Pelvic Girdle Pain

Pelvic girdle pain (PGP) is referred to as pain at the front or back of the pelvis (or both) during pregnancy. There is often no obvious explanation for the cause of pelvic girdle pain; usually, there is a combination of factors that contribute to it. Most women with pelvic girdle pain can still have a spontaneous vaginal delivery ⁽⁴⁾. They should speak with their midwife about their birth plan, including pain relief options, as well as alternative positions for birth, such as supported kneeling or side lying. Using a birth pool may also help freedom of movement ⁽⁵⁾.

A cesarean section is not usually needed or recommended for women with pelvic girdle pain as this might slow down recovery ⁽⁵⁾.

• Pelvic girdle moving unevenly.
• Changes in activity of the muscular system around the hips, buttocks and pelvic floor – this can result in some weakness, be less supporting and then produce irritation to the pelvic girdle.
• Previous trauma to the pelvis.
• A small percentage of woman can experience pain due to hormones.
• In some cases, baby’s position can be a factor.

Approximately 1 in 5 women will experience pelvic girdle pain at some point in their pregnancy ⁽²⁾.

A woman’s health physiotherapist and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress and will allow appropriate adjustments to your treatment to be made.

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your pelvic girdle pain. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference

Below is some advice which often helps with pelvic girdle pain ⁽⁵⁾:

• Gentle exercise can still be achieved and is encouraged during pregnancy. Remain active within the limits of what you find comfortable and can manage. Where possible, reduce activities that you know aggravate your pain.
• Accept offers of help.
• Reduce standing on one leg, for example sit down to get dressed.
• Try to keep your knees together when getting in and out of cars.
• Consider alternative sleeping positions. For example, try lying on one side with a pillow between your knees. When turning in bed keep your knees together and squeeze your buttock muscles. You could try a pillow under your side as well.
• When getting out of bed try rolling onto your side, bring your legs off the edge of the bed, keeping them together, then use your hand to push you into a sitting position.
• Try not to lean backwards or twist when standing.
• Try going up and down stairs one leg at a time, with the most pain-free leg first and the other leg joining it on the step.
• Reduce activities that involve asymmetrical positions of the pelvis such as sitting cross-legged or carrying anything on one hip.
• Consider alternative positions for sexual intercourse such as lying on the side or kneeling on all fours.
• Use of heat or ice packs for pain relief.

93% of a woman’s symptoms improve 12 weeks following the delivery of her child ⁽²⁾. Breastfeeding will not slow the rate of recovery from pelvic girdle pain ⁽⁵⁾.

For women whose symptoms do not settle postnatally, or those who are struggling with return to a higher level of function or sport, we would encourage a consultation with a musculoskeletal physiotherapist as they will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

Treatments such as acupuncture, manual therapy, maternity belt prescription or mobility aid prescription may also provide relief, but they are not recommended as stand-alone treatments ⁽²⁾. If your pain is severe then regular pain relief might be needed ⁽⁵⁾. Your GP can discuss options with you.

Pelvic Girdle Pain:

• Pelvic Obstetric and Gynaecological Physiotherapy: Pregnancy related pelvic girdle pain for mothers to be and new mothers: https://thepogp.co.uk/Resources/112/pregnancy_related_pelvic_girdle_pain_for_mothers_to_be_and_new_mothers
• Royal college of Obstetricians and Gynaecologist: Information for you: Pelvic Girdle pain and pregnancy: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pelvic-girdle-pain-and-pregnancy.pdf
• NHS: Pelvic pain in pregnancy: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/pelvic-pain/
• Pelvic Obstetric and Gynaecological Physiotherapy: Fit for birth: https://thepogp.co.uk/Resources/120/fit_for_birth
• Pelvic Partnership: https://pelvicpartnership.org.uk/

Looking after yourself during pregnancy:

• Pelvic Obstetric and Gynaecological Physiotherapy: Fit for pregnancy: https://thepogp.co.uk/Resources/121/fit_for_pregnancy

Exercise during Pregnancy:

• Government guidelines on physical activity during pregnancy: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829894/5-physical-activity-for-pregnant-women.pdf
• NHS: Exercise during pregnancy: https://www.nhs.uk/pregnancy/keeping-well/exercise/

Pelvic Floor Exercises:

• Pelvic Obstetric and Gynaecological Physiotherapy: Pelvic floor exercises for women: https://thepogp.co.uk/Resources/115/pelvic_floor_muscle_exercises_for_women
• NHS Squeezy app: https://www.nhs.uk/apps-library/squeezy/