Pelvic Girdle Pain (PGP)

Pelvic Girdle Pain (PGP), formerly known as Symphysis Pubis Dysfunction (SPD)

Pregnancy related pelvic girdle pain (PGP) is common. The sooner it is identified and assessed the better.

Around 1 in 5 pregnant women suffer from PGP. They may experience different symptoms and these can be more severe in some women than
in others. With the right treatment early during pregnancy, PGP can usually be managed well. However, in a small percentage of women, PGP may continue after birth, particularly if left untreated.

What is PGP?

• PGP describes pain in the joints that make up your pelvic
girdle; this includes the symphysis pubis joint at the front and/or the
sacroiliac joint at the back.

• The discomfort is often felt over the pubic bone at the front, below your tummy or across one side of your lower back.

• You may also have: – difficulty walking; – pain when standing on one leg, e.g. climbing the stairs, dressing or getting in or out of the bath; – pain and/or difficulty moving your legs apart, e.g. getting in and out of the car; – clicking or grinding in the pelvic area; – limited or painful hip movements, e.g. turning over in bed; – pain during normal activities of daily living; – pain and difficulty during sexual intercourse.

With PGP the degree of discomfort you are feeling might vary from being intermittent and irritating to being very wearing and upsetting.

What causes PGP?

Usually, PGP is caused by a combination of factors including:

• The pelvic girdle joints moving unevenly.

• A change in the activity of the muscles of your tummy, pelvic girdle, hips and pelvic floor, which can lead to a less stable and more painful pelvic girdle.

• A previous fall or accident that has damaged your pelvis.

• Some women may have pain in the pelvic joints caused by hormones.

• Occasionally, the position of the baby may produce symptoms related to PGP.

Risk factors

Not all women that develop PGP have identifiable risk factors but for some the following may apply:

• A history of previous low-back pain and pelvic girdle pain.

• Previous injury to pelvis.

• More than one pregnancy.

• A hard physical job or workload.

• PGP in previous pregnancy.

• Inappropriate or awkward working conditions / incorrectly adjusted work station.

• Increased body weight and body mass index before and or by the end of pregnancy.

Increased mobility of the other joints in the body.

PGP management General advice:

• Be as active as possible within the pain limits and avoid activities that make your pain worse.

• Ask for and accept help with household chores.

• Rest when you can.

• Sit down to get dressed and undressed; avoid standing on one leg.

• Wear flat, supportive shoes.

• Avoid standing to do tasks such as ironing.

downstairs, lead with your more painful leg.

• Try to keep your knees together when doing tasks such as getting in and out of the car (use a plastic bag to sit on which may help make the transition smoother).

• Sleep in a comfortable position such as on your side with a pillow between your legs.

• Try different ways of turning in bed, e.g. turning under or turning over with your knees together and squeezing your buttocks.

• Roll in and out of bed keeping your knees together.

• Take the stairs one at a time; try leading with your less painful leg

Plan your day – bring everything you need downstairs in the morning.

• If you are using crutches, use a small rucksack to carry things in.

• When having sex, consider alternative positions, e.g. lying on your side or kneeling on all fours.

Avoid:

• Activities that make your pain worse.

• Standing on one leg.

• Bending or twisting to lift or carry a toddler or baby.

• Crossing your legs.

• Sitting on the floor.

• Sitting twisted.

• Sitting or standing for long periods.

• Lifting heavy weights (shopping bags, wet washing, vacuum cleaners, toddlers).

• Vacuuming.

• Carrying anything in only one hand.

For further ideas for managing day-to-day and for further support, see the Pelvic Partnership website – http://www.pelvipartnership.org.uk,  Tel: 01235 820921

Physiotherapy treatment aims to improve your spinal and pelvic joint position and stability, relieve pain and improve muscle function.

Treatment includes:

• Manual therapy.

• Exercise to retain and strengthen your abdominals, back, pelvic floor and hip muscles.

• Advice on back care, lifting, suggested positions for labour.

• Exercise in water.

• Advice on helpful equipment, such as crutches and pelvic support belts (and where to get them).

Exercise during pregnancy

• Do take moderate exercise.

• Do walk with shorter strides than normal.

• Swimming may be beneficial but avoid breaststroke leg kicks.

• Don’t take up new sporting activities.

• Don’t indulge in intensive or extensive periods of exercise.

• Avoid high impact exercise, such as running, racquet sport and aerobics.

Labour and birth

Most women with PGP can have a normal vaginal birth. Many women worry that the pain will be worse if they have to go through labour. This is not usually the case when good care is taken to protect the pelvic joints from further strain or trauma.  Make sure you tell your midwife that you have suffered from PGP.

Your physiotherapist may measure how far you are able to part your legs. It is important to keep within this range as much as possible, especially if you have an epidural.

If you are severely affected, you may wish to discuss the options of having a Caesarean section with your midwife or doctor.

Before the birth think about birthing positions that are comfortable for you. Record these in your birth plan.

Consider a labour and birth in water – this allows you to move freely and change position. Speak to your midwife who will be able to give you more information.

During labour

Use gravity to help the baby to move downwards by staying as upright as possible:

• Kneeling

• On all-fours

• Standing

These positions can allow labour to progress and avoid further strain on your pelvis.

Try to avoid lying on your back or sitting propped up on the bed – these positions reduce the pelvic opening and may slow labour.

The squatting position and birthing stool may be uncomfortable positions for labour.

You should never place your feet on the midwife’s or your partner’s hips, when pushing to deliver your baby, as it may put too much strain on your pelvic joints and may also damage your helper’s back.

You may be able to lie on your side for internal examinations – ask your midwife or doctor to consider this.

The best position for delivery may be side lying or kneeling upright with support.

After the birth

• After the birth it is important to continue to follow the advice, even if the pain has reduced, in order to avoid straining the pelvis.

• Take prescribed pain relief.

• Listen to your body and move within your pain limits.

• Accept help with caring for your baby and family.

• Gradually increase your activity as you feel able.

Feeding your baby

Your midwife will help you to find a comfortable position to experience skin to skin as soon as possible after the birth.  You will be encouraged to breastfeed as soon as your baby is interested. It is important that you are comfortable and your back is supported. You should not be leaning forward – use pillows to raise your baby to the correct level for you.

Looking after your baby (this also applies if you have toddlers)

• Change nappies on a surface at waist height.

• Try not to lift your baby unnecessarily.

• Carry your baby in front of you.

• Do not carry your baby on one hip

• Kneel at the bath side rather than leaning over.

• Lower the cot side when lifting or lowering your baby.

• Keep the baby close to you when moving him/her in and out of a car seat.

• If you have to carry baby in a car seat, hold it in front of you, not on your hip.

• Do your pelvic floor exercises daily.

Useful websites and contacts Association of chartered physiotherapist in Women’s health www.acpwh.co.uk

Pelvic Partnership www.pelvicpartnership.org.uk Tel: 01235
820921

Chartered Society of Physiotherapy (CSP) www.csp.org.uk Tel:
0207 366 6666
A Guidance for Mothers-to-be and New Mothers, Association of Charter Physiotherapist in Women’s Health – http://www.acpwh.org.uk