Pelvic Girdle Pain

What does this mean? Where does it come from? How can I get better?

Pelvic Girdle Pain (PGP) includes pain in the pelvic region – the pubis symphysis (PS) joint at the front of the pelvis, the sacroiliac joint (SIJ) at the lower back region, the coccyx (tailbone) and the sacrum. Pain in this region can also be related to groin pain, hip pain and lower back pain. Often PGP arises from trauma, sports injuries, pregnancy, arthritis, and even postural dysfunctions.

Some activities that are commonly painful with PGP are static postures (sitting, standing, lying), changes in positions (rolling, sit to stand), walking, driving, dressing, and household chores such as dishwashing, vacuuming, and cooking.  The pain may be continuous or intermittent in nature, sharp, burning, inconsistent and may seem to switch sides of the body.  With PGP the pain is typically located in the lower back and tailbone region, but can also manifest in the hips, groin, back of thighs or sides of legs.  There may be a strain on lumbo-pelvic musculature or a rotational imbalance in the pelvic joints that subsequently leads to muscle spasm, poor motor control patterns (how and when your muscles contract), pain and fear of movement.

There may be a history of back pain that predisposes you to acquire a pelvic dysfunction later in life, or you may have had direct trauma to your pelvis, such as with a fall or sporting injury.  There are many causes of pain in the pelvic region and more serious conditions such as a lumbar disc injury, spondylolithesis (a slippage of one vertebrae on another in the lower back), an inguinal hernia, or endometriosis must be ruled out.

It is very common to experience pelvic pain during or after pregnancy.  Hormones are changing, your center of gravity is changing, there is weight gain and supportive core musculature is stretching out!  There is an old school mentality however, that this laxity, or looseness, in the pelvis region due to hormones and a growing fetus may be the CAUSE of pelvic pain. Women are often taught to be cautious, avoid stretching, use walking aids, wear supportive belts to secure the pelvis region.  Furthermore, women are often advised to adopt bed rest during the latter stages of pregnancy and post partum for 48 hours or until the pain subsides.  While in certain cases, this is medically necessary – for a healthy, normal pregnancy this may not be great advice. There is no evidence to support the idea that the laxity is the root cause of pain. It is a necessary situation for our body to create during pregnancy to allow for a growing baby and prepare for delivery. Problems arise when there is ASYMMETRY in the pelvis. If a habitual position, postural dysfunction, or trauma cause joints to become mal-aligned, this is when our body reacts with pain, muscle spasm, and potential nerve tension.  It can be much more beneficial to learn how to move properly, where and how to strengthen during pregnancy and what positions are most effective for pelvis stability.

An assessment by a physiotherapist could help determine what is causing PGP and address joint dysfunctions, muscle imbalances, and postural contributing factors.  It is important to learn how to recruit the stabilizing muscles, such as the pelvic floor, transverse abdominus, diaphragm, and the gluteals.

Learning to “de-train” the tight muscles will help the deeper stabilizers to do their job more effectively. These tight muscles are typically the piriformis (deep gluteal muscle), the inner thigh adductors, the oblique abdominals, and the lumbar paraspinals.  The coordination and timing of how muscles act together is also important. When there is pain somewhere in the body, certain muscles get inhibited and lose their ability to contract when necessary. There are myofascial systems in our body that require certain muscles to work in coordination with each other for optimal mobility and stability.  It is possible to retrain our body how to use these “systems” and get back our optimal movement patterns.

Whether you are experiencing pelvic pain from a recent injury, a pregnancy, or certain activities give you grief – it is worth getting checked out.  Don’t suffer in silence! We would love to help get you back to your sport, the activities you enjoy, or simply participate in activities of daily living pain free.

Jennifer Gordon (BSc.PT, GunnIMS, AFCI)

Bragg Creek Physiotherapy