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Pelvic Girdle Pain (PGP)

What is PGP?

PGP is the name given to pain and mobility problems caused by instability of the pelvis during pregnancy. It can occur at any stage in your pregnancy or even after your baby is born. The pelvis is a closed boney ring held together by three joints: two sacro-iliac joints (at the back of the pelvis) and one pubic symphysis joint (at the front of the pelvis). During pregnancy, these joints are under more strain due to the weight of the growing baby and due to altered postures. This may lead to instability, pain and mobility problems in some women.


Symptoms of PGP

SPD effects women of all ages and backgrounds. Common symptoms are:

  • Pain at the front and/or back of the pelvis

  • Occasional pain in the groin and/or legs

  • Pain and difficulty doing normal activities like getting in/out of a car or bed, carrying shopping and doing household activities.

Diagnosis

There is no definitive test to diagnosis PGP. Normally, it is diagnosed based on your symptoms alone after excluding other conditions. X-ray and MRI scans can be used to exclude a diastases (separation) of the pubic symphysis or osteitis pubis (inflammation of the pubic symphysis).


Treatment

An assessment by a Physiotherapist will determine whether there is any abnormal (increased or decreased) movement in any of the pelvic joints. In most women with PGP there is no structural alteration at the spine or pelvis, but there may be increased or decreased movement in one or more of the joints of the pelvis. This in turn could place abnormal stresses through the remaining joints of the pelvis. A trained Physiotherapist could apply manual therapy to restore movement of the spine and pelvis. Once the joints are treated, your therapist will teach you a specific exercise programme that can help to stabilise and support the pelvis for longer term relief.


Tips to help recovery:

  • Keep your legs together when moving in and out of bed

  • In standing try to find equal weight through both feet

  • When shopping, carry bags in both hands to even out the weight distribution

  • Avoid heavy lifting

  • Avoid twisting your body i.e household chores such as hoovering

  • Be careful not to slip or fall as your pelvis is vulnerable


Modified Pilates & PGP

Pilates is a toning and conditioning exercise programme that concentrates on building a strong efficient 'central core' of abdominals, spine and pelvic floor muscles. Essentially this strong core will act to brace the spine and pelvis to support the extra weight of the baby and provide stability to the joints. Check out the Modified Pilates videos for PGP with a variety of different pilates exercises that can help to improve your symptoms or provide you a comfortable posture to complete the classes in.



Birth with PGP

Planning for the delivery of your baby can help to alleviate your concerns about birth. Birthplans can be useful when you are thinking about how you would like to give birth to your baby. A birthplan can also help to give your carers / midwives the information that they need to provide a supportive and enjoyable environment for you.


The following tips are useful:

  • Make sure your birthing partner or midwife is aware of your PGP and how it affects you

  • Measure how far your knees can open without pain and have this written in your notes

  • Try alternative positions you may wish to consider when delivering your baby; for example lying on your side, four point kneeling

  • If you require stitches to the perineum, request for this to be done lying on your side.

After you have had your baby and going home

It is important that you receive effective pain relief when required. Whilst you are still in hospital, ask that your meals and drinks are delivered to you if you are having difficulty walking.

Before leaving hospital check that all the help and support you may need at home is arranged. If you require additional help, speak to your midwife. Ensure you have adequate pain relief for home and arrange an appointment with your Physiotherapist when you can.

Be aware that you symptoms may continue for months or years postnatally, but If managed well does not need to be so serious or disabling. Breastfeeding does not impact your PGP.


Myths About PGP

  • A hormonal condition

  • Untreatable

  • Only occurs in late pregnancy

  • Affects women who are not active enough

  • Will get better as soon as the baby is born

  • Gets worse with each pregnancy

  • Will stop when you stop breastfeeding



Useful contacts:

The pelvis partnership is a voluntary group of women who have, or have had PGP. It provides useful information and support for women and their families of those with PGP.


If you have any other questions about this post or would like a Physiotherapy assessment if you think you are struggling with any of the symptoms state above then email us at: thebodyclinicliv@gmail.com


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