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The tell-tale signs of PGP

Can cause difficulty in:

•  Swelling, pain and/or inflammation over joint

•  Difficulty lifting leg especially when lying down

•  Pain separating legs apart

•  Unable to stand on one leg

•  Groin pain

•  Pain in hip/s and/or restriction of hip movement

•  Referred nerve pain down rear, front or inner thigh

•  Can be associated with bladder and/or bowel dysfunction

•  Feeling of symphysis pubis giving way

•  Feeling of being out of alignment

•  Struggle to sit, stand or turn over in bed

•  Waddle or shuffle

•  Aware of an audible ‘clicking’ sound coming from the pelvis

  • Standing still

  • Cycling

  • Walking

  • Sitting

  • Lying down especially on back

  • Turning over in bed

  • Getting out of bed, into/out of car

Contact us to arrange a home osteopathy visit.

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Call now: 01494 880 649

Mobile: 07730 395 700

Pelvic Girdle Pain

Pelvic girdle pain (PGP) has been known about since Hippocrates’ time, and has been called many different names, it must be one of the most renamed conditions in history!* When referring to the condition during pregnancy it is now known as Pregnancy Related PGP.

 

PGP also affects men and children and is not solely confined to pregnant women, any trauma or asymmetry can also cause it.

 

For most women PGP resolves in weeks after delivery and for a tiny minority it can persist resulting in a reduced tolerance for weight bearing activities. Overall, about 45% of all pregnant women and 25% of all women postpartum suffers from PGP. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%.

 

Before reading the following, remember that in most cases this condition is eminently treatable and managed even during pregnancy and sometimes a couple of treatments and home exercises are sufficient to control it.

*(Diastastasis of pubic symphysis (DPS), Symphysis pubis Dysfunction(SPD), Pelvic Joint Syndrome, Physiological Pelvic Girdle Relaxation, Symptom Giving Pelvic Girdle Relaxation, Posterior Pelvic Pain, Pelvic Arthropathy, Inferior Pubic Shear/ Superior Pubic Shear /Symphyseal Shear, Symphysiolysis, Osteitis Pubis (usually postpartum), Sacroilitis, One-sided Sacroiliac Syndrome /Double Sided Sacroiliac Syndrome, Hypermobility)

Predisposing reasons for PGP/PRPGP:

  • The pelvic joints moving unevenly.

  • A change in the activity of the muscles in the pelvis, hip, abdomen, back and pelvic floor.

  • A history of pelvic trauma including birth trauma.

  • The position of the baby altering the loading stresses on the pelvic ligaments and joints.

  • Strenuous work.

  • Previous lower back pain.

  • Previous pelvic girdle pain during pregnancy.

  • Hypermobility, genetic ability to stretch joints beyond normal range.

  • An event during the pregnancy or birth that caused injury or strain to the pelvic joints or rupture of the fibrocartilage.

  • The occurrence of PGP is associated with twin pregnancy, first pregnancy and a higher age at first pregnancy

  • History of horse riding, swimming or gymnastics

How I diagnose the condition:

  • Take full case history

  • Active and passive movement assessment

  • Check reflexes and muscle power

  • Note any asymmetry of movement in Sacro iliac joints (SIJ)

  • Active Straight Leg and other specific tests

  • Palpate the abdomen, pelvic organs, pubic symphysis, long dorsal ligament and piriformis and SIJ’s

  • Assess ability to activate pelvic floor muscles

  • Rule out other conditions

Treatment:

  • Calm and re-assure will probably not have to walk on crutches!!

  • Explain how the asymmetry of movement of pelvis and use of unhelpful breathing strategies reduces ability of the core muscles to stabilise the pelvis.

  • Use either a very gentle manipulation to SIJ to unlock stiff joint or teach patient self mobilisation

  • Massage and mobilisation of restricted joints and tight or weak muscles

  • Teach postural awareness

  • Correct sway back posture and teach releasing buttocks, tail bone and rear pelvic floor

  • Teach how to sit on sitting bones and discuss the effects of slouching on ligaments, pelvic floor etc

  • Discuss pregnancy gait and how to walk to take pain off joints and using both legs to weight bear

  • Give compression belt if necessary

Take Home/Self Help Techniques:

1. Sit correctly maintaining lumbar lordosis, reducing slouching.

2. Hips higher than knees

3. Ankles together knees apart!

4. Teach Squat to sit

5. Reverse squat to stand

6. How to self correct the unbalanced sitting bones

7. Learn correct posture

8. Learn how to perform squats

9. Learn correct breathing

10. Learn correct pelvic floor contraction

11. Learn correct gait How to remain calm and not catastrophise

12. How to release tail bone and any butt gripping

During both my pregnancies I've experienced discomfort in my sacroiliac joint, which at times could be very painful.

 

It was my yoga teacher, Jennie Phenix, who suggested I contact Diane for some osteopathic treatment.

 

Following an initial consultation, I was seeing Diane weekly during my third trimester and the session brought tremendous relief. Not only did the massage itself feel so wonderful in manipulating my increasingly aching muscles, but it definitely helped to manage my pelvic girdle pain. I'm convinced that I would have been in much worse shape had it not been for these weekly sessions with Diane.

 

What's more, Diane is an oracle on all things relating to PGP, as well as offering lots of advice on postpartum recovery and exercise, so I was able to benefit from all her advice in these areas too. I continued to see Diane for several weeks postpartum to help with realigning my pelvis, regaining my core strength and offering general relief to my post pregnancy body!

 

My weekly hour with Diane was genuinely one of my highlights of the week, both in terms of the physical relief as well as a mental break from my very busy life as a stay at home mum.  I really miss those sessions!

cta

I adhere to the following guidelines in my treatment and diagnosis of Pelvic Girdle Pain

European Spine Journal 2008 Jun; 17 (6) : 794-819.

European guidelines for the diagnosis and treatment of pelvic girdle pain.

Andry Vleeming, Hanne B Albert, Hans Christian Ostgaard, Bengt Sturesson, Britt Stuge

PMID: 18259783