Pelvic Girdle Pain/SPD

Pelvic Girdle Pain/Symphsis Pubic Dysfunction is the name given to pain and mobility problems caused by instability of the pelvis during pregnancy. During pregnancy pain can develop in the joints of the pelvis. This pain is sometimes caused by altered symmetry /position of the joints. The combination of pelvic instability, the growing baby and postural changes can result in varying levels of pain.

In pregnancy the hormone relaxin is released into the blood to soften the joints in preparation for the birth of your baby. In around 1 in 35 women the hormone causes the ligaments  to soften and stretch too much and become painful.

It is normal for there to be a gap of 4-5mm between the two pubic bones at the symphsis pubis joint and during pregnancy this widens by another 2-3mm. If this gap widens more than this pain may occur and in some cases a painful condition called pubic symphsis diastasis is diagnosed.

How to recognise Pelvic Girdle Pain/SPD

  • Pain in one or more joints of the pelvis, often affecting the pubic bone at the front or one or both sacro-iliac joints at the back
  • Pain in the lower back, hip joints or inner thighs
  • Pain in the groin across the lower abdomen
  • Pain and difficulty with walking
  • Waddling gait
  • Pain or difficulty moving your legs apart
  • Pain standing on one leg and climbing the stairs.
  • Difficulty getting in and out of the car / bed
  • Clicking or grinding in the pelvic joints which can be heard or felt.

The main symptoms are pain in your pubic area, groin, inside of your thighs and sometimes in your lower back and hips. The pain is generally worse when you walk and climb the stairs. Getting in and out of the car or turning in bed is also painful. Some women report that they hear a clicking sound when they walk and feel as if their bones are rubbing together.

If you are experiencing these symptoms let your doctor know so that you can be referred for physiotherapy. SPD normally happens from the second trimester of pregnancy onwards, but can occur at any stage in pregnancy, even if you’ve never suffered before.

Treating SPD:

The best person to treat SPD is a Chartered Physiotherapist and usually your GP or Consultant can refer you.

  • The physiotherapist will assess you and may prescribe a pelvic support garment, or crutches.
  • The physiotherapist may do some gentle manual therapy if certain joints have become stiff or stuck or if some muscles have become tight.
  • The alignment of the joints within and around the lumbar spine, pelvis and hip may need to be corrected
  • The deep stabilising muscles of the core area may need to be strengthened.
  • You will be advised on the do’s and don’ts recommended with this complaint.
  • You will be advised about positions during labour and delivery implications

How will SPD affect my labour?

– Make sure your midwife or consultant is aware that you have SPD so that this can be taken into consideration during labour and your legs are not widened beyond your comfortable range.

– If you have an epidural or spinal it is particularly important that you do not exceed the comfortable widening of your legs as you won’t be able to feel the pain.

– In very severe cases elective caesarean maybe considered.

After the birth:

The majority of women recover in the first few months after the birth and some notice an immediate improvement. However for some women they may continue to have problems. Women often delay in seeking help as they are waiting for hormones to “settle down” or are just too busy with their new arrival.

Seek help early and ask for a referral to a physiotherapist with experience in treating this condition.

 

Low Back Pain and Sciatica in Pregnancy:

Back pain is one of the most common discomforts during pregnancy. As your baby grows your uterus expands to as much as 1000 times its original size. This amount of growth when centered in one area affects the balance of your body and may cause discomfort. Posture often changes during pregnancy and most women begin to lean backward in the later months of pregnancy.

Weakness of the abdominal muscles can also cause back pain. During pregnancy the supportive abdominal muscles become stretched and may weaken, causing back pain.

Pregnancy hormones may also contribute to back pain.

What you can do?

Consult your Chartered Physiotherapist for a full assessment of your symptoms. To help prevent or ease back pain be aware of how you stand, sit, and move. Here are some tips that may help:

  • Wear low heeled shoes with a good arch support
  • Avoid lifting heavy objects.
  • Do not bend from the waist to pick up objects- keep your back straight and bend hips and knees.
  • Watch your posture in sitting.
  • Attend Ante Natal PILATES Classes.

Your physiotherapist will instruct you on exercises to help strengthen your core abdominal muscles.