiotherapy appropriate for PGP?
Yes. Physiotherapy is safe at any stage of physiotherapy, unless otherwise advised by your doctor. Physiotherapy will help to identify factors which may be causing your symptoms. The aim of physiotherapy is to control pain and improve your function/mobility. We will work to improve joint mobility and strengthen areas of the lumbo-pelvic region to provide symptom relief.
What will happen during my Physiotherapy appointment?
Firstly, a Physiotherapist will perform an assessment:
- Discussing symptoms you are experiencing, previous history of injury, previous birthing history, physical activity levels etc.
- Examination of movement in the lumbar spine, pelvic girdle, and hip joint
- Examination of strength and control of the muscles involved in trunk, pelvic girdle, and hip stability.
- Assessment of functional abilities and mobility
Based on the findings of this assessment, treatment may then include:
- Education regarding the findings of our assessment, and advice on how best to manage this. Advice will be given regarding appropriate pain management techniques.
- Manual therapy may also be used to improve mobility or muscle function. This may include soft tissue release, joint mobilisations, dry needling, acupuncture etc.
- Advice re use of TENS machines for pain management as appropriate.
- Provision of a home exercise programme tailored towards your individual needs. The aim of which is to reduce pain, improve posture, improve joint mobility and improve muscle strength of abdominal, spinal, hip and pelvic girdle muscles.
- Advice re use of equipment as an adjunct to treatment e.g. pelvic girdle support belts.