By Nicole Davis
We all know one or two of those superhero mamas that REALLY enjoy being pregnant. You know, the ones that can eat anything without feeling nauseous during their first trimester or the ones that are able to run 20 miles a week until they deliver. Yes, pregnancy is a beautiful part of life and yes, we are happy for those ladies that can get through their pregnancy without any major aches, but what about those mothers-to-be that experience pain when walking, climbing stairs or changing positions in bed?
Pelvic girdle pain during pregnancy is common and can oftentimes interfere with mobility and quality of life. Many women with pelvic girdle pain echo the above complaints. What exactly is pelvic girdle pain, why does it occur and how can it be managed to make pregnancy more comfortable? Let’s first do a quick review of the structure and function of the pelvis.
The pelvic girdle is a bowl-shaped structure that sits at the base of the trunk. It is composed of three bony groups: the innominates (ilium, ischium and pubis), sacrum and coccyx. With the support from the pelvic ligaments, these bones fit nicely together to form the major joints of the pelvis: pubic symphysis, sacroiliac, and sacrococcygeal joints. The pelvic girdle is primarily responsible for transferring weight and providing stability during movement, serving as an attachment point for ligaments and muscles, supporting and protecting abdominopelvic viscera, and forming the bony portion of the birth canal. Check out Shannon’s blog for more detailed information on pelvic anatomy.
As we can see, the pelvis is an important structure to consider during pregnancy. It not only houses the fetus but is also responsible for keeping the body stable as the baby bump grows. This can sometimes be a difficult task when relaxin is introduced into the system. Relaxin is a hormone that is released by the ovaries and placenta during pregnancy, with the primary function of slacking the ligaments in the pelvis and softening the cervix. Though essential in preparing the body for vaginal delivery, increased laxity in the pelvic ligaments can create greater motion at the joints and affect pelvic stability. It is true that each joint has varied degrees of motion, however, this increased motion and decreased stability can lead to pelvic girdle pain during and/or after pregnancy. The most commonly reported ailments include pubic symphysis pain, sacroiliac joint pain and sacrococcygeal pain.
Pubic Symphysis Pain/Dysfunction
The pubic symphysis is a fibrocartilaginous disk that joins the right and left pubic bones. Individuals with pubic symphysis pain may report a dull ache or sometimes sharp pain at or along the pubic symphysis or pubic bones. Additionally, pain may radiate down the front/inner thighs. Women may experience symptoms with walking, weighted and unweighted single leg activities (i.e. climbing stairs, putting on pants) and asymmetrical positioning ( i.e. sitting cross-legged, carrying items on one side).
Sacroiliac Joint Pain/Dysfunction
The sacroiliac joints are formed by two pelvic bones, the sacrum and the ilium. We have both right and left sacroiliac joints and they are located along the back of the pelvis. Women may characterize their pain as deep at the joint with radiation of symptoms along the low back and hip/buttock. Oftentimes, the pain is exacerbated by similar activities as pubic symphysis dysfunction.
Sacrococcygeal Joint Pain/Coccydynia
The sacrococcygeal joint is created by the sacrum and the coccyx. This tiny little joint sits at the base of the spine. The coccyx is the smaller triangular bone (learn more about it here) and given it’s big role as an attachment point for many pelvic ligaments, the sacroccygeal joint can become quite mobile. The quality of the pain may be dull or sharp and may become aggravated with direct pressure at the joint, increased intraabdominal pressure (i.e. sneezing, coughing), sitting and walking.
Women with pelvic girdle pain are often frustrated because they can experience symptoms with simple daily activities. Fortunately, many resources exist to help keep pregnancy comfortable. If you are experiencing any pelvic girdle pain, consulting with a physical therapist is a nice first step. Though we cannot directly address the hormones or growing babe, physical therapists can (1) provide education (i.e. on body mechanics, birthing positions), (2) recommend tools/techniques (i.e. pelvic stability belts, taping), (3) perform manual therapy (i.e. joint mobilization,myofascial trigger point release, connective tissue manipulation), and (4) prescribe individualized home exercise programs (i.e. deep core strengthening, neuromuscular re-education, aquatic exercise). Many women do well with a combination of these treatments. So, if any of these ailments sound familiar, give your local PT a call or come visit us – we love our mamas-to-be! You can read more about the pelvic floor physical therapy evaluation here.
*Pro tip: If these nuisances persist or develop post-partum, do not be alarmed. The relaxin hormone continues to circulate while breastfeeding and is sometimes present at low levels once breastfeeding ceases. Thankfully, treatment recommendations are similar.