By Amy Price, PT

Many people who have been pregnant are familiar with the “aches and pains” that can come along with pregnancy, some people even expect or anticipate the arrival of things like low back pain, hip pain, and pelvic pain.  Most people might be quick to assume that this type of pain during pregnancy is rooted solely in physical causes, however we now know that it is much more multifactorial.  With this blog I hope to dive into pregnancy-related pelvic girdle pain and discuss some of the factors that contribute to it.

Pelvic girdle pain (PGP) is a specific type of low back pain that is experienced between the top of the pelvis and the bottom of the glutes, particularly around the sacroiliac joins (SIJ) on either side of the sacrum at the base of the spine.  Additionally, pain or discomfort can be present at the symphysis pubis joint (pubic bone) at the front of the pelvis.  Pregnancy-related PGP is a specific type of PGP that occurs during the time that an individual is pregnant.

PGP is common during pregnancy, and studies have shown that 46-58% of pregnant people experience it.  PGP can affect mobility, sleep, and a pregnant person’s ability to participate in their day to day activities or physical activity.  Due to the fact that PGP is so common, and often even seen as an “expected” part of pregnancy, women may be under the impression that treatment is not required or that nothing can be done to help the symptoms.  Additionally, traditionally PGP has been seen as purely physical or mechanical in nature.  However, research has shown that PGP is multifactorial, and specifically that psychosocial factors play a role.  Emotional distress, stress, depression, and anxiety have been shown to be indicative of PGP that is more likely to persist, and can contribute to an individuals overall experience of pain.  Other psychosocial factors like passive coping strategies and faulty beliefs can also impact PGP.  Therefore, when assessing the underlying causes of PGP in a pregnant person, it’s important not just to look at the physical factors but also investigate psychological factors with standardized questionnaires to see if these are contributing to an individual’s symptoms.

Goals for management of PGP during pregnancy are to alleviate pain, improve function, and prevent persistence of symptoms.  Similar to assessment of PGP, management of PGP during pregnancy should be multifactorial, and needs to address all the contributing factors to be successful.  Soft tissue release and mobilization of the pelvic joints can be used for symptoms relief, as well as pelvic support belts on a short term basis. These treatment strategies help to address the physical aspects of PGP.  Exercise is recommended to improve mobility and function.  Pain education and reassurance are helpful to address the psychosocial factors related to the pain itself, and teaching individualized stress management and mindfulness strategies can improve the prognosis.  A pelvic physiotherapist can develop an individualized program to address all the factors contributing to PGP for a pregnant individual.

References:

1. S. Dufour, S. Britnell. Pregnancy-related pelvic girdle pain: embrace the evidence and move beyond biomechanics. Journal of Yoga and Physiotherapy. 3 (5). 2018.

2. P. B. O’Sullivan, D. J. Beales. Diagnosis and classification of pelvic girdle pain disorders – Part 1: a mechanism based approach within a biopsychosocial framework. Manual Therapy. 12(2). 2007.

3. S. Dufour, S. Daniel. Understanding clinic decision making: pregnancy-related pelvic girdle pain. Journal of Women’s Health Physical Therapy. 2018.

4. S. C. Clinton, A. Newell, P. A. Downey, K. Ferreira. Pelvic girdle pain in the antepartum population: physical therapy clinical practise guidelines linked to the international classification of functioning, disability, and health from the section on women’s health and the orthopeaedic section of the American Physical Therapy Association. Journal of Women’s Health Physical Therapy. 41(2). 2017.