Pelvic Girdle Pain (PGP)

A guide for you and your relatives

Pelvic Girdle Pain (PGP)

There are a number of factors that can cause pelvic girdle pain (PGP) These include: the pelvic girdle joints moving unevenly weakness of the pelvic floor and tummy muscles prior to and during pregnancy a previous fall or accident hormone changes during pregnancy. These factors can cause pain in the back, pubis, groins, thighs or lower abdomen. Sometimes if you have a previous history of back pain or pelvic injury this can be a risk factor for developing PGP. Other factors include more than one pregnancy, a hard, physical job or awkward working conditions, PGP in a previous pregnancy, being overweight and increased mobility in your joints. Sacro-iliac

Symphysis pubis

ADVICE
Rest You may need to REST more often but be as active as the pain allows. Tell EVERYBODY who deals with you about your condition e.g. midwife, GP 2

Record this in your hand held notes and make sure the midwife in the labour suite is aware of your condition.

In severe cases caesarean section may need to be considered but this will have to be discussed with your consultant and there is no evidence to suggest that there are better outcomes than with vaginal deliveries.

FOLLOWING THE BIRTH

Your pain may not resolve immediately after delivery. Give it time to settle, following the advice previously detailed. If you have had no improvement four weeks postnatally you may wish to seek a referral from your GP to physiotherapy for an assessment and treatment. do not be afraid to ask for help. You should get as much rest as possible recruit your partner, relatives or friends! if you are still in pain while in hospital ask the doctor for some anti-inflammatory medication and analgesics before going home start doing your stabilising exercises as soon as possible avoid heavy lifting and twisting for the first few months premenstrual recurrence is commonly reported so be careful around this time.

You can get further information from the:

Association of Chartered Physiotherapists in Womens Health www.acpwh.org.uk (click on Publications, then Leaflets and then you can print a copy of Pregnancy Related Pelvic Girdle Pain for Mothers-to be and New Mums). There are other useful leaflets to look at too. Pelvic Partnership www.pelvicpartnership.org. ukTel 01235 820921. 7

You can also do the above exercises on all fours this will involve the spine a little more. On all fours, hands slightly in front of shoulders, knees below hips and feet hip distance apart, round your spine, tucking your bottom under. Then roll back the opposite way so that you stick your tailbone up in the air. Repeat this sequence up to 10 times.
Pelvic tilting on all fours

DURING LABOUR AND DELIVERY

Make sure that everybody who deals with you knows about your condition. Try to keep separation of the legs to a minimum. Adopt a comfortable position in all stages of labour, e.g. lying on the left or right side, kneeling upright with support from cushions or a partner, or standing leaning onto a high bed. You can also use the birthing ball during the first stage, rocking and bouncing gently. DO NOT place your feet onto your midwife/partners hips or shoulders to push as this puts excessive strain onto the pelvis. If your legs need to go into stirrups it is important that someone lifts and lowers them TOGETHER. You should be in this position for as short a time as possible. It is important to remember these points even if you have an epidural and are not aware of any pain. You may find it useful to measure your pain-free gap as you approach labour. Lie on your back, knees bent, feet flat. Allow your knees to fall apart gently and measure the distance between your knees at which you are no longer comfortable. 6

DURING PREGNANCY
if necessary you may be referred to a specialist physiotherapist for assessment and treatment you may need to wear a pelvic support to minimise pelvic discomfort. If the pain is severe you may need some help with walking e.g. crutches, or advice about pain relief minimise non-essential weight bearing activities e.g. shopping, lifting and carrying. Be particularly careful if you have a young child you should avoid carrying them on one hip to lift correctly, bend your knees, keep your weight evenly distributed through both legs and your back fairly straight. Try to keep the load close to your body sit with your weight equally distributed through both buttocks and stand with both feet flat on the floor, avoiding shifting your weight to one side. Avoid standing on one leg e.g. to get dressed avoid straddle movements e.g. in and out of the bath or car, and low squatting sleeping on top of an inside-out sleeping bag or wearing a silky nightdress may make it easier to turn over in bed and sleeping on your side with a pillow between your knees can make your pelvis more level consider alternative positions for intercourse e.g. lying on your side or kneeling on all fours if swimming take care getting in and out of the pool, and AVOID breast stroke.

STABILISING EXERCISES
it is important to work the deep supporting muscles around the abdomen and lower back to help stabilise the pelvis and spine. They will have to work during different functional activities therefore it is important to practise them in different positions 3

 if you are lying down ensure you are well supported with pillows and have your shoulders higher than your hips, or lie on your side if you are sitting make sure you sit up tall, with your back supported if you are standing have your feet hip distance apart and parallel. Keep your shoulders back and relaxed imagine there is a string from your head to your tailbone drawing you up to the ceiling attain a midway pelvis position by rocking your pelvis backwards and forwards and finding the midpoint.

Rock forwards Rock backwards Find the midpoint and try to maintain this upright position

Once you have set your posture, you are ready to make your stabilising muscles in the pelvic floor and lower abdominals do some work. Tighten your pelvic floor gently by squeezing around the back passage, as if trying to stop yourself from passing wind, and at the same time lifting the muscles at the front, as if trying to stop a flow of urine. Hold each contraction for up to 10 seconds and relax then repeat up to 10 times. Now try to activate your lower abdominal muscles. Place your hands on your lower tummy, thumbs and index fingers creating a diamond shape between your belly button and pubic bone. 4

Try to draw your tummy away from your hands, gently tightening the lower abdominal muscles. Hold for 10 seconds; then relax and repeat up to 10 times. You may be able to work both pelvic floor and abdominal muscles together but if you are struggling try them separately. Try to get into the habit of tightening these muscles whenever you bend, lift or get out of a chair.

Points to Watch
You must keep breathing normally during the exercises do not hold your breath. If you find this difficult, try to activate the muscles as you breathe out. Try to relax your shoulders and ribcage.

Pelvic tilting
You can try this exercise when sitting or standing. Sit towards the edge of the chair (or gym/ birthing ball), feet and knees hip distance apart. Try to grow up as tall as you can, coming off your tailbone and sticking your bottom out. Then roll back onto your tailbone tucking your bottom under. Take care to keep your upper body as still as possible the movement should come from the pelvis. Repeat the sequence up to 10 times.

Pelvic tilting when standing

Pelvic tilting when sitting

Our service
If you have any further questions about your condition, treatment or procedure then please telephone 0161 624 0420 and ask to be transferred to the ward/department you visited or were treated on.
If English is not your first language and you need help, please contact the Ethnic Health Team on 0161 627 8770

Jeeli angielski nie jest twoim pierwszym jzykiem i potrzebujesz pomocy prosz skontaktowa si z zaog Ethic Health pod numerem telefonu 0161 627 8770.

For general enquires contact your local Patient Advice Liaison Service: Fairfield Oldham 0161 778 2455 0161 627 8678 Rochdale North Manchester 01706 517354 0161 720 2707

Date of publication: April 2010 Date of review: April 2012 Ref: 0473-PI(DS) The Pennine Acute Hospitals NHS Trust

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