Managing Pelvic Girdle Pain During Pregnancy

Tendon pain and dysfunction

Childbearing is a natural physical process that the female anatomy is uniquely designed to handle, but it places an enormous amount of stress on the pelvic structures. While a few aches and pains are inevitable during pregnancy, intense pelvic pain can indicate excessive stain on your joints and connective tissues. Prenatal physical therapy can help you manage prenatal pelvic girdle pain (PPGP), and help prepare your body for a successful delivery.

Physical Changes During Pregnancy

Growing another human being is demanding work, and the mother’s body goes through multiple adaptations as the baby develops. Depending on your unique anatomy, you may have difficulty drawing a complete breath as your diaphragm has less room to contract. Women with a shorter trunk often feel as though they are carrying the baby in their rib cage. With the baby taking up so much room, you may experience digestive problems and constipation.

As the baby grows and the volume of amniotic fluid increases, you gain weight in your breasts and pelvic region and your center of gravity shifts upward, making your body less stable and your body weight harder to balance. Pressure on your pelvic muscles makes them stretch, reducing their ability to stabilize your core, and adding stress to your pelvic joints.

The Pelvic Structures During Pregnancy

Tendon pain and dysfunction

Your pelvic girdle is formed by the bones of your pelvis, the ilium, ischium, and pubis. Together, they create a bowl-like enclosure to house your reproductive organs. The pelvic bones are connected by two sacroiliac joints in the back and the pubic symphysis joint in the front. The joints are supported and held in place by strong ligaments.

During pregnancy, your body releases a hormone called relaxin. As its name implies, relaxin causes the ligaments to become looser and more relaxed, allowing for the pelvic girdle to widen as the baby grows, and to open up as the child travels through the birth canal.

While relaxed ligaments are essential for a successful pregnancy and delivery, they also make the pelvic joints less stable. In some women, instability in the sacroiliac joints and the pubic symphysis causes excess strain on the joints that manifests as pain.

Symptoms of Prenatal Pelvic Girdle Pain

Tendon pain and dysfunction

PPGP is often described as stabbing, dull, shooting, or burning. Pain may be felt close to the sacroiliac joints and extend to the gluteal area, or it may occur in the front of the pelvis near the symphysis pubis. PPGP sometimes radiates to the groin, perineum or hamstrings. Because of their location in the lumbopelvic region, pain in the sacroiliac joints can mimic symptoms of sciatica.

Symptoms of PPGP include:

  • Difficulty walking for long distance
  • Difficulty climbing stairs
  • Pain when shifting body weight to one leg
  • Difficulty rolling over in bed or getting in and out of the bathtub.
  • Clicking or grinding sounds or sensations in the pelvis
  • Reduced and painful lateral range of motion at the hip
  • Pain in a side-lying position
  • Pain and difficulty during sexual intercourse

Pelvic girdle pain can lead to muscle pain in the inner thighs and buttocks as those muscles are overused to maintain stability.

Diagnosis of Pain in the Pelvic Girdle

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The primary means of diagnosing pelvic girdle pain are health history, physical exam and assessments for hip joint function and range of motion. The clinician may use the FARBER test for flexion, abduction, and external rotation of the hip.

An experienced prenatal clinician will be able to distinguish pelvic girdle pain from sciatica, based on reported symptoms. Ultrasound imaging may be used to confirm a PPGP diagnosis, since ultrasound does not pose a threat to the health of the mother or baby.

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Pelvic Girdle Pain Treatment

Physical therapy can help you manage PPGP by relieving pain, improving muscle function and pelvic stability, and adjusting your pelvic joint position. Your therapist can show you strategies for alleviating pain and pressure on your pelvic girdle and strengthening your pelvic muscles. Aquatic exercise can be beneficial, as the buoyancy of the water helps take pressure off the pelvic girdle joints.

Chiropractic care can also be effective for managing PPGP. A chiropractor may use ligament release techniques, blocking strategies to relieve pain and pressure, diaphragmatic release, manual therapy, pubic bone adjustment, and techniques to reposition the baby.

Early treatment is recommended, to prevent more intense pain and symptoms in the late stages of pregnancy.

Pre and Postnatal Physical Therapy in NYC

The women’s health specialists at NYDNRehab can help you stay strong and healthy throughout your pregnancy and beyond. We individualize our prenatal and postpartum care plans to meet the specific needs of the mother. Physical therapy and chiropractic care begun in the early stages of pregnancy can help you enjoy an easy and care-free pregnancy and successful delivery. Postpartum care can help you bounce back more quickly after your baby is born.

NYDNRehab now offers Telehealth services for patients who are unable to do in-person visits.

Resource

Kanakaris, Nikolaos K., Craig S. Roberts, and Peter V. Giannoudis. “Pregnancy-related pelvic girdle pain: an update.” BMC medicine 9.1 (2011): 15.

Range of Available Unique Physical Therapy Treatments at Nydnrehab

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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