Introduction:
Pelvic girdle pain (PGP) refers to pain in the pubic area in the front, lower back, buttocks, groin, or perineum (area between the vagina and the anus). About one in five women experience pelvic girdle pain. The cause of the condition is still not certain. But, many factors contribute to the development of pelvic girdle pain.
What Is Pelvic Girdle Pain?
Pelvic girdle pain is associated with stiffness of the pelvic joints or their malalignment at the pelvis. Other names referring to this condition are symphysis pubis dysfunction, pubic shear, symphyseal separation, pelvic girdle relaxation, pelvic joint syndrome, and posterior pelvic pain.
Pelvic girdle pain can affect pregnant women in regular activities like walking long distances, standing on one leg while getting dressed, or using stairs. Pregnant women can also have difficulties in turning in the bed and moving their knees apart, such as getting in and out of a car. Pelvic girdle pain, however, does not affect the baby.
What to Know About Pelvic Girdles?
Symphysis pubis becomes an incomplete joint in pregnancy. It is a joint with cartilage and synovial membranes. In pregnancy, this joint becomes distended due to the secretion of synovial fluid, increasing the mobility of the symphysis pubis. This, in turn, will affect locomotion and give rise to distress and pain in pregnant women.
Why Does Pelvic Girdle Pain Occur in Pregnancy?
The following factors can contribute to pelvic girdle pain:
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Any changes in the tummy, pelvic girdle, pelvic and hip muscle.
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Weight and position of the baby in the uterus.
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Sitting and standing patterns can affect the pelvic floor.
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Pelvic joints move asymmetrically.
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Hormonal changes.
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Previous trauma to the pelvis.
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Transient osteoporosis of the hip. It is a bone pathology that occurs during the third trimester, which will cause sudden pain in the hip and pelvis.
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High body mass index (BMI).
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A poor workplace with working positions that are incompatible.
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Multiparity (women who give more births).
What Are the Symptoms of Pelvic Girdle Pain?
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The patient complains of a stabbing, dull, shooting sensation.
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On walking, clicking, or a grinding sensation is felt in the pelvic area that is either audible or palpable.
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Patients find difficulty in doing household chores.
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Pain while turning over in bed.
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Pain on having sex.
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Discomfort during sleep.
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Difficulty in sitting and standing for long periods.
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Pain while standing on a single leg, such as climbing stairs.
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Inability to do weight bearing.
What Are the Tests Taken to Diagnose Pelvic Girdle Pain?
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Posterior Pelvic Pain Provocation Test: It is done by asking the patient to lie down on a bed. The therapist bends the knee of one leg to a 90-degree angle and applies a posterior or axially directed pressure to the sacroiliac joint (which links the pelvis to the lower spine) through the femur (thigh bone). The test is considered positive if the pain is present in the gluteal region.
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Patrick’s or Fabere Test: The patient is asked to lie down on a bed with hips flexed, and one leg of the patient is externally rotated and abducted with the heel of the same leg, allowing it to rest on the opposite knee. Diagnosis is confirmed if the pain is present in the joints of the pelvis on the examined side.
How to Manage Pregnancy-Related Pelvic Girdle Pain?
1. Pelvic Support Garments: Pelvic support garments can be used to stabilize the pelvic girdle, thereby reducing mobility and ultimately reducing pain. It can be used for short periods of time only.
2. Drug Therapy: Simple analgesics like Paracetamol can be given. Low-potency opiates like Codeine are given to patients suffering from severe pain. However, opiates and NSAIDs (non-steroidal anti-inflammatory drugs) are generally avoided during pregnancy.
3. Water Gymnastics: Exercising in the water can help reduce hip and back pain.
4. Manual Therapy: Manual therapy techniques such as soft tissue mobilization and manipulation and massage therapy have provided symptomatic relief.
5. TENS (Transcutaneous Electric Nerve Stimulation): This method is a type of electrotherapy in which electricity is applied through electrodes to the affected area in a controlled manner. This has helped reduce pain and increase function in pregnant women.
6. Pelvic Floor Exercises:
- Pelvic Tilt: Use a gym ball to sit tall on it. Breathe in and out while drawing in and out of the abdominal muscles. Try tilting the pelvis so that sitting on the lowest part of the spine or tailbone is felt. Breathe in a while, sitting up again. Repeat this exercise 15 to 20 times.
- Roll-Down: Use a gym ball to sit tall on it. Slowly, try to slide both hands down, starting from the knee. While doing this, drop down the head, and allow the shoulders, mid back, and lower back to slide the hands. Hold for five seconds, and then slowly return to the sitting position. Repeat this exercise five to ten times.
- Child’s Pose: Lie on the hands and knees facing the floor. Stretching the arms in front, try to sit back on the heels and hold for 30 seconds. Repeat three times.
- Cat Stretch: Lie down on both hands and knees by facing the floor. In this position, the hands have to be under the shoulders, and the knees should be under the hips. Try to draw in the tummy, arching back like a cat as far as it is comfortable. Hold for five seconds and relax to a normal position. Repeat this exercise 10 to 15 times.
- Clam Shell: Lie on the side with knees bent and hips flexed by gently drawing in the tummy. Keeping the ankles touched together, try to separate the knee as far as it is comfortable. Repeat 15 times on both sides. Do not roll the pelvis backward.
Conclusion:
Pelvic girdle pain is quite familiar nowadays because of increased public awareness. Knowing the cause and avoiding them can greatly help in reducing the symptoms. Prolonged standing and walking should be avoided. Following the right posture while getting up and standing can help reduce the incidence of pelvic girdle pain. Visiting a physiotherapist can help in relieving the symptoms. Pelvic floor exercises not only help relieve the pain but also help during labor. Following a few tips to ease pelvic girdle pain can help in relieving the symptoms.
