Your Guide to Pelvic Girdle Pain (PGP)
Everything you need to know about Pelvic Girdle Pain (PGP)/Symphysis Pubis Dysfunction (SPD)
Pelvic Girdle Pain (PGP)/Symphysis Pubis Dysfunction (SPD), is a painful, debilitating condition that can occur during or after pregnancy.
Tunbridge Wells Osteopaths is one of the UK’s leading Osteopathic centres for PGP treatment. We have helped hundreds of pregnant and postpartum women towards a swift and full recovery.
This page provides insights into PGP, from your diagnosis and prognosis and everything in between. Please remember that debilitating pelvic pain is not a normal part of pregnancy – if you are suffering, you should seek support and treatment from the experts.
What is PGP/SPD?
Pelvic pain in pregnancy, known as PGP/SPD, means you are experiencing discomfort around your joints, ligaments, and muscles that make up the pelvic girdle. PGP can occur during pregnancy, in labour, or after birth due to the body’s hormonal changes and coping with the extra weight load on your body.
PGP can be very painful and affect your everyday movement. You may have difficulty with walking, standing, or even shifting positions because movement impacts the joints connecting the pelvis and the spine. This is not a normal part of pregnancy and can be upsetting and frustrating for new mothers or mothers-to-be.
It is key to maintain the integrity of your pelvic girdle through pregnancy. A balanced pelvic girdle provides a stable structure for your growing baby. If your pelvic structure is weak or out of balance before pregnancy, your body can become unstable and vulnerable to stress, strain, and dysfunction.
What is the pelvic girdle?
There are 35 pairs of muscles attached to your pelvis, which synchronise movement between your upper body and legs, and vice versa. These muscles play a vital role in stabilising the pelvic girdle.
The pelvic girdle consists of:
- Four bones and five joints
- Two sacroiliac joints, which connect the base of the spine to the pelvis
- The symphysis pubis joint, which connects your left and right pelvic bones at the front
- The sacro-coccygeal joint
- The lumbar-sacral joint
The pelvic joints act and react to each other in response to movement, stress, and the balance of your spine. During pregnancy your centre of gravity is altered, causing your body to have to adjust quickly.
How and why does PGP happen?
During pregnancy, a hormone called relaxin softens the ligaments through your body. This means your joints become more mobile and flexible in preparation for birth.
Relaxin is elevated during the first trimester and declines early in the second trimester to a level that remains stable until labour. One of the most dramatic changes to your joints is between the 10th and 12th week of pregnancy, where joints in your pelvic area widen.
The symphysis pubis joint can separate as much as 9mm without problems arising. However, if you have a misaligned pelvis before the pregnancy begins, or if your joints separate too much, this can complicate the musculoskeletal structure of your body.
Pregnancy hormones create a more vulnerable base for your pelvis, which can struggle with the added weight-bearing of pregnancy. An unbalanced or rigid pelvis can cause difficulties giving birth and cause PGP/SPD to develop after birth.
What are the symptoms of PGP?
Pregnancy changes the musculoskeletal position and function of the pelvic girdle. Some women’s bodies are not able to adjust to the increasing weight load on the pelvis, which causes pain.
Types of PGP pain
- Intensity of pain can vary from sudden, severe and intermittent to constant, chronic and disabling
- You may feel aching, sharp, burning, tender, or dull sensations
- Acute pain that begins suddenly and is relieved within three months
- Chronic pain that persists past the normal time of healing for more than six months
Location of PGP pain
- In and around the pelvic girdle: for example, the sacroiliac joints, the pubic symphysis joint, the coccyx, and one or both hip joints
- In the lower abdomen, groin, or perineal area
- In the inner thigh
- Pain that radiates from the pelvis up into the spinal column, or down into the buttocks and back of the leg
Other signs of PGP
- Clicking within the pelvic joints
- Bladder dysfunction, e.g. stress incontinence
- Sensation that the hip is out of place or has to ‘pop’ into place before walking
- Waddling gait
- Difficulty starting to walk after sleep
- Round ligament pain
- Lower back pain
As a general rule of thumb, the majority of the maternal body’s mechanical adjustments tend to diminish after the 28th week of pregnancy. This means if you have not experienced pelvic pain up to this stage, you are much less likely to develop it during this pregnancy.
How can PGP affect the body?
PGP can be debilitating. Patients have come to us saying they find it difficult to sit, stand, or lie down comfortably, or even have the strength to hold their newborn baby.
Activities that can be painful include:
- Bending down
- Lifting one leg at a time, such as going up and down the stairs
- Parting the legs, such as getting in and out of the car or bath
- Standing
- Standing on one leg to get dressed or undressed
- Turning over in bed
What are the risk factors for PGP?
PGP may begin at any time throughout your pregnancy, and/or after labour. However, you may be more likely to develop pelvic girdle pain if you have faced one of the following issues.
- Endometriosis
- History of lower back, pelvic, or hip pain
- History of pelvic inflammatory diseases
- Hypermobility conditions, such as Ehlers-Danlos syndrome
- Increased number of pregnancies
- Increased maternal age
- Lax, loose ligaments
- Osteoarthritis of the hip
- Ovarian cysts
- Painful varicosities in the legs, vulva, or haemorrhoids
- Previous injury or trauma to your pelvis or lower extremities
- Rheumatoid arthritis
- Scoliosis or poor postural development
- Vaginal infections
- Weak abdominal muscle tone
How is PGP diagnosed and treated?
To provide an accurate Osteopathic diagnosis of PGP, an Osteopath must gather information. This includes a comprehensive case history and an examination of your spinal column, pelvis, posture and gait.
Pain experienced within the pelvic girdle can be caused by numerous conditions – not just PGP/SPD. Some of these pains are not musculoskeletal and may not be suited for Osteopathy. If this is the case, we refer you to a doctor for further tests.
Treatment is based on Classical Osteopathic principles, techniques and postural rehabilitation exercises. These treatments are specifically tailored to each person and the severity of your case.
Why is the pelvic position so important in pregnancy?
Pregnancy is a time of incredible change within a woman’s body. The pelvis plays a key role in maintaining the balance and transfer of weight and movement throughout the body. Your pelvic girdle position can determine your posture, your centre of gravity, and how your spinal curves alter to accommodate the growing foetus.
Pelvic girdle pain is not a “normal” part of pregnancy, although more than half of all pregnant women report some kind of musculoskeletal pain. Pain in or around the pelvis is a sign that your body is having difficulty adjusting to the positional and functional demands of pregnancy.
How to maintain the correct posture during pregnancy if you have PGP
Pregnancy makes demands on your body’s posture by altering your centre of gravity and weight distribution. Developing and maintaining a good posture helps to reduce stress and strain on your pelvis.
To maintain the correct posture, make a conscious effort to maintain the balance between the pelvis, abdomen and chest (thorax). Be aware of how you are standing and how your movements may cause or aggravate your condition.
A common postural mistake in pregnancy is to let the weight of your bump rotate the pelvis too far forward. The lower back then arches forward excessively, locking up your lumbar and pelvic joints. This means too much stress on the symphysis pubis joint.
Another common mistake is when you let the pelvis rotate backwards excessively. This leads to a build up of pressure within the pelvic cavity, straining the pubis symphysis joint and sacroiliac joints and the ligaments that encapsulate these joints.
What is the prognosis for PGP?
Although PGP often improves quite soon after you have given birth, we have met many women who have suffered from ongoing pelvic pain for years.
Classical Osteopathy, coupled with postural movement rehabilitation exercises, can make a considerable difference for women suffering with PGP and SPD, both during and after pregnancy.
Read more
Osteopathy for pregnancy
Osteopathy for Pelvic Girdle Pain (PGP)
Why Tunbridge Wells Osteopaths stands out for PGP treatments
What women say about our PGP treatments
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5 Upper Grosvenor Road
Tunbridge Wells
Kent
TN1 2DU
United Kingdom
+ 44 (0)1892 535858