The Pelvis & Pregnancy

A common presentation during and after pregnancy is either low back or pelvic pain and although most of these symptoms usually resolve in the few weeks after giving birth some women do however experience more persistent pelvic pain & reduced function. These women should be assessed by a Physiotherapist who has specific experience in treating pregnancy related pelvic dysfunction.

During pregnancy, the mother’s body will undergo some extraordinary changes mainly to the physiology and anatomy but also structurally to the pelvis as it prepares itself for the delivery of the baby. In order to allow for the baby’s passage through the pelvis the mother’s body produces a hormone called relaxin, which softens the ligaments of the pelvis. As a result, these joints move more during and just after pregnancy.

Reduced core muscle strength and abdominal muscle separation also contribute to ongoing low back & pelvic region pain during and after pregnancy. Physiotherapy can help treat and manage these symptoms and our Physios are experienced in dealing with these types of presentations. An added benefit is the Women’s Health service that we offer that may also be of benefit.

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Pelvic Girdle Pain

Pelvic Girdle Pain (Pelvic Girdle Pain PGP) is not widely known or understood, and we are still learning about the exact causes of pelvic pain but it is thought that with postural changes, muscle weakness and differences in the movement occurring between the left and right pelvic joints can cause too much stress on the joints, ligaments and muscles of the pelvis.

What are the symptoms of PGP?

The pain is often one sided and may be concentrated in the buttock area
Or the pain can be a widespread deep ache and soreness across the entire pelvis
It can send shooting pains into your buttocks or down the back of the legs
Pain can often be felt in the region of the coccyx
Pain is often experienced in the hips, one or both of your legs may feel very weak and you may not be able to lift your legs, particularly when lying down
If you experience pain in or around your pubic bone at the front, you may be suffering from Pubic Symphysis Dysfunction

It is worth noting that if the pain is accompanied by pins and needles or numbness and extends further than the knee then there may be a greater contribution from the lumbar spine structures (such as disc and nerves) rather than a primary pelvic dysfunction.

What makes the pain worse?

The pain is usually made worse by turning over in bed, walking, and standing or getting up from a sitting position. It is often worse at night and the degree of night pain you may experience will probably be related to how active you are during the day. Separating your legs especially when sitting or lying down can be painful.

At what stage in the pregnancy does it occur?

Pelvic region dysfunction and pain can begin as early as 8-12 weeks or as late as the last few weeks before delivery. If the pain comes on at the very end of pregnancy, it may be due to the baby’s head ‘engaging’ or moving down into the pelvis. If you experience pelvic related dysfunction in one pregnancy it is likely to reoccur in any subsequent pregnancy, and without professional advice or treatment, may be more severe.

How is it diagnosed?

It is important to see a Physiotherapist who is experienced in treating pelvic joint complaints and treating pregnant women. At Spinal Synergy Physiotherapy we will assess the stability of your pelvic joints, examine your back and posture and take a detailed look at how the deep core stability muscles of your abdominal region, lumbar spine, pelvis and hip are working.

How is it treated?

Treatment at Spinal Synergy Physiotherapy uses gentle techniques which assist in mobilising the pelvis, lumbar spine and hips. We use specific soft-tissue type treatments to release tight muscles, correct any pelvic or sacro-iliac joint imbalances. Pelvic/SIJ stability belts are often used in the case of pelvic instability and provide for immediate relief and can be worn safely during pregnancy. In some instances, the Physiotherapist will apply tape directly to the pelvic region which can assist in restoring pelvic stability and control.

Exercise for the deep core abdominal and pelvic floor muscles are a key part of treatment and are aimed at improving stability of your pelvis and back. We will provide you with corrective posture exercise and a program for strengthening the deep core stability muscles. This can be either closely supervised one-on-one rehabilitation with the physiotherapist and we also recommend small group focused exercise classes.

Pubic Symphysis Injuries & Instability

Pubic symphysis joint related problems

The pubic symphysis joint connects the two pelvic bones at the front and together with the sacro-iliac joints at the back maintain stability of the pelvis. The pubic symphysis is supported by local ligaments as well as muscles but does come under a lot of loading and stresses during exercise, sporting activities and especially during pregnancy. A cartilage structure that connects between the two halves of the pubic symphysis is often the cause of persistent pubic region or groin pain.

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The SIJ & Pelvis

Pubic Symphysis Dysfunction

What is Pubic Symphysis Dysfunction?

The two halves of the pelvis are connected at the front at the pubic symphysis. This joint is strengthened by a network of ligaments which means under normal conditions very little movement occurs. The pelvic girdle however will exhibit excessive mobility due to relaxation of the ligaments of the pubic symphysis and sacro-iliac joints during pregnancy.

Consequently the “locking” mechanism of the pelvic girdle is less effective and increases the strain of both the pubic symphysis and sacro-iliac joints partly because these joints move more during and just after pregnancy. If one side of the pelvis moves more than the other when you walk or move your legs, this can lead to pain and inflammation at the pubic symphysis.

Pubic symphysis problems can occur towards the end of the first trimester or after delivery. Many women notice their symptoms for the first time around the middle of their pregnancy. Most women find that their symptoms improve after the birth of their baby although a small percentage still has pain when their babies are a year old.

What are the symptoms?

Pain in the pubic area and groin are the most common symptoms.
You may also suffer from back pain in pregnancy, Pelvic Girdle Pain or hip pain.
It is common to feel a grinding or clicking in your pubic area and the pain may travel down the inside of the thighs or between your legs.
The pain is usually made worse by separating your legs, walking, going up or down stairs or moving around in bed.
It is often much worse at night and can stop you getting much sleep. Getting up to go to the toilet in the middle of the night can be especially painful.

How does Spinal Synergy Physiotherapy treat pubic symphysis problems?

Pubic symphysis related joint problems are still not widely understood by GPs, obstetricians and midwives and pregnant women who continue to suffer with these problems are given few options with regards to actual treatment. It is important that you see a Physiotherapist who has a good understanding of the pelvic biomechanics and with comprehensive experience in treating pregnant women.
At Spinal Synergy Physiotherapy we will assess the stability of your pelvis and in particular the joints of the pubic symphysis, examine your back, hips and assess your posture, and take a detailed look at how the deep core stability muscles such as the pelvic floor are working. Treatment may encompass gentle techniques which assist in mobilizing the pubic symphysis and release tight muscles and a program of very specific pelvic floor and deep core stability exercisers. Exercise for the deep core abdominal and pelvic floor muscles form a large part of the treatment and are aimed at improving stability of your pelvis.

Self-help tips

Avoid pushing through any pain.
If this type of pain is allowed to flare up, it can take a long time to settle back down again.
Avoid heavy lifting or pushing (supermarket trolleys can be particularly painful).
When dressing, sit down to put on clothing such as underwear or trousers. Pull the clothing over your feet and then stand up to pull them up. Do not try to put your legs into trousers, skirts or underwear whilst standing up.
Take care when separating your legs and making straddling movements such as when getting in and out of the car or bath.
Avoid swimming breaststroke if you can and take care with other strokes.
Performing regular pelvic floor exercise can help to reduce the strain of the pregnancy on your pelvis.

Pubic Symphysis Diastasis

A more severe and related condition is pubic symphysis diastasis in which the pubic joint loosens and leaves an abnormally wide gap between the two pelvic bones. The increased motion at the pubic symphysis creates increased shearing forces which results in tissue inflammation and or pain. Once again, the hormone relaxin plays a significant role in mobility of the pubic symphysis and pelvic ligaments.

Some women experience severe pubic symphysis pain both during pregnancy and post-partum (after delivery). The physiological widening associated with pregnancy and delivery is small and asymptomatic and resolves within a few months of delivery. Diagnosis of a pubic symphysis diastasis can be assisted by performing a Flamingo view X-ray. This requires an X-ray to be taken whilst standing on a single leg and measuring the degree of separation at the pubic symphysis – a comparison is made between the right and left single leg findings.