Pelvic pain has undoubtedly been the most debilitating part of my 2 otherwise low-risk pregnancies so far! I am one of the 1 in 5 of all pregnant women affected by this issue, so I feel very passionate about sharing ways we can help to treat the symptoms and help pregnant women to continue leading their normal lives!
Im so grateful to Clare Bourne, Specialist Women’s and Men’s Health Physiotherapist at Six Physio for writing this blog with me, and sharing her expertise. It has been written in collaboration with bbhugme, creators of our favourite pregnancy pillow!
What is Pelvic Girdle Pain (PGP)?
The pelvic girdle is a ring of bones around your body at the base of your spine.
PGP is pain in the front and/or the back of your pelvis that can also affect other areas such as the hips or thighs. It can affect the sacroiliac joints at the back and/or the symphysis pubis joint at the front. PGP used to be known as symphysis pubis dysfunction (SPD).
Do I have PGP?
If you are pregnant and have joint pains in your back or pelvis the chances are you have some element of PGP.
If you have abdominal/ pelvic pain that comes and goes periodically, or is accompanied by bleeding, leaking water or changes in your baby’s movements then this is NOT PGP and you should seek urgent medical advice.
Pain when you are walking, climbing stairs and turning over in
bed are common symptoms of PGP. The pain is often brought on by certain specific activities and shouldnt be just dismissed as ‘part of pregnancy’!
Other symptoms include:
- Pain in the pubic region, lower back, hips, groin, thighs or knees
- Clicking or grinding in the pelvic area
- Pain made worse by movement, for example:
- Walking on uneven surfaces/rough ground or for long distances
- Moving your knees apart, like getting in and out of the car
- Standing on one leg, climbing stairs, dressing or getting in or out of the bath
- Rolling over in bed
- During sexual intercourse
It is really important to bear in mind there is SO much that can be done to help. Initially there are some simple measures you can try, but if your concerns dont improve, then discuss your symptoms with your midwife or doctor and ask to be referred early to a Women’s Health Physiotherapist!
Ways to prevent PGP
- Strength before pregnancy is absolutely key, so if you just so happen to read this article before your pregnancy (or between babies!) then working on your muscle strength will help you prepare your body.
- If you had symptoms in a previous pregnancy then seeing a physiotherapist when not pregnant can help you to know the right muscle groups and exercises to strengthen the affected areas.
- Safe options for exercise during pregnancy:
- Pilates
- Pregnancy yoga
- Body weight exercises squats and lunges are great if they dont bring on any pain.
- You can also incorporate arm exercises
- It is important to avoid sit ups but to still activate the deeper abdominal muscles, as shown in the exercises below
- If you are looking for some safe pregnancy workouts, we recommend the following websites:
Things to avoid if you are already a mum:
- Where possible, avoid carrying your toddler on one hip
- By doing this, you are switching off one of your gluteal muscles and tightening the lower back muscles on one side. This can worsen the muscle imbalances around the pelvis.
- Sitting cross-legged, especially if you are getting down onto the floor with your child!
- If you can reduce any heavy lifting, especially unbalanced weights then this will really help your symptoms.
- Where possible reduce the need to take the car seat in and out of the car
- If you can in your area, consider options like online food shopping delivery rather than needing to carry lots of bags!
Sleeping positions
We have covered this at length in another blog post, but it is really important to consider your sleeping position, both to prevent PGP and to help whilst you are working on treating it!
We both love the bbhugme pregnancy pillow to help maintain sleeping position, and these pictures demonstrate the best ways to use it!
Use code 164 at checkout for 10% off – affiliate link!
There is some more useful information about sleep in pregnancy, and the importance of sleeping on your side, in this previous blog post.
Simple measures you can try at home
- Posture:
- Stand tall with your bump and bottom tucked in a little
- Change your position frequently – try not to sit for more than 30 minutes at a time
- Sit to get dressed and undressed
- Distribute weight equally between your legs
- Try to keep your legs together when getting in and out of the car and turning over in bed
- Avoid anything that may make your symptoms worse, such as:
- Stooping, bending or twisting to lift or carry a toddler or baby on one hip
- Sitting on the floor, sitting twisted, or sitting
Pregnancy back pain
- Unlike it used to be in the ‘old days’, one thing we know is that movement is key when it comes to preventing and treating back pain. Therefore it is really important not to sign yourself off and spend the rest of your pregnancy in bed because that will make your pain worse, not better!
- If you already have known problems with your vertebral discs then you may experience a worsening of sciatica. This is quite different to the type of pain that you can get from inflammation in the joints of your back.
- However if you are experiencing pain that is travelling down your legs in any form, seeing a womens health physiotherapy for a personalised review would be really helpful!
- Exercises to try:
Deep abdominal activation
- To activate the deep abdominals, imagine you have a magnet on either side of your pelvic bones and gently draw these magnets together.
- As you can see in the video – your bump should gently draw inwards.
- Do this as you exhale.
Pelvic tilts
- Sit on the edge of a chair, gently tilt your pelvis backwards (like you are slumping)
- You can engage your deep abdominals as described in the exercise above
- Then grow up tall again
- Aim 10-15 every 30mins to an hour, especially if you sit at a desk all day
Glute stretches
- Sit on the edge of a chair and cross your legs as shown so your ankle is resting on the opposite knee
- Place a gentle pressure on the bent knee with your hand
- Then lean your body forwards from your pelvis, don’t just round your back
- You should feel the stretch deep in your bottom and hold for 30 seconds
- It should not recreate your pain
Lower back mobility – Cat/Cow stretch
- In 4 point kneeling gently curl your tailbone underneath and arch your back
- The priority is to start the movement from the lower back and not the mid/upper back
- Gently come back to a flat back.
- You can drop your back slightly if that is comfortable for you
Thoracic mobility
- In 4 point kneeling rotate your upper back taking your free arm through the hole created between your leg and arm (this is the eye of your needle, your arm is the thread)
- You can hold this position if you feel a stretch
- Then take the hand up towards the ceiling, follow the hands movement with your eyes so your neck moves as well as your upper back
- Keep your hips still, don’t let them sway from side to side
Pregnancy related pelvic pain (PGP/ SPD)
Here are some basic exercises to get you started on treating your own symptoms, but the ideal situation is to be referred to a physiotherapist to specifically assess your own combination of symptoms.
Pelvic tilts – as above
Squats with resistance bands
- Sit on the edge of a chair, feet behind your knees
- Place a loop resistance band around your legs just above your knees and press your knees gently into the band lean your body forwards from your hips
- Engage your deep abdominals (as shown in the first exercise in the blog)
- Push up through your heels to standing as you exhale then slowly lower back to the chair, allow your bottom to touch and then stand up again
- You should feel this exercise in your glutes, but your legs will work as well
- Try 10-15 of these to start and make sure you are feeling it in your bottom and it doesn’t aggravate your symptoms. If it is ok then continue and do as many as you feel you can, working your muscles to fatigue (the point where they feel on fire!).
Thoracic mobility using bbhugbme pillow
- This exercise is great to do in bed at the beginning and end of your day
- Lie with your hands together in front of you
- Take your upper hand and arm up and over your body so it goes behind you
- Follow the hand with your eyes so there is movement of your head and neck as well
- Keep your hips still
- You should feel a stretch across your chest and you can hold this for 30 seconds before taking the arm back across to meet the other hand again
This blog post has been written in collaboration with bbhugme. For more information on their products, head over to www.bbhugme.com
Recommended reading:
RCOG pelvic pain leaflet – this fab leaflet has loads more information that hasnt been covered here, including whether it is likely to recur, and important information for planning your birth!