Pelvic Girdle Pain During Pregnancy
Hey there, Bestie. It’s been a little while since we’ve talked about anything pregnancy-related and we’re changing that today! Let’s talk about one of the hottest topics in pregnancy: pelvic girdle pain (PGP). If you have been pregnant or know someone that’s been pregnant, you’ve probably heard about some of the aches and pains that seem to come along with pregnancy. Growing a human for nearly 10 months is no joke! While PGP during pregnancy is common, there are treatment options out there that can help you manage your symptoms. Let’s dive in!
What is pelvic girdle pain (PGP)?
PGP is pain in any of the joints of the pelvis (1). These include the sacroiliac joint (SIJ) (where the sacrum bone and back side of the hip bones meet), the lumbosacral region (where the lumbar and sacral spines meet), and the pubic symphysis (where the front sides of your two hip bones join together and form what many refer to as the pubic bone. PGP has been estimated to effect nearly 50% of all pregnant women (1).
Why does PGP occur during pregnancy?
During pregnancy, the body goes through a lot of changes. I’m talking a LOT of changes. I’ve outlined some of these changes below:
- Cardiovascular changes during pregnancy: Throughout pregnancy, one can expect increased blood volume, peripheral vasodilation, increased stroke volume, increased heart rate, and increased cardiac output (2).
- Respiratory changes during pregnancy: Pregnant folks have been shown to undergo a 20% increase in oxygen consumption and pregnant women may spend a lot of time feeling breathless (2).
- Endocrine changes during pregnancy: In pregnancy, the body has increased levels of the hormone relaxin, which loosens joints and muscles, allowing the body to stretch and accommodate a growing fetus more easily (2). A pregnant person will also have increased insulin, increased oxytocin, increased prolactin, and increased cortisol.
- Musculoskeletal changes during pregnancy: Many pregnant women experienced increased lumbar lordosis (curving of the lower back), joint laxity, widening and increased motion of the SIJ and pubic symphysis, and separation of rectus abdominis (RA) muscles (diastasis rectus abdominis) (2, 3). Most pregnant folks also undergo an overall gain in weight, which places more strain than usual on joints and ligaments.
All of these changes have a significant impact on the body’s ability to function. In fact, in a recently published article, scientists calculated the amount of energy required by pregnancy in addition to the normal energy the body needs to function, is equivalent to 50 pints of Ben & Jerry’s ice cream (4). I think any human who has been pregnant before will be utterly un-shocked by this news, but for those that have never been pregnant, it’s an analogy that can be used to help them understand just how much work the body is doing when growing a fetus.
How is PGP managed during pregnancy?
So, we know the body is changing rapidly during pregnancy and in every way possible while using huge amounts of energy. It’s no surprise that aches and pains arise when the body is going through such a quick and intense period of change. Even so, it doesn’t mean these ailments should just be accepted as “unfixable.” Let’s talk about some of the common ways your physical therapist can help you manage your PGP during pregnancy:
- Support Belts: A support belt, such as a Serola Belt, has been shown to be potentially beneficial for treating PGP during pregnancy (5). Support belts are worn low on the hips and help to squeeze together the SIJs. This can, in turn, make walking and stair climbing more comfortable. Your healthcare provider can teach you the appropriate placement for the belt.
- Exercise: Exercise is a relatively low-risk intervention, as long as the person exercising has been cleared for physical activity. Contraindications to certain types of exercise during pregnancy include new vaginal bleeding, new contractions, placenta previa after 26 weeks, carrying multiples while at risk for premature labor, preeclampsia, severe anemia, and more (5). If cleared to exercise, your physical therapist can create an appropriate exercise plan specific to you. This may include stabilizing, strengthening, and mobilizing exercises.
- Education: Your therapist may provide you with education that can help you to manage your symptoms during pregnancy. Positioning, posture, and breathing are three common education topics. The way you position yourself in bed, on the couch, and during your work day can impact your symptoms. Making small changes to your position can improve your pain and discomfort. Your therapist might also give you some advice on your posture during pregnancy. Sometimes, providing some kinesiotape to the belly or low back can relive some of the painful symptoms. Finally, breathing appropriately is essential and it is easier said than done when it comes to pregnancy. As we talked about above, pregnant folks are breathing more and consuming more oxygen than their non-pregnant counterparts (2). Also, as the fetus grows, their lungs and diaphragm have less room to move and expand, making breathing even more difficult. Your therapist will help you work on using your diaphragm to breathe most effectively and this can help improve low back pain.
- Manual therapy: Manual therapy includes joint mobilization, soft-tissue mobilization, muscle energy techniques, and more. There is limited evidence for the benefit of manual therapy on PGP during pregnancy, but some evidence does exist to support the therapeutic effect of manual therapy on this population (5). Manual therapy techniques have been shown to be safe in the pregnant population, as long as contraindications don’t exist and may help alleviate symptoms (5).
- Transcutaneous electrical nerve stimulation (TENS): TENS machines have been shown to improve low back pain in the pregnant population (6). While there is no evidence that a TENS treatment can result in adverse effects, it the electrode pads should not be placed over the abdomen and should instead be used on the back in folks with PGP (6). If you are at all concerned about the use of a TENS during pregnancy, clear this with your OB-GYN.
- Ice/Heat: Ice and heat can be used to relieve symptoms associated with PGP. As always, use layers of cloth between the skin and the ice or heat pack for protection and don’t leave on for more than 30 minutes.
If you are pregnant and you have PGP, talk with your medical provider about what you can do to manage your symptoms. If your provider tells you there’s nothing that can be done, talk to a different provider. You are growing an entire human (or multiple) and deserve to be as comfortable as possible. Let’s chat soon.
XOXO,
Your Pelvic Bestie
References:
1. Fiani B, Sekhon M, Doan T, Bowers B, Covarrubias C, Barthelmass M, De Stefano F, Kondilis A. Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women. Cureus. 2021 Oct 9;13(10):e18619. doi: 10.7759/cureus.18619. PMID: 34786225; PMCID: PMC8580107.
2. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016 Mar-Apr;27(2):89-94. doi: 10.5830/CVJA-2016-021. PMID: 27213856; PMCID: PMC4928162.
3. Boissonnault, J, Blaschak, MJ. Incidence of Diastasis Recti Abdominis During the Childbearing Years. 1988 Aug 1. Doi: 10.1093/ptj/68.7.1082
4. Samuel C. Ginther et al. Metabolic loads and the costs of metazoan reproduction.Science384,763-767(2024).DOI:10.1126/science.adk6772
5. Clinton SC, Newell A, Downey PA, Ferreira K. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classifi cation of Functioning, Disability, and Health From the Section on Women’s Health and the Orthopaedic Section of the American Physical Therapy Association. DOI: 10.1097/JWH.0000000000000081
6. Keskin EA1, Onur O, Keskin HL, Gumus II, Kafali H, Turhan N. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecol Obstet Invest. 2012;74(1):76-83. doi: 10.1159/000337720. Epub 2012 Jun 21.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
