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Pelvic girdle Pain (PGP)/ Symphysis Pubis Dysfunction (SPD)

In the UK it is estimated that one in five woman suffer with Pelvic Girdle Pain (PGP) during or after pregnancy (The Pelvic Partnership Charity).

PGP is the term now being used by the medical community to describe what was previously known as Symphysis Pubis Dysfunction (SPD). It is the name given to a group of symptoms arising from the joints at the front and/or back of your pelvis.

Common symptoms are;

  • Pain walking and standing
  • Difficulty climbing stairs
  • Pain and difficulty turning over in bed
  • Having to sit to dress
  • Pain getting in and out of the car or bed
  • Pain with squatting
  • Difficulty swimming breast stroke
  • Pain on lifting one leg to step over something

Previous falls or accidents as well as a sedentary job or lifestyle can weaken the muscles around the pelvis leading onto poor posture which could increase the chances of developing PGP.

Postural and hormonal changes do contribute to PGP. The most common postural changes are due to the bulk of the growing baby, the enlarging breasts and secondary weight gain. Hormones released during pregnancy cause softening and relaxation of the ligaments and joints. This creates more space for the growing baby but also make the pelvic joints and muscles more prone to injury and pain.

Pelvic Girdle Pain can be caused by irritation or inflammation of the joints of the pelvis, stiffness of pelvic joints on one side or laxity in the ligaments that provide the crucial stability to the pelvic joint complex.

The joints at which the problems occur are the Sacroiliac joints at the back of the pelvis and the Symphysis Pubis which is a fibrocartilagenous joint, joining the two pelvic bones at the front allowing it to form a ring. A dysfunction at the back can in turn cause pain and torsion at the front.

Pelvic Girdle Pain is aggravated by any movement that causes one side of the pelvis to move against the other, for example standing on one leg which results in a vertical (or up and down) movement of the Symphysis Pubis and Sacroiliac joints, or movements that cause each side of the pelvis to move in opposite directions which results in "gapping" movements of the Symphysis Pubis.

PGP brace picIn most instances symptoms and pain can be controlled both during and after pregnancy with manual therapy treatment such as Physiotherapy, Osteopathy or Chiropractic. A range of manual treatment techniques are suitable for treating musculoskeletal problems in the pregnant patient and can be used to provide comfort and pain relief. These techniques, along with sleeping advice, exercise and postural advice, provide pain relief whilst coping with the changes the body undergoes during pregnancy. Treatment aims to improve joint position and stability, however in some instances equipment such as crutches or a support belt will be recommended to help and aid the individual in walking more comfortably. Manual therapies provide a safe, gentle, drug free alternative for the relief of discomfort during pregnancy and can play an important role in ensuring that your body and spine are functioning normally. This can result in less pain for the mother to be and more room for the developing baby so that both mother and baby experience less physical and emotional stress.

The European Guidelines for the diagnosis and treatment of Pelvic Girdle Pain (2011) recommend an individualised treatment program, focusing on stability exercises and physical therapy in order to reduce symptoms of Pelvic Girdle Pain and improve function.

Unfortunately, a few women do have pain for a long time after birth, where manual therapy has not been successful. This however is a small minority.

Prolotherapy may help where women have had long term problems with Pelvic Girdle Pain after pregnancy, despite having courses of manual therapy from experienced and skilful practitioners. The reason that the pelvis cannot maintain its position once it is realigned may be due to a true instability at the pelvic joints, where the ligaments have been overstretched and cannot return to their normal tension and length. When the ligaments are weak and inefficient, pain can recur.

Prolotherapy is also known as proliferation therapy or regenerative injection therapy. It involves the injection of an 'irritant' solution into the area where connective tissue has been weakened or damaged through injury or strain. It appears to work by causing a local, inflammatory reaction which tightens up and strengthens the ligaments. It has been called the regeneration injection therapy because this method causes inflammation which stimulates the natural healing, growth and repair of tissue at site of damage and pain. These changes result in the deposition of new collagen which is the material from which tendon and ligaments are made. As the collagen matures it shrinks and this in turn tightens the ligaments so they appear to be stronger than before.

Prolotherapy treatment has been successful in treating chronic Pelvic Girdle Pain. The sessions required can vary depending on the severity of symptoms and the needs of the individual. Some have reported relief in pain after just one session. However, the average person requires more than one session of treatment.

Rarely, and only in very severe cases, surgery is necessary to resolve the instability of the pelvis seen in PGP.

Contributing Authors:
Shelley Doole DC MChiro

References
Andry Vleeming Æ, Hanne B. Albert Æ, Hans Christian O¨ stgaard Æ, Bengt Sturesson Æ, Britt Stuge. European guidelines for the diagnosis and treatment of pelvic girdle pain, Eur Spine J (2007).

Cara L. Borggren, Pregnancy and chiropractic: a narrative review of the literature. Journal of Chiropractic Medicine, Volume 6, Issue 2, June 2007, Pages 70-74

The Pelvic Partnership: providing support and information about pelvic girdle pain, < http://www.pelvicpartnership.org.uk>, July 2012