Pregnancy-related Pelvic Girdle Pain (PGP)

What is PGP?

PGP affects one in five pregnant women to a great or lesser extent. It causes pain in one or all of the pelvic joints and surrounding muscles. In more severe (untreated) cases, women find their mobility decreases during and after pregnancy so that they need to use crutches or a wheelchair to get around. However, usually this can be avoided if women access good manual therapy treatment (hands on treatment) from a suitably qualified physiotherapist, osteopath or chiropractor as soon as they develop symptoms. This treatment is safe and effective at any stage during or after pregnancy - the sooner it is provided, the better.
Although women are often told that PGP (formerly known as Symphysis Pubis Dysfunction) is caused by hormones, up-to-date research shows that it is usually caused by a biomechanical pelvic joint problem. This is good news because it normally responds successfully to treatment from an experienced manual therapist. If it is not treated, PGP can sometimes persist for months or years after pregnancy.

What causes the pain?

The pelvis is made up of a ring of three bones which join at the two sacroiliac joints (at the back) and the symphysis pubis joint (at the front). The joints normally all move a little bit to allow you to walk, turn over in bed, climb stairs, etc. Often one joint becomes stiff and stops moving normally and this causes irritation in the other joints which have to compensate and move more or differently, so they become irritated and painful. This causes pain and difficulty with day-to-day activities.

Treating PGP

PGP can usually be treated effectively by 'hands-on' manual therapy from an experienced physiotherapist, osteopath or chiropractor. The therapist gently uses their hands to release stiff or ‘stuck’ pelvic joints to get the joints moving normally and symmetrically again, and to treat and relieve painful muscles.

PGP is unlikely to get better on its own without treatment although many women are erroneously reassured that this will be the case. They can then wait for months with severe pain before seeking treatment, and this may hinder their long-term prospects of a full recovery.

Early intervention with manual therapy can improve the long-term outcome and reduce pain. Individual assessment is important, looking at the position and symmetry of movement of the pelvic joints, to find out which joints are causing the problem. Often the joint causing the problem is not particularly painful, so treating the painful point is unlikely to sort out the underlying problem.

Manual therapy treatment involves a full assessment (or reassessment) of the pelvic joints at each session, identification of the joint causing the problem, and treatment to restore the joint's function. After each treatment the therapist will reassess the joints to check that the treatment has effected a change. Women should walk out of each treatment session feeling some improvement in either pain or function and preferably in both. If this is not the case it is worth seeking a second opinion. It is completely safe to treat women while they are pregnant without any adverse implications for the baby, and appropriate treatment can transform women's experience of pregnancy and birth by relieving the pain.

Is there a place for crutches and support belts?

Exercises, crutches, support belts and painkillers etc. can help alongside manual therapy but do not address the underlying cause of PGP pain so tend not to work in isolation. Often pain prevents muscles from working normally, so regardless of how much they are exercised, the muscles can’t function properly and so doesn't get any stronger. However, once the joints are treated with manual therapy, and move more freely (normally), and pain has reduced, exercise can be very helpful to strengthen the muscles supporting the pelvis.

What happens if PGP is not treated during pregnancy?

We sometimes hear from women who have been disabled by PGP for more than five years after giving birth because their symptoms of PGP have not been recognised and treated, as well as from women in their 60s and 70s who have had pain since having their babies. PGP can put a great deal of pressure on a young family and as well as physical problems, can bring additional social and psychological issues of a woman is housebound and she and her children become isolated from the wider community.

Further Reading:

The Pelvic Partnership

Written by Sarah Fishburn

Date: 09/2017

Reviewed by Nadia Higson

Review needed: 09/2019


AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.

Latest Content

Journal

« »

Book Review: Mothership by Francesc…

AIMS Journal, 2019, Vol 31, No 4 Reviewed for AIMS by Jo Dagustun Mothership By Francesca Segal Chatto and Windus, 2019 288 pages £14.99 ISBN 978-1-78474-269-0 Find this…

Read more

Book Review: Eleven Hours by Pamela…

AIMS Journal, 2019, Vol 31, No 4 Reviewed for AIMS by Emma Mason Eleven Hours By Pamela Erens Published by Tin House Books 2016 ISBN 978-1941040294 176 pages Publisher's…

Read more

Book Review: The Breast Book by Emm…

AIMS Journal, 2019, Vol 31, No 4 Reviewed for AIMS by Clara Hubbard, age 12 The Breast Book: A puberty guide with a difference - it's the when, why and how of breasts By…

Read more

Events

« »

NICE Annual Conference 2020

Registration for the NICE Annual Conference 2020 will open on 22 January 2020. For more details and to register your interest, please visit http://www.niceconference.org.…

Read more

IMUK National Conference 2020

The theme of IMUK's 2020 National Conference 2020 is The Science Behind The Art of Midwifery. Speakers to be announced and tickets will be released soon. Information is a…

Read more

Northern Maternity & Midwifery Fest…

The Northern Maternity & Midwifery Festival will be returning on Thursday 9th July 2020. There is a call for papers and award nominations are being accepted. For more inf…

Read more

Latest Campaigns

« »

AIMS' Response to Hull Daily Mail a…

AIMS has responded to the Hull Daily Mail's article entitled, " https://www.hulldailymail.co.uk/news/health/baby-born-bus-stop-shoelace-3571474 ". 26 November 2019 Dear E…

Read more

AIMS Response to NMC Consultation o…

The Nursing and Midwifery Council (NMC) plays a key role in the ongoing quality assurance and regulation of the maternity services and its staff. Effective and efficient…

Read more

AIMS Submission to the UN Special R…

Call for submissions: Mistreatment and violence against women during reproductive health care with a focus on childbirth The mandate of the United Nations Special Rapport…

Read more