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Pregnancy related pelvic girdle pain (PRPGP OR PGP)

Pelvic Girdle Pain (PGP)

At CSPC physiotherapy clinic, a number of our physiotherapists are experienced in treating pregnancy related pelvic girdle pain (PRPGP or pregnancy related PGP) and are registered as recommended practitioners by the Pelvic Partnership

At CSPC, a number of the physios are experienced in treating pregnancy related pelvic girdle pain (PRPGP or pregnancy related PGP). We have experience of treating women during all stages of their pregnancy, including those who suddenly run into difficulty during a pregnancy. We have worked with women wanting to get in shape for their pregnancy, and we have also worked with women who have had a previous pregnancy, had problems ever since, and come to see us a number of years later, wanting to have another baby, but hopefully without the issues they had the last time.

Pregnancy related PGP is a term to describe pain in and around the pelvic girdle, which comes on during pregnancy, due to the release of the hormone relaxin and the changes that occur within a woman’s body during pregnancy. This pain can be coming from the pubic symphysis at the front of the pelvis, from the sacro-iliac joints at the back, the lower back and the hips. Sometimes it is simply from the combination of all of these things. Pregnancy related PGP used to be called symphysis pubis dysfunction (SPD) or osteitis pubis (OP).

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Causes of pregnancy related pelvic girdle pain (PRPGP)

Pelvic pain during pregnancy is partly due to a hormone called relaxin which is released from the beginning of the pregnancy and helps to prepare the ligaments in the pelvis for birth. Relaxin starts to affect the ligaments of the pelvis from six weeks, and reaches it’s peak at twelve weeks. This high level of relaxin continues throughout pregnancy and not only affects the ligaments around the pelvis, but also affects all the other ligaments in the body, causing there to be more joint play in all joints. The pubic symphysis and sacroiliac joints are particularly affected by relaxin. This laxity in the ligaments around the pelvis, hips and feet will alter the lower limb biomechanics which further affects the stability of the pelvis, and this can result in pain.

Pelvic pain is also due to alterations in the position of the pelvis and the size of the bump. The pelvis can tip anteriorly, which will put additional stress on the SI joints and the pubic symphysis. This will mean that the bump is lying slightly more in front of the pelvic rim, rather than on top of it, and will result in increased tightness in the back muscles to support this. Some of the anterior tilt of the pelvis can also be due to tightness in the quadriceps muscles (the muscles down the front of the thighs), which attach onto the front of the pelvis and will tip it further forwards.

Treating pregnancy related pelvic girdle pain (PRPGP)

As with any injury, it is important to work out why the person is experiencing pain or dysfunction. The physios that work with this condition will do a thorough examination, taking into account the stage of pregnancy, if it is the first or subsequent pregnancy, the size of the bump, symptoms, alignment of the pelvis, ligamentous laxity, and muscle strength and flexibility, particularly in muscles attaching onto the pelvis, and which may be pulling the pelvis out of line. From this, it is possible to advise on stretches or strengthening exercises that may help the person to have as comfortable pregnancy as possible. It is possible to do gentle realignment work on the pelvis, it is just necessary to adapt some of our techniques due to the bump!

Pain stops your muscles working properly, so exercising when you are in a lot of pain can often make you worse, and is unlikely to make you stronger. By correcting the pelvic position, and reducing your pain, it is possible for the muscles to work better to support your pelvis in a more functional way, which should help manage the symptoms.

Pregnancy and Osteitis Pubis

Osteitis pubis is a common diagnosis in pregnant women and women post pregnancy, and generally needs to be treated in a similar but slightly different way to osteitis pubis in patients who have not had children, taking into account the effects of relaxin and the effect of pregnancy on the abdominal muscles. The term osteitis pubis is used to describe pain in the pubic symphysis which is the joint at the front of the pelvis. However, it is common for women during and post pregnancy to have additional pain elsewhere in the pelvis.

Pregnancy and the pudendal nerve

The pudendal nerve is a key nerve that emanates from the lower part of the sacrum, passes around the inside rim of the base of the pelvis and can become compressed during childbirth. It can also be affected if an episiotomy is needed or tearing occurs.

The resultant scar tissue can reduce the ability of the nerve to glide normally through the tissues, causing pain and dysfunction. This can also cause changes in pelvic floor tone which can alter the stability of the pelvis and affect continence.

Further information

A lot of further information and resources for pregnancy related pelvic girdle pain can be found on the Pelvic Partnership website: Pelvic Partnership or https://pelvicpartnership.org.uk

PATIENT TESTIMONIALS

I started at CSPC 18 months ago with severe post-natal pelvic pain. At that point, I could barely walk, in chronic pain every day and unable to look after my daughter in the way I expected.

Following the most amazing treatment and advice from Claire - I've spent the last 18 months on the road to recovery. I am now pain free, able to run around with my daughter and have started to take up jogging again. Thank you to Claire for giving me my life back!!

Many thanks, K 2022

I am absolutely delighted with the shockwave treatment I have received at CSPC physiotherapy Clinic and the results it has produced. Each session has measurably reduced the size of my bursitis to the point it has almost gone, with corresponding improvement in my range of movement and comfort in the affected area. It has also ameliorated calcification in my shoulder. A great big thank you to Alison and Julianna for your help!

I cannot believe how well I feel. Four years ago, I felt consigned to the ‘rust pile’, today I feel ‘shiny’ and ready for the next challenge. CSPC can seriously alter your way of life …for the better.

Within the one hour appointment I received hands on treatment that relieved most of my pain and by the evening I was breathing and moving pain free. By the following morning I was back to ‘full dad duties’ much to the surprise of my partner, who with seeing how quickly I had recovered, started to think I’d made it all up to have a good rest!

After a long car journey to Leeds, I arrived with some discomfort in my upper back that worsened over the next day to the point that I could hardly breathe or move without feeling excruciating pain.

I’d done a gym session a week or so previously and had felt some discomfort in my back but rested and thought nothing of it. A long car journey combined with caring for two young children resulted in me having excruciating back pain and if it wasn’t for getting an emergency appointment at CSPC physiotherapy clinic I would not have made it home and probably checked myself into A&E!

Within the one hour appointment I received hands on treatment that relieved most of my pain and by the evening I was breathing and moving pain free. By the following morning I was back to ‘full dad duties’ much to the surprise of my partner, who with seeing how quickly I had recovered, started to think I’d made it all up to have a good rest!
Thanks CSPC physiotherapy for getting me back to my best – super quickly!

JACK

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