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Low Back Pain and Pelvic Girdle Pain in Pregnancy

Updated: May 4, 2023


Pregnancy-related Pelvic Girdle Pain or PGP, is a common condition affecting 1 in 5 pregnant women. Postural changes during the second and third trimester, combined with an increase in the hormone relaxin, puts extra strain on surrounding joints and muscles. This can lead to pain and instability in the pelvis.


Anatomical diagram pelvis

The pelvis is a ring made up of three bones; (two ilia and a sacrum), which form three joints (two sacroiliac joints at the back and a pubic symphysis joint at the front). This ring is designed to hold the internal organs, including the uterus (womb), and has a certain amount of normal movement whilst walking. During pregnancy, the hormone relaxin is produced by the placenta and ovaries. Relaxin loosens the ligaments holding the joints in the pelvis, in preparation for birth. This can lead to the pelvic joints moving more than they should, and being under extra postural strain, can lead to inflammation, pain and instability. Women who have had previous injuries in the pelvis, low back and hip joints, or who are hypermobile, are at an increased risk of developing PGP, as well as those women who have had PGP in previous pregnancies.


Symptoms

Pain, stiffness and/or clicking in the pelvic joints (one or both sacroiliac joints at the back of the pelvis, and symphysis pubis joint at the front).

Pain in the perineum (the area between your legs) which may spread to your thighs.

Difficulty performing everyday tasks such as walking, prolonged standing or sitting, climbing the stairs, turning over in bed, abducting the leg (such as getting out of a car), standing on one leg, carrying heavy objects or pushing objects such as a vacuum.


Treatment

Prevention is often better than cure, so starting pregnancy with good core strength and fitness level is really beneficial, especially if you have suffered with PGP previously. Strengthening transverse abdominis (a deep lower abdominal responsible for stabilising the pelvis and low back, especially when moving) and gluteus medius (a commonly weak muscle which stabilises the hip and pelvis when standing on one leg or the supporting leg whilst mid-stride walking) will help stabilise the pelvis before it becomes aggravated by postural load and hormonal changes. Rehabilitation and strengthening continues to be beneficial throughout pregnancy, along with pelvic floor exercises, and will help with recovery after birth also.

Pain can also be managed through taking painkillers (paracetamol only), warm baths, ice compresses (no more than 10 minutes at a time and always wrapped in a cloth to stop it hurting the skin), and soft tissue work such as massage and stretching. Stabilising the pelvis with a support belt can also be used if and when core stability becomes too compromised by the pregnancy. Avoiding activities which aggravate the condition can help manage symptoms. Making sure knees are kept together whilst turning over in bed or getting out of the car (a plastic bag on the seat can help you swivel on your seat).

PGP is usually a self-limiting condition which resolves in the weeks or months after birth, however it is not uncommon for it to continue postnatally, especially in more severe cases, which can make lifting and carrying a newborn (and older children) a real challenge. Trying to lift carefully by bending the knees rather than using your back to lift, strengthening your core and your quads, and gluteals and pelvic floor postnatally can help speed up recovery and avoid any further injury.


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