Pregnancy is a time anticipated with positive expectations of joy and a time to relax and take care of themselves. However, for some, unexpected pains and aches make this journey troublesome. One such discomfort is pelvic girdle pain or PGP or pregnancy-related pelvic girdle pain or PPGP. PGP is a common difficulty as 1 out of 5 antenatal mothers experience it during their pregnancy. PGP is often described as a symptom-related syndrome and can have different presentations for individuals. The clinical manifestations of this syndrome refer to a musculoskeletal type of persistent pain localized at the anterior and/or posterior aspect of the pelvic ring. The symptoms may begin either during the first trimester of pregnancy, during labour or even during the postpartum period.
PGP limits daily activities and working ability and thus decreases the health-related quality of life. Imagine experiencing pain in the pelvic region while side-turning in bed or getting out of bed. Pain in the groin region while getting dressed for the lower half of their body, walking, standing on one leg or climbing up and down steps. All these or one among these can be a presentation for PGP.
Symptoms
Pain in the pubic bone in front, between the two legs.
Pain in the groin region onto one side or both.
Pain above the vaginal region.
Over the hips, lower back till the buttocks onto one side or both.
Causes-
Pregnant women who experience such pain are always keen to find out the reason for the pain. The cause can be multifactorial but in a maximum number of cases, the reason is mechanical, which can be because of changes in the posture that may happen because of exaggerated lumbar curvature or the pelvic joint misalignment that may occur in pregnancy or during the labour process.
Another reason can be hormonal changes in pregnancy, because of the laxity in the ligaments in the pelvic region that happens because of the relaxing hormone, this laxity of ligaments can cause uneven movements and these movements can create sharp pain.
PGP can also be because of past history of backache because of misalignment of the spine/pelvic joint or excessive weight gain in pregnancy. All of these together also can cause pelvic girdle pain.
How Physiotherapy may help with PGP?
Physiotherapy helps in preventing as well as treating pelvic girdle pain
Prevention-
Postural guidance for antenatal mothers, by teaching them the right way of maintaining their posture while sitting and walking, to make sure lumbar lordosis is not further increased and the chances of developing waddling gait in pregnancy are decreased.
Making the muscle along the pelvic joint strengthen by designing an antenatal workout routine that has enough strengthening exercises for lower back muscles, pelvic floor muscles, glute muscles and long muscle group of the trunk.
Incorporating core strengthening exercises as a part of antenatal exercises.
Introducing balance and agility exercises as soon as the second trimester of the pregnancy.
During Pregnancy
Education towards instability - Pregnant women must be made aware of the basic anatomy (body parts and muscles around the pelvic region) and how certain movements are directly related to increasing the pain. The patient must be guided about basic everyday activities of daily living and how they can be modified so that the pain is relieved/reduced.
Soft tissue treatment - It includes relieving any trigger points and muscular spasms with the help of soft tissue release manually, through needling, through instrument-assisted soft tissue mobilization or myofascial release. It highly depends on the type of pain the patient complains and its presentation.
Correcting functional impairments - Any misalignment in the pelvis, sacroiliac joints or lumbopelvic region is assessed by the physiotherapist and corrected by various mobilization and manipulation techniques and can be maintained by exercises.
Core & Pelvic floor exercises - Patient presenting with PGP, their core and pelvic floor muscle strengthening must be evaluated by a physiotherapist and any signs of weakness/tightness present are treated according to strengthening/stretching exercises guided.
Strengthening in weight-bearing conditions - Strengthening exercises is an excellent way to strengthen muscle and reduce pain. Weight of 1-5 kgs can be used as ankle weights or theraband can also be used.
Supportive belts - Pregnancy belts can be used in the third trimester when there is an increase in the baby’s weight that causes further pressure over the pelvic region. Pregnancy belts are of great help for antenatal mothers carrying twins/triplets.
During Labour
Women with PGP are worried to have normal delivery as they fear that the pain may be more excruciating for them and they will not be able to have a normal birthing experience, however, with certain interventions, pelvic pain can be eased out during labour.
Being active - Walking, moving around or mere standing helps in labour as it lets gravity work and prevents the positions that may cause pain like rolling in bed. One can keep the pelvis moving by swaying it from side to side taking support of the partner or slightly forward leaning on the wall/stable object.
Using swiss ball - Swiss ball or birthing ball is an excellent way to let the mother be active and in a painless posture. If walking is also painful, one can sit on a swiss ball and perform pelvic movements like rotations, forward and backward sways and figure of 8 motions. A peanut ball can also be used, it is a double ball, attached in the center and resembles a peanut shape.
TENS - TENS is an electrical modality that stands for transcutaneous electrical nerve stimulation, it is nowadays widely used by physiotherapists in labour to relieve the pain caused by contractions. It is used in the latent and active phase of labour and the electrodes are placed on the lower back and the intensity is maintained by a hand-held machine.
Different labouring positions - Since for patients with PGP, abduction (moving their legs away from the body) is painful, one must look for alternative positions for labouring other than the traditional way of giving birth on the back, one can opt for a forward bending position supported with the raised bed being on their knees or a half squat position. For resting side-lying position pillows/peanut balls kept in between the knees can be used.
Pelvic pain usually subsides gradually after the delivery process, however, in some cases, it may persist. During a normal delivery, the pelvic floor muscles stretch, if there is any trauma from the labour and delivery process, muscles may go into spasms that can elicit pain. Complications such as a perineal tear, infection and prolonged healing may worsen the pain.
Pelvic floor therapy is the term used for postnatal pelvic pain, in this therapy evaluation is done first that may include external and internal examination. After the assessment, if the pelvic floor muscles are tense/tight relaxation techniques are suggested for patients, if the muscles are weak, strengthening exercise are programmed accordingly.
Diastasis recti or abdominal separation can also attribute to pelvic pain, diastasis recti are also assessed by physiotherapists and core strengthening exercises are included as an exercise regime.
Post birth, one must keep themselves active as pain permits. One must obtain a comfortable supported seated position for breastfeeding.
Though, pelvic girdle pain may be considered common in pregnancy but must not be considered normal. This pain does not cause any harm to the growing foetus, but it is difficult and inconvenient for the pregnant lady as it causes excruciating pain with basic everyday activities. One must visit an OBG-GYN Physiotherapist for treatment as such pains are completely curable and make the journey from pregnancy to motherhood pain-free.
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