Pregnancy related Pelvic Girdle Pain (PGP)

Pelvic Girdle Pain (PGP) are common among pregnant women. Symptoms of PGP include pain in the front and/or back of your pelvis, which could range from a mild discomfort to agonizing pain that interferes with normal daily life. It is important to understand what causes PGP and to seek help to minimize its effect on quality of life.
Pelvic Girdle Pain is also commonly referred to as pelvic instability or symphysis pubis dysfunction.

What is PGP?
Pain in the joints of your pelvic girdle is known as PGP. The pain or discomfort commonly affects your pubic symphysis joint, your sacroiliac joints, and/or your hip joints. The pain or discomfort may also refer into your lower back and buttock region, lower abdominal region, groin and inner thigh, and anterior and posterior thighs.
You may find that your everyday activities become more difficult and cause pain. For example:
•Walking or exercising
•Turning in bed and getting out of bed
•Getting in and out of the car
•Going up and down the stairs
•Changing your clothes or putting pants on
•Putting your shoes on or taking them off
•Lying in certain positions such as on your back or on your side
•Pain during normal activities of daily life
Other symptoms include clicking and grinding in the pelvis or pain and difficulty during sexual intercourse.

​Source: Association of Chartered Physiotherapists in Women’s Health

What causes PGP?
PGP is attributed to several different factors. During pregnancy, the body produces certain hormones that affect your pelvis by loosening the ligaments that hold the joints together.
In addition to this, posture in the way you stand and walk may be altered due to a changed centre of mass. As the baby develops, more weight is placed on the front of the pelvis, causing it to have a tendency to tilt forwards. This puts extra stress on the pubic symphysis joint at the front. You may also notice that the arch in your lower back becomes more defined, increasing the amount of extension in your lumbar spine and creating more work on your lower back. All of these forces acting on the pelvis may cause the pelvis to move out of alignment and the pelvic joints to move unevenly.
Muscles are another force that help keep the pelvis stable. However, changes (weakness and/or tightness) to muscles around the pelvic area such as the abdomen, back, pelvic floor and hips make it difficult for the muscles to work to hold the pelvis in alignment and therefore painful. Muscles are prone to become more fatigued and tight during pregnancy because of the extra stress on your pelvis. This can also affect your ability to stand and walk. One common adaptive strategy is to start waddling from side to side instead of with the usual heel-toe gait.
Sometimes the baby’s position may produce symptoms related to PGP.
Assessment and Management of PGP

At Sydney Women’s Physiotherapy, we have trained physiotherapists who can check to see whether your pelvis is out of alignment. This is one factor that could be contributing to your pain. We will then work to bring the pelvis back into a neutral position and minimize any asymmetries.
Treatment of PGP can involve the following:
•Manual therapy to correct alignment of pelvis e.g. muscle energy techniques, joint mobilisations
•Trigger point release of tight muscles e.g. piriformis, gluteals, hip flexors, hip adductors, hamstrings
•Strengthening exercises for muscles that aid in pelvic stability
•Core stability strengthening exercises for the pelvic floor, transversus abdominus and multifidus
•Stabilising the pelvis and core via external means e.g. taping, pelvic girdle belts, tubigrip, SRC shorts, lumbar-pelvic brace
•Postural advice for activity modification e.g. sleeping, walking, standing, sitting
Other Risk Factors for PGP
•Previous injury to the pelvic area (e.g. a fall or birth trauma) or having had previous low back or pelvic pain
•A history of PGP during a previous pregnancy
•Having a heavy physical job or workload, working in awkward postures
•Having increased body weight or body mass index before or during your pregnancy
•Having increased mobility in other joints e.g. hypermobile syndrome
Some tips and advice for posture!

Teaching women about the forces that act upon the pelvis allows them to better understand the types of activities and risk factors that worsen PGP. Education on static and dynamic postures is essential to correct any postural habits that could be contributing to PGP.  
When standing:
•Distribute your weight evenly through your feet
•Avoid favouring one side and hip hanging
•Keep your knees soft and unlocked, rather than in full extension
•Remember to keep your buttocks soft and avoid butt clenching!
When walking:
•Each step should be from heel to toe
•Avoid waddling from side to side
•You may need to take smaller steps
When sitting:
•Sit evenly on your sit bones (Ischial Tuberosities). You may need to physically part your buttocks to do this
•Avoid leaning too far backwards as this may cause tailbone pain
•Use a lumbar support for your chair or car seat
Tel:  0412 382 834
Email:  info@sydneywomensphysiotherapy.com.au