Pelvic Girdle Pain

Pelvic girdle pain (PGP) or what was in the past referred to as Pelvic Instability is defined as pain in the back of the pelvis and buttocks, particularly in the region around the sacroiliac joints and the front pubic bone. Pain may refer down the leg, so is often confused with sciatica. PGP involving the pubic symphysis joint can also refer pain to the groin, inner thigh, lower abdomen, and vaginal area.
During pregnancy your body produces hormones that soften the ligaments (the tough, inflexible tissues) that connect and guide your joints and bones of your pelvis and surrounding joints.

Softening of these ligaments helps your baby to pass through your pelvis during birth. This increased softness in the pelvic ligaments means there is more movement in the pelvic joints during pregnancy and six to twelve weeks after the birth.
The prevalence rates of pregnancy-related PGP are estimated to be in the range of 24–50% during pregnancy. After delivery, severe pain and disability remain in 3–7% of women. Although the cause of PGP is unknown, possible underlying mechanisms are hormonal, biomechanical, inadequate motor control of the postural muscles and stress on ligament structures. PGP is regarded as a serious problem when a woman needs professional help to cope with her daily life activities.
PGP during pregnancy can greatly affect a woman’s experience of her pregnancy, her relationships and social life.

(Pelvic girdle pain affects the whole life - a study in Norway on woman’s experiences with pelvic girdle pain after delivery http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196110/)

It appears there is an imbalance of movement of the pelvis and surrounding joints causing pain and discomfort. Pregnancy constantly changes your centre of gravity weekly if not daily. If a woman has relied on her ligamentous tissue for stability and not her deep stabilising muscles such as deep back muscle, multifidus that connects the lower lumbar spine to the pelvis. Pelvic floor muscles that support the pelvic organs and connect the back of the pelvis to the front of the pelvis and the deep abdominal muscles which act as a cylinder working in unison with the diaphragm. These deep muscles in ideal functional movement work together to keep our pelvis stable. In pregnancy with the change of centre of gravity and increased postural sway and or loading one side greater than the other, the timing and recruitment of these deep supportive muscles maybe less than ideal and the pelvis is incorrectly loaded causing some pelvic joints to move too much and others to become stiff. The power muscles which are the big movers take over causing the pelvis to move in a less than ideal way resulting in pain. The brain is giving you a signal that important deep muscles are not being switch on when needed.

We are focused on making you aware of the movement patterns that aggravate your pelvic girdle symptoms and movement patterns that reduce your bothersome symptoms. It may be as simple as how you go from sit to stand, what is your habitual standing pattern is it even through both legs or do you like to load one leg more than another. How do you roll in bed? Identifying these potentially aggravating movements is critical and learns basic functional movements that the brain is happy with; resulting in reduction is pelvic girdle pain. Engaging your brain and connecting to your deep supportive muscles can be extremely helpful to put you in the control position of moving well with positive functional movements.
Treatment may need to focus on mobilising stiff pelvic and lumbar joints, massaging over recruited tight muscles. However we are always moving to self-management and teaching you ideal movement patterns that the brain likes to help reduce your symptoms. This is called Cognitive Functional Therapy. Many women then attend once or twice weekly group Pilates session for Pregnancy and beyond.

Pregnancy and Beyond Pilates Management strategies may include

• real-time ultrasound biofeedback to teach optimal motor control of the pelvic floor muscles ( performed before and after pregnancy)
• pelvic floor strength exercise program
• Education on how to maximise the function of the pelvic floor muscles in everyday life by connecting to the abdominal cylinder muscles commonly referred to as ‘The Core’, the deep back muscles and diaphragm.
• clinical Pilates program with a safe pelvic floor exercise to bridge the gap into everyday function
• Whole body functional strengthening to enjoy the adaptive mind body changes as your pregnancy progresses
• Pelvic support belt or garment maybe prescribed to improve movement control
• discussion of lifestyle change to help best manage the problem