Pelvic Girdle Dysfunction
It is estimated that between 16%-20.1% of pregnant women suffer from Pelvic Girdle Dysfunction ( PGD). ( Larsen et al 1999, Ostgaard et al 1991 and Albert et al 2002).
PGD can respond very well to Physiotherapy treatment including Manual therapy, massage, Acupuncture and Lifestyle modification.
What are the symptoms of PGD?
Many women have a pain-free pregnancy from start to finish but unfortunately a lot of women develop symptoms of Pelvic Girdle Dysfunction when their pelvis is overloaded at the joints, ligaments and muscles. The symptoms of PGD are:
- Lower back pain , usually to one or both sides ie around your sacro-iliac joints
- Pain in the Pubic Symphysis joint between your legs in front
- Pain in your groin and inner leg
- Buttock pain that radiates down your leg but usually no further than your knee
- A feeling of “giving way” when you walk.
- Pain on movements such as sitting to standing, turning in bed, getting in and out of the car
- Pain on walking. Sometimes the pain eases out after a few minutes of walking but when you rest again it gets very sore again.
- Pain going up and down the stairs
- Pain doing normal daily activities
What is the Pelvic Girdle?
Your pelvis is a closed ring made up of three bones:
- The sacrum which is the triangular bone at the base of your spine and
- The two ilea that join with the sacrum at the back to form two sacro-iliac joints, and with eachother at the front to form the pubic symphysis.
The primary role of the pubic ring is to support the weight of the upper body and transfer this onto the legs. It is important for tasks such as lifting, turning, standing, lifting etc. During pregnancy, hormones may lead to laxity in the joints and muscles surrounding the pelvis. While this is normal and is crucial to allow the body adapt to the needs of the growing fetus, from stretching the abdomen to delivering the baby, these hormones have an effect on normal function too. This means that the pelvic has to work harder to maintain the stability required for day to day tasks.
The pelvis is also dependent on the muscles of the pelvis and trunk to allow it to function normally and any change in muscle control will result in increased stress across the joints. Normal function of the pelvis provides a self-locking mechanism provided by the joint and ligament supports working together. The surrounding muscles dynamics and stability control are vital to this.
What causes PGD?
If one joint or set of muscles cannot meet the demands of the pregnancy, the other joints and muscles start to work harder to compensate and this is where problems arise. One joint may be stiff and the other joints may need to work harder to achieve the motion required for normal everyday tasks, this will eventually lead to overloaded muscles, tired joints and pain. Until the stiff joint becomes loose the symptoms may not go away.
What does physiotherapy do to help?
Physiotherapy by a Charted Physiotherapist, with experience treating PGD, can be very helpful to identify what is causing your PGD and to correct it. An assessment will identify what is causing your problem and treatment will include the following:
- Manual techniques to realign the joints, stretch muscles and ease out trigger points
- Acupuncture/ Dry Needling to help with pain and function
- Home Exercise Programme to help maintain the gains made during your physiotherapy session
- Advice re posture, positions for sitting/sleeping/Work/Childcare
- Advice re safe use of ice and heat for symptom relief at home
Sometime symptoms of PGD can go away or at least be managed by yourself once you know what it causing them. Other times you may need to manage the symptoms during pregnancy by attending physiotherapy more regularly. The aim of physiotherapy for treatment of PGD is to provide pain relief and to correct the underlying cause of your PGD. As your baby will be growing every week during your pregnancy it is hard sometimes, despite using strengthening programmes, to absolutely cure PGD but the good news is that most times the symptoms go away soon after your baby is born.
There is a high recurrence rate so post-natally it is a good idea to focus on strengthening your core and focus on preventing PGD in future pregnancies or for the future in general. This can be done by attending post-natal Pilates classes or by finding other way to target your core while you are exercising.
In studies amongst young and middle aged women with chronic low back pain 10% – 28% stated that their first episode of LBP occured during their pregnancy ( Mens et al 2000). So it is really important that we don’t ignore low back pain and Pelvic Girdle pain during pregnancy.