Pregnancy related back and pelvic pain

  • It is estimated that pelvic girdle pain (PGP) affects up to one in five pregnant women to some degree.  Symptoms and severity vary between women and pregnancies 
  • Many pelvic problems are dismissed as the “normal aches and pains” of pregnancy, but you can adopt lifestyle changes and carry out simple exercises to reduce pain and improve function 
  • PGP is a specific form of Low Back Pain (LBP) which can occur separately or in conjunction with LBP
  • There is an overall agreement that PGP results in more affliction of pain and functional disturbances than LBP
  • As the pregnancy progresses, the pelvis tries to cope with the changes associated with the baby growing such as the altered shape and posture, the muscles stretching and the weight gain 
  • With appropriate treatment the pressures on the pelvis are minimised so that the discomfort is manageable

 

Subjective Examination:

  • Pain in the front of the pelvis
  • Pain in the lower back and can radiate down the legs
  • Pain in the groin
  • Pain over the inner thighs
  • Pain between the legs
  • Clicking/grinding over the front of the pelvis if severe

Women often describe having difficulty doing the following activities:

  • Walking distances (often a “waddling” gait is common)
  • Climbing up and down the stairs
  • Getting in and out of the car
  • Climbing in and out of the bath
  • Turning over in bed
  • Standing for long periods
  • Dressing

Treatment:

If you feel that your patient is suffering with pregnancy related back and pelvic pain advice can be given;

  • Reassure the patient that most Pelvic girdle symptoms settle as soon as their have given birth
  • Advice on simple lifestyle modifications such as;
    • Appropriate footwear that is cushioned and supportive 
    • Sitting posture and trying supportive chair rather than sofa 
    • Avoid standing for long periods
    • Cuddle children sitting on your lap rather than lifting them, if have to liftg young children sit down and then pick up child
    • Sit when getting dressed and putting on shoes
    • Rest frequently throughout the day.  Take the weight off your pelvis – lie down
    • When sleeping/resting on your side, use a small pillow between your knees
    • Take smaller steps and avoid rushing
    • Accept help form your partner/family/friends particularly in stressful postures or strenuous shopping trips etc.
    • Avoid straddle movements or activities where you stretch your knees apart 

Referral to physiotherapy if the patient is unable to manage their pain and we can work with the patient to get them to manage their condition by:

  • Exercises for posture and core stability
  • Education and advice on lifestyle modifications
  • Education on sleeping and sexual position
  • Advice on specialist equipment if required for example pelvic belts and crutches
  • Education on birthing positions and the postnatal period
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