What is Pelvic Girdle Pain?

This is sometimes called pregnancy-related pelvic girdle pain (PGP), pelvic girdle dysfunction (PGD) or symphysis pubis dysfunction (SPD). Here we will refer to it as PGP. 

PGP is a collection of uncomfortable symptoms and/or pain caused by changes of your pelvic joints. The position of the pelvic joints goes through adaptive changes during pregnancy, this happens mostly to adapt to the changes in weight and posture caused by pregnancy. Additionally, pregnancy hormones such as progesterone and relaxin result in increased laxity of the joints making them unstable which may also contribute to pain. The weight of the pregnancy itself and the pressure of the foetus on the pelvis, especially at the end, continues to cause more pressure which may result in further discomfort and/or pain.

What are the symptoms of PGP?

Although PGP is not harmful to the growing baby, it may cause great discomfort and pain to the mother. 

Common areas of pain are:

1. On the pubic bone at the front in the centre, roughly level with your hips or lower
2. 1 or both sides of your lower back, near the back dimples (known as the sacroiliac joint)
3. In the area between your vagina and anus (perineum)
4. Sometimes also spreading the thighs 
5. Some also experience or hear a clicking or grinding in the pelvic area.

What aggravates the pain?

1. Walking
2. Stairs
3. Activities standing on 1 leg (for example, when you’re getting dressed)
4. Turning in bed
5. Moving your legs apart such as getting in and out of bed or a car

How can PGP be treated?

Firstly, having it diagnosed early on prevents it from getting worse and causing long term effects. Physiotherapy is usually one of the major tools to deal with this pain. It aims to relieve or ease pain, improve muscle function, and improve your pelvic joint position and stability.

Several treatments are available, these include: 

1. Manual therapy to aid normal function of the pelvic joints
2. Home exercise program to strengthen your pelvic floor, core, back and hip muscles
3. Exercises in water
4. Advice on positioning, handling daily tasks etc.
5. Pain relief, such as TENS and acupuncture
6. Advice to use certain aids  if necessary, such as crutches or pelvic support belts

Further advice to control or ease the pain

1. Avoid activities that make the pain worse rest when you can
2. Make use of proper supportive footwear
3. Avoid doing activities standing on one leg. For eg.  sit down to get dressed 
4. Try to keep your knees together when getting in and out of the car or turning in bed
5. Try using a pillow between your knees when sleeping
6. Go up and down the stairs one step at a time
7. Avoid crossing your legs
8. Avoid sitting or standing in the same position for a prolonged period
9. Avoid lifting heavy things
10. Avoid twisting activities such as washing the floor and vacuuming

Who is most likely to get PGP?

It’s estimated that PGP affects up to 1 in 5 pregnant women to some degree. There are many factors that make contribute to PGP these include:

1. Hormonal changes
2. Weight and position of the baby
3. History of lower back or pelvic girdle pain or core weakness
4. Previous injury to the pelvis (for example, from a fall or accident)
5. Being overweight

Exercises for PGP (on the video) using a ball or a cushion

1. Pelvic tilting with ball or cushion between knees
2. Mini squats with pelvic tilting and ball, keeping core engaged
3. Deeper squats but not beyond 90 degrees
4. Heel raises with knees straight( going on tiptoes) with the ball between knees
5. Heel raises but in squat position
6. Squatting while on tiptoes
7. Marching in a squat position maintaining core activation and pelvic tilt 
8. Heel taps in a squat position maintaining core activation and pelvic tilt 
9. Side walking in a squat position maintaining core activation and pelvic tilt 
10.  Front and back walking in a squat position maintaining core activation and pelvic tilt 
11. Mini lunges with ball between knees
12. Toe/ heel rocking in a lunge position but knees straight

You can do these exercises as tolerated, at least once a day up to several times a day.

Link here: https://www.youtube.com/watch?v=vHM6bKIEpHo&t=22s