Pelvic girdle pain and Symphysis Pubis Instability
You might also be interested in Frequently asked questions about massage and pregnancy which has some practical tips. Shiatsu and massage can help support you and as pelvic girdle instability expresses itself differently for different women your therapist can support you to work out the best approach for you.
Testimonial: Shiatsu helps with SPD (pelvic girdle pain)
“I went to see Hannah Mackay with SPD (Pelvic Girdle Pain) in my second pregnancy. I had problems with walking any distance over a few minutes without resting, and was in a lot of discomfort, sitting, standing. The pain and discomfort were causing me a lot of anxiety as I was only half way through my pregnancy and was worrying about being able to look after my two year old and how long I would be able to work into the pregnancy. The day before my first appointment with Hannah I had had a panic attack (my first) which I feel was caused by my increased anxiety levels, caused by the pain.
After my first session, I immediately felt clearer headed and got my sense of ‘self’ back which had become a little bit lost. I wasn’t in anywhere near as much discomfort and felt able to move more easily than before. I had another two sessions after this, both before week 30 – although I still wasn’t able to walk very far for the remainder of my pregnancy, the shiatsu definitely helped me to feel more together both mentally and physically, significantly eased my discomfort and gave me a clear head to plan in spite of and accept my physical limitations. Unfortunately I don’t think that shiatsu for SPD is known about widely, but I recommend it and Hannah to any pregnant women suffering from it I come across. Natalie Q”
What is it?
Essentially what it says: pain in the pelvic area.
In every pregnancy there is a natural increase in the mobility of the pelvis due to the softness of tissue under the influence of pregnancy hormones. This helps create space for your baby. As your baby puts on weight your pelvis has to work harder. The main joints of the pelvis are the sacro iliac (the two bones at the base of your spine and the. symphysis pubis – pubic bone joint – right in the middle at the front.
For many women, these changes do not cause any discomfort, For others they can experience extreme discomfort which may even begin in the first trimester, as already hormonal changes begin or it could be that they have a weaker pelvis caused by a previous pregnancy or birth.
What are the symptoms?
The symptoms are a pain which can be on-going or sudden and felt in the pubis, groin, inside of thighs, either on one side or both. It is frequently accompanied by low back, sacro iliac and pain just above the pubic bone which can be mild or severe . Of course, there are many other things which can cause these symptoms e.g. repetitive kicking from your baby in the womb, stretching of the uterine ligaments. What often helps identify the pelvic girdle weakness is that there is often a more specific symphysis pubis pain or pain in the sacro iliac which has a burning sensation..
What can make it worse?
What makes it worse are any activities or movements which involve opening the hips i.e. turning from side to side in bed at night, breast stroke swimming (legs), squatting. Walking and all weight bearing activities can aggravate it. The problem is that in its early stages the pain may not be felt while doing these activities, only several hours later so the connection is not always made. Symphysial “clicking” or grinding may be audible and can be felt by the woman. There is a characteristic waddling gait. Some people confuse it with urinary tract infections because of the burning pain, but with UTI’s the pain is more internal.
It can come on gradually in pregnancy, usually in the last trimester with a first pregnancy. It can appear from 20 weeks and usually starts early in a second or subsequent pregnancy. It can be caused by labour usually by being in stirrups for extended periods.
What is it caused by?
The numbers of women experiencing this problem are growing. I think that it is caused by modern lifestyles which mean we are sat down at desks a lot more, driving around rather than walking. This means that our muscles are less toned/strong and therefore support the whole pelvic girdle less effectively during pregnancy. I also feel that there is a stress link. Women who are working outside the home during pregnancy are not always able to rest as much as they need to and the body copes less well with the physical demands of the pregnancy.
The other group of women who tend to suffer are those who did excessive amounts of hip opening exercises while young e.g. gymnasts or ballerinas. Women who have suffered from any kind of pelvic injury are also more likely to suffer as in these cases there is usually a slight displacement of the pelvis which means that the symphysis pubis is placed under an unequal stress on one side.
What should I do?
If you suspect that you have any of the symptoms, then avoid, as much as possible, for one week any movements where you part your legs. If turning in bed at night try and keep your knees together as much as you can. It is best if you can to turn over by rolling into all fours and then lying on the other side. Try to minimise for this week the amount of walking and lifting that you do. If you notice a difference, then the chances are you have symphysis pubis diastasis and then continue in this way. You need to find the pain free gap. For some women this means pretty much keeping your legs together most of the time, especially when changing position. For others, the legs can be a little apart, however not more than hip width. If you notice no difference, then it is probably something else.
As it is caused either by lack of exercise or excessive exercise, then correct exercise is important. Do some back and abdominal strengthening exercises, to give support to the pelvis. You must make sure you are only doing movements which don’t involve moving your hips apart and where your knees are close together. A good exercise is the yoga cat stretch.
As stress is also a factor, having some form of bodywork which can relax you, as well as addressing the physical problems is extremely helpful. Shiatsu is excellent. You may also like to try massage or acupuncture. The therapist can include techniques which specifically support this condition by strengthening the area of weakness, structurally and emotionally.
If you do need to walk distances or have a toddler you can’t avoid picking up much, then you can ask your midwife to refer you to an obstetric physiotherapist who can prescribe a kind of tubigrip support belt which helps hold the pubic joint together. If you do get this, you must still follow all the above advice.
If you follow all this, the chances of having a relatively pain free pregnancy are high. You can not “cure” it, as the amount of relaxin increases until the end of pregnancy and your baby is getting heavier, but you can learn to be relatively pain free.
You can have a vaginal delivery but you must make sure that you labour and ideally deliver if possible in the all fours position, keeping your knees as close together as you can. Avoid stirrups if at all possible. Often being in water is helpful as it gives support to your joints, but obviulsy you need to be careful how you get in and out of the pool. Discuss it with your midwife. Otherwise you can aggravate the problem and so it remains a problem postnatally.
If you have followed all the above advice in pregnancy and labour, you may well find that as soon as you have delivered there is no pain. You still need to be careful to avoid leg abduction movements for 4-6 weeks postnatally and then resume them gradually. In the first 4-6 weeks follow a gentle back/abdominal/pelvic floor strengthening programme. If you can, continue to have some shiatsu or massage from a trained specialist in maternity skills.