Pain in the Pelvis During Pregnancy?
Find Relief with Physical Therapy
Have you experienced sharp pain radiating down your leg while climbing stairs or rolling over in bed?
Do you notice a grinding sound near your groin when walking?
Are you compelled to sit down due to pain when putting on leggings?
If you answered yes to these questions, you may be experiencing Pelvic Girdle Pain (PGP), specifically pubic symphysis pain.
There’s a common misconception that experiencing aches and pains during pregnancy is normal. While it’s true that pregnancy involves significant changes in the body as you nurture a growing baby over 40 weeks, these discomforts shouldn’t hinder your day-to-day activities. Pelvic floor physical therapy can play a crucial role in restoring function and alleviating pain during pregnancy.
What is Pubic Symphysis Pain?
Pregnancy affects the musculoskeletal system due to hormonal changes that cause ligament laxity, as well as postural and gait alterations. One of the most common complaints during pregnancy is pelvic girdle pain (PGP) and/or low back pain (LBP) (1). Both LBP and PGP can occur simultaneously or separately. PGP is characterized by pain in the joints between the hips and lower gluteal region, sometimes extending down into the knee. (2). Symptoms that radiate to the front of the pelvic are referred to as Pubic Symphysis Pain. PGP typically arises in the first trimester, with over 20% of women experiencing pelvic pain in either the front or back. Pregnancy poses a risk for PGP.
Signs and Symptoms of Pubic Symphysis Pain (PSP) :
Symptoms can often overlap with LBP but some distinct symptoms for pubic symphysis pain tend to occur with walking, standing on one leg, carrying heavy items, going up and down stairs or rolling over in bed. Some women may even have pain while standing. Pain is intermittent with occurring in the groin or in the front or inside of the thigh. Some individuals have severe pain needing to use a walker or cane to help walk. Pelvic floor physical therapy can help differentiate if you are experiencing specifically pubic symphysis pain vs. LBP vs sacroiliac joint pain.
Role of Pelvic Floor Physical Therapy in Managing Pubic Symphysis Pain
As mentioned earlier, pelvic floor physical therapy plays a crucial role in managing pubic symphysis pain. The primary focus of physical therapy is to restore function, alleviate pain, and enhance pelvic stability. Through a thorough assessment and diagnosis, physical therapists can pinpoint the underlying cause of discomfort during pregnancy. We have the tools to differentiate between common complaints such as low back pain, pubic pain, or sacroiliac joint (SIJ) pain.
Since every individual is unique, creating a personalized treatment plan tailored to your specific needs is imperative. While there are certain common exercises and manual techniques that can be beneficial, it’s essential to identify what works best for you.
Additionally, physical therapy can aid in pain management, educate you on strategies to navigate the ever-changing pregnant body, and recommend specific external support belts if necessary.
Seven Movements to Approach with Caution
As the body undergoes changes, adopting movement strategies to alleviate pain and restore function becomes crucial. Below are common movements that may need to be approached with caution or avoided, depending on the discomfort you are experiencing:
Lunges (forward or lateral)
Crossing leg
Single-leg stance (i.e putting on pants or slipping into a shoe)
Going up and down stairs (sideways movement may alleviate discomfort)
Getting out of a car one leg at a time
Rolling over in bed with legs separating
Lifting heavy objects in a wide squat
Being mindful of these movements can help reduce strain and discomfort, promoting comfort and mobility during pregnancy or periods of pelvic discomfort. Always listen to your body, if it doesn’t feel right, don’t do it!
Life-style modifications, self-care strategies and exercise:
During pregnancy, implementing various strategies, adjusting lifestyle, and incorporating appropriate exercises can help manage symptoms throughout the 40 weeks. Altering movements during daily activities can alleviate pain, particularly when the legs are spread too far apart. A helpful guide is to maintain a neutral posture in the lower extremities when performing a task. For instance, instead of swinging one leg off the bed at a time, keeping the legs together can reduce separation-induced pain.
External support tools, such as a sacroiliac joint (SIJ) belt, can provide relief by offering slight compression around the pelvis. Placing a pillow or wedge between the legs while sleeping promotes a neutral spine and aids in maintaining leg alignment when rolling over in bed. During these periods, adopting a slower pace and being mindful of movements can be beneficial. Opt for slow, small steps while walking instead of rushing down the hall. Taking breaks throughout the day can also alleviate discomfort and minimize irritation.
Exercise plays a vitalital role in rescuing pubic symphysis pain. Engaging the deep trunk muscles and pelvic floor muscle through functional movements and exercise fosters stability around the pelvis, promoting greater comfort and mobility.
Will pelvic girdle pain, including pubic symphysis pain, affect labor?
Experiencing pubic symphysis pain can raise concerns about its impact on labor. In an article by Bhardwaj, A. et al., six management principles during labor are described (3):
Labor position: Finding a position within a pain-free range when legs are separate (i.e. abducted). This position should be explored in sitting, laying down and side-lying positions and communicated to the delivery team.
Using epidural or spinal techniques is not contraindicated for birth.
Attempting a spontaneous vaginal delivery may be the preferred option, but if severe pain is experienced, induction may be warranted.
If an assisted device is necessary, being in a side-lying position on the left side is recommended to help reduce pain.
If a c-section is required for any reason, women may experience a longer recovery period and require additional pain management.
Pelvic Floor Physical Therapy should be recommended to manage residual symptoms in the postpartum period.
Pregnancy brings many changes, but it can also bring discomfort, especially in the pelvic region. Pubic Symphysis Pain is a common complaint among expecting moms. If you are experiencing sharp pains in your pelvis, difficulty walking or moving, or discomfort when changing positions it could be pubic symphysis pain.
Pelvic floor physical therapy can be a game-changer in managing your pain.
With targeted exercise, gentle manual therapy, and education, your pain can improve during movements and restore function throughout the remainder of your pregnancy.
🚨If you have any health concerns or pre-existing conditions, consult with a health professional such as a pelvic floor physical therapist before attempting a new exercise and/or manual treatment. This blog is for educational purposes only and is not intended to treat or diagnose any medical condition. 🚨
Dr. Susan Miller PT, DPT, is a licensed pelvic floor physical therapist and the owner of Lotus Core Physical Therapy in Colorado. She welcomes both in-person and telehealth appointments for Colorado residents, as well as coaching calls for clients residing out of state.
Book at www.lotuscorept.com
References:
Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low Back Pain and Pelvic Girdle Pain in Pregnancy. J Am Acad Orthop Surg. 2015;23(9):539-549. doi:10.5435/JAAOS-D-14-00248
Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008 Jun;17(6):794-819. doi: 10.1007/s00586-008-0602-4. Epub 2008 Feb 8. PMID: 18259783; PMCID: PMC2518998.
Amit Bhardwaj, Kavitha Nagandla, Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management, Postgraduate Medical Journal, Volume 90, Issue 1066, August 2014, Pages 450–460, https://doi.org/10.1136/postgradmedj-2013-132377
