Pelvic Girdle Pain
1. Introduction
Pelvic girdle pain (PGP) is referred to as pain at the front or back of the pelvis (or both) during pregnancy. There is often no obvious explanation for the cause of pelvic girdle pain; usually, there is a combination of factors that contribute to it. Most women with pelvic girdle pain can still have a spontaneous vaginal delivery (4). They should speak with their midwife about their birth plan, including pain relief options, as well as alternative positions for birth, such as supported kneeling or side lying. Using a birth pool may also help freedom of movement (5).
A cesarean section is not usually needed or recommended for women with pelvic girdle pain as this might slow down recovery (5).
Frequently Asked Questions
- Pelvic girdle pain is a pregnancy discomfort that causes pain, instability, and limitation of mobility and functioning in any of the three pelvic joints.
- Pelvic girdle pain (PGP) is a pregnancy-related pain condition.
- PGP is relating to pain experienced at the front and back of your pelvis (5).
- It is common for women to experience PGP in pregnancy (1).
- No.
- Pelvic girdle pain is not linked to other serious pathology.
- The condition will not harm your baby (3).
- Most women can still have a spontaneous vaginal delivery (4).
- It will usually improve after delivery of your baby (6).
- Most commonly arises during pregnancy.
- It can occur at any stage of pregnancy.
- Pelvic girdle pain can affect anyone who is pregnant, however people can experience different levels of pain/discomfort.
- Pain at the front or back of your pelvis (2).
- Pain with activities such as (1):
- Standing on one leg, e.g. dressing.
- Split leg movements, e.g. using stairs.
- Moving your legs apart, e.g. getting in or out of a car.
- Twisting movements, e.g. turning in bed.
- Lying on your side.
- Clicking or grinding sensations in the pelvic area (this is not a sign of harm or damage to your joints) (5).
- Remain active within the limits of what you find comfortable (5).
- Reduce activities which aggravate your symptoms (5).
- Exercise therapy has been shown to be an effective treatment (6).
- Advice by a qualified women’s health physiotherapist will be helpful in most cases.
- Symptoms should improve with appropriate treatment and prevent worsening of symptoms as your pregnancy progresses (3).
- 93% of women’s symptoms improve within the first 12 weeks after pregnancy (2).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
- Symptoms can develop at any stage of pregnancy.
- The location of pain varies. Pain may be felt at the back of the pelvis (on one or both sides), on the buttocks, the outside of the hips, the groin or over the pubic bone (at the front of the pelvis, below the tummy) (5).
Activities which often produce pain include (1):
- Standing on one leg (e.g. dressing, getting in and out of a bath).
- Split leg movements (e.g. using stairs, walking).
- Moving your legs apart (e.g. getting in or out of a car).
- Twisting movements (e.g. turning in bed).
- Difficulty lying on your sides.
- Pain during normal activities and/or pain during sex.
3. Causes
- Pelvic girdle moving unevenly.
- Changes in activity of the muscular system around the hips, buttocks and pelvic floor – this can result in some weakness, be less supporting and then produce irritation to the pelvic girdle.
- Previous trauma to the pelvis.
- A small percentage of women can experience pain due to hormones.
- In some cases, baby’s position can be a factor.
4. Risk Factors
These factors could increase the likelihood of someone developing pelvic girdle pain. It does not mean everyone with these risk factors will develop symptoms.
The main risk factors include (2):
- Previous lower back or pelvic girdle pain.
- Previous injury to the pelvis.
Other risk factors may include (5):
- History of pelvic girdle pain in a previous pregnancy.
- More than one pregnancy.
- A hard physical job.
- Poor working postures.
- Being overweight.
- Increased joint mobility in other parts of the body (known as joint hypermobility).
Factors that are not associated with pelvic girdle pain include (2):
- Contraceptive pill use.
- Time interval since last pregnancy.
- Age.
- Height.
- Smoking.
- Breastfeeding.
5. Prevalence
Approximately 1 in 5 women will experience pelvic girdle pain at some point in their pregnancy (2).
6. Assessment & Diagnosis
A woman’s health physiotherapist and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress and will allow appropriate adjustments to your treatment to be made.
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your pelvic girdle pain. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference
Below is some advice which often helps with pelvic girdle pain (5):
- Gentle exercise can still be achieved and is encouraged during pregnancy. Remain active within the limits of what you find comfortable and can manage. Where possible, reduce activities that you know aggravate your pain.
- Accept offers of help.
- Reduce standing on one leg, for example sit down to get dressed.
- Try to keep your knees together when getting in and out of cars.
- Consider alternative sleeping positions. For example, try lying on one side with a pillow between your knees. When turning in bed keep your knees together and squeeze your buttock muscles. You could try a pillow under your side as well.
- When getting out of bed try rolling onto your side, bring your legs off the edge of the bed, keeping them together, then use your hand to push you into a sitting position.
- Try not to lean backwards or twist when standing.
- Try going up and down stairs one leg at a time, with the most pain-free leg first and the other leg joining it on the step.
- Reduce activities that involve asymmetrical positions of the pelvis such as sitting cross-legged or carrying anything on one hip.
- Consider alternative positions for sexual intercourse such as lying on the side or kneeling on all fours.
- Use of heat or ice packs for pain relief.
8. Rehabilitation
Exercise is recommended to treat pelvic girdle pain (2). It has been shown to decrease the severity of pelvic girdle pain during pregnancy (6).
Below are three rehabilitation programmes created by our physiotherapists targeted at addressing pelvic girdle pain. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
It is also important to complete pelvic floor exercises daily during pregnancy to reduce the risk of pelvic floor dysfunction during or after pregnancy. Please refer to the additional resources below for further information or have a look at the pelvic floor dysfunction section of our website.
9. Pelvic Girdle Pain
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme focuses on moving the pelvis and lumbar spine (lower back), as well as beginning gentle strengthening of the abdominal and pelvic girdle muscles to help maintain stability. Some of these simple exercises can be performed little and often during the day to help relieve pain. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
In this programme more focus is given to progressive stretching of the pelvis and lumbar spine, and strengthening of the abdominal and pelvic girdle muscles. Try and complete this programme once daily. You may wish to continue the gentle stretching exercises in the early programme little and often throughout the day too. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This programme challenges the pelvic joints and muscles by reintroducing some positions that may have been uncomfortable previously. Again, it may be helpful to continue with some of the exercises from the previous programmes, particularly if you found they gave you some relief. Aim to complete this programme once daily. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
93% of a woman’s symptoms improve 12 weeks following the delivery of her child (2). Breastfeeding will not slow the rate of recovery from pelvic girdle pain (5).
For women whose symptoms do not settle postnatally, or those who are struggling with return to a higher level of function or sport, we would encourage a consultation with a musculoskeletal physiotherapist as they will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
Treatments such as acupuncture, manual therapy, maternity belt prescription or mobility aid prescription may also provide relief, but they are not recommended as stand-alone treatments (2). If your pain is severe then regular pain relief might be needed (5). Your GP can discuss options with you.
12. Links for Further Reading
Pelvic Girdle Pain:
- https://thepogp.co.uk/Resources/112/pregnancy_related_pelvic_girdle_pain_for_mothers_to_be_and_new_mothers
- https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pelvic-girdle-pain-and-pregnancy.pdf
- https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/pelvic-pain/
- https://thepogp.co.uk/Resources/120/fit_for_birth
- https://pelvicpartnership.org.uk/
Looking after yourself during pregnancy:
Exercise during Pregnancy:
- https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829894/5-physical-activity-for-pregnant-women.pdf
- https://www.nhs.uk/pregnancy/keeping-well/exercise/
Pelvic Floor Exercises:
References
- Vermani, E., Rajnish, M. & Weeks, A. (2010). ‘Pelvic Girdle Pan and Low Back Pain in Pregnancy: A review’. Pain Practice, Wiley Online Library. Available at: https://doi.org/10.1111/j.1533-2500.2009.00327. 10, 60-71.
- Vleeming, A., Hanne, A., Hans, C., Bengt, S. & Britt, S. (2008). ‘European guidelines for diagnosis and treatment of pelvic girdle pain’. European Spine Journal, 17, 794-819, Springer Linkt: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518998/pdf/586_2008_Article_602.pdf/?tool=EBI.
- Royal College of Obstetricians and Gynaecologists. (2015). Information for you: Pelvic girdle pain and pregnancy. Available at: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pelvic-girdle-pain-and-pregnancy.pdf.
- Jain, S., Eedarapalli, P., Jamjute, P., Sawdy, R. (2006). ‘Review: Symphysis pubis dysfunction: a practical approach to management. The Obstetrician and Gynaecologist, 8(3), pp 153-158, Wiley Online Library [Online]. Available at: https://doi.org/10.1576/toag.8.3.153.27250.
- Pelvic Obstetric and Gynaecological Physiotherapy. (2015). Guidance for Health Professionals: Pregnancy-related Pelvic Girdle pain. Available at: https://thepogp.co.uk/_userfiles/pages/files/POGP-PGP(Pros).pdf
- Davenport, M., Marchand, A., Mottola, M., Poitras, V., Gray, C., Garcia, A., Barrowman, N., Sobierajski, F. James, M., Meah, V., Skow, R., Riske, L., Nuspl, M., Nagpal, T., Courbalay, A., Slater, L., Adamo, K., Davies, G., Barakat, R. & Ruchat S. (2019). ‘Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis’. British Journal of Sports Medicine. BMJ Journals. Available at: https://bjsm.bmj.com/content/53/2/90. 53, 90-98.
Other Conditions in
Hips & Pelvis, Long Term Conditions, Other
Sacroiliac Joint Dysfunction
Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.
Proximal Hamstring Tendinopathy
Pain and weakness under the buttock or the back of your upper thigh caused by tendon issues.
Pelvic Floor Dysfunction
The inability to effectively control the muscles of your pelvic floor, leading to issues with continence and pain.
Lumbar Disc Injury
Lumbar discs sit between each of the bones of the spine. Problems can occur when these discs become irritated.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Iliotibial Band Syndrome
Presents as pain on the outside of the knee, normally occurring because of overload due to prolonged or repeated bouts of exercise.
Hip Replacement Surgery
Replacement of the hip ball and socket joint, typically as a result of severe osteoarthritis or trauma.
Hip Osteoarthritis
Common age-related changes to the structure of the hip joint may be associated with pain, stiffness and loss of function.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Adolescent Hip Dysplasia
A result of an abnormality of the hip joint anatomy resulting in pain in the hip with occasional instability.
Adductor-Related Groin Pain
Localised discomfort to the inner upper thigh and groin.