PT for Pelvic Girdle Pain during Pregnancy

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pregnancy pain One of the issues we treat regularly at our clinics is prenatal and postnatal pain. Although discomfort or pain during and after pregnancy is an extremely common problem, like other pelvic pain syndromes, it’s often mistreated, misunderstood, or ignored by the medical community.

So you can imagine my delight when I came across an article this month on the topic in the U.K.’s Daily Mail. I was further delighted to discover that the article—titled “How Expectant Mothers can be Left in Crippling Pain without the Right Treatment,” and written by Louise Atkinson—gave some on point information about pregnancy pain and the treatment options available for it.

[To read the article in its entirety before reading my commentary, click here.]

There are a variety of musculoskeletal issues that can occur with pregnancy, but this particular article focuses on one fairly common condition called pelvic girdle pain or PGP, formerly known as Symphysis Pubis Dysfunction (or SPD) .

As the article explains: “The condition occurs when pregnancy hormones cause the tendons and ligaments that secure and stabilize the pelvis to become more lax, leaving the bones susceptible to sheering out of place.

The pelvis is made up of two bones that are joined to the base of the spine in two places, and then at the front to the pubic bone. The structure is designed to be strong enough to support the body, but flexible enough to absorb the impact of feet hitting the ground.

PGP occurs when the bones become misaligned at the pelvic joints. Sometimes these can lock, leaving the woman temporarily unable to move one or both legs.”

According to research by the Chartered Society of Physiotherapists, PGP occurs in a whopping 20 percent of pregnant women, and for an estimated 7 to 8 percent, it results in severe disability.

Despite the high occurrence of the condition, and the fact that it is treatable, more often than not, patients are getting “the wrong type of treatment, leaving them at risk of the condition with future pregnancies, and vulnerable to long-term back and pelvic problems,” the article points out.

According to the article, when women seek treatment, more often than not, they are simply prescribed “paracetamol” (acetaminophen!), and told to “rest because you’ll feel better once the baby is born.” Unacceptable!

For one thing, I believe it’s not acceptable to leave a woman in pain during pregnancy, and for some women, not treating PGP correctly can lead to future pelvic floor issues down the line.

Proper PT is the best treatment for PGP as it can allow a woman to become more functional and experience less pain during the course of the pregnancy as well as during her labor and delivery.

However, as the article shows, patients who are sent to PT are often receiving incomplete or incomprehensive treatment. They’re given exercises to strengthen their abdominal muscles and are instructed to wear supportive belts, the article says. While these treatments could be helpful, they’re more helpful when used in combination with the strategies I’ll expand on in more detail below.

The article goes on to describe successful treatment for PGP when a PT who specializes in treating it discusses the success she has with manual PT.  She describes her treatment methodology as “‘manual realignment’  — an expert technique of gentle massage, rocking and manipulation,” and explains that this strategy can “put the pelvis back in the correct position and get the joints working properly once more.”

I totally agree with these treatment methods, but I believe they should be used in addition to stabilization techniques to help decrease the source of pain (commonly trigger points and the joints) and maintain the therapeutic changes.

Overall, I think the article is well-done.

The manual PT described at the end of the article is accurate. However, here is a comprehensive list of all the strategies that can be used to treat PGP: They are:

  • manual therapy techniques for soft tissue issues and joint dysfunction,
  • stabilization exercises,
  • stabilization tools such as orthotics and sacro-iliac joint belts,
  • and patient education for lifestyle and biomechanical modifications.

However, as with pelvic pain, it’s important to know why the symptoms are present and treat the impairments, not just to administer a one-size-fits-all treatment approach.

The article also points to steroid injections and prolotherapy as possible treatment for PGP. (Prolotherapy is a treatment for pelvic girdle instability whereby a solution is injected into a ligament with the aim of causing the growth of collagen tissue, the main component in ligaments, in an effort to provide additional stability to hypermobile joints.)

In addition, the article says that  “the final recourse for a very small number of women is pelvic fusion surgery, where metal plates and sometimes bone grafts are used to permanently stabilise the pelvis.”

I believe the need for surgery is EXTREMELY rare, however, the injections may help if conservative measures fail. Obviously, the time either of these measures should be considered is AFTER the birth of the baby and a failure of more conservative measures.

As I mentioned earlier, PGP is just one type of pregnancy pain that we treat at our clinics. In future posts, we’ll discuss the slew of other prenatal and postnatal issues we’ve had success treating.

Please let me know if you have any questions about PGP.

Also, please share your experiences with PGP or any other prenatal or postnatal pelvic pain issues.

All the best,
Steph


26 thoughts on “PT for Pelvic Girdle Pain during Pregnancy

  1. Hi,
    I am 10months postpartum.
    I had servere pgp from 5 months to delivery.
    I ended up in crutches and had an elective section and on delivery my son was 10lb15oz.
    I am still attending physio but in pain.
    Pain in quite deep! Stems from right SI joint and travels all around both sides to the front.
    General X-ray taken and pelvis came back normal.
    Pain is so bad I am having pain on occasion on bowel and urine movements.
    Pain is at it worst on the build up and during menstruation.
    At my wits end to know what to do as the gp is limited.

    Any help would be great!
    Thanks

    • Hi Keva,
      Sorry to hear you are having residual difficulties. It sounds like you have PPGP (posterior pelvic girdle pain in pregnancy) and resulting pelvic girdle/ sacroiliac joint dysfunction. Since I haven’t evaluated you, it’s difficult to answer your specific questions. I would say, however, continue with the physical therapy if it is helping, perhaps try a sacroiliac joint belt to help with stability, and make sure you see a qualified pelvic floor physical therapist to evaluate your pelvic floor muscles. Since you are having symptoms with urination and bowel movements, it would be a good idea to make sure your pelvic floor is not involved.

      All my best,
      Marcy

  2. Hi,
    I have been having pelvic pain for 2 1/2 years, since the birth of my first baby (vaginal delivery). I have seen a couple of specialists and physiotherapists and they couldn’t figure out what was wrong. MRI andbone scan of pelvis came normal.
    . I have recently had a second baby (3 months), via elective caesarean and the pains have since got worse.
    Pain is usually triggered by walking, sitting, standing etc, and is not in one area.
    Sometimes it’s a sharp pain in the buttocks
    shooting pain down the thighs
    pain in the groin
    hip pain
    back pain

    I have gained a lot of weight as I am unable to exercise, which doesn’t help.

    I am clueless as to what I should do.

  3. Hi! My second baby is 10 months old. He is a chunk! Not huge, but already 21 Lbs. If I attempt physical activity beyond mild household chores and a slow, gentle walk with the kids and dog, I have sharp pain in my pelvic girdle including pressure in my sacrum that sets my teeth on edge. I have always had hyper-mobile joints, and I am very afraid of ending up in treatment with someone who doesn’t understand what that means. I am a stay-at-home mother who hopes to return to a career in massage therapy in the future. I am completely freaked out about the possibility of damaging my body in a way that will mean that I cannot do either of my jobs without pain. Do you perhaps have any advice for how to present my concerns clearly to a doctor or physical therapist?

    • Hello Rachel,

      I recommend that you see a physical therapist who specializes in pelvic floor dysfunctions. A pelvic PT can better understand your concerns, and your needs as a patient. He/she can work with you to treat your symptoms, educate you, teach you behavior modification, exersices, and relaxation techniques. When necessary, your therapist can also coordinate your care with other physicians so that you do not have to manage your care on your own. Where are you located? I may be able to recommend a therapist in your area.

      All my best,

      Malinda

  4. Hello I am very relieved to come across your article it gives me much hope. I am currently entering my six month of pregnancy am in unbearable pain when I walk sit or lay down virtually all the time. I am hoping that you can let me know of a physical therapist in the New York City area who may be able to treat me for the pubic/pelvic pain. Thank you.

    • Hello Maria,

      Yes we can recommend several PF therapists in your area. Their information is located below.

      Diana Kafka, DPT
      Beyond Basics Physical Therapy
      New York, NY
      (212)3542622

      Stacey Futterman, PT
      Five Points Physical Therapy
      New York, NY
      (212)226-2066

      Regards,

      Liz

  5. Hi, I just had my baby three weeks ago. I’ve had pgp a little bit with each pregnancy toward the end but always it is relieved after the baby is born. This is my 6th birth. She was 8lb 5 oz. I deliver her natural with only three pushes. This time my pelvic pain is not going away, it hurts when I pick her up, or my 2 year old up. When I walk, sit from laying down, when I cough. Pretty much any movement.
    Is it too early for me to worry about this not getting better, should I wait longer before I see a pt? And do you know of any in Utah? I live in the south end of salt lake.

    • Hello Eliza,

      A pelvic physical therapist can usually evaluate post partum patients 6 weeks weeks after delivery. That is usually when your OB will clear you for internal manual therapy. However if you are experiencing severe pain/complications, a physical therapist can still evaluate you externally to help minimize your discomfort. Below is our therapist recommendation for Utah.

      Best,

      Allison

      Bonnijane Monson, DPT
      Salt Lake City UT
      (801) 587-7005/ 801-581-2897
      bonnijane.monson@hsc.utah.edu

  6. Hi I’m having a pain when I lay down and turn at night it’s so painful I don’t know how I’m going to give a birth I’m 27 weeks and doctor put therapy for me and therapist are so busy at kaiser I cannot even get appt for month that’s not really helpful my question is I heard vaginal birth is so painful is c section is best way to go I don’t wanna damage more I’m already suffering lots pain when I lay down sitting is harder walking sometime hurt what is you advice do u know good therapist in Portland Oregon thanks. Tina

    • Hello Jatina,

      Marcy Crouch, DPT is located in Portland and would be able to assist you. Here is her information:

      Marcy Crouch, DPT
      OHSU
      808 SW Campus Dr, Portland, OR 97239
      (503) 418-4500

      Regards,

      Liz

  7. After giving birth to my baby – that night maybe 12 hours following labor – I was getting out of bed to put her back in her crib when I was hit by sheering pain in my pelvis. My scream woke my husband who was able to take the baby from me. Trying to walk shear agony with the horrible sensation of bones rubbing together. A nurse recognized this as pgp. I had a CT scan which revealed that my pelvic tendon actually tore. I did not have pgp with my first pregnancy until after delivery. I had a very good PT who helped me regain the ability to walk with manual realignment and some additional exercises. Still I was unable to walk without a walker for six weeks. In perhaps another year I would like to have an additional child but my question in regards to how this injury may affect a future pregnancy haven’t been answered. Apparently this is rare. I will be moving to Missouri. Any one in that area with expertise with this condition would be very helpful. Thanks

    • Hello Natasha,

      Sandy Gibson, PT is located in Kansas City, MO and would be a good resource for you. Her information is below:

      Saint Luke’s Hospital
      Sandy Gibson, PT
      (816) 932-3344

      Regards,

      Melinda

  8. Thank you so much for this article. I saw your comment on my Pinterest pin. I’m 3.5 months postpartum and I have symphysis pain while sitting or lying down on my side if I don’t use a pillow (underneath me or between my knees). I thought it would get better after birth, at least by now, but it doesn’t seem to be healing. This morning I bought a pelvic belt to try, but I have been thinking I may need PT. I wish I could make it to see y’all in California, but I can’t afford to travel at this time. I live in Sylacauga, AL, which is not near a bigger city, but I could get to Birmingham, Auburn, or Montgomery within an hour or two. Do you have any recommendations?

    • Hello Jesie,

      Thank you for stopping by our blog! I’m sorry to hear about your situation. How has the belt worked so far? Unfortunately, we do not have a therapist recommendation in AL, but if you are able to travel a few hours, we can offer you a nearby referral. Here is the information:

      Melissa Kubic,PT
      Chattanooga TN
      (423)778-8660

      All my best,

      Stephanie

  9. Malinda,
    i have had pain in my pelvic region since i was about 12 weeks pregnant but thought it was from an injury i had during my first pregnancy. I was doing a squat an pulled something in my upper inner left thigh close to my pelvis. I saw my chiropractor who realigned what he could and then sent me to arriosti for the muscle issues that were still there. Didn’t help at all and concluded from searching online that i probably have pubic symphisis dysfunction but didn’t know there was anyone who could help until i came across your article. I’m in San Antonio and saw you referred some people from Austin a year ago. Is there anyone in sa area now that i could see? I’m currently 34 weeks and my problem seems to be increasing even with a pelvic belt. I don’t really feel like i can do the drive to austin either on a regular basis.

    • Hello Karen,

      We do not have a therapist recommendation for San Antonio at this time. Perhaps you can consult with a therapist further away for a few sessions, but ask for as much patient education as possible, as well as partner training in case you can perform self release work at home.

      All my best,

      Malinda

  10. Hi, can you make a recommendation for pt in Seattle or Bellevue area? I don’t think my pt is experienced in pregnancy pelvic problems.

    • Hello Elena,

      Here are our Seattle recommendations:

      Tina Allen, PT
      University of Washington-Roosevelt
      Seattle WA
      (206) 598-2889

      Sagira Vora, PT
      Overlake Hospital Medical Center
      Bellevue, WA
      (425)688-5900

      Best,

      Stephanie

    • Hello Brittany,

      We do not have a therapist recommendation in Detroit at this time, but I have enclosed recommendations for therapists located 3-4 hours away.

      Kristen Markett, PT
      Flexeon Rehab
      Orland Park IL
      (708) 671-1971

      Jamie Justice, PT
      Creative Therapeutics
      Dekalb IL
      (815) 785-5508

      Regards,

      Melinda

  11. I was in a car accident over 4 years ago and have an unstable pelvis, including pubic symphysis dysfunction where my hips rotate forward and backward causing pelvic and back pain. I don’t know where to turn as the pain is debilitating. Do you know of any physicians who understand this condition in the Illinois area and how to diagnose it, when the separation isnt a spreading at the pubic symphesis but rather a shearing? Also, any PTs who can treat it and it’s resulting spinal instability?

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