4 tips to treat your Pregnancy Pelvic Girdle Pain

When I was 29 weeks pregnant with my son, I began experiencing pain in my low back and pelvis. I had difficulty performing my duties at work, sleeping, and even standing or sitting for long periods of time. The pain made it so difficult to function, and I began to worry about my job, my finances and most importantly, how this all impacted my son. The stress I was experiencing really affected my day to day and in turn, made my pain worse. 

When we look at what pain is, we know that pain is an unpleasant sensory and emotional experience. An individual’s pain experience is impacted by not only biological drivers, but also, by psychological, social, and environmental factors. Therefore, to address the pain I was experiencing, I knew I had to look at all potential drivers that were contributing to my pelvic girdle pain. 

Pregnancy – pelvic girdle pain (PGP) is a specific low back pain that can occur during the perinatal period, with or without additional low back pain, which is influenced by a variety of biopsychosocial factors (as discussed above). For example, pregnancy itself is a stress on the body, a good one of course, but it is a stress placed on your muscles, ligaments, organs…you catch my drift. Social and environmental factors are things such as your support system, your living arrangements, your culture, and religion. Psychological factors include things your coping skills, your expectations, and beliefs, and factors that may cause you to feel anxious, stressed, or depressed.

The reason why we take this biopsychosocial approach to treat pain is because while our pelvic floor muscles are similar to our biceps or our hamstrings, in that they are musculoskeletal muscles, our pelvic floor muscles are different from those muscles because they are more governed by our autonomic nervous system. This means that during fearful or stressful situations, our initial fight or flight response is to protect, studies have shown that the first muscles to contract and protect are our upper traps muscles around our neck and our pelvic floor muscles. Therefore, you can imagine what would happen if your muscles if they were placed under chronic stress. 

So treatment techniques did I use to treat my pregnancy-related pelvic girdle pain (PGP)?

With a Pelvic Health Colleague, we began looking at the drivers of my pain, to see what were contributing factors. We came up with the following tips to help alleviate my pain during my pregnancy:

TIP #1: If you are pregnant, I encourage you to connect with a Pelvic Health Physiotherapist throughout your pregnancy and postpartum, to help your body manage and cope with the physical and emotional changes that occur, as well as, to help prepare for you for labour and delivery! 

Pelvic Health Physiotherapy treatment has been shown to help prevent complications like incontinence, prolapse, and perineal trauma/pain during and after birth. Not to mention, help make your labour and delivery easier for you and shorter in duration! Sign me up right?! 
Recent studies have shown the importance of addressing women’s self-efficacy, thoughts, fears and expectations when it refers to their pregnancy-related PGP, therefore:
TIP #2: Learning strategies to address the pain stress response and build resilience is essential throughout your pregnancy, labour/delivery, and post-partum recovery!

TIP #3: I began incorporating activities to help elicit the Relaxation Response. Examples of these strategies include:

1. 1. Breathing Techniques (Ex. Core Breath, Labour Breath, Body Scan)
   2. Mindfulness practices/Meditation
   3. Yin Yoga/Yoga
   4. Qi Qong

Tip #4: I began performing a specialized pre/post-natal exercise program that was tailored to my specific needs, interests, and goals. Examples of these exercises:

1. Pelvic Floor Muscle Training
2. Hip/Gluteal Strength training
3. Whole body stretches
4. Core exercises
5. Practicing optimal birthing and laboring positions
6. Perineal release/massage

Giving birth is like running a marathon, so in preparation for this event, women need to prepare their minds and bodies. Not only does this help you have a more comfortable and shorter birthing experience, but also helps reduce the risk of perineal trauma or pain during and/or after birth! Not to mention, having greater confidence, self-efficacy and coping strategies throughout your pregnancy, birth, and journey as a parent! 

Want to know more about pre and post-natal exercise programs? Connect with one of our Pelvic Health Physiotherapist at Foundation Physiotherapy & Wellness who will work with you to develop an individualized program to help optimize your birthing experience and postpartum recovery!

References

1. Bø K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women. Br J Sports Med. 2018;52(17):1080‐1085. doi:10.1136/bjsports-2018-099351
2. Clinton S, Newell A, Downey P, Ferreira K (2016) Pelvic girdle painin the antepartum population: Physical therapy clinical practiceguidelines linked to the international classification of functioning,disability, and health. section on women’s health and the orthopaedicsection of the American physical therapy association.
3. Mottola MF, Davenport MH, Ruchat S, et al. 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine 2018;52:1339-1346.
4. Rost CCM, Jacqueline J, Kaiser A, Verhagen AP, Koes BW (2004) Pelvic pain during pregnancy. a descriptive study of Signs and symptoms of 870 patients in primary care. Spine 29(22): 2567-2572
5. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B (2008)European guidelines for the diagnosis and Treatment of pelvic girdlepain. Eur Spine J 17(6): 794-819.