Dr. Jaclyn H. Bonder, Assistant Professor of the Department of Rehabilitation Medicine and the Medical Director of Women’s Health Rehabilitation at Weill Cornell Medical College – New York Presbyterian Hospital, has written a fantastic piece on the subject of Pelvic Girdle Pain, or PGP, a very true reality for many pregnant women:

Pelvic Girdle Pain (PGP) in Pregnancy

by Dr. Jaclyn H. Bonder

What is Pelvic Girdle Pain (PGP) in Pregnancy?

The pelvic girdle is the ring formed by the bones of your pelvis. The ring has three joints (a connection between two bones), the two sacroiliac joints in the buttock area and the pubic symphysis joint in the front of the body. These joints are connected by ligaments that can loosen during pregnancy as a result of the hormonal changes that occur. When the ligaments are looser, they cannot hold the joints together as well and are more unstable. In addition, there is increased strain on the joints because of the growing baby and changes that occur in a women’s body to accommodate the enlarging uterus.  For instance, the loosening of the ligaments allows for the necessary expansion of the pelvic girdle which allows enough room for the baby to pass through the birth canal during delivery.
Pelvic girdle pain (PGP) is pain from the sacroiliac joints and/or the pubic symphysis joint that occurs because of the instability in and strain on these joints. It occurs in about 1 in 5 women and is more common in women with a history of previous back problems or an injury in the area. Pain in the sacroiliac joint is usually the cause of “sciatica” during pregnancy.

What are the symptoms of PGP in pregnancy?

Symptoms of PGP include pain in the buttocks and pubic bone that can radiate into the thigh, hips, or groin areas. Unlike true sciatica, PGP will not radiate past the knee. It is often increased with movement, especially when you move from one position to another such as turning in bed and going from sitting to standing.  Women will also describe pain with activities such as with walking prolonged distances, climbing stairs, and standing on one leg to put on pants.  Women may also experience clicking and grinding with any of these movements.  Often, women will also have muscle aches in the buttocks in the inner thigh area because of strain and overuse of the muscles that need to do overtime to compensate for the loosened ligaments.

How is PGP diagnosed?

PGP can be diagnosed by a practitioner who is trained to assess musculoskeletal conditions in pregnant women. Practitioners can base your diagnosis on the symptoms you are having combined with doing a physical examination.  You do not need to have imaging or laboratory tests done to make a diagnosis of PGP. However, if some cases if pain is severe enough and symptoms are not improving with traditional treatments (see below), your doctor may order an MRI. MRIs do not have any radiation and are safe in pregnant women past the first trimester.

What are the treatments for PGP?

Treatment of PGP is usually quite helpful and most women will feel relief when incorporating these therapies. The most common and effective treatment is physical therapy with a therapist trained in pregnancy-related musculoskeletal conditions. At these sessions a physical therapist will often provide:

• Education on ways in which you can and should move to avoid strain on the region. They will often go through everyday activities with you to help you determine which ones may be aggravating your symptoms and show you how you can do them differently to avoid pain.
• Exercises to strengthen and stabilize your core muscles.  Your core muscles include the abdominal, back and pelvic floor muscles. These exercises will improve your spine, pelvic girdle and pelvic floor strength so that you have more support for the joints and ligaments that are being strained. It is safe to do certain core exercises but some can put a lot of strain on a women’s back or abdomen, which is why it is important learn how to do them correctly with a trained professional.  These will not hurt the baby but may hurt the mother, if done incorrectly!
• Manual therapy (hands-on treatment) to muscles and joints. This treatment can release muscles that may be tight from overworking to stabilize joints and contributing to the pain.  In addition, mobilizing joints in the pelvic girdle can shift bones into better position or help them move more normally.

Other treatment options include:

• Support belts – there are many types of belts out there.  You should work with your doctor or physical therapist to fine the one that is right for your particular issue. PGP usually gets better when you use a sacroiliac joint belt around the pelvic ring, rather than a supportive band for the belly.
• Warm baths – you should talk to your obstetrician and make sure you have no restrictions in taking a warm bath.  These can be helpful to relieve muscle spasm and ease pain.
• Heating pads – should only be applied for short periods of time (15 minutes or less) and should never be placed over the abdomen directly.
• Ice packs – can be used a few times per day for symptomatic relief.  Ice is the world’s most natural anti-inflammatory!  If you use it over your pubic joint, you may even feel the baby kicking.
• Ambulatory assistive devices – this includes walkers, crutches, and canes. Using these may be temporary until your pain decreases with some of the other modalities, but can also be quite useful when walking longer distances is necessary. A stroller is kind of like using a walker so you may find your pain is better when using one.
• Acetaminophen – an effective over-the-counter pain reliever is considered safe during pregnancy and usually recommended by most obstetricians.  You should always talk to your doctor though first before taking any medications.

What type of delivery is indicated for PGP?

A vaginal birth is considered safe and is the recommended mode of delivery in most women with PGP.  There is no evidence that a Caesarian section is necessary and in some studies, there has been evidence that it slows recovery and prolongs healing of PGP.

Will PGP go away after delivery?

In most cases, PGP will diminish after delivery and resolve within a few weeks of the baby being born. If symptoms persist, women should be referred to a physician (often a physiatrist) who can help decide if an additional workup and/or treatment is needed. Typically, physicians will recommend x-rays and non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, if pain persists after delivery. NSAIDs will help decrease inflammation in the area as well as control pain. ∎

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Thank you to Dr. Bonder for sharing her insight and knowledge!

Did you know SPEAR has a dedicated pelvic floor physical therapy program? Learn about SPEAR’s pelvicore classes,  view our expert specialists, or request an appointment today. You can also contac the pelvic floor team at pelvicfloor@spearcenter.com.