20100730 0473 pi(ds)pregnancyrelatedpelvicgirdlepaini

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A guide for you and your relatives

Pelvic Girdle Pain(PGP)


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There are a number of factors that can cause pelvic girdle pain(PGP) These include:

thepelvicgirdlejointsmovingunevenly

weaknessofthepelvicfloorandtummymusclespriortoandduring pregnancy

apreviousfalloraccident

hormonechangesduringpregnancy.

These factors can cause pain in the back, pubis, groins, thighs orlower abdomen.

Sometimes if you have a previous history of back pain or pelvicinjurythiscanbeariskfactorfordevelopingPGP.Otherfactorsincludemorethanonepregnancy,ahard,physicaljobor awkward working conditions, PGP in a previous pregnancy,beingoverweightandincreasedmobilityinyourjoints.

ADVICE

Rest

You may need to REST more often but be as active as the

pain allows. Tell EVERYBODY who deals with you about yourcondition e.g. midwife, GP

Pelvic Girdle Pain(PGP)

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Sacro-iliac

Symphysis pubis


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Record this in your hand held notes and make sure the midwifein the labour suite is aware of your condition.

In severe cases caesarean section may need to be considered butthis will have to be discussed with your consultant and thereis no evidence to suggest that there are better outcomes thanwith vaginal deliveries.

FOLLOWING THE BIRTH

Your pain may not resolve immediately after delivery. Give ittime to settle, following the advice previously detailed. If youhave had no improvement four weeks postnatally you maywish to seek a referral from your GP to physiotherapy for anassessment and treatment.

donotbeafraidtoaskforhelp.Youshouldgetasmuchrest as possible recruit your partner, relatives or friends!

ifyouarestillinpainwhileinhospitalaskthedoctorforsome anti-inflammatory medication and analgesics beforegoing home

startdoingyourstabilisingexercisesassoonaspossible avoidheavyliftingandtwistingforthefirstfewmonths

premenstrualrecurrenceiscommonlyreportedsobecarefularound this time.

You can get further information from the:

Association of Chartered Physiotherapists in Womens Healthwww.acpwh.org.uk (click on Publications, then Leaflets and thenyou can print a copy of Pregnancy Related Pelvic Girdle Pain forMothers-to be and New Mums). There are other useful leaflets

to look at too. Pelvic Partnership www.pelvicpartnership.org.ukTel 01235 820921.

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Youcanalsodotheaboveexercisesonallfoursthiswillinvolve the spine a little more.

On all fours, hands slightly in front of shoulders, knees below

hips and feet hip distance apart, round your spine, tucking yourbottom under. Then roll back the opposite way so that you stickyour tailbone up in the air. Repeat this sequence up to 10 times.

DURING LABOUR AND DELIVERY

Make sure that everybody who deals with you knows about yourcondition.

Try to keep separation of the legs to a minimum.

Adopt a comfortable position in all stages of labour, e.g. lying

on the left or right side, kneeling upright with support fromcushions or a partner, or standing leaning onto a high bed. Youcan also use the birthing ball during the first stage, rocking andbouncing gently.

DO NOT place your feet onto your midwife/partners hips orshoulderstopushasthisputsexcessivestrainontothepelvis.

If your legs need to go into stirrups it is important that someone

lifts and lowers them TOGETHER. You should be in this positionfor as short a time as possible.

It is important to remember these points even if you have anepidural and are not aware of any pain.

You may find it useful to measure your pain-free gap as youapproach labour. Lie on your back, knees bent, feet flat.

Allow your knees to fall apart gently and measure the distancebetween your knees at which you are no longer comfortable.

Pelvic tiltingon all fours


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DURING PREGNANCY

ifnecessaryyoumaybereferredtoaspecialistphysiotherapist for assessment and treatment

youmayneedtowearapelvicsupporttominimisepelvicdiscomfort. If the pain is severe you may need some helpwith walking e.g. crutches, or advice about pain relief

minimisenon-essentialweightbearingactivitiese.g.shopping, lifting and carrying. Be particularly careful if youhave a young child you should avoid carrying them on onehip

toliftcorrectly,bendyourknees,keepyourweightevenlydistributed through both legs and your back fairly straight.Try to keep the load close to your body

sitwithyourweightequallydistributedthroughbothbuttocks and stand with both feet flat on the floor, avoidingshifting your weight to one side. Avoid standing on one lege.g. to get dressed

avoidstraddlemovementse.g.inandoutofthebathorcar,and low squatting

sleepingontopofaninside-outsleepingbagorwearingasilky nightdress may make it easier to turn over in bed andsleeping on your side with a pillow between your knees canmake your pelvis more level

consideralternativepositionsforintercoursee.g.lyingon

your side or kneeling on all fours ifswimmingtakecaregettinginandoutofthepool,andAVOID breast stroke.

STABILISING EXERCISES

itisimportanttoworkthedeepsupportingmusclesaroundthe abdomen and lower back to help stabilise the pelvis andspine. They will have to work during different functional

activities therefore it is important to practise them indifferent positions


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ifyouarelyingdownensureyouarewellsupportedwithpillows and have your shoulders higher than your hips, or lieon your side

ifyouaresittingmakesureyousituptall,withyourbacksupported

ifyouarestandinghaveyourfeethipdistanceapartandparallel.Keepyourshouldersbackandrelaxedimaginethere is a string from your head to your tailbone drawingyou up to the ceiling

attainamidwaypelvispositionbyrockingyourpelvis

backwards and forwards and finding the midpoint.

Once you have set your posture, you are ready to make yourstabilising muscles in the pelvic floor and lower abdominals dosome work.

Tighten your pelvic floor gently by squeezing around the backpassage, as if trying to stop yourself from passing wind, and at

the same time lifting the muscles at the front, as if trying to stopa flow of urine. Hold each contraction for up to 10 seconds andrelaxthenrepeatupto10times.

Now try to activate your lower abdominalmuscles.

Place your hands on your lower tummy,

thumbsandindexfingerscreatingadiamond shape between your belly buttonand pubic bone.

Rock backwards Rock forwardsFind the midpoint and try to maintain this upright position


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Try to draw your tummy away from your hands, gentlytightening the lower abdominal muscles. Hold for 10 seconds;thenrelaxandrepeatupto10times.

You may be able to work both pelvic floor and abdominalmuscles together but if you are struggling try them separately.Try to get into the habit of tightening these muscles wheneveryou bend, lift or get out of a chair.

Points to Watch

Youmustkeepbreathingnormallyduringtheexercisesdonothold your breath. If you find this difficult, try to activate themuscles as you breathe out.

Trytorelaxyourshouldersandribcage.

Pelvic tilting

Youcantrythisexercisewhensittingorstanding.

Sit towards the edge of the chair (or gym/ birthing ball), feet

and knees hip distance apart.

Try to grow up as tall as you can, coming off your tailbone andsticking your bottom out. Then roll back onto your tailbonetucking your bottom under. Take care to keep your upper bodyas still as possible the movement should come from the pelvis.Repeat the sequence up to 10 times.

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Pelvic tiltingwhen standing

Pelvic tilting

when sitting


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Date of publication: April 2010

Date of review: April 2012

Ref: 0473-PI(DS)

The Pennine Acute Hospitals NHS Trustwww.pat.nhs.uk

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Our service

If you have any further questions about your condition,

treatment or procedure then please telephone

0161 624 0420 and ask to be transferred to the

ward/department you visited or were treated on.

If English is not your first language and you need help,please contact the Ethnic Health Team on 0161 627 8770

Jeeli angielski nie jest twoim pierwszym jzykiem i potrzebujesz pomocy prosz skontaktowa

si z zaog Ethic Health pod numerem telefonu 0161 627 8770.

For general enquires contact your local Patient Advice Liaison Service:

Fairfield 0161 778 2455 Rochdale 01706 517354

Oldham 0161 627 8678 North Manchester 0161 720 2707

20100730 0473 pi(ds)pregnancyrelatedpelvicgirdlepaini

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