Pelvic girdle pain (PGP) is defined by pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joints (SIJ). Pain may refer to the posterior thigh and may also be present around the pubic symphysis (front of the pelvis). Approximately 20% of pregnant women suffer from PGP at some stage throughout pregnancy (Vleeming et al, 2008). Pelvic girdle pain can be caused by uneven movement of either side of the pelvis, decreased strength of core and pelvic floor muscles leading to increased pelvic instability, a previous fall which has affected the pelvis or muscles around the pelvis, or changes in hormones during pregnancy which affects the laxity of ligaments supporting the pelvis.

PGP normally causes pain with prolonged standing, walking and sitting. Activities involving lifting one leg at a time such as getting in/out of a car and turning in bed also tend to be quite painful. Pain can range from a mild discomfort to severe pain and disability during or after pregnancy. In severe cases some sufferers have required crutches to help ease pain with walking. Pelvic girdle pain can also occur due to trauma or reactive arthritis.

Risk factors for the development of PGP include previous lower back pain, previous PGP during pregnancy, general hypermobility, and strenuous work postures. It is important to address PGP in the early stages to prevent worsening of symptoms and increased pelvic instability. Below are a number of exercises which can help ease or prevent the symptoms of PGP:

• Transverse abs activations: This exercise can be performed in supine (if in early stages of pregnancy) or in 4 point kneel. Your back should be in its neutral position (small arch in your back). Imagine you are pulling your pelvic bones towards one another and hold this contraction. Make sure you maintain a relaxed breathing pattern as you do so. Aim to hold for 10 seconds and perform 10 repetitions.
• Pelvic tilting: In lying or 4 point kneeling, contract your abdominal muscles to tilt your pelvis backwards and flatten your lower back. Following this relax your abdominals and arch your lower back as you tilt your pelvis forwards. Repeat this 10 times.
• Bridging: Lying on your back with knees bent and feet hip distance apart. Tilt your pelvis backwards to flatten your back into the floor and then slowly peel your back, vertebra by vertebra away from the floor. Keep your upper back and shoulder blades resting on the floor. Coming down from the bridge position, lower your back again. Make sure your knees stay hip distance apart throughout the exercise.
• Squatting: This may be performed with your back against a wall to begin. Make sure the feet are hip distance apart with knees in line with second toe. Activate your transverse abs and slowly squat down until your knee is at a right angle. Make sure you keep your weight back on your heels to ensure you activate your gluts rather than just using your quads. Squeeze your gluts as you come back up into standing and repeat 10 times.

For optimum results and prevention of ongoing pelvic girdle pain and instability, it is important to be assessed and treated by a chartered physiotherapist. Hands on manual treatment can assist in easing pain and discomfort. Your physiotherapist can also provide you with a tailored strengthening program to ensure you are doing the correct exercises and not aggravating your condition. Taping and provision of a stability belt may also be suitable in some cases until strength and stability around the pelvis is improved.

If you are experiencing the symptoms of PGP, contact us here at Ballsbridge Physiotherapy Clinic, where one of our physiotherapists can asses you and provide you with an appropriate strengthening program.