Pelvic Girdle Pain

What is it?

The pelvic girdle is a ring of bones that makes up the boney pelvis. This central area connects the trunk of the body to the lower limbs. It has a joint in the front, called the pubic symphysis joint, as well as two joints in the back on the right and left sides of the pelvis called the sacroiliac joints (SI joints).

Pelvic Girdle Pain (PGP) is an umbrella term used to describe a variety of pelvic pain conditions, including symphysis pubis pain, previously referred to as symphysis pubis dysfunction, and SI joint pain on either the left, the right, or both sides of the back of the pelvis. Pain may be experienced at the pubic symphysis joint, the buttocks, the sides of the hips, in the groin, and/or down the insides of the thighs.

What causes it?

It is believed that PGP is the result of multiple factors including mechanical, motor control, and sometimes hormonal issues. Additionally, research has shown that fear, beliefs about pain and recovery, and avoidance of movement all play a role in how an individual experiences pain such as PGP.

Commonly reported aggravating activities include: 

• Pain and/or difficulty walking.
• Pain with weight-bearing on only one leg (eg. Climbing stairs, putting on pants).
• Pain with “straddling” movements (eg. Getting into and out of a car or bathtub).
• Pain with turning over in bed or lying on one’s side.
• Pain with the first few steps after rising from a seated position.
  
  

Pelvic Girdle Pain Myths

Myth: Your pelvis is unstable.

Fact: Your pelvis is incredibly stable. The joints of the pelvis are strong and reinforced by many ligaments. Activities of daily living including lifting, rising from a seated position, walking up stairs, and pregnancy are not activities that put the pelvis at risk of instability.

Myth: Your pelvis is out of alignment (in the absence of severe injury).

Fact: In the absence of severe injury (eg. multiple storey fall, car accident), these joints are extremely robust. In fact, the joints are so strong that there is almost no movement within them. Only a few degrees can be appreciated at your SI joints and that is only for part of your life before they become fused together.

 Myth: Rest and avoid activity.

Fact: Limiting your movement can make your symptoms worse. In fact, exercise therapy is recommended to help alleviate PGP.

Myth: Relaxin, a hormone prevalent during pregnancy, is responsible for PGP.

Fact: Men and non-pregnant women alike can develop PGP, and we now know that even in pregnant women, there is likely a combination of factors involved in the experience of PGP. We can no longer blame PGP on Relaxin.

 Treatment for Pelvic Girdle Pain

• Pain education.
• Therapeutic exercise.
• Postural and activity modification.
• External myofascial techniques.
• Internal myofascial techniques.
• Treatment of the nervous system.
  
  

Prognosis

PGP can most often be managed very well with physiotherapy. Your therapist will help you to understand what is contributing to your experience of pain, as well as develop a plan to help manage your symptoms as you embark on a journey towards recovery.