How to treat post-partum pelvic girdle pain

women squatting with kettle bell

January 10, 2024

Pelvic girdle pain is a common condition during pregnancy, with the RCOG estimating it affects 1 in 5 pregnant women.  It is a common misconception that pelvic girdle pain resolves itself after birth; if you are reading this, you are probably one of the women who are still struggling with pain after birth. I often see these women in my chiropractic practice and know it can be very frustrating to be suffering with pain when you feel you should be enjoying your newborn baby. The good news is you CAN improve, and even eliminate, post-partum pelvic girdle pain.

Firstly, what is pelvic girdle pain?

Pelvic girdle pain is a term used to describe pain around the pelvis area and hips. It affects the joints at the back of the pelvis called the sacro-iliac joints, and the pubic symphsis at the front of the pelvis. Pelvic girdle pain can often be associated with pubic symphysis dysfunction (SPD). I go into more detail on SPD and how to manage it here.

What causes pelvic girdle pain?

The sacro-iliac joints and pubic symphysis are connected by ligaments, which provide support to the joint. During pregnancy, a hormone called relaxin is produced which increases the ligament laxity in preparation for pregnancy and birth. This ligament laxity can cause a slight increase in movement within the pelvis joints. If the muscles are not able to stabilise the pelvis instead, this increased movement can lead to pain in the joints. Changes in the posture during pregnancy as the baby grows also increases the pressure on the pelvic joints.

Pelvic girdle pain can affect anyone and everyone. However, you are more likely to suffer if you have had a previous injury to the pelvis as the ligaments are not as strong. You are also more likely to suffer if you are hypermobile, as this means the ligaments in the pelvis are already laxer than they should be. There are many different ways to help manage pelvic girdle pain during pregnancy; for more information, have a look at our pages on using a maternity belt, how to train with SPD and how to help rectus diastasis.

What is post-partum pelvic girdle pain?

Whilst a lot of pelvic girdle pain will resolve after birth, the Royal College of Obstetricians and Gynaecologists estimate that 1 in 10 women will have ongoing pain. Some of those women will walk into my Chiropractic office a few months after giving birth, with pain and difficulty moving around with their new born baby. Some of them will walk in when their children are 10 years old, having had recurrent pelvic pain since giving birth.

The symptoms of post-partum pelvic pain are similar those experienced during pregnancy.

  • Pelvic pain, sometimes extending into the bottom muscles and hips
  • Groin pain and pubic symphysis pain
  • Pain when walking
  • Pain when standing on one leg
  • Pain going up and down the stairs

The goods news is this pain can get better! I’ve seen it happen to many women in practice Keep reading to find out how.

What are the causes of post-partum pelvic girdle pain?

  1. Pregnancy– the increased laxity that occurs in the ligaments during pregnancy does not automatically go away after birth. This means the pelvic joints continue to move more than they should, which leads to pain and discomfort. Furthermore, muscles that are designed to stabilise the pelvis, such as your stomach and bottom muscles, have naturally been underused during pregnancy. This means they have become weaker than they were before.
  2. Birth -During birth, pelvic floor muscles can stretch up to three times their normal length! Trauma to these muscles can lead to pelvic pain in itself. Tearing or episiotomies during the delivery process can also lead to perineal pain and pelvic pain.
  3. Pelvic Floor Dysfunction- Weakened pelvic floor muscles from the birth can lead to stress incontinence, which can make day to day activities such as lifting, bending and exercising very difficult. The pelvic floor muscles play an important role in stabilising the pelvis. If they are weakened by birth trauma, it can make existing symptoms of pelvic pain worse.
  4. Separation of the muscle muscles– this is a common occurrence that happens in pregnancy. I’ve written a whole article on rectus diastasis here
  5. Lifting Baby– All of the factors listed above mean your body may be less strong and stable than it was prior to pregnancy and birth. But you now have to lift and carry your baby all day….not forgetting the car seat, the buggy and the nappy bag! This means we are asking the body to do more, but with less support than it needs- this is usually when the problems arise!

What is the treatment for post-partum pelvic girdle pain?

1. Pelvic floor exercises

Exercises to build up your pelvic floor can help to relieve symptoms of pelvic girdle pain and improve incontinence. The NHS website has some great advice on how to do your pelvic floor exercises . Alternatively, it is definitely worth speakign to your GP or seeing a specialist women’s health physiotherapist who will be able to make sure you are doing them correctly.

2. Strengthen your core and abdominal muscles

The most important thing to help resolve post natal pelvic girdle pain is to build up your muscle strength! Your core and bottom muscles are perfectly positioned to help to stabilise the pelvis, reduce movement in your sacro-iliac joints and relieve your pain. Whilst it may seem daunting to start exercising with a young baby, these exercises can all be done at home with minimal equipment. it is important to do these exercises 2-3 times a week to have the best chance of success. Remember, if you are new to exercising, or not sure if these exercises are right for you, please consult your GP first.

  1. Bridge
  • Lie on back with knees bent
  • squeeze bottom muscles and lift bottom off the floor until your back is in a straight line.
  • Do not over extend the back
  • hold for 3 s and relax. Aim to build up to 3 x 10 times

2. Oblique Muscle Contraction

  • Lie on back with knees bent. Place both hands on right knee.
  • Breathe in and, as you breathe out, push hands and knee together to activate your stomach muscle, the right knee may come off the floor as you do this.
  • Breathe in and out for 3 more breathes, then relax.
  • Repeat 5 times each side.

3. Leg Slides

  • Lie on back with knees bent.
  • Activate your stomach muscles.
  • Slowly straighten one leg out along the floor. Once you feel the back start top arch, don’t go any further as your core will switch off.
  • Bring leg back to neutral.
  • Repeat 5 time each side

4. Clam

  • Lie on side with knees bent.
  • Keep ankles together and open up knees like a clam.
  • Ensure you keep hips still.
  • Repeat 3 x 10 reps

5. Bird Dog

  • Start on hands and knees
  • Gently engage core and straighten out opposite arm and leg.
  • Try to keep the back level as much as possible.
  • Repeat 3 x 10 reps

These are the first level of exercises to get you started building up your strength. As you get stronger, you may need some more challenging ones.

3. Sacro-iliac belt

During pregnancy, you may have worn a pelvic girdle belt to help with the pain. There is no reason why you can’t continue to wear a SIJ belt whilst you continue to build your strength up with the exercises. Not sure which belt to get? Have a look at one of our posts about maternity belts. However, don’t let wearing the belt stop you doing the strength exercises- the belt is not a long term solution whereas the exercises are.

4. See a Chiropractor or Physiotherapist

Sometimes it’s good to have a helping hand alongside the exercises. Having hands on manual work by a chiropractor or physiotherapist can have huge benefits on your symptoms as they can help to relieve tight muscles and get your joints moving properly. Try to find a practitioner who has experience in pre and post natal patients.

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