Are you struggling with the simple act of walking, being reduced to short shuffles due to the pubic pain caused when you stride out normally? Does your back feel like it’s grinding, locking, or clicking? Are you exhausted by the pain and concerned about the prospect of birthing your child vaginally when the pelvic and groin regions feel so unstable? Has your obstetrician advised you to prepare for a cesarian because of the pain and instability you’re currently experiencing, is not improving with time?
Don’t worry, our women’s health Physiotherapists have seen many antenatal and postnatal patients suffering from pelvic and pubic pain and instabilities. This condition when managed correctly, can be successfully treated.
So why does this happen at your most vulnerable moment? During the first trimester between 8 -12 weeks, there are rising hormonal levels of oestrogen and relaxin. The purpose of relaxin, as the name suggests, is to soften and relax the ligaments, muscle tendons, and joint capsules around the pelvis, pubis, and spine regions to assist with the delivery of your baby. Remember a rather large head must exit, so to make this possible, the body softens normally rigid inflexible structures (especially the symphysis pubis) allowing them to stretch just for a moment in time in preparation for the pending birth. Usually, most of these soft tissue structures (tendons, joint capsules, etc) are not that flexible as they must stabilise our pelvic, lower back, and hip regions helping to carry the weight of our trunk, head, and upper body. This is why women with no prior history of back, pelvic, hip, or pubic pain suffer it for the first time pre and postpartum. The things we do for love!
As the baby grows and relaxin does its thing over a period of months. But, along with this necessary process so does the risk of developing pelvic girdle pain. So what can you do at home to help yourself? Well, let’s start with what to avoid…..
Activities that may increase your pelvic girdle pain :
- Prolonged or fast walking
- Getting in and out of the car regularly
- Lifting heavy loads such as a basket of wet clothes
- Deep squatting or lunging
- Going up or down staircases – use ramps or lifts whenever possible
- Standing on one leg to put on socks or pants. Sit down for these tricky events to avoid placing a shearing force through your symphysis pubis (front pubic bones)
- Moving from sitting to standing regularly
- High impact exercise (e.g. running or jumping activities), assuming this is at all possible
- Certain positions during intercourse
What you can do to ease the symptoms:
- Walk using smaller steps
- Avoid prolonged housework – break it up and spot clean certain sections over a period of days
- Avoid lifting heavy loads ~ better 2 lighter trips than a heavy single one
- Roll with one bent knee onto your side, bring the knee next to it then lift yourself to a sitting position using your hands before you raise from bed
- Go up and down steps by squeezing your lower buttock prior to landing your foot on the step
- Avoid sitting on anything low. A high chair would be better than a low couch
- Strengthening exercises for gluts and abdominal muscles guided by your Physiotherapist. A word of caution, if you have developed rectus diastasis (partial or complete separation of the abdominal muscles) situps will significantly worsen your condition so please get diagnosed correctly before you embark on any well-meaning exercise program.
- In the early stages of treatment, you may need crutches, pelvic belts & or pregnancy shorts.
Tips to reduce your pelvic girdle pain at home:
- Use an ice pack on the painful area for 20–30 minutes every 2–3 hours. Wrap the ice pack to avoid direct skin contact
- Stand and sit tall or lie down whenever possible to take the load off the low back and pelvic structures
- Wear a compression garment or support belt
- Perform strengthening exercises for the hip, pelvic floor, and deep abdominal muscles. Remember don’t mistake rectus abdominis diastasis for weak abdominal muscles that can be exercised because the separation of the muscle will worsen!
- Use home massage or trigger points to release tight muscles
So what can your Physio do?
Lots….. but the most important thing to start with is to balance and stabilise the pelvic girdle joints, sacrum, and low back facet joints. If these are misaligned unable to work and support each other normally, it will trigger pain and inflammation in the joints and eventually into the adjacent spinal nerves. This is a reason why some people may report pain and/or numbness traveling down the leg(s). The next stage is to treat the soft tissue structures and make sure rectus diastasis is excluded from the diagnosis before any individualised exercise rehab program is formulated. In some cases, pelvic and/or low back orthotics may also be prescribed and fitted. Usually, we try to avoid any dependency on external orthotics such as sacral compression belts or SRC post-pregnancy recovery garments but in the early stages, this can be helpful as pain can be so distressing and exhausting for mums.
