Pregnancy-Related Pelvic Girdle Pain (PPGP) – Is it Normal?

This past weekend I had the opportunity to take a refresher course on the Pelvic Floor and Pregnancy, with a specific interest in Pelvic Girdle Pain (PGP). Pregnancy-related PGP is something that I see often in the clinic and I usually hear a similar story from my patients- “It’s taken me a while to come in because I thought/I was told that pelvic pain during pregnancy is normal.”

 

“Normal?”, I usually respond, “as in, something that you should just have to deal with, while simultaneously growing a baby, experiencing new feelings in your body AND preparing to be a mother?”

 

This had me thinking – why is it considered normal? What puts someone more at risk of developing PGP during her pregnancy? And most importantly, how can we prevent/treat it?

 

Let’s start with what exactly PGP is: according to the Royal College of Obstetricians and Gynaecologists, “PGP is pain in the front and/or the back of your pelvis that can also affect other areas such as the hips or thighs. It can affect the sacroiliac joints at the back and/or the symphysis pubis joint at the front.” (5)

 

If you are someone that has or currently experienced PGP, you may find it difficult to preform daily tasks, such as, getting in and out of bed, walking, standing or sitting for long periods, going up/down stairs, standing up from a chair or bending over.

 

To help you learn about some truths and myths about PGP, I’ve listed some common beliefs below – can you guess the correct answer?

 

1- About 45% of all pregnant women and 25% of all women postpartum suffer from pelvic girdle pain and/or low back pain – TRUE (7)

 

2- Relaxin (a hormone released during pregnancy) is one of the contributors of pelvic girdle/sacro-iliac joint pain – FALSE

There is low evidence for the role of higher relaxin levels and its association with more pelvic joint laxity (6)

 

3- Widening of the symphysis pubis is abnormal and can contribute to PGP – FALSE

Widening of the symphysis can be seen as normal physiology in pregnancy when it does not exceed 9.5mm (3)

 

4- Emotional distress (depression, anxiety, and stress) are strong predictors of ongoing disability in PGP – TRUE (1)

 

5- Fear of movement is highly correlated with increased pain and disability – TRUE (1)

 

6- During pregnancy, the sacroiliac joints (SIJ) move too much and can become displaced – FALSE
Due to the anatomical makeup, displacements within the SIJ’s are unlikely to occur and no study utilizing a valid measurement instrument has identified position faults of the SIJ (4)

7- Most doctors perceive pregnancy related pelvic girdle pain (PPGP) as ‘normal’ or ‘expected during pregnancy’, where no treatment or additional care is needed – Unfortunately, TRUE (2) – help us change this message!


As you can see, PPGP is common but NOT normal and is affected by a variety of factors. You may be still wondering why one may get PPGP, considering it’s not a “normal” part of pregnancy.

That is where your physiotherapist plays a role. By taking a full body look at your posture, movement, environmental factors (e.g. if you sit for work or if you’re constantly lifting your toddler), biopsychosocial factors, breathing patterns, as well as what your pelvic floor muscles are doing, we can have a better idea of the root of the pain and create a treatment plan specific to you. It is important to reduce your pain as early as possible in your pregnancy to help prepare your body for the upcoming birth & labour and to reduce the chances of continued PGP post-partum.

And if there was one thing I could teach my patients about PPGP, it is to NOT be fearful of the pain. Our body likes movement and avoiding it could add to the issues at hand, and worst of all, add to the pain.

 

SANDRA GHALY

Pelvic Floor & Paediatric Physiotherapist

Sandra graduated from Dalhousie University with a Masters degree in Physiotherapy after completing her Bachelor of Kinesiology degree with honours from McMaster University. She has worked with a variety of clientele but has developed a true passion in working with both the paediatric and women’s health populations. Sandra has extensive experience assessing and treating a variety of paediatric conditions and most recently has become certified as a pelvic health physiotherapist. She also has additional training in acupuncture and kinesiotaping. Sandra finds great value in guiding each individual through a tailored rehabilitation program to optimize their function and quality of life. In her free time, Sandra enjoys yoga, pilates, traveling and spending time with family and friends.

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References

 

1- Bjelland, E., Stuge, B., Engdahl, B., & Eberhard-Gran, M. (2012). The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study. BJOG: An International Journal of Obstetrics & Gynaecology, 120(1), 32–40.

 

2- Fredriksen EH, Moland KM, Sundby J. “Listen to your body”. A qualitative text analysis of internet discussions related to pregnancy health and pelvic girdle pain in pregnancy. Patient Educ Couns. 2008;73(2):294–299.

 

3- Mens JMA, Pool-Goudzwaard A, Stam HJ. Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. Obstet Gynecol Surv. 2009;64(3):200–208.

 

4- Sutton, C., Nono, L., Johnston, R. G., & Thomson, O. P. (2013). The effects of experience on the inter-reliability of osteopaths to detect changes in posterior superior iliac spine levels using a hidden heel wedge. Journal of Bodywork and Movement Therapies, 17(2), 143–150.

 

5- Symphysis pubis dysfunction: a practical approach to management’ published in The Obstetrician & Gynaecologist (2006;8:153–8)

 

6- Verstraete EH, Vanderstraeten G, Parewijck W. Pelvic Girdle Pain during or after Pregnancy: a review of recent evidence and a clinical care path proposal. Facts Views Vis Obgyn. 2013;5(1):33–43.

 

7- Wu, W. H., Meijer, O. G., Uegaki, K., Mens, J. M. A., van Dieën, J. H., Wuisman, P. I. J. M., & Östgaard, H. C. (2004). Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal, 13(7), 575–589.

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