Pelvic Girdle Pain in Pregnancy

What is Pelvic Girdle Pain?

Written by Dr. David Howard - B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Pelvic girdle pain is a set of very commonly occurring symptoms in pregnancy and includes the conditions of sacroiliac joint dysfunction, sacroiliac joint instability, pubic symphysis dysfunction and diastasis symphysis pubis.

These conditions are all linked as they have a very similar set of symptoms but with differing intensities and primary source of pain. They can also occur together because the anatomy of the pelvis is like a 'bowl' with all of the bones connected in a circle. If one of the joints is affected or dysfunctional, the other joints are also likely to be affected and cannot function normally. For simplicity, the conditions are named according to where the majority of the pain is being experienced. In most cases, there will also be symptoms occurring at the other pelvic joints simultaneously.

Anatomy of the pelvis

The sacroiliac joints lie below the dimples in your low back. Each joint is between the Innominate bone (A) and the Sacrum (B). These joints are involved in movements of the low back and hips such as walking, moving between sitting and standing, climbing stairs, etc. The pubic symphysis is the joint (E) at the front of the pelvis between the two innominates (A) at the pubic ramus (D). This joint rotates and compresses, especially during the gait/walking cycle.

A: Innominate Bone
B: Sacrum
C: Acetabulum ('cup' of the hip joint)
D: Pubic Ramus
E: Pubic Symphysis or joint
F: Ischial Tuberosity or 'sit' bone

Sacroiliac Joint Dysfunction

Pain is primarily experienced at the sacroiliac joints and tends to be a deep ache with a sharp grabbing sensation with certain movements such as standing up from a seated position.
This condition tends to be a result of muscle imbalance within the pelvis due to tightness or weakness, which effects the joint's ability to move freely and symmetrically. Sacroiliac joint dysfunction can occur in any person and is not specific to pregnancy.

Sacroiliac Joint Instability

Pain is primarily experienced in the sacroiliac joints but to a much greater intensity than with sacroiliac joint dysfunction. This is a condition largely associated with pregnancy and can become very debilitating, especially in the final few months, with a small percentage of women requiring a wheelchair or crutches to move around. For pregnant ladies this condition occurs due to the increased levels of relaxin, estrogen and progesterone hormones which act to soften the pelvic ligaments to enable birth. In some women, especially those with prior history of lower back pain, the ligament softening occurs more than normal and results in the sacroiliac joint not being stable enough.

Pubic Symphysis Dysfunction

Pain is primarily experienced at the pubic symphysis joint at the front of the pelvis with the joint widening (<9mm). Pain may also be experienced in the sacroiliac joints, gluteal muscles and the inner thigh muscles. This condition occurs due to muscular imbalance from weakness or tightness that prevents symmetrical and normal movement/functioning of the pelvic joints. This condition can occur in any person and is not specific to pregnancy.

Diastasis Symphysis Pubis

Pain is primarily experienced at the pubic symphysis joint at the front of the pelvis with the joint widening (>9mm). Pain and disability is much greater than with pubic symphysis dysfunction. As well as muscluar soreness, many women also experience a clicking or clunking sensation in the pelvis. For pregnant ladies this condition occurs due to the increased levels of relaxin, estrogen and progesterone hormones which act to soften the pelvic ligaments to enable birth. Some women however seem to be affected more by these hormones and the joint widening is greater than normal.

What can be done about these conditions?

If you, or someone you know, is suffering any of the above conditions or symptoms you/they may benefit from seeing a registered Osteopath like Dr. David Howard. Even if the conditions and/or symptoms cannot necessarily be 'fixed', they can be managed throughout the pregnancy - osteopathic treatment can reduce the intensity/severity of any pain being experienced. If you're still unsure as to whether osteopathic treatment would be of benefit to you, please feel free to call the clinic - 0493 120 268 - or send through your questions/queries via the Contact Us page.

Disclaimer: Information provided in this post is of a general nature and should not be used solely in place of individual advice from either myself or another medical professional. Pascoe Vale Osteopathy and Dr. David Howard will not take responsibility for any injury resulting from following information in this post.

Pascoe Vale Osteopathy provides osteopathic services to patients from a wide number of suburbs such as Pascoe Vale, Essendon, Essendon North, Moonee Ponds, Strathmore, Niddrie, Keilor, Coburg, Brunswick, Oak Park, Glenroy, Airport West, Travancore, Melbourne, Australia.

Correct sleeping posture

Is your bed a pain in the butt?

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

As most people spend about the same time sleeping as they do sitting at a desk, your sleeping posture is just as important as your sitting posture. Research has indicated that 41% of people sleep in the foetal position. This posture, however, isn’t optimal in maintaining correct spinal alignment.

The best spinal alignment when sleeping is the same as when sitting, but obviously lying down – click onto this previous article for more detail. The triple C-curve of your spine is maintained and there is no excess pressure on any part of the spine. I know bad habits are hard to change but try going to sleep correctly and hopefully your sleeping body eventually gets the picture. We will start from the top…

*Neck straight with your chin away from your chest
*Good supportive pillow filling the gap between your head and shoulders – click onto this previous article for more detail
*Arms in front of you or hugging a pillow
*Maintain the curve in your low back or lumbar spine by having your knees below the level of your hips
*Both knees should be together so that the back is nice and straight. (Many people, especially women with larger hips will find this uncomfortable or impossible. Placing a pillow between your knees will remedy this).

Core Strength – why it’s important and how to get it!

Written by Dr. David Howard – B.Sc. (Clinical Sci.), M.H.Sc. (Osteopathy), B.App.Sc (Human Movement) from Pascoe Vale Osteopathy located in Pascoe Vale, Melbourne, Victoria, Australia.

Although we all love the idea of having a 6 pack and a flat stomach, doing lots of stomach crunches isn’t the key to strengthening the mid section – focusing on the core is! Not only does having a strong core act like a corset tightening the midsection, it is also vital in preventing lower back pain and injury. Strong core muscles are your own internal back brace when lifting or going about your everyday activities. This type of exercise also trains you to be more conscious of your posture which further helps in preventing injury.

The Muscles

The function of the core muscles is to stabilise movement of the lumbar spine and pelvis before and during any movement. There are two types of muscle fibres in the body – fast and slow twitch fibres. Fast twitch fibres can be found in muscles like the biceps whose function predominantly involves short, fast and strong contractions (i.e. when lifting something). Slow twitch fibres are your postural muscles like those of the core, whose function is to contract softly yet over a long period of time. The exercises therefore to strengthen the core are slow and controlled and initially require a lot of concentration to do correctly.

The key muscles of the core are the Transversus Abdominus, Multifidus, Internal Oblique and the pelvic floor. When all of these muscles contract together, they produce pressure within the abdomen which stabilises the lumbar spine. This core ‘protective system’ is very intelligent – as you think of performing a movement, the muscles contract ready for when you do the movement.

Since these muscles have a postural and stabilising function, they need to be strengthened when your spine and pelvis is in the correct alignment. These muscles don’t need great strength but instead need endurance. The key to training the core is doing it regularly, carefully and correctly.

Pregnancy