Pelvic pain is a common complaint during pregnancy, but it doesn’t have to be something you just endure until you give birth. In this blog post, we’ll delve into the causes, types, and potential solutions for pelvic pain during pregnancy.
Pain is NOT a requirement of pregnancy–and the only solution to pain relief is not birth–there is a lot we can do throughout pregnancy to find relief!
What is Pelvic Pain During Pregnancy?
Pelvic pain during pregnancy, often referred to as pelvic girdle pain (PGP), can manifest in different ways depending on the area affected. Two common types of pelvic pain include:
- Pubic Symphysis Dysfunction (SPD): Pain in the front of the pelvis, where the pubic bones meet.
- Sacroiliac (SI) Joint Pain: Pain in the back of the pelvis, where the sacrum meets the iliac bones of the pelvis.
Symptoms of SPD
SPD typically feels like a deep ache in the front of the pelvis. It can sometimes present as sharp, shooting pains, especially during movements that involve single-leg activity. This pain is often described as a grinding sensation in the pubic area, and it tends to worsen with specific activities, such as getting out of bed or walking.
Symptoms of SI Joint Pain
SI joint pain is usually felt in the lower back and can be more pronounced on one side. It often intensifies with movements such as rolling in bed, walking, or any activity that involves pivoting on one leg. This pain is sometimes confused with sciatic pain due to its location and intensity.
Causes of Pelvic Pain
Contrary to popular belief, elevated levels of the hormone relaxin, which increases joint mobility, do not directly cause pelvic pain. Instead, the primary culprits are often related to pelvic positioning and muscle imbalances.
1) Pelvic Positioning: How do the pelvic joints align to stabilize??
The pelvic position refers to the position which your two pelvic halves are oriented, and this can impact the form closure of the pelvic joints–how well the joints align to stabilize. If the pelvic position is “off” it can cause instability at the joint or sheering during movement–which can contribute towards pelvic pain.
During pregnancy, the increased levels of relaxin increase joint laxity or how much the joints can move–and now levels of relaxin do not equal to certain levels of pelvic pain, these increased levels of relaxin can cause you to “sink deeper” into your common postural tendencies, decreasing movement capability at the pelvic joint and impacting the pelvic position.
Common Pelvic Positions
Most people tend to favor a stance where the left hip is positioned slightly forward, and the right hip is pulled back. This habitual posture can lead to muscle imbalances and uneven tension on the pelvic joints, contributing to pain. Specifically:
- The right side often has a tighter glute and quad.
- The left side tends to have a tighter hamstring and adductor (inner thigh).
Strategies for Relief
Mobility Exercises
Mobility exercises can help release tight muscles and allow for better pelvic alignment. Some effective mobility exercises include:
- Adductor Rock Back: Focus on releasing tension in the inner thigh, which can help alleviate pubic symphysis pain.
- Foam Rolling: Targeting the inner thigh and hamstring can provide relief by reducing muscle tightness.
Strengthening Exercises
Strengthening specific muscles can help correct imbalances and support pelvic stability. The pelvis is pulled forward on the left side (anterior tilt) and backward on the right side (posterior tilt). This means the right glute/quad is not pulling enough (weaker) to counter the pull from the left side. The left inner thigh/hamstring is weaker compared to the right side. Because of this muscular imbalance impacting pelvic position, we may need to focus on one-sided strengthening.
For the Right Side:
- Glute Strengthening: Exercises like Bulgarian split squats and side-lying hip abductions can help.
- Quad Strengthening: Focus on exercises that target the front of the thighs
For the Left Side:
- Hamstring Strengthening: Exercises like Romanian deadlifts and single-leg deadlifts are beneficial.
- Adductor Strengthening: Copenhagen planks can help strengthen the inner thigh.
Pain with Single Leg Movements?? Try These Exercises!
For those who find single-leg exercises too painful, modifying bilateral movements to target specific sides can be helpful. For example:
- Squats with Resistance Bands: Use bands to add resistance in a way that targets the weaker or less active side.
- You can place the resistance band to emphasize left adductor activation, and right glute activation when doing the squats. This can strengthen the legs unilaterally but in a more supportive stance.
- Stationary Lunges: Using support, such as rings or a squat rack, to maintain stability while focusing on one leg at a time.
- You can continue to do single leg movements but add more upper body support by holding onto rings or a sturdy structure.
2) Muscular Coordination: How do the supporting muscles stabilize the pelvic joints?
Several myofascial slings support the front and back pelvic joints.
Myofascial slings are interconnected systems of muscles and fascia that help stabilize the body and facilitate efficient movement. These slings play a crucial role in maintaining balance, posture, and coordination, especially during dynamic activities such as walking, running, and lifting.
The primary myofascial slings include the lateral, anterior oblique, and posterior oblique slings. Each sling involves a specific set of muscles and connective tissues that work together to stabilize the pelvis and spine.
If the myofascial slings are not well coordinated (they activate at the wrong time or are too slow to activate), or not well balanced (one sling is stronger than another), then it can impact how well we stabilize the pelvic joints.
There are several myofascial slings:
- Anterior Oblique Sling: Involves the external oblique muscles, the opposite side’s internal oblique muscles, and the adductors.
- Posterior Oblique Sling: Involves the latissimus dorsi muscle on one side and the gluteus maximus muscle on the opposite side.
- Deep Longitudinal Sling: Includes the erector spinae muscles, multifidus, thoracolumbar fascia, and the sacrotuberous ligament.
- Lateral Sling: Includes the gluteus medius and minimis, tensor fasciae latae, IT band, adductors, and opposite QL.
Anterior Oblique Sling
Components:
- External Oblique: Located on the side of the abdomen, involved in trunk rotation and lateral flexion.
- Internal Oblique: Located deeper than the external oblique, assists in trunk rotation and lateral flexion.
- Adductors (primarily the adductor longus): Contribute to stabilizing the pelvis and controlling leg movements.
- Abdominal Fascia: Connective tissue linking the oblique muscles across the midline.
Functions: The anterior oblique sling stabilizes the pelvis and trunk during rotational and diagonal movements, essential for activities like walking, running, and throwing.
Exercises:
- Cable or Banded Upward Chops: Use a cable machine or band to perform diagonal pulling motions, engaging the oblique muscles and adductors.
- Diagonal Banded Pull Downs: In a half lunge or split stance position, rotate diagonally downward to activate the oblique to opposite adductor.
- Split Stance Marches with Rotation: This exercise helps engage the adductors and obliques to rotate.
Posterior Oblique Sling
Components:
- Latissimus Dorsi: A large back muscle involved in shoulder extension and adduction.
- Gluteus Maximus: A powerful hip extensor, crucial for movements like walking and running.
- Thoracolumbar Fascia: Connective tissue that transmits forces between the upper and lower body.
- Sacrotuberous Ligament: Connects the sacrum to the pelvis, providing stability.
Functions: The posterior oblique sling stabilizes the pelvis and lower back during movements involving hip extension and rotation, such as running and lifting.
Exercises:
- Bird Dogs: Engage the latissimus dorsi and gluteus maximus to stabilize the pelvis and spine.
- Single-Leg Deadlifts with Banded Row: Strengthen the gluteus maximus and enhance balance.
- Deadlifts: Activate the posterior chain muscles, including the latissimus dorsi and gluteus maximus.
- Lunge and Step Ups with Banded Row: strengthen the glute maximus and opposite latissimus dorsi.
Lateral Myofascial Sling
Components:
- Gluteus Medius and Minimus: Located on the outer side of the hip, these muscles are essential for stabilizing the pelvis during single-leg activities.
- Tensor Fasciae Latae (TFL): Works with the gluteus medius and minimus to stabilize the pelvis.
- Iliotibial Band (IT Band): A thick band of fascia running down the outside of the thigh, transmitting forces from the hip to the knee.
- Adductors (particularly the adductor longus): Located on the inner thigh, these muscles balance the forces on the pelvis.
- Contralateral Quadratus Lumborum (QL): This lower back muscle stabilizes the pelvis and spine on the opposite side.
Functions: The lateral sling stabilizes the pelvis and lower back during side-to-side movements and single-leg stance, crucial for activities like walking and running.
Exercises:
- Side-Lying Leg Raises: Target the gluteus medius and TFL.
- Lateral Band Walks: Activate the gluteus medius and IT band.
- Standing Hip Abductions: Strengthen the gluteus medius and TFL.
- Side Planks: Engage the quadratus lumborum and lateral core muscles.
- Copenhagen Planks: Strengthen the adductors, particularly the adductor longus.
The Deep Longitudinal Sling
The deep longitudinal sling provides stability for the posterior chain and is involved in transmitting forces from the lower body to the upper body. It includes:
- Erector Spinae: A group of muscles running along the spine, providing support and movement.
- Multifidus: Deep spinal muscles that stabilize individual vertebrae.
- Thoracolumbar Fascia: Connective tissue in the lower back, linking the erector spinae to the pelvis.
- Sacrotuberous Ligament: Connects the sacrum to the pelvis, stabilizing the sacroiliac joint.
- Biceps Femoris (part of the hamstrings): Transmits forces from the pelvis to the lower leg.
Exercises to Engage the Deep Longitudinal Sling:
- Deadlifts: Strengthen the posterior chain, including the erector spinae and hamstrings.
- Single-Leg Deadlifts: Target the deep longitudinal sling while improving balance and stability.
- Good Mornings: Engage the erector spinae and hamstrings.
- Bird Dogs: Stabilize the spine and pelvis while activating the multifidus.
- Romanian Deadlifts: Focus on the hamstrings and thoracolumbar fascia.
Pain is NOT a Requirement of Pregnancy!!
Pelvic pain during pregnancy is not something you have to endure until birth. By understanding the causes and employing targeted exercises, you can find relief and maintain a comfortable pregnancy. Myofascial slings play a critical role in stabilizing the pelvis and engaging them through specific exercises can alleviate pain and improve your overall well-being.
For more detailed guidance and exercise demonstrations, check out our podcast episode on pelvic pain and consider pre-ordering our book, “Training for Two,” which includes comprehensive sections on managing pelvic pain during pregnancy.
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