Fitness professional David Kingsbury, founder of Opus Fitness, has seen Leonora though all her three pregnancies. Here, OPUS trainer Amy Moore uses her personal experience to explain the causes and remedies of pelvic girdle pain.
As an exercise professional, I am used to educating women about the benefits of exercise during and following pregnancy. Nowadays, it’s increasingly understood that exercise can help with pregnancy-related conditions such as back pain, postural, and abdominal related changes during pregnancy. The benefits of a fit mum-to-be are unquestionable, as long as we are aware of the correct protocols to follow.
Well this may be true, but for one in 5 women who experience pregnancy related Pelvic Girdle Pain (PPGP), following the current guidelines for exercising when pregnant may be something to think twice about (Kanakaris, 2011).
PPGP is common, but not yet widely recognised. Perhaps this is due to the multiple factors causing PPGP and the differing symptoms that are often presented (Bennett, 2014). I first came across it when working with a team of physios in a women’s health clinic. PPGP presents a wide range of symptoms – anything from mild discomfort in the back or front of the pelvis to severe disability whereby even walking is just too painful – often leading to the use crutches or wheel chair/mobility scooters!
I was later shocked when I too developed the condition at 20 weeks pregnant. No level of previous fitness or exercise during my pregnancy had prevented this from happening. For me, and for many women who develop PPGP during pregnancy, certain activities would bring on the pain or make it worse; going up and down stairs; turning over in bed; standing or sitting cross legged for long periods of time and pushing or lifting heavy things are to name just a few. The advice is to remain active, but not to overdo it. However, if like me, you are used to being active, this can be quite confusing!
So, what causes it?
The most up-to-date research shows that it is usually caused by the pelvic joints moving unevenly, and PPGP can cause pain in any, or all of the pelvic joints – specifically between the posterior iliac crest and the gluteal fold, and in the vicinity of the sacroiliac joints (Stuge, 2011). The pain can often radiate in the back of the thighs, and occur in conjunction with, or separately, in the pubis symphysis (Verstraete, 2013). Research often suggests that when one joint becomes stiff and stops moving correctly, the other joints begin to compensate and become irritated and inflamed. Consequently, muscles become tight and painful – which doesn’t make the experience any more pleasant!
The good news!
PPGP is treatable with a good manual therapist, and in most cases, the pain dramatically decreases post-delivery. In fact, research shows that symptoms tend to settle in the majority of patients within the first 3 months post-delivery, and after one year post-partum only 1% to 2% of patients report the persistence of pain (Kanakaris and Haugland).
Can any exercise help?
Gentle pelvic mobility and stability exercises are recommended. The main thing to remember, however, is to avoid anything that brings on the pain or makes the pain worse, but to be as active as possible within the pain limits. Here are some pelvic tilting exercises to try…
Supine pelvic tilt
On all fours…
Sitting pelvic tilt
NB: Please always consult your doctor or health practitioner before starting any new exercise regime.
Opus Fitness have two wonderful gyms in London and will be opening another in the new year, which we’re super excited for!
J. Bennett (2014) Exercise for postnatal low back pain and pelvic pain; Literature Review. Journal of the Association of Chartered Physiotherapists in Women’s Health, PP. 115, 14–21
Verstraete et al (2013) Pelvic Girdle Pain during or after Pregnancy: a review of recent evidence and a clinical care path proposal. Facts, views and visions in Obgyn, 5(1): 33–43.
Kanakaris et al (2011) Pregnancy-related pelvic girdle pain: an update. BMC medicine, pp 9: 15.
Haugland et al (2006) Group intervention for women with pelvic girdle pain in pregnancy. A randomized controlled trial. Acta Obstetricia et Gynecologica 85: 1320-1326
Stuge (2011) Pelvic girdle pain: examination, treatment, and the development and implementation of the European guidelines. Journal of the Association of Chartered Physiotherapists in Women’s Health, Autumn 111, 5–12