Pelvic Girdle Pain

I'm sure if you're pregnant you've heard this term quite a lot, but what is pelvic girdle pain and is there anything we can do to help prevent it?

We’ll start with a quick anatomy lesson: The pelvic girdle is a ring made up of the two halves of your pelvis (which you can feel when you put your hands on your hips) and your sacrum (the triangle shaped bone at the base of your spine). These bones are connected by the pubic symphysis at the front and the sacro-iliac joints (SIJ’s) at the back. These joints are held together passively by your ligaments and actively by your muscles. 

In more simple terms, the pelvic girdle is made up of 3 bones and 3 joints and is held together by ligaments and muscles. 

Pelvic Girdle Pain (PGP) is caused by increased load on the structures that support the pelvis, which can cause irritation of these joints. Pain may be felt at the front (pubic symphysis), the back (SIJ’s) or both. It can also be felt on one or both sides and this will all be relative to your individual anatomy and daily activities. Although it can be experienced by people who are not pregnant, during pregnancy this condition becomes more common due to changes to our anatomy, posture and hormones. 

As your baby and your belly grows, the load going through your muscles and joints increases, particularly in your lower body. In addition to your weight increasing, the distribution of your weight also changes, altering your centre of gravity. With most of your weight sitting at the front of your body, your pelvis can start to tilt forward (anteriorly) and your lower back can start to arch more than usual. This affects the usual biomechanics of your pelvis and spine and with the extra weight going through these areas, can be one factor that contributes to PGP. 

In addition to the postural and biomechanical changes happening in your body, we also have the relaxation of our ligaments to help widen the pelvis and let our baby pass through during birth. This is such an important and necessary part of pregnancy and childbirth, but it does affect the stability of our pelvic girdle and is another factor that can lead to overload of these joints. 

The good news is that there is actually a lot we can do to reduce our risk of developing PGP and as with everything, prevention is key!

1.Activity modifications. Activities that will potentially contribute to PGP are movements that load the pelvis asymmetrically. To minimise this asymmetrical load:

• Stand with your weight evenly distributed across both feet
• Try not to sit with your legs crossed
• Avoid walking lunges and high step ups
• Be mindful of how you feel if you are running through pregnancy
• Consider walking on flatter ground rather than hills
• When getting in and out of the car, keep your legs together
• Sleep with a pillow between your legs
• If you have another child, try not to carry them on one hip

2. Muscle strengthening. To compensate for the laxity of our ligaments, it is important to build strength in the muscles that support the pelvic girdle. Pilates is a great way to focus on these muscle groups as it is low impact and low load. All of our prenatal Pilates classes are helpful in preventing PGP and safe to do at any stage of your pregnancy. Muscle groups that support the pelvic girdle:

• Glutes (buttock muscles)
• Adductors (inner thighs)
• Pelvic floor
• Deep abdominals
• Hip flexors
• General lower limb strength: Hamstrings, Quads, Calves

3. Avoid deep stretching. Try not to stretch deeply or to hold your stretches for too long during pregnancy. Because of the increased laxity in your ligaments, you may be able to take your joints further than usual, so to avoid overstretching:

• Stretch just to the point of tension, never past this point
• Have pillows or towels to support you in your stretch
• Use a spikey ball or foam roller instead of stretching around your hips
• Move in and out of the stretch, rather than sustaining it for a prolonged period

4. Pelvic support belts. In addition to modifying your activities and building your muscle strength, you can also look into a pelvic support brace. These are very comfortable to wear and provide an added level of support to the pelvic girdle if needed:

• See a physio with experience in pregnancy to have your belt fitted correctly
• Wear the belt when you’re on your feet and take it off at rest

As you can see, there are plenty of really easy things you can do to help prevent your risk of developing PGP during pregnancy. The best time to make these changes is BEFORE you experience any pain or discomfort. However, if you are already experiencing pain around your pelvis, it is best to see a physiotherapist to assess you and create a specific plan for you. Everyone’s body is different and there are other causes of pain in this area that require different management strategies, so a correct diagnosis is essential.

If you have any questions, please reach out to me via DM @ourpilates or email hello@ourpilates.com.au. I am happy to help and guide you in the right direction. 

Han x