What is pelvic girdle pain?? Pelvic girdle pain is usually pain or discomfort associated with something going one at one of the pelvic joints: pubic symphysis towards the front; the two sacroiliac joints on the back; or even the sacrococcygeal joint by your tailbone. The pain is usually experienced with a single leg, shifting weight from one side to the other, or pivoting type movements. The pain can be sudden and sharp, then linger, making moving around challenging.
Sometimes the prognosis is “well, once you’re not pregnant anymore it will go away,” which is not helpful. It is defeating to think that there is nothing that you can do other than suffer through it for however many weeks or months are left of your pregnancy!
It’s important to note that pelvic girdle pain can be really complex. Maybe a muscle is shortened more on one side than the other and is pulling unevenly on the joint, inhibiting form closure. The muscles that support the joints may be weakened or imbalanced, allowing for extra movement, or not enough movement. So, it could be a mobility issue; it could be a strength issue; it could be a coordination issue… you can see how it can be complex.
The pelvic girdle joints outside of pregnancy have very little movement, but they do move. During pregnancy, there is an increase in the hormone relaxin that allows there to be more movement in the joints. This is important because we want the pelvic joints to have more displacement so that your baby’s head can more easily fit through the pelvis for birth. The extra movement allows there to be greater diameters within the various levels of the pelvis. But, if we do not support that extra movement with increased strength and balance, we may find that we have pelvic girdle pain.
How can we address pelvic girdle pain??
While there is no one solution for everyone, we can approach supporting comfort during pregnancy and help you continue to move with little to no discomfort as much as possible.
1. Mobility
There is so much to mobility! We need to find out where the uneven pull or tension may be and try to resolve it. Maybe it’s your posture from front to back; do you tend to arch excessively in the low back where the belly hangs out? This could be causing more of a pull in the SI joint area, causing your discomfort. We could address mobility with releasing the hip flexors, quads, and lats. Or do you tuck your butt underneath and favor a sway back posture? If so, we may want to address releasing the glutes, hamstrings, and core.
Maybe your pelvic floor has tension, or uneven tension that is causing an uneven pull on the joints. Seeing a pelvic floor physical therapist can be incredibly helpful if you have any pelvic girdle issues!
Or maybe it’s your pelvic positioning from side to side, or even how it torques! See the video below on the hip airplane. When you open the hip, you should feel more of a stretch in the hip flexor area. Then rotate, bending in the standing leg, to feel more of a stretch in the glutes. Option to hold onto a supportive beam or structure.
2. Strengthening
After we have address mobility, we can focus on strengthening. For pelvic girdle stability, we find that strengthening the myofascial slings tends to be the most helpful. We have had a lot of success with both our in-person and online clients with incorporating these myofascial slings into our programming. The myofascial slings cross the pelvic girdle and support it from various directions. The anterior oblique sling runs from the oblique to the opposite adductor (inner thigh), supporting the pubic symphysis. The posterior oblique sling runs from the lat to the opposite glute, supporting the SI joints. Then we have the lateral and deep longitudinal slings that support vertically along one side.
If we can strengthen the neuromuscular connection of these slings, we find that the coordination of the supporting muscles helps to stabilize the joint = less pain/discomfort.
We have a 3-week pelvic stability accessory program that utilizes exercises focused on the myofascial sling. This program can be used as a stand-alone program or as an accessory program to add to your current workout routine as prehab during pregnancy or the postpartum period.
Here are a few examples of myofascial sling-focused exercises. The pallof split squat with rotation focuses more on the anterior oblique sling, while the reverse lunge row focuses more on the posterior oblique sling.
3. Support
If moving with one leg is painful, we need to increase the support. This could include wearing a pregnancy belt or belly support. It is important that any pregnancy belly support device that you wear allow the belly to move freely, should be flexible, and allow you to breathe normally. If it is rigid or prevents your belly to expand, it can be causing more issues than helping.
Next, we can increase support by focusing on diaphragmatic breathing and coordinating our breath with movement. When we inhale, we inhale down and out. You should feel an expansion and stretch of the abs, back, and pelvic floor. When we exhale, we exhale up and in. You should feel a contraction or muscular activation of the entire core. On exhales, we can also completely relax. Learning to coordinate our breathing and then sync it to movement can be helpful with stabilization.
When we are moving against gravity, or in the more challenging part of the lift, we want to exhale. Think coming up out of the squat; lifting the weight from the floor; picking up your kid. Those would all be times when we would want to exhale.
When we are moving with gravity, or in the eccentric portion of the lift, we want to inhale. So when you are lowering the weight back to the floor, putting your kid down.
And then finally, we can adjust our stance in our movement to increase support. If single leg movements are difficult, we have a few options. We can hold onto something to take the effort out of the lower body, such as holding onto a squat rack as you step up on a box. Then we can decrease the movement, such as a lunge to a split squat. And then we can even the stance, such as lunge to squat. Watch the video below for some more ideas.
Pelvic girdle pain can be managed during pregnancy and postpartum. There is no reason that you need to just wait until your baby is born to feel comfortable and pain-free. Pregnancy and motherhood are not a reason to suffer. We hope to help you move comfortably and with strength throughout your entire pregnancy and motherhood journey.
All of our prenatal and postpartum fitness programs incorporate pelvic stability-focused exercises and offer intentional progressions for each phase of motherhood. Our prenatal program is synced to your week of pregnancy, so you can start at any time. The final two months taper in preparation for birth. Our postpartum program gradually helps you return to your sport of choice: general fitness, weightlifting, running, and also C-section-specific recovery.
You can work with our pelvic floor physical therapists in person or virtually in a group setting for only $20! If you have pelvic girdle pain, you do not need to suffer! We are here to support.