Pregnancy-Related Pelvic Girdle Pain: What’s the Deal and What Can I Do About It?
By Terri Robertson Elder @terri.elder.dpt and Kate Johnson @coach_katejohnson
Overview | Causes | Strategies
"Lightning crotch," also known as Symphysis Pubis Dysfunction (SPD) and/or Sacroiliac (SI) joint dysfunction, falls under the umbrella term pregnancy-related pelvic girdle pain, which we will call PR-PGP from here on out because that name’s a mouthful! Over the years we've come to understand that what we're dealing with is pain (rather than "dysfunction") in the joints, and so the condition's name has been changed to reflect that understanding. There is so much conflicting and outdated information out there about PR-PGP and what to do about it. We’d love to help you sort it out!
So, you’ve made it through the first trimester of pregnancy, and the nausea and fatigue have started to subside (kind of)... only now you get hit with pain. This might even be your second or third pregnancy and you never dealt with this the first time around! PR-PGP more commonly affects second pregnancies and beyond. The theory behind this timing is you quite often have other children that need care, and your nervous system is in a heightened state of alert. Your sleep is likely not optimal. Read on…
PR-PGP: Overview
Pregnancy-related pelvic girdle pain is pain that occurs in the regions of the pelvic joints in the front at the pubic bones (just above your vulva, which is why it's called lightning crotch!) or on either side of your low back where your spine meets your pelvis (sacroiliac joints). It is most common to have pain during walking or with transitional movements, such as rolling over in bed. Pain can range from mild to debilitating.
PR-PGP is a prevalent condition with an incidence as high as 58% (Röst et al., 2004), with ~20% of pregnant individuals reporting severe symptoms. The causes of pregnancy-related pelvic girdle pain have not been clearly established and are still being debated and researched. However, it is believed to be related to a combination of factors including hormonal, biomechanical, traumatic, metabolic, and genetics.
PR-PGP: Causes
Why is it important to think about the causes of pain? We've seen firsthand how wrapping your head around what is taking place in your body can either help alleviate or worsen your pain.
But first, we need to bust a few myths!
MYTH #1: Your pelvis is “unstable.”
While it’s true there are a lot of biomechanical changes during pregnancy, research shows that the pelvis is stable, even during pregnancy! (Vleeming et al., 2008, Damen, 2001) This is important — the fear of instability or being misaligned can be harmful, causing individuals to change or altogether avoid movement and to have increased muscular guarding. Ironically, this change in movement patterns and avoidance of movement can generate more pain.
MYTH #2: The hormone relaxin is to blame for your pain.
While you may have heard that a hormone called relaxin is at fault, the link between relaxin and PGP during pregnancy has not been supported by research literature (Bhardwaj et al., 2014, Kanakaris et al., 2011). While hormones do play a role in pain, it’s not as simple as that. For example, the risk of developing PR-PGP is higher for second pregnancies and beyond, but the hormonal profiles are the same as for first pregnancies, so blaming symptoms all on hormones does not hold up.
So why does pain/symptoms seem to be worse in second (or third, fourth, etc.) pregnancies? Think about what may be different. You likely have other children to care for, which means all sorts of things…
Your sleep schedule is not ideal (to say the least!).
Your stress levels are a lot higher, and your nervous system responds accordingly.
You don’t have as much time for self-care (movement, bodywork, etc.).
There are different physical demands (those toddlers are wiggly and can get really heavy!).
Pain is often a result of many factors, not just one thing. We want you to be aware of how sleep, stress, and nutrition play a role in pain because these are important tools for reducing and resolving your discomfort. Some other risk factors for developing PR-PGP are work dissatisfaction and believing you will not improve. Our thoughts and mindsets matter!
A few other MYTHS:
Myth: Moving less and keeping your legs together will reduce pain.
Busted! Moving more and in different ways is often helpful for pain.
Myth: Support belts need to be worn by everyone.
Busted! Support belts only seem to help about half the time, and when they do, they aren’t improving “stability” but rather helping turn your alarm system down.
Myth: Your pain won’t get better until you stop lactating.
Busted! Lactation (breastfeeding and/or pumping) actually seems to be protective because of global anti-inflammatory effects (Bjelland et al., 2015).
These widespread myths were based in well-intentioned theories that have not been supported by research. It’s time to move ahead!
PR-PGP: Strategies to Help
The pregnant pelvis is STABLE and ADAPTABLE.
Please keep in mind these are simply options to try. There isn’t (unfortunately!) one perfect recipe for movement or one perfect recommendation that will help everyone. Try different things, see how they feel for you, and please don’t hesitate to seek individualized help from a pro if you have the access and resources.
General Strategies
Lifestyle management: sleep hygiene, tech hygiene
Aim for good quality sleep, keeping as regular hours as possible and avoiding your phone before bed.
Movement snacks!
🔑 What is a “movement snack”? This strategy refers to adding in some movement throughout the day (rather than saving up all your movement to have one larger “meal”). Try 5 minutes or so of movements from the options that follow in the “Calm It Down” and “Build It Up” sections. You may consider trying to “snack” a few times a day (or more if you’d like), especially if you are in a more sedentary role. Even if you are running around, movement snacks throughout the day can be a focused way to reduce pain and keep you moving. Motion is lotion!
Nervous system health, mindfulness, stress-reduction, emotional support
General cardiovascular exercise (150 min/week, 20 minutes most days): studies show it has an equal effect as taking an over-the-counter pain medication.
I know, easier said than done! Do your best to find something that works for you, and reach out for support if needed.
Posture: Postural changes during pregnancy are normal adaptations and have not been linked to pain. At the same time, changing postures throughout the day can be helpful.
Your best posture is your NEXT posture!
New/different movements: find different ways to move, not because you are moving incorrectly, but because the body loves variability.
Try different ways of moving in bed, different customizations for exercise, go by trial and error to find what works for you.
🔑 Sometimes we need strategies that are a bit more specific to our condition/pain levels. “Calm It Down” and “Build It Up” are not necessarily two distinct phases. If your pain is mild, you may focus on more from the “Build It Up” category, whereas if your pain is more moderate, you may choose more from the “Calm It Down” and work towards the “Build It Up” options as you are able. If your pain is severe, please consider seeing a professional for individualized guidance and support. We suggest choosing a few movements to explore as a movement “snack” during the day, as a part of a warm-up or cool-down, or with some of the “Build It Up” options as a focused PGP session. You might spend 30 seconds to a minute (or longer if it feels good!) exploring each stretch or movement and then switch sides.
Calm It Down Movement Strategies
Bed Mobility: While some like having a pillow between the legs for rolling, this may not be comfortable for everyone. Some prefer to allow the legs to “butterfly open” during movements, with support from hands if needed. Try different things and see what feels best.
Elevated Figure 4 or Reclined Figure 4
Build It Up Movement Strategies
Banded Lateral Walk (degrees of band placement)
Bird Dog (arms only, legs only, arms and legs)
➜ See Part 2 of this blog series for more detailed information on programming and strategies!
When to See a Professional
Many people think that pain should be an expected part of pregnancy. While some discomfort and physical changes are to be expected, pain that limits your ability to function in your daily life (including being able to exercise!) is not something that you “have” to accept, and there are often many things that can be done to help. If you have the resources, time, and access, you could seek professional guidance at any time. We encourage you to seek help if you are moderately to severely impacted, recognizing that not everyone has the same resources.
Additional Resources
Podcast interview with top PGP researcher Dr. Sinead Dufour
Products
Taping
Taping is low risk and may be helpful for some
Kinesiotaping article
Support belts
Support garments
SRC Health (many types of garments available including over/under bump, short and long leggings, postpartum recovery shorts and leggings)
Our goal is to provide you with strategies to ease your symptoms and to stay as active as possible across your pregnancy and postpartum journey. As always, the information provided is not a substitute for medical advice. If your pain is significantly impacting you, please speak to a provider such as your OB/Midwife and/or a pelvic health physical therapist if you are able to access care. If you need support with your workouts, please reach out to mamas@streetparking.com.