Pelvic Girdle Pain in Pregnancy: Treatment & Relief

What is Pelvic Girdle Pain (PGP)?

Pelvic Girdle Pain (PGP) describes pain and discomfort in the joints of the pelvis during pregnancy. It can affect the front joint (pubic symphysis) or the rear joints (sacroiliac joints in the lower back). PGP can range from a mild ache to sharp pain that limits walking, climbing stairs, and turning in bed.

PGP is caused by a combination of factors: the hormone relaxin relaxes pelvic ligaments to prepare for birth, while the growing baby shifts the mother's center of gravity forward, placing extra strain on the joints. Specialized pelvic girdle pain pregnancy physiotherapy helps stabilize the pelvis, improve strength, and provide relief through modified movement strategies.

Comparison: SPD vs. SI Joint Pain in Pregnancy

While PGP affects the entire pelvic ring, pain is typically concentrated in the front or the back joints:

| Clinical Parameter | Symphysis Pubis Dysfunction (SPD) | Sacroiliac (SI) Joint Pain | | :--- | :--- | :--- | | Primary Pain Location | The front of the pelvis (pubic bone), sometimes radiating to the groin or inner thighs. | The lower back, just above the buttocks on one or both sides. | | Aggravating Factors | Standing on one leg, parting the knees wide, or walking long distances. | Rolling in bed, standing up from a chair, or walking on uneven ground. | | Clinical Sign | Tenderness over the pubic bone; clicking or grinding sensation in the pelvis. | Tenderness over the sacroiliac joints; pain with pelvic compression tests. | | Primary Treatment Focus | Stabilizing the front pelvic joint, avoiding wide stretches, and using pelvic support belts. | Rebalancing the sacroiliac joints, stretching tight hip muscles, and stabilizing the core. | | Safe Exercise Focus | Glute bridges, gentle clamshells, and pelvic tilts. | Hamstring stretches, gluteal strengthening, and low-back stretches. |

Physiotherapy Management of PGP

Physical therapists use targeted strategies to stabilize the pelvis, support joint alignment, and manage pain:

1. Pelvic Stabilization Exercises

Strengthening the muscles that support the pelvis helps compensate for loose ligaments. Key exercises include:

• Glute Bridges: Lie on your back with knees bent and feet flat. Squeeze your buttocks and lift your hips slightly, keeping your pelvis level.
• Clamshells: Lie on your side with knees bent. Keep your feet together and slowly lift your top knee, then lower it back down.
• Transverse Abdominis Activation: Gently pull your lower belly inward toward your spine while exhaling, holding for 3 to 5 seconds to engage the deep core.

2. Manual Therapy

Physical therapists may use gentle manual therapy, such as myofascial release, soft tissue massage, and safe joint mobilizations, to relieve muscle tension around the hips and lower back.

3. Maternity Support Belts

A pelvic support belt (trochanteric belt) can help by providing external compression around the pelvis, stabilizing the joints and reducing shear forces during walking and daily activities.

Guidelines for Daily Movement

Modifying daily movements is key to reducing stress on the pelvic joints:

1. Keep Knees Together: Keep your knees together when getting in and out of a car, or when turning in bed.
2. Sit Down to Dress: Sit down on a chair or bed when putting on pants, socks, or shoes to avoid standing on one leg.
3. Use a Pillow in Bed: Sleep on your side with a pillow between your knees and ankles to keep your pelvis aligned.
4. Avoid Heavy Lifting: Limit lifting heavy bags or carrying toddlers on one hip, which can tilt the pelvis unevenly.