Pelvic Girdle Pain During Pregnancy

Lumbo-pelvic pain, which can be defined as, pregnancy related low back pain or pregnancy related pelvic girdle pain, occurs in 24%-90% of women while they are pregnant (Van Benten et al., 2014). Although this usually goes away after birth over 1/3rd of women still have pain 1-year post pregnancy (JOSPT, 2014).

What is Pelvic Girdle Pain?

Your pelvis is made up of your hip bones (ilium, ischium, pubis bones), your tailbone (sacrum/coccyx) and various muscles, tendons and nerves which all work together to support your pelvis and internal organs. When these bones, tendons and muscles do not work together as they should this is when you feel pain. Pain can be in the posterior pelvic girdle (below your lower back) most often caused by an unstable sacral iliac (SI joint), or in the anterior pelvic girdle (in your groin) due to instability in the symphysis pubis. These ‘joints’ are not meant to move, but due to the lovely relaxin hormone floating through your pregnant body they can easily become unstable and extremely painful!    pelvic girdle pain

Pelvic girdle pain (PGP) increases with everyday activities such as walking, standing, sitting and lying down. It can increase drastically after only 30 minutes of activity (Fagevik Olsen, Elden & Gutke, 2014). Sounds pretty annoying right?

Why is it important to identify and treat pelvic girdle pain?

This persistent and awful pain not only effects women physically but also puts them at an increased risk of depression and decreased quality of life. Lumbo-pelvic pain is responsible for a large percentage of sick leave costs for pregnant women as well (Fagevik Olsen, Elden & Gutke, 2014). I laugh because my doctor wrote me a note to have modified work due to pelvic pain and my restrictions were “no standing, no walking, no sitting, or lying down for more than 25% of the day”…Uh, so what exactly could I do? Obviously this resulted in me going off on maternity leave a little earlier than planned.

Identification of women with severe PGP is also important since they are at the “highest risk of persistent pain both during and after pregnancy…and have the greatest consequences in terms of pain, intensity, disability and health related quality of life” (Olsen, Elden & Gutke, 2014). As a sufferer of PGP I can attest that it absolutely affected my quality of life and overall mood since some days even walking around the house was intolerable.

How can I tell if I have PGP?

A recent study by Fagevik Olsen, Elden & Gutke (2014) looked at the effectiveness of self-tests for pregnant women to screen for pelvic girdle pain so that they can be referred to a doctor or physical therapist for evaluation. Here are some of the tests I pulled from this study and this study !  Now, just a warning, if you do have Sacroiliac (SI) joint pain or Symphysis Pubis Dysfunction (SPD) you will know within SECONDS of attempting any of these tests.

SI joint pain is felt beside your tailbone and is often a sharp, deep pain that occurs with certain movements. It can even feel like your hip or tailbone is ‘out of place’. Symphysis Pubis pain is a sharp, lightning bolt type pain that feels like it is often deep in your pelvis. These pains can range from a dull ache or nothing at rest to constant excruciating pain all the time.

Please note all the images and descriptions for these tests were taken directly from the two articles cited above. (Fagevik Olsen M et al, 2009) and (Fagevik Olsen, Elden & Gutke, 2014)

1) P4 Test

Lying in the supine position with 90-degree flexion at the hip the patient presses on the flexed knee, along the longitudinal axis of the femur.

Positive test = reproducing the pain in the SI area
POSH test self adminstered

http://www.thestudentphysicaltherapist.com/posh-test.html <– see more info on this test here

Patrick Faber Test

Lying in the supine position with one hip flexed, abducted and rotated so that the heel rests on the opposite kneecap. Positive test = reproducing the pain in the SI area

faber test self administered

http://www.thestudentphysicaltherapist.com/faber-test1.html <– see more info on this test here

Trendelenberg Test

Standing on one leg, flexing the other with the hip and knee at 90. Positive test = reproducing the pain in the SI area

trelenberg test

http://www.thestudentphysicaltherapist.com/trendelenburg-test.html

Bridging Test

The patient lifts the buttock and extended one leg. Positive test = reproducing the pain in the SI area

bridging test pelvic pain

Mat Test

The patient performed a movement of hip abduction and adduction simulating the movement to pull a mat across the floor. Positive test = pain in the symphysis
mat sliding test

Straight Leg Raise Test

Tests for disc involvement, see more info here.

straight leg raise test

Per (Fagevik Olsen, Elden & Gutke, 2014) , in order to be classified as PGP the following criteria had to be fulfilled…

  • Pain experienced between the hip bones and the gluteal fold particularly in the area of the SI joint in the symphysis.
  • Reports by the women of weight-bearing related pain and its duration in the pelvic girdle.
  • Diminished capacity to stand, walk and sit.
  • Positive clinical diagnostic tests, which reproduced pain in the pelvic girdle.
  • No nerve root syndrome (Negative SLR test).

Be sure to quantify your pain on a scale if you are bringing it to the attention of a doctor or therapist! It really helps them establish a baseline and help rule out other problems.

pain scale

What can I do about it?

Physical and Occupational Therapy during and after pregnancy can help decrease low back and pelvic pain and increase mobility and quality of life.

Van Benten et. al (2014) concluded “according to the literature there is moderate evidence for the positive effect of exercise therapy on pain, disability, and/or sick leave for the treatment of lumbo-pelvic pain during pregnancy. Moreover, data shows that patient education seems to be a helpful intervention”.

Talk to you doctor about a referral to therapy or seek out a therapist near you. A physical therapist who specializes in orthopedic rehabilitation or women’s health will be able to do a proper assessment and prescribe exercises for you to continue at home which can provide some relief! They can also recommend appropriate braces or taping techniques that may help decrease the pain and provide increased stability to those poor overstretched joints. If you are able to see an Occupational Therapist (usually covered by insurance with a doctors order) be sure to take advantage, a home visit will help identify the daily activities that are most difficult and how you can modify the activity or the environment to be able to complete them with as little pain as possible! Also, chiropractic care is fantastic for helping to realign your pelvic bones and spine. This can decrease pain due to nerve irritation and  inflammation. This is what helped me the MOST during my pregnancy and I always recommend chiropractic care to other pregnant mamas out there. As always please comment below or send me an email if you have any questions!

Hope this helps!

In fitness & good health,

Natasha

 

References

JOSPT (2014). “Pregnancy and Low Back Pain: Physical Therapy can Reduce Back and Pelvic Pain During and After Pregnancy”. J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505

Fagevik Olsen et al. (2009). “Self Adminstered Tests as a Screening Procedure for Pregnancy Related Pelvic Girdle Pain”. Eur Spine J (2009) 18:1121–1129 DOI 10.1007/s00586-009-0948-2

Fagevik Olsen, Elden, & Gutke. (2014) “Evaluation of Self-adminstered Tests for Pelvic Girdle Pain in Pregnancy”. BMC Musculoskelet Disord. 15(138)

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