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Our experienced physiotherapists can help you manage your pain and get back to your life! We have been successful treating this problem both in-clinic and online. |
WHAT IS PELVIC GIRDLE PAIN?
WHAT CAUSES IT?
HOW CAN PHYSIO HELP?
WHAT IS PELVIC GIRDLE PAIN?
Pelvic girdle pain (PGP) is a functional and mechanical condition where pain is felt in the joints, muscles or ligaments of the pelvis. It is also known as symphysis pubis dysfunction, sacroiliitis, osteitis pubis, or pelvic joint syndrome depending on the painful region, but these conditions are now all categorised as and referred to as PGP. PGP is more common in women than in men.
Three different joints make up the pelvic girdle. At the front the symphysis pubis unites the right and left pubic bones in the midline. On either side are the hip joints, important weight-bearing structures that transfer the load of the body from the pelvis to the femurs for standing and walking. At the back are the strong sacroiliac joints, located between the sacrum and the ilium on both sides. Pain can occur in one or more of these three joints when they have difficulty accommodating functional (activity-related) or structural (anatomical or physiological) changes.
The type, intensity and location of the pain with PGP can vary, and can be intermittent or constant. Pain locations can be the lower abdomen, the lower back, the sacroiliac joints, the coccyx, the pubic symphysis, the hips, the groin, the thighs and/or the perineum, and the intensity can range from a sensation of stiffness, to a severe pain. The activities that provoke the onset of the pain are also different from one person to the other. Typically, activities provoking PGP include standing on one leg (e.g. walking or going up and down the stairs), lifting on leg at a time (e.g. getting dressed), parting the legs, turning in bed, bending over, sitting and/or sexual intercourse.
The most common cause of PGP is pregnancy. In this case, it is referred to as pregnancy-related pelvic girdle pain (PRPGP). In the case of PRPGP, the pain can appear at any point during pregnancy or after giving birth. It can develop quite suddenly or gradually over time. It tends to get worse as the baby grows if the pelvic joints have difficulty adjusting to the increased weight they need to bear. Some women have a sensation of instability or clicking in the pelvic joints. Stress incontinence can also occur in the last months of pregnancy. Often, PRPGP is not only challenging physically, but also emotionally. Some patients therefore experience symptoms of isolation, anger, sadness or guilt.
Three different joints make up the pelvic girdle. At the front the symphysis pubis unites the right and left pubic bones in the midline. On either side are the hip joints, important weight-bearing structures that transfer the load of the body from the pelvis to the femurs for standing and walking. At the back are the strong sacroiliac joints, located between the sacrum and the ilium on both sides. Pain can occur in one or more of these three joints when they have difficulty accommodating functional (activity-related) or structural (anatomical or physiological) changes.
The type, intensity and location of the pain with PGP can vary, and can be intermittent or constant. Pain locations can be the lower abdomen, the lower back, the sacroiliac joints, the coccyx, the pubic symphysis, the hips, the groin, the thighs and/or the perineum, and the intensity can range from a sensation of stiffness, to a severe pain. The activities that provoke the onset of the pain are also different from one person to the other. Typically, activities provoking PGP include standing on one leg (e.g. walking or going up and down the stairs), lifting on leg at a time (e.g. getting dressed), parting the legs, turning in bed, bending over, sitting and/or sexual intercourse.
The most common cause of PGP is pregnancy. In this case, it is referred to as pregnancy-related pelvic girdle pain (PRPGP). In the case of PRPGP, the pain can appear at any point during pregnancy or after giving birth. It can develop quite suddenly or gradually over time. It tends to get worse as the baby grows if the pelvic joints have difficulty adjusting to the increased weight they need to bear. Some women have a sensation of instability or clicking in the pelvic joints. Stress incontinence can also occur in the last months of pregnancy. Often, PRPGP is not only challenging physically, but also emotionally. Some patients therefore experience symptoms of isolation, anger, sadness or guilt.
WHAT CAUSES IT?
PGP can occur following a trauma to the pelvis, arthritis or osteoarthritis or in some cases be idiopathic (with no known cause).
During pregnancy, the function and musculoskeletal position of the pelvic girdle is altered. One of the contributing factors is the presence of relaxin, a hormone released during pregnancy to allow the ligaments and muscles to loosen in the pelvis, the hips and the pelvic floor in preparation for delivery. This leads to an increase in the range of motion of these joints, sometimes making them less balanced, which in turn causes pain or discomfort with certain movements or activities. In addition, the body’s center of gravity is altered during pregnancy, which can bring further mechanical imbalances if the body has difficulty adjusting. In some cases, the pain can be influenced by the position of the baby. Some risk factors for PRPGP include a misaligned pelvis before pregnancy, postural issues, weak abdominal muscles, a previous trauma to the pelvis or lower extremities, an increased number of pregnancies and maternal age.
During pregnancy, the function and musculoskeletal position of the pelvic girdle is altered. One of the contributing factors is the presence of relaxin, a hormone released during pregnancy to allow the ligaments and muscles to loosen in the pelvis, the hips and the pelvic floor in preparation for delivery. This leads to an increase in the range of motion of these joints, sometimes making them less balanced, which in turn causes pain or discomfort with certain movements or activities. In addition, the body’s center of gravity is altered during pregnancy, which can bring further mechanical imbalances if the body has difficulty adjusting. In some cases, the pain can be influenced by the position of the baby. Some risk factors for PRPGP include a misaligned pelvis before pregnancy, postural issues, weak abdominal muscles, a previous trauma to the pelvis or lower extremities, an increased number of pregnancies and maternal age.
HOW CAN PHYSIO HELP?
If you suspect you have PGP, an assessment with a physiotherapist is strongly recommended. An important first step will be to determine whether the true cause of the pelvic pain and dysfunction is the lumbar spine or the pelvic girdle itself, since the former can frequently refer pain into the buttock, hip and thigh. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) uses a systematic approach to establish the source of your symptoms and properly classify your condition. If the pelvic joints are actually the cause of the pain, interventions to improve the stability and function of the pelvic girdle will be necessary. The physiotherapist will assess the flexibility, strength and stability of the pelvic joints, and any limitations of functional movements and activities. The gathered information will allow the elaboration of an appropriate treatment plan for you. A typical treatment approach involves Postural advice and education to limit movements or habits can exacerbate the problem, specific exercises given the root physical cause for your pain, and manual techniques.
Temporarily avoiding the positions and activities that increase the pain is recommended. Repetitive or sustained bending over or twisting, crossing of the legs, pushing or lifting heavy objects, asymmetrical loading (e.g. heavy loads in one arm) can aggravate the pain. On the other hand, taking more rests during tasks at work and at home, sitting rather than standing for some chores, wearing supportive footwear, avoiding prolonged time in one position (varying sleeping and resting positions) can all be helpful strategies. The physiotherapist will help you improve your biomechanics during your everyday activities in order to make them as easy and pain free as possible. In certain cases, temporary use of a support belt may help improve symptoms and function by increasing the stability of the pelvic girdle joints during movement.
Temporarily avoiding the positions and activities that increase the pain is recommended. Repetitive or sustained bending over or twisting, crossing of the legs, pushing or lifting heavy objects, asymmetrical loading (e.g. heavy loads in one arm) can aggravate the pain. On the other hand, taking more rests during tasks at work and at home, sitting rather than standing for some chores, wearing supportive footwear, avoiding prolonged time in one position (varying sleeping and resting positions) can all be helpful strategies. The physiotherapist will help you improve your biomechanics during your everyday activities in order to make them as easy and pain free as possible. In certain cases, temporary use of a support belt may help improve symptoms and function by increasing the stability of the pelvic girdle joints during movement.
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