Pelvic Girdle Pain

What Is Pelvic Girdle Pain?

Pain in the hip or pelvic girdle is a type of low back pain that affects many pregnant and post-partum women. Nearly half of all pregnant women experience these low back pains that start during the early (14th to 22nd) weeks of pregnancy; half of them suffer from serious pain and around eight percent are severely disabled. After delivery of the babies, about a quarter of women still continue to experience pelvic girdle pain (PGP).

The pelvic bones which are connected by ligaments support the weight of a mother and her baby and make up the bony passage of the baby during delivery. The pelvis undergoes stretching and remodeling during the pregnancy to accommodate a growing baby and to become ready for its final passage during delivery. Because of these changes pelvic instability can result and cause pain in the hips.

Causes of PGP

PGP disorder is related to many factors but is mostly associated with hip joint instability. This is caused by hormonal and mechanical factors related to the many changes in pregnancy. These factors are:

  • Laxity, uneven movements or hypermobility of the pelvic girdle
  • The position, size and weight of the baby
  • Increasing weight of the mother, especially if obese
  • Injury or strain to the pelvic joints during pregnancy or delivery
  • Changes in the activity of the pelvic, back and abdominal muscles
  • Older age of a woman at pregnancy
  • Previous history of PGP
  • Strenuous work, trauma or strain to the hip
  • Twin pregnancy

Symptoms

Pelvic pains related to pregnancy and delivery may be experienced as tenderness, inflammation and swelling over the symphysis pubis, which is the midline cartilaginous joint between the halves of the hip. For this reason PGP disorder is also known as symphysis pubis dysfunction.

The woman may be unable to stand straight, stand on one leg or shift weight from one hip or leg to the other. She may struggle to get up, sit or stand. There may be pain down the inner thighs and legs. She may waddle while walking and feel a clicking sound coming from the pelvis.

The pain may be so severe as to restrict a woman’s daily activities and some may need a wheelchair to be able to mobilize.

Options for Relief of Pelvic Girdle Pain

Treatment for PGP should be individualized and taken seriously because pelvic pains that start during pregnancy may remain or worsen after delivery. Recommendations include:

  • Physiotherapy and exercises – should be supervised by a health worker and continue after delivery; these aim to stabilize and improve joint mobility
  • Muscle relaxation techniques and massage – to reduce back pain, reduce anxiety and promote sleep
  • Use of pelvic belt for support – reduces mobility or laxity of the pelvic joint and improves stability of the hip
  • Acupuncture – there is evidence that this therapeutic measure alleviates low back pain and pelvic pain
  • Therapeutic injection of steroids into the sacroiliac joint of the lower back – just like other painful joints with inflammation the injection of steroids reduce symptoms or low back pain
  • Pharmacologic treatment – consists of medications that are safe to be taken during pregnancy, mainly paracetamol (Tylenol) or other nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Surgery – there is generally no need for surgery except if there is a severe traumatic cause for the disorder. Application of external fixators to stabilize the sacroiliac joint prior to fusion is recommended.

Self-help management includes:

  • Avoiding beds, chairs and sofas that are too low or too soft
  • Taking smaller steps while walking
  • Avoiding the use of stairs if possible
  • Avoiding stress on the joint – not lifting heavy objects
  • Avoiding any movement or positions with knees wide apart
  • Taking breaks, not working or physically exerting too much
  • Avoiding activities which require twisting, bending or squatting
  • Sleeping with pillow between legs
  • Getting out of the bed or from a car with knees together
  • Not attempting to pull yourself up from lying on your back

The severity of symptoms differs in every woman and in every pregnancy or delivery. Pelvic pain may persist for weeks, months or up to two years after delivery. Therapy should therefore be individualized.

References

Pelvic Instability Network Support, “Pelvic Girdle Pain”, https://pelvicgirdlepain.com/pelvic-girdle-pain.htm#self-help-management

European Spine Journal, “European guidelines for the diagnosis and treatment of pelvic girdle pain”, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518998/