Introduction

Pregnancy-related pelvic girdle pain (PGP) is common, but that doesn’t mean it’s normal or to be expected! And the earlier it is recognised the better it can be managed. Previously called Symphysis Pubis Dysfunction (SPD) it affects 1-in-5 pregnant women and is any pain in your pelvic area during pregnancy, often more common in subsequent pregnancies after your first. If you have pain that doesn’t improve in a week or two, that’s when you need to ask for help, from your midwife, GP or specialist osteopath (of course I’m going to say that, however other brands of physical therapy are available!). The symptoms are not always the same for everyone, but understanding why you have pain and how you can help yourself can make all the difference to this joyous time.

What is Pelvic Girdle Pain?

Essentially, it’s pain you feel anywhere around your pelvis, whether at the front, sides or back and could be pain in all or some of these areas. You could have difficulty walking or standing on one leg, such as when getting dressed or getting in or out of the bath. You can also have trouble moving your legs apart such as when you get in or out of the car.  Sometimes people feel clicking or grinding in the pelvic area, which sounds or feels distressing but isn’t harmful. Also lying in different positions such as one your back can be painful.

What causes Pelvic Girdle Pain?

In the past we thought PGP was only caused by a hormone called “relaxin” making the whole pelvis loose in preparation for labour. However, we now know this isn’t the whole picture. There are several factors that contribute to pelvic pain of which hormones are only a part. As your baby grows, your abdominal muscles expand, reducing the support they provide to your pelvis and changing your center of gravity, putting more stress on the pelvis and lower back. These body changes can also highlight any differences in joint mobility and stiffness on either side of your body, accentuating any uneven forces on joints. Finally, we now understand that pregnant women have a significantly lower pain threshold (oh the joy!), giving rise to the theory that PGP is not related to any physical problems but to women’s altered sensory processing, giving pain because of faulty signaling.

What puts you at risk?

Not only do some women get PGP whilst others don’t, but each person’s experience of PGP is different. We now know that some factors put you at more risk of experiencing PGP, including having a history of low back pain, a high body mass index, suffering from depression and/or anxiety and smoking can. All of these can increase your chances of getting PGP and increase the pain you experience if you do. 

How to manage the Pelvic Girdle Pain?

Firstly, it is best to start tackling this early. Approach your midwife as they can often have lots of resources and suggestions on how to manage PGP. Taking pain medication such as paracetamol can also help. Local pregnancy support groups can also be a great help. Managing and prioritising your daily activities. There are some simple steps you can take to reduce your pain:

Sleep: Get a good amount of sleep, about 7-9 hours. This can be a little tricky when heavily pregnant and/or your have toddlers that need looking after but do try to prioritise sleep as much as you can. Sleep really helps with body repair and reset helping reduce pain.

Hydration: One of the most underrated pain relievers, water helps reduce pain by keeping the joints lubricated and helping muscles work more efficiently. This does of course mean you need to go to the toilet more often but it’s a small price to pay!

Supportive clothing: investing in supportive clothing, such as maternity belts or bands, can help by giving you additional support to your pelvis. They help lift your baby bump, reduce strain on your lower back and alleviate pressure on the pelvis. Make sure that you choose ones that fit comfortably and don’t restrict your movement.

Movement and Exercise: Generally, just move! Some movements might aggravate your pain, but there will be a lot that won’t. Movement helps relieve the pain and helps the body function better. Consider swimming as the water is incredibly supportive whilst the movement helps relieve the pain. Pregnancy yoga or Pilates are also good options and help you socialise with other local pregnant women.

Pelvic Floor Exercises: Doing pelvic floor exercises can help your circulation in and around the pelvis which will help alleviate the pain, with the added benefit of preparing you for labour. Pelvic floor exercises can also help in daily activities, for example when turning in bed try squeezing your pelvic floor to help support the movement and reduce pain.

Breathing Exercises: Holding your breath whilst moving can cause more problems and contribute to the pain. Try doing some deep breathing exercises to reduce the anxiety of movement, lessening muscle tension, and helping with the overall mechanics. Breathe in slowly through your nose and our through your mouth, keeping shoulder relaxed, for 2-3 mins at a time.

Women’s Health Osteopathy: Don’t underestimate the power of a Women’s Health Osteopath! We look at how your whole body is working and address any weaknesses or imbalances that could be contributing to your pain. Treatment can include gentle massage and mobilisation to help your body work more effectively, advice on ways to move and exercises that can help.

What exercises can you do to help?

It’s not a good idea to take up a new high impact sport or exercise in pregnancy but some gentle movements and exercises can help relieve the pain of PGP.

Pelvic tilt: Sitting on a chair/gym ball. Rock your pelvis back and forwards to arch your back then round through your back. Pelvic tilting can also be done standing or lying down. Repeat as many times as is comfortable.

Pelvic circles: Sitting on a chair/gym ball. Circle your pelvis underneath you starting with small movements and increase by small amounts as you feel comfortable. Make sure you swap and change direction every few circles.

Inner thigh stretch: Sitting on the edge of a chair/bed. Walk your feet apart as far as is comfortable. Keeping you legs relaxed, use your hands on the inside of your knees to push them apart gently. You should feel the stretch in your inner thigh.

Cat stretch: Resting on all fours on the floor/bed. Arch your back up like a cat and hold for a few seconds, then relax back down.

Child’s pose: Kneel on the floor/bed, sitting your bottom onto your heels (using a pillow behind your knees to make more comfortable). Widen your knees to allow space for your bump, bending forwards stretch your arms forward as far as comfortable.

Side bends: Sitting on a chair gentle reach down to one side, feeling the stretch in your ribs and back on the opposite side. Then bend to the other side.

Summary

Pelvic pain during pregnancy is common, but with the right strategies, it can be well managed. By incorporating exercises, practicing proper posture, using supportive clothing, and exploring relaxation techniques, you can reduce the pain and feel better. It’s always better to see a professional for personal guidance and treatment.

And if you are still struggling, please do come in for a diagnosis and treatment with your local Farnham based osteopath, specialising in getting you better fast and keeping you that way. Get in touch by calling 01252 850814, emailing enquiries@outlinehealth.com or book online.

Resources

Palsson TS, Beales D, Slater H, O'Sullivan P, Graven-Nielsen T. 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. J Pain. 2015 Mar;16(3):270-82. doi: 10.1016/j.jpain.2014.12.002. Epub 2014 Dec 23. PMID: 25540938.

Sward L, Manning N, Murchison AB, Ghahremani T, McCaulley JA, Magann EF. Pelvic Girdle Pain in Pregnancy: A Review. Obstet Gynecol Surv. 2023 Jun;78(6):349-357. doi: 10.1097/OGX.0000000000001140. PMID: 37322996.