In my last article I asked a number of questions – What is pregnancy pelvic girdle pain? What causes it? Will it get better?  What can I do to help myself? The good news is that lots of research has been done on these very questions. The bad news is that a lot of the research is poor quality. We’ve managed to conclude that pregnancy pelvic girdle pain occurs because of a number of different factors,but how best to treat it is still the burning question.

Clinical guidelines have recommended we treat the dysfunction (the problem causing the pain) rather than the pain. However research has mainly focused on the effects of pain-relieving treatments. These types of treatments unfortunately don’t eliminate the underlying problem that’s causing the pain in the first place!

Researchers have investigated treatments such as:

paracetamol

manipulations

rigid maternity belts (don’t work)

acupuncture

pillows

positioning, (some weak evidence that they may work)

strengthening exercises

yoga (promising results)

stretchy pregnancy belts (which seemed to help in some cases)

The big message this holds for us?

Don’t settle for pain relieving treatments!

What Causes Pregnancy Pelvic Girdle Pain?

The most compelling evidence for what causes pregnancy pelvic girdle pain is what pain scientists have been telling us for years about pain. It is caused by a perfect storm of various different factors. These seem to include genetics, hormones, metabolic issues like diabetes, number of previous pregnancies and very importantly – emotions. Researchers also found that ‘suboptimal motor control strategies’ (in other words, poor muscle and joint co-ordination, muscle balance and/or physical habits) may cause or worsen pelvic girdle pain.

Of course, we can’t change our genetic make-up or how many pregnancies we’ve had. There may not be a lot we can do about our hormones or metabolic issues. But let’s look at what often causes the different types of pregnancy pelvic girdle pain and what we can do about it.

What Can I do?

Slight separation of the pubic symphysis (the joint at the front of the pelvis) is normal during pregnancy. In most women, this separation is not enough to cause instability and pain at the joint. But for a small percentage (about 6% of women with pain here) it is instability at the pubic symphysis that causes the pain, known as symphysiolysis.

Pregnancy stretching and StrengtheningIf this is you, a stretchy maternity belt and performing regular gentle, correctly co-ordinated pelvic floor exercises can really help. Applying ice to the joint can also help to calm any inflammation in the area. It’s really important also to pace your activity. If it hurts, you should rest and not push through pain. This can cause muscle spasm and more pain as a result.

If you’re not one of the 6%, you may have a problem with muscle co-ordination and balance around your pelvis. This often contributes to both double sided sacroiliac syndrome and pelvic girdle syndrome. It’s thought that some women who develop pelvic pain during pregnancy already have a ‘dysfunction’ before becoming pregnant. The added demands of pregnancy, and a changing centre of gravity may then spark an episode of pelvic pain.

 

1. Mindfulness

Here’s where your mindfulness comes in! Many of us have habits which cause muscle overactivity. This can result in poor co-ordination around the pelvis. For example, habitually holding in our tummy muscles and ignoring urges to empty the bladder and ‘holding on’ for long periods. Our tummy and pelvic floor muscles tend to be an area where we hold our stress too. Having a history of low back pain or painful periods can also contribute to unhelpful muscle tension in and around the pelvis.

Noticing habits like ignoring bladder urges or holding your tummy or pelvic floor muscles tense and letting them go, can help to reduce this tension. Noticing your emotions too can be beneficial. Not only do negative emotions magnify pain, they have an important effect on muscle tone. If you’re  stressed or worried, your muscles likely won’t be too relaxed!

 

2. Breathing

Research has also found an important link between breathing, low back pain (and possibly pelvic girdle pain) and bladder and bowel control. We know (and you’ve probably noticed too!), that your breathing changes as your pregnancy progresses. Your diaphragm (breathing muscle) doesn’t move as much. This changes the co-ordination around your ‘core’ and pelvis. We also know that some women with pelvic girdle pain breathe differently to those without it.

Pain also changes your breathing pattern – women with pelvic girdle pain often hold their breath as they move, particularly during movements which are painful. This usually doesn’t reduce the pain and in some cases can actually be unhelpful, contributing to a cycle of pain, muscle tightening and more pain that can prove difficult to break if it continues for a long period.

Because of this, I always encourage my all clients with pelvic girdle pain to practice abdominal breathing as part of their treatment programme and to be mindful of their breathing pattern throughout their day.

3. Physical Habits

If you think you have one sided sacroiliac syndrome, it can be helpful to bear in mind that most of us will have habits which can cause tightness (or weakness) on one side that we don’t have on the other. Identifying these habits can be the key to eliminating or significantly reducing your symptoms.  Some common ones include crossing the legs while sitting and taking your weight on one leg more than the other while standing or walking. If you’ve had an injury to one leg at any stage, you may have developed a habit of taking more weight on your ‘good’ leg without even being aware of it.

Specific exercises are important too. Often exercises can exacerbate pregnancy pelvic girdle pain. However, your physiotherapist will be able to assess you and provide you with a programme that will help with the cause of your pelvic girdle pain without worsening your symptoms. If you have very acute pelvic girdle pain and find it very difficult to sit, stand or move around, these exercises may help too.

Tuning into your body and being mindful of how you use it can be hugely helpful to you in helping yourself. It can also help your physiotherapist to identify the cause of your symptoms. So notice your breathing, your movements, your muscle tone, your emotions and look at that pain in the bum as a message from your body – to slow down, notice, let go and take time for yourself and your baby.

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