First you get nausea. Then fatigue. And now this?!
Everyone’s ride through pregnancy is different; from the joyous glowing mother-to-be, to the to-be-mum struggling to simply get out of bed; the experience can vary greatly.
Pregnancy related pelvic girdle pain (PRPGP) is one of those symptoms not every woman gets, and this too can range from a nagging nuisance, through to a debilitating problem impacting on exercise and activities of daily living like putting on your pants, walking stairs, or even just rolling over in bed.
So, is there anything we can do? Most Pelvic and Women’s Health physios are confident in treating PRPGP. We understand the biophysical, as well as the biomechanical changes happening in the pregnant pelvis. We have many treatment options we regularly turn to in order to manage symptoms related to PRPGP. Let’s explore some of these options:
“Hands on treatment”
In my own experience I find hands on treatment can be very effective in addressing pelvic girdle pain. I typically will attempt to gain control over symptoms by using techniques such as soft tissue massage and “muscle energy techniques” to realign and reduce (or optimise) the forces acting on the pelvis. My experience is this approach either begins to work within 1-3 sessions, where there is a significant improvement in symptoms early on, or hands on treatment isn’t the answer. Should we get a significant improvement, there is still work to do in order to stop the pain returning and a strengthening program is a must!
Interestingly, there is no evidence out there currently supporting hands on treatment in the management of PRPGP. I believe this is related to the variability in a women’s presentation but also the skill of the clinician. As such, pelvic and women’s health physios tend to turn to exercise prescription as we have good evidence behind this treatment approach.
Exercise prescription
We have research papers showing that appropriately prescribed exercise is effective in managing PRGPG. In fact, there is good evidence to support 2x weekly pilates being effective in managing PRPGP.
Exercise can be a bit intimidating when a woman is not only sore but also managing a pregnancy. What exercise is the most effective? What is safe? Should I do more? Should I do less?
Strengthening sometimes needs to be guided with 1:1 sessions in clinic, but often a woman will find she can perform a prescribed exercise program at home, and can attend as she chooses to adapt this as needed along her pregnancy journey.
Belts
Sometimes we find a belt is needed to manage PRPGP. I often turn to my 3 favourites; Leto, Smiley, and Serola belts. These all do slightly different things and which one to use depends on the mechanical contributing factors causing the PRPGP.
Sometimes taping with k-tape or rigid tape is more effective and worth trying prior to a belt.
Does this mean you need to do an internal examination on me??
Short answer, NO!
Though, persistent, ongoing PRPGP can cause spasm in the pelvic floor muscles, in which case this might be something to consider prior to delivery. It is more common that pelvic health physios avoid any internal examination/work during pregnancy, to minimise any avoidable risk factors to the pregnancy.
In my clinic, if I feel internal work is justified or an assessment would add significant value to your management, I send a “DVE clearance” (digital vaginal examination) form to your LMC or OB to approve the examination. This allows them to decline the examination, which is important should you have any concerns such as placenta previa, where the risks would typically outweigh the benefits. I also tend to avoid any internal examination or work prior to 35 weeks.
If it is believed the pelvic floor is contributing to your pain, and we wish to avoid internal work, I will try teach you to stretch and release the pelvic floor through what we call pelvic floor “down training”. This is achieved through a series of prescribed exercises, deep breathing training, and pelvic floor coordination work.
Pregnancy WOF
A pregnancy WOF in your 3rd trimester is strongly encouraged for every pregnant woman, but even more so if you have had PRPGP and you are planning a vaginal delivery. It is important to check you have good coordination of your pelvic floor muscles, so that as baby descends down the birth canal, you know how to use your breath and coordinate the pelvic floor to open and relax in response to stretch. When you have pain in an area over a long period of time, local muscles learn to guard and spasm, which is an undesirable effect during childbirth.
Click here to read more about pregnancy and post natal WOF’s
Leave a Reply