Pelvic Pain During Pregnancy
During pregnancy, women hope to be as comfortable as possible and maintain their same quality of life. But some mothers-to-be experience low back and pelvic pain that affects their ability to function. Most women expect a certain amount of discomfort associated with pregnancy; however, pain in the pelvic area should not be accepted as normal. If a pregnant woman cannot perform her usual normal daily activities and cannot exercise because of pain, then she should be offered, and encouraged to get, treatment. Women with pelvic girdle pain in pregnancy should know that specially trained physical therapists, called women’s health physical therapists, can help and possibly cure the problem.
Pelvic girdle pain is pain in the pubic area or the groin, and/or pain in the back of the pelvis below the waist, which can radiate into the buttock, hip, or leg. Studies show that many normal changes in pregnancy predispose women to back and pelvic pain. One of the normal changes is the effect of the hormone called “relaxin”. A pregnant woman’s body produces relaxin, which gradually loosens the pelvic ligaments to allow increased pelvic joint movement and spreading of the pelvis to allow for the delivery of the baby. Problems and pain can occur during the pregnancy, as early as the first trimester, when one side of the pelvis becomes more loose or mobile than the other side. The ligaments and joints on one side can loosen too much and too early before birth, resulting in pain in any part of or the entire pelvis. After childbirth, the body stops producing relaxin and the ligaments and joints tighten up again.
For pelvic girdle pain, a physical therapist will first perform an examination of posture, joint alignment, joint mobility, joint pain, balance, body mechanics, flexibility, control, and strength. They will then develop a plan of care to provide treatment to restore normal pain-free movement. Physical therapy is an active partnership, so the mother-to-be will work closely with her physical therapist to make sure that all of her issues related to movement and pain are addressed. The pregnant woman will quickly learn to perform techniques, which allow her to treat herself and to prevent her problems from worsening. She will learn specific movements during normal activities and during exercise, which promote healing and avoid aggravation of the pelvic joints. For example, the therapist will train the mother-to-be to intentionally move in symmetrical patterns, to avoid over stressing one side or the other of the pelvic joints. She will learn to bend from her knees and hips instead of flexing from the spine in order to avoid re-injury.
Because the joints are normally loose in pregnancy, the physical therapist will also train the mother-to-be to activate the deep core muscles during movement. These muscles include the deep abdominal muscles, the pelvic floor (“Kegel”) muscles, and the deep spinal muscles. The physical therapist may recommend that the mother-to-be learn to wear a pelvic belt, or sacroiliac belt, not only to stabilize the pelvic joints, but also to activate control of the core muscles. The woman with pelvic girdle pain must be able to control her movements and purposefully activate her muscles not only during exercise, but also during normal daily activities.
Studies have shown that having severe pain in pregnancy makes women more likely to have pain after delivery. When problems are identified early on, the mother-to-be’s chances of ongoing pain after delivery are greatly reduced. An added benefit of working with a physical therapist to treat pain during pregnancy is that if a mother is still in pain after delivery, she will already know some techniques and strategies to care for her and to keep pain under control. The physical therapist may monitor the patient’s pain and abilities until she delivers her baby. After the baby is born, the physical therapist may advise the new mother to return for a postpartum session to treat any ongoing pain issues, and to recommend active steps for a complete and pain free recovery.
Simple tips to prevent back and pelvic pain during pregnancy:
- Practice good postures when standing and sitting, avoid cross-legged sitting, avoid putting all of your weight on one leg, or jutting your hip out.
- Activate the deep core muscles during activities, exercise, and movements:
Lift and squeeze the pelvic floor muscles up and in, sink in the deep abdominals, visualize the contraction of the deep spinal muscles.
- Avoid bending and twisting from the low back at the same time (during vacuuming, for example).
- Use good body mechanics, bend from knees and hips, not your back.
- Keep your low back in a neutral posture with a slight arch, not too flat or too arched; practice this posture during all exercises, especially when lifting weights.
- Do your pelvic floor muscle (“kegel”) exercises every day: lift and squeeze your pelvic floor muscles as if trying to avoid passing gas, hold and squeeze for 10 seconds, repeat 10 times, 3-5 times per day. Don’t forget to practice quick and strong pelvic floor exercises, 1-2 second hold, 10 times, 3-5 times per day.
