Moving Safely with Pelvic Girdle Pain

Written by Laura Coventry - Founder and Women's Health Physiotherapist PhysioFemina

Pelvic pain can feel incredibly debilitating. Some of the ways that members of the Empowered Motherhood Program (EMP) describe pelvic girdle pain include 'feeling like someone is repeatedly stabbing you in pubic bone' to 'constant low-level pain that slowly disrupts your ability to do anything.' 

It is easy to feel helpless in the presence of constant pain. We hope that this post will give you some insights into the causes of pregnancy-related pelvic girdle pain, show you some useful tools to help break the cycle of pain and inspire you to start moving again. 

I feel like I'm the only one... just how common is pelvic girdle pain in pregnancy? 

In Australia, almost 50-60% of women will experience some form of pregnancy-related pelvic girdle pain (PGP) throughout their pregnancy. PGP affects women in many different ways, and it can have significant impacts on both physical and mental well-being

There is currently no standard screening for PGP during pregnancy, and many women report feeling unsupported as it is deemed a ‘normal’ part of pregnancy. In addition, women with pelvic girdle pain can often write it off as sciatica and assume that they have to put up with the pain. Consequently, a significant portion of affected women do not receive adequate treatment or are unaware that treatment options exist. Physiotherapists, midwives, nurses, and other healthcare providers must be equipped to identify women at risk of PGP and provide them with well-researched information about the condition and treatment options available to them.

Where does pelvic girdle pain occur?

PGP presents in multiple different regions throughout the pelvis and typically has an onset between 20-28 weeks gestation (although it can start earlier, especially in second and third pregnancies). Women experiencing PGP struggle with basic physical activities like standing, stairs, walking and exercise. Not to mention the impossibility of keeping up with a way-too-energetic toddler.  

Pelvic girdle pain refers to pain around the entire pelvis. The lumbar spine (the lowest section of the spine), the sacrum (the upside down triangle shaped bone below the lumbar spine), our hip bones (the ilium), and the pubic bone (the bone located at the very front of the pelvis) all join together to form the pelvis collectively. The sacroiliac joint (SIJ) is like a connection point between the lower part of your spine and the bones of your pelvis. It is the bridge that joins these two parts of your body together.

These intimate connections mean that PGP occurs in four main areas

1. Pubic Bone - commonly called pubic symphysis dysfunction or SPD. This is caused by inflammation of the pubic symphysis (the small disc between the two bones), and you may experience sharp pain with single-leg activities, e.g., getting dressed. It is often described as ‘lightning crotch pain’.
2. Sacroiliac Joint - pain at the SIJ, the ‘back dimple’ site, and is described as a pinching style feeling
3. Buttocks - pain through the gluteal muscles that typically occurs because the buttock muscles are working so hard to help with the demands of the pregnancy. This may be an aching sensation and may cause ‘sciatic’ style pain that goes down your leg.
4. Low back - pain through the lumbar spine that can be an aching sensation.

What causes Pelvic Girdle Pain?

A number of factors can contribute to the development of PGP in pregnancy. A combination of hormonal, biomechanical, traumatic, metabolic, genetic, and degenerative factors can all play a part in the amount of pain you are experiencing. 

Hormonal Changes

The extraordinary hormonal changes that occur during your pregnancy to support foetal growth and prepare your body for birth and breastfeeding have a role in pelvic girdle pain. We know that the pelvis needs to widen to allow space for the baby's birth, and your body is preparing itself throughout the pregnancy for this. As the widening of the pelvis occurs, there is more mobility within the joints in the pelvis. Do not worry; the pelvis itself is not unstable; it is still very strong. There is just a change in the overall mobility of the ligaments.

Biomechanical Changes

The biomechanical factors are all about how your body moves and functions and how different parts work together to keep you moving smoothly and without pain. Your body goes through significant changes throughout pregnancy, and some of these changes contribute to pain in the pelvic region. The lumbar spine region becomes maximally stressed throughout the pregnancy journey due to large changes in your posture. The main postural changes that occur are:

• Increased Lumbar Curve: The increased weight through the abdomen leads to a more pronounced arch through the lower back. This change typically occurs around 20-30 weeks.
• Widening of the Pelvis: The increased mobility within the pelvis, and in preparation for birth, the pelvis begins to widen. You may notice you stand with your legs slightly wider, and the weight distribution between your legs can change. This is more pronounced around 30-40 weeks.
• Forward Head Posture: As your belly increases in size, your center of gravity begins to move forward. Due to this pull forward, your head and neck also pull forward to help you maintain your balance. This may be more pronounced throughout the third trimester.
• Rounded Shoulders: The increased weight through the abdomen and increased breast size can cause your shoulders to begin to round forward. Many women experience upper back pain because of this.

We understand the lack of control, body image concerns, pain, and discomfort can cause significant distress and affect your mental health and well-being. The impact that pelvic girdle pain has on your daily activities all have significant effects on your overall well-being. 

What can you do about your pelvic girdle pain?

Keep moving! When putting on your underwear hurts, we understand the temptation to avoid all types of exercise and movement. However, over the long term, reducing or completely stopping the amount of exercise you do can lead to weakening or wasting the muscles surrounding your pelvis, which, in turn, can contribute to more pain.  

That is why the EMP is so passionate about helping people continue to move safely in the presence of pelvic pain. Our goal is to provide you with the education and exercises you need to help you reduce the amount of pain you are experiencing and feel stronger and more confident in your body on a daily basis. 

The Empowered Motherhood Program Pelvic Pain Safe program combines physio-led pilates, strength, and cardio workouts along with specialized yoga and stretching classes to help you continue to move safely with pelvic girdle pain. Our members report feeling less pain, increased confidence and an increased ability to get on with their life without the constant feelings of pain. 

Additional Support and Ways to Reduce Pain 

In addition to the modification of daily movements and pelvic pain-safe exercise, physiotherapy can play a crucial role in helping you manage your pelvic girdle pain. The overall goal of physiotherapy is to reduce pain, improve function and mobility, and equip you with strategies and techniques to manage symptoms, continue exercising, and enhance quality of life.

For those of you who are unable to seek in-person treatment, here are some easy tools you can implement to help ease any pain you are experiencing:

1. Limit single-leg activities during exercise - For example, replace lunges with split squats or regular squats. Complete upper body movements in a stable neutral stance.  
2. Sit down to get dressed. 
3. Ensure equal weight bearing through both feet at all times (e.g., avoid standing with more weight on one hip), and be mindful of how you carry older children. 
4. Improve glute, core, hamstring, and adductor strength through pelvic pain-specific exercises such as those in the EMP. 
5. Self-release your gluteal muscle with a trigger ball or foam roller (see the EMP fascial release class or Pelvic Pain Stretch class).
6. Limit stairs, uneven surfaces, and hills when walking (see EMP Pelvic Pain safe strength and cardio classes to maintain cardiovascular fitness during your pregnancy). 
7. Apply ice to your pubic bone at night to reduce inflammation. 
8. Keep feet and knees together when rolling in bed and getting in and out of the car.
9. Use a pelvic support belt to provide additional pelvic support. 
10. Sleep with a cushion between your knees to provide extra support to your pelvis at night. 

If you are experiencing pelvic girdle pain - don't put up with it! Join the Empowered Motherhood Program and take advantage of our free trial. See the difference that safe, physio-led exercise and education can make to you. 

About the Author 

Laura Coventry is a physiotherapist specialising in women’s health and the founder of Physiofemina. Laura works with women experiencing pelvic floor concerns throughout any stage of their life. She helps them nurture their pelvic health and return to exercise transformed.

Physiofemina is based on the Central Coast of NSW. Physiofemina’s goal is to create meaningful lifestyle changes through women's health physiotherapy. We provide health and wellness support to women throughout every life stage - from puberty, pregnancy, postpartum to menopause. We aspire to teach, educate and arm women with knowledge about their bodies, their pelvic health, and how to create proactive change for their future.

Learn more about Laura and Physiofemina here https://physiofemina.com.au/

Resources and references

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