Pregnancy related pelvic girdle pain

Around 1 in 5 pregnant women experience pain around the pelvic area during pregnancy. Pelvic girdle pain (PGP) is pain felt anywhere around the front, back or sides of the pelvis or the lower back. PGP is often only experienced during pregnancy and for most women (94%) the pain will resolve after labour or within a few weeks of giving birth.

Although PGP is common, it is not a normal experience during pregnancy and there are many things you can do to improve your pain.

Symptoms of PGP

• Difficulty walking.  
• Pain when standing on one leg (e.g. climbing stairs, dressing, or getting in/out of the bath). 
• Pain and/or difficulty moving your legs apart (e.g. getting in or out of the car). 
• Clicking or grinding in the pelvic area – you may hear or feel this but it is not harmful. 
• Limited or painful hip movements (e.g. turning over in bed). 
• Difficulty lying in some positions (e.g. on your back or side). 
• Pain during normal activities of daily life. 
• Pain or discomfort during sexual intercourse. 

Understanding PGP

Hormonal changes that occur during pregnancy alter tissue sensitivity, flexibility and inflammation in the body. These are normal changes to accommodate a growing baby.

When these tissues are more sensitive the brain responds by creating pain to try and protect us, even if we are not going to cause any damage! 

Evidence shows that emotions and pain are processed in the same part of the brain, which means that how we are feeling emotionally may impact on our pain levels.  

There are a lot of changes that happen in pregnancy which naturally ‘turn up the volume dial’ on our nervous system. These changes make us more alert to what is happening in our body, particularly to things happening inside and around the pelvis. This can mean that our muscles feel tight or our movement feels difficult, restricted or painful. Sometimes pain can be felt even when there is no immediate or ongoing risk of harm. 

Risk Factors of PGP 

Research has found that women with PGP may have experience with one or more of the following: 

•  A history of low back pain or PGP. 
• Smoking.
• A high body mass index (BMI).
• Having a high-stress job or home environment.
• Depression and / or anxiety. 
• A heavy workload in pregnancy. 

Factors NOT associated with PGP include:

Factors NOT associated with PGP include:

• Breastfeeding.
• Age and height.
• The contraceptive pill.
• Vaginal birth.
• Time since last pregnancy.
• Pelvic joint changes.

Understanding pain 

Pain comes from our brain’s perception of what is likely to cause us harm as a way to protect us. The brain stores information about previous experiences, especially those related to painful experiences. It will also take into consideration our emotional state and then decide how much pain we feel and how the body should react. There are certain factors in life that may increase pain (turn up the volume dial). 

Factors that may contribute to ‘turning the volume dial up’ 

• Not being satisfied with work. 
• The belief that pain will not improve. 
• Fertility issues. 
• Unplanned pregnancy. 
• Previous pregnancy related trauma.
• Previous miscarriage or loss. 
• Previous PGP. 
• Nausea/vomiting. 
• Fatigue.

Factors that may help to ‘turn the volume dial down’ 

• Sleep. 
• Hydration. 
• Movement and exercise. 
• Pacing strategies. 
• Good social support. 
• Breathing and relaxation exercises.  

Management of PGP 

Sleep 

Prioritising sleep is important; studies suggest 7 to 9 hours. If you feel that you do not get these hours at night then try to catch up with a short nap during the day.  

Hydration  

Aim to drink between 2-3L throughout the day. Water is preferred, but there are alternatives, such as decaf or herbal teas. Drinking more can help to reduce other pregnancy challenges, such as constipation, headaches and muscle cramps.  

Movement and exercise 

Movement is important to keep you healthy and strong throughout pregnancy. Some movements or activities may be painful but it is important to find exercises that cause little to no pain.  

The Chief Medical Officer for Scotland recommends 150 minutes of moderate activity each week for pregnant women. 

It is safe to continue exercise from pre-pregnancy, however you may need to modify this as your pregnancy progresses or based on how you feel. If the exercise you usually do causes discomfort then you could try antenatal Pilates, yoga, or swimming.  

When exercising consider the following: 

• Don’t bump the bump – avoid contact, high risk, and extreme sports. 
• Avoid lying flat for long periods on your back after 19 weeks. 
• Keep hydrated and avoid overheating. 
• Listen to your body and adapt exercise if causing discomfort. 
• Avoid high altitudes or low depths. 
• Try not to get too breathless – you should be able to still have a conversation. 

If your pregnancy is considered high risk, or are not keeping well please discuss exercise with your obstetric team. 

Pacing 

Although movement and exercise help to reduce symptoms, pacing is just as important. Try to be mindful of your energy levels during your day as this directly contributes to the sensitivity of your nervous system. When your energy levels are running low, your alarm system is more likely to go off and create pain (remember this is your body’s way of communicating with you). Try to modify your daily activities so you are not draining your energy too quickly.  

There are many ways you can do this: 

• Avoid having too much planned in one day. 
• Avoid being on your feet for long periods. 
• Take regular breaks if possible. 
• Be kind to yourself! 
• Prioritise sleep and rest. 
• Arrange a meeting at work to complete your risk assessment and discuss modification of work duties. 

Social support  

As explained above, our life stressors and thoughts can impact our pain by turning up the ‘volume dial’ of the body, which increases our response to pain.  

• Do something that you enjoy. 
• Meet with friends and/or family who make you laugh. 
• Put time aside for yourself. 
• Be kind to yourself! 
• Speak to your GP if you need further support. 

Breathing exercises 

We know that the way we breathe has a big impact on the tension in our muscles. If you are feeling anxious, deep breathing can help you feel calmer and reduce muscle tension by helping to slow down the body’s ‘flight or fight’ response and ‘turn down the volume dial down’.  

• Find a comfortable position.  
• Place your hands on your tummy at the bottom of your ribs.  
• Keep your shoulders relaxed.  
• Breathe in slowly and feel the tummy rise, as you breathe out feel the tummy fall.  
• You can do this for 2-3 minutes at a time.

Tips and tricks for daily movement 

If some day-to-day tasks are difficult due to discomfort, try some of the following: 

• Sit down when getting dressed. 
• When sleeping, place a pillow in between your legs and under your bump. 
• Try turning in bed by going onto your hands and knees (try not to hold your breath or brace). 
• If standing for long periods, take regular breaks and try sitting on a gym ball. 
• When getting in and out of the car attempt to keep your legs together. You could also try use a plastic bag under your bottom to allow you to slide more effectively. Just make sure to remove it from your seat before driving the car. 
• Try getting in/out of bed by rolling onto your side, pushing yourself up with your arms to sit up. Then using your hands to push off the bed, stand up. 

Breathing exercises 

We know that the way we breathe has a big impact on the tension in our muscles. If you are feeling anxious, deep breathing can help you feel calmer and reduce muscle tension by helping to slow down the body’s ‘flight or fight’ response and ‘turn down the volume dial down’.  

• Find a comfortable position.  
• Place your hands on your tummy at the bottom of your ribs.  
• Keep your shoulders relaxed.  
• Breathe in slowly and feel the tummy rise, as you breathe out feel the tummy fall.  
• You can do this for 2-3 minutes at a time.

Lumbar roll 

A lumbar roll or small rolled up towel placed at the curve of your lower back can provide extra support when sitting.

Tubigrip  

Tubigrip is a soft, stretchy support bandage that can be worn over your tummy, hips and pelvis during pregnancy. It is a safe and comfortable way to give your tummy support and may help to reduce discomfort in pelvis. Wear Tubigrip as guided by your physiotherapist or midwife. 

• Do not use it you have an allergy to latex.
• You should not wear the Tubigrip overnight or if you are sleeping during the day. 
• Take the Tubigrip off if it feels too tight.
• Take it off if you notice redness, swelling or itching of the skin under the Tubigrip. 
• Take it off if you are exercising, or doing stretches. 
• If you are worried that your baby is not moving normally, take the Tubigrip off and contact your midwife. 

Support belts 

A maternity belt is designed to help support your pelvis. It should sit around your pelvis and closes under your bump. 

You should wear the maternity belt during any activity that you normally find painful, such as walking or housework. It is not recommended to use a maternity belt while sleeping or for long periods of time. 

Using a tennis ball or spiky massage ball can help ease tight muscles during pregnancy.  

Place the tennis ball against your bottom or lower back area (not over the spine) and use your body to push the tennis ball against a wall, making small circular movements with the ball. 

Remember this should not cause more pain and it is important to keep breathing to help with relaxation.  

Exercises to help manage PGP 

Pelvic floor exercises 

It is important to exercise the pelvic floor muscles to help reduce PGP. Strong pelvic floor muscles help with labour and pelvic floor recovery, reducing the chances of urinary incontinence and PGP following birth.  

The NHS Squeezy App can be a useful tool to use whilst doing these exercises. 

• Sit or lie in a comfortable position. 
• Imagine that you are trying to stop yourself from passing wind and urine at the same time; drawing the pelvic floor muscles upwards and forwards from the back passage towards the bladder.  
• You may feel a lifting up and tightening as your muscles contract. 
• Keep breathing throughout.  
• Keep your buttocks and legs relaxed. 
• Let your pelvic floor muscles relax fully after every contraction. 

Long holds 

• Squeeze your pelvic floor muscles, gently hold them for up to 10 seconds, then release and let them fully relax.  
• Repeat the squeeze and hold until the pelvic floor muscles tire. How many times can you repeat the squeezes? 

Short squeezes  

• Quickly and strongly tighten your pelvic floor muscles, then immediately let them go again. How many times can you do this quick squeeze before the muscles get tired? 
• Always let the muscles fully relax after each squeeze. 

Aim to be able to do 10 long squeezes, holding each squeeze for 10 seconds, followed by 10 short squeezes. Do your pelvic floor exercises 3 times each day.  

You may need to start with ‘little and often’ if you find that you can only hold the squeeze for a short time, or only do a few before the muscles tire.  

Build up your exercise routine gradually over the weeks and months. You should notice an improvement in 3 - 5 months and then keep practicing your pelvic floor muscle exercises daily. 

As your muscles improve, aim to do your exercises in other positions such as standing up. Eventually you can practice using these muscles whilst doing activities such as walking and bending. 

Pelvic tilts

• Sit comfortably at the front of a chair/gym ball.
• Rock your pelvis backwards as if you are slumping in the chair.
• Then roll your pelvis forwards to gently arch your lower back.
• This movement helps to ease stiffness and pain in your lower back.
• Repeat as many times as comfortable.

Side stretch

• Sitting on a ball or chair gently lean side to side.
• You may feel a gentle stretch on your ribcage and back.
• Repeat as many times as is comfortable.

Cat Stretch

• Starting in a neutral position on your hands and knees.
• Arch your back up like an angry cat and hold for a few seconds.
• You should feel your lower abdominal muscles gently working and your back muscles stretch.
• Return to a neutral position.
• Repeat as many times as comfortable.

Pelvic circles 

• Sitting on a gym or birthing ball, or you can do this in standing too.
• Circle the ball underneath you in 1 direction. 
• Swap and change direction. 
• This exercise helps to increase flexibility around your hips and pelvis.  
• Keep the movement small to start with and increase by small amounts as you feel comfortable.   

Kneeling and leaning forward onto a ball/chair.   

• Keep your back horizontal to the floor.  
• You may find it comfortable to rock forwards and backwards for a few minutes. 

Child’s pose stretch – wide legged

• From a kneeling position, separate your knees slightly wider than your shoulders to make space for your bump.
• Gently walk you hands forward and lower your torso.

With a gym ball/pillows

• Kneel on the floor with the ball in front of you, holding it on either side with your hands.
• As you roll the ball forward, sit back on your hips and keep your gaze downward.
• Hold for a few seconds. Return to a kneeling position and repeat as needed.
• If you need to, you can place a bolster or stack of pillows on the mat in front of you, relax your arms on either side of the pillows.
• You can also place a pillow behind your knees to give yourself a bit more support if you struggle with knee pain.
• Try and do 6-8 cycles of breath before pushing yourself back up to a seated position.

What about labour?

Most women with PGP go on to have a vaginal birth if they wish to. The following tips are recommended to reduce pain in the pelvic joints:

• Keep as mobile as possible either standing, walking or sitting on a birthing ball.
• Try to adopt positions that use gravity to help move your baby downwards. Such as kneeling over the end of the bed or a birthing ball, or resting on all-fours.
• Water birth.

It is important to discuss specific requirements with your midwife.

Contacts

If you feel that your PGP is affecting your walking and you need some additional support:

If you have already attended physiotherapy/pregnancy advice class please call 01592 643 355 and ask for an appointment with Pelvic Health Physiotherapy for crutches.

If you have not yet attended physiotherapy/pregnancy advice class, please ask your midwife to refer you to Pelvic Health Physiotherapy.

References 

Pregnancy PGP & LBP | POGP (thepogp.co.uk) 

23697pogppelvic_girdle_pain.pdf (thepogp.co.uk) 

Exercise in pregnancy - NHS (www.nhs.uk) 

Exercise during pregnancy - gov.scot (www.gov.scot) 

Pelvic girdle pain (PGP) is common in pregnancy | Pregnancy, Worries and discomforts articles & support | NCT