Pelvic Girdle Pain

By Lisa Toth /
September 2018

This blog discusses what PGP is, what causes discomfort in the pelvic region in pregnancy and possible ways to actively manage PGP symptoms. I will also discuss implications for your daily routines, and yoga practices to support you in your pregnancy.

The pelvic girdle, a basin shaped cavity, is a bony ring between the movable vertebrae of the vertebral column which it supports, and the lower limbs that it rests on. It contains and protects the bladder, rectum and internal reproductive organs. It is formed of 4 bones;  the two innominate bones (consisting of: illium, ischium, symphysis pubis) the coccyx and sacrum.

The primary function of the pelvic girdle is to allow for movement such as walking and running, it’s a bridge between upper and lower body and incredibly strong. In addition to the functions described, your pelvis is also the bony base and outlet of your trunk through which your baby must pass to be born.

Pelvic Girdle Pain or PGP
PGP used to also be known at SPD (Symphysis Pubic Dysfunction) but this implies it only affects the symphysis pubic joint which is not true. Any of the pelvic bones can be affected and often women feel the discomfort or pain in the sacroiliac joint or outer hips.

PGP describes pain anywhere in your hips, tailbone or groin area.

Symphysis Pubis Dysfunction (SPD) is a particular type of PGP.

SI joint dysfunction (sacro-iliac dysfunction) is another common symptom during pregnancy, often felt as pain radiating from the centre of one buttock or both. This is not the same as sciatica nerve pain which can radiate from the buttocks  down one or both legs.

Physical symptoms
Common symptoms are feeling discomfort or pain when walking, climbing stairs, getting on or off a bus or tube, getting off a chair, turning over in bed or lifting one leg to put on shoes or trousers.

PGP can occur in pregnancy or postnatally, but that doesn’t mean it’s normal or that every mum gets it. Some do, some don’t, about 45% will have mild to severe PGP in pregnancy or postnatally.

The good news is it is treatable and I recommend tackling it early on when first symptoms are noticed.  Untreated PGP can become severe in some very extreme (and very rare) cases might lead to a mum needing to use crutches or even a wheelchair. I have never experienced PGP this severe in all the years I have been teaching but milder discomfort is fairly common.

PGP is a mechanical joint issue and it can be effectively treated with manual therapy from a physiotherapist, osteopath or chiropractor who is experienced in treating PGP.

The emotional side of being in pain or discomfort is not talked about a lot but I feel it very important to address. It is recognized that PGP can have an effect on how you feel emotionally. Coping with pain and limited mobility can be incredibly challenging in managing simple day-to-day tasks and can leave you feeling isolated and not able to cope. Another good reason to not suffer in silence and see someone as soon as you notice symptoms.

What causes PGP?
The pelvis joints move unevenly, possibly caused by stiffness or an old injury, this can lead to more pressure or irritation in another part of the pelvic joints
Position of baby altering the loading of stress on pelvic ligaments and joints
Previous experience of PGP during pregnancy or postpartum
A history of pelvic trauma
Strenuous physical work
Previous lower back pain
An event (like a fall or overstretching)that caused injury to the pelvic joints or ligaments
It is also believed the the hormone Relaxin can contribute to PGP as it leads to more pelvic instability though the joints and ligaments
Most likely it is a mix of several contributing factors
The hormone Relaxin present in pregnancy and postnatally

The hormone Relaxin
Relaxin does what it says on the tin: it relaxes stuff!
It’s great in preparing the body for birth but it can affect any part of the body. Most often this increased looseness of ligaments is felt in hips, lower back, feet, knees and it can even cause acid reflux where the closure between oesophagus and stomach is too relaxed.

The pelvic joints are held together by very strong ligaments that are designed not to allow movement. In pregnancy the hormone Relaxin loosens the pelvic ligaments (in preparation for baby’s head to move through the pelvis during birth) but this also means that the pelvic area has a wider range of movement during pregnancy. This in turn can mean that uneven stresses can make this instability worse and the pelvic area might feel sore as a result of inflammation in the tissues.

What is SPD, SI joint dysfunction?
PGP describes pain anywhere in your hips, tailbone or groin area.

Symphysis Pubis Dysfunction (SPD)
is a particular type of PGP felt around the symphysis pubis bone at the front of the pelvis. Most often noticed when walking, turning in bed, walking up stairs or trying to stand on one leg to put on shoes or socks.

Sacro-iliac (SI) joint dysfunction
is most often felt as a pain in the bum, literally. It occurs in the area where the sacrum meets the iliac (hip) bone and is experienced as pain radiating from the centre of the buttocks outwards. Most often SI joint discomfort is more noticeable after sitting for long durations or sitting cross legged which can aggravate this area. Deep lunges, forward bends with straight legs or down dog with legs straight legs, too can increase pain. Bend knees, avoid deep lunges, and vary your seated positions.

Ways to manage and treat PGP
Have an experienced practitioner re-align the pelvis (Osteopath, Physiotherapist or Chiropractor) treatment might involve a combination of joint realignment or mobilization and soft tissue or muscle treatment
Practice movements to stabilize the muscles around the pelvis (gluteus, quadriceps, inner thighs, low back, and pelvic floor). Stronger muscles can help compensate for laxity in the ligaments due to the hormone Relaxin
Avoid movements that are painful
Slow down when walking and be conscious of how you move
Wear comfortable, and supportive shoes. Relaxin causes the arches of the feet to drop this can have an effect on the joints in the knees and pelvis.
A strong pelvic floor, practice pelvic floor strengthening exercises
Avoid sitting in a cross legged position (sukhasana / easy seated pose). Instead try sitting on your heels or on a bolster in virasana / hero pose or on a chair
Keep hips level in bed by using a pillow between legs
Wear silk pyjamas, or use satin bedsheets, it can make turning much easier
When getting out of bed, out of a car, or off a chair; swing both legs around, place both feet firmly on the ground and push up through both legs.
Use a silk scarf to sit on and to glide off the seat more easily.

During your yoga class - some tips for practice:

Think feet hip distance apart but not wider.

Avoid asymmetrical shapes such as deep lunges, warriors with a wide stance, especially  with SPD or SI joint dysfunction.

Avoid balances where excessive pressure on one side of the pelvis can aggravate symptoms, especially of SPD.

With SI joint dysfunction, avoid crossed legged sitting and in downward facing dog pose bend knees slightly and allow sit-bones to move in towards each other. Bend knees slightly in forward folds.

Generally, stop any movement if it causes discomfort immediately.

If you notice you feel uncomfortable or in pain after a class or the next day, discuss this with your yoga teacher and try and work out together which poses to avoid or to adjust so that you get the most benefit from your practice.

Please note
This blog post is by no means exhaustive and should not be a replacement for proper antenatal care and advice from your midwife or experienced practitioner or health care provider. It is aimed to inform you and support you in your pregancy.

I hope you find this article informative, if you discover any errors, omissions, would like to add information, share your story or anything else at all; please contact me:
Lisa Toth – / 07812 474471


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