Category: Assessment and treatment of PGP

PGP: it’s not about hormones

Were you told that pelvic girdle pain (PGP) is caused by pregnancy hormones? If you were, you aren’t the only one. This is an ‘old wives’ tale’ which is often believed by midwives and doctors and passed on to pregnant women.

Even though hormones are not the cause of PGP, it is surprising how many of us have been told by healthcare professionals that there is a link. Although this idea is now outdated, it is amazing how it still seems to continue. The Pelvic Partnership’s helpline regularly receives calls from women who are upset because they have just got the hang of breastfeeding and their GP has advised them to give it up in the (mistaken) belief that it will help their PGP to improve. The idea is that continuing to breastfeed keeps stimulating hormones to produce milk which also causes the PGP. Not only is this notion of a causal relation wrong, but it can be very upsetting if not deeply damaging when women then stop breastfeeding only to find that it makes no difference at all to their PGP symptoms which continue just as they did before they stopped. Clearly, the breastfeeding hormones are different from the main pregnancy hormones, which makes it difficult to understand the logic behind this particular myth!

Before we spill the beans on what really causes PGP, it might be a good idea to cover some basics about PGP and its common symptoms…

What is PGP?

PGP (Pelvic Girdle Pain) is a condition which affects up to 1 in 5 pregnant women. It was commonly known as SPD (Symphysis Pubis Dysfunction), but this implies that only the symphysis pubis is affected, which is not usually the case. This is one of the reasons why it is now known as ‘pelvic girdle pain.’

There is a wide range of symptoms and the severity also varies between women. So how you experience it may not mirror the symptoms of a friend although you might both have PGP. It is important to remember that PGP is a common, treatable condition. It can be safely treated at any stage during or after pregnancy (i.e. treatment won’t harm your unborn baby). The main symptom that women report with PGP is pain while walking, bending, climbing stairs and turning over in bed. This means that it affects virtually everything you do in a day, and therefore has a major impact on your life. This pain can be an ache, a sharp shooting pain or a deep muscle pain. You may also have a clicking or grinding feeling in your pelvic joints or in your hips.

Does PGP occur only during pregnancy?

Again your symptoms may differ from someone else’s. PGP may come on suddenly, or start gradually. Sometimes women are told that the symptoms will disappear as soon as the baby is born but sadly this is rarely the case. It can also occur during birth – usually this happens if you have a difficult birth or are in an awkward position for labour or birth. It may also start after birth, sometimes weeks or months later. Whatever the cause and whenever it started, PGP is assessed, managed and treated in the same way.

So if hormones don’t cause PGP, what does?

Instead of being caused by hormones, the root problem with PGP is biomechanical – the usual free movement and smooth functioning of your body is disrupted by a problem. Although women are often told that PGP is caused by their hormones, up-to-date research shows that it is usually caused by a pelvic joint problem. Ahead of looking at what goes wrong, it may be best to explain what happens when your pelvis is functioning normally.

The pelvis is made up of a ring of three bones. They join together at the sacro-iliac joints (at the back) and the symphysis pubis joint (at the front). These joints normally have a little ‘play’ between them so that they move a little bit to allow you to walk, turn over in bed, climb stairs, etc. However, the three bones in this ring should work together closely and in harmony. In PGP the usual unity between these joints goes wrong and they stop working together. Often, one joint becomes stiff or stuck and this causes irritation in the other joints (you may not even feel pain in the stiff joint). Sometimes PGP brings pain in one of the joints, sometimes it can be in all three. When one joint becomes stiff and stops moving normally, this causes irritation in the other joints which have to compensate. An associated asymmetry can arise in the joints and this can result in further pain and lack of free movement. As a result, muscles may also be tight and painful; mobility can also be affected.

The old name SPD (symphysis pubis dysfunction) implies that the condition affects only the symphysis pubis joint at the front, which is not true, as any or all of the three pelvic joints can be affected, and commonly the two sacroiliac joints at the back of the pelvis are the cause when pain and discomfort begins.

So why is a biomechanical cause better than a hormonal one?

If PGP were caused by hormones, it would suggest that no treatment would work while the pregnancy hormones are still present – in other words – the treatment would be useless until the baby was born. As hormones are not the cause of PGP but a biomechanical problem is, it means that it is possible to treat at any time during pregnancy or after the baby is born (even a long time after) because it is usually possible to resolve the biomechanical problems with appropriate treatment.

What is the most effective treatment for PGP?

PGP can usually be treated effectively by a ‘hands-on’ manual therapy from a physiotherapist, osteopath or chiropractor. The therapist gently uses their hands to reposition a joint which has moved out of its natural position and to help it work freely again. An individual assessment is important to look at the position and symmetry of movement of your pelvic joints, to find out which joints are causing the problem and to work out a suitable treatment plan. You should walk out of each treatment feeling some improvement in either pain or function and preferably in both. Often the joint causing the problem is not particularly painful, so treating the painful point is unlikely to sort out the underlying problem.

Last word on hormones

Although hormones are not the cause of PGP, some women find that there is a connection between PGP and hormones. In a very small minority of women, pelvic pain experienced after their baby is born seems to be influenced by their monthly cycle so the PGP pain feels worse at that time. This is a sign that the symmetry of the joints is still affected, and this cyclical pain will get better once the joints have been treated with manual therapy and are working normally again.

Anyone who experiences pregnancy-related PGP at any time before or after their baby is born can benefit from visiting an experienced physiotherapist, osteopath or chiropractor for relief through manual therapy. It’s also important to seek help as soon as symptoms arise.

The value of good manual therapy and a wonderful product

By Anita Johnson

My name is Anita and I have been a member of the Pelvic Partnership for just under four years. I wanted to pass on the benefits of good manual therapy and how important it is to take care of yourself between treatment sessions. One of the best ways of doing this for me was to make a purchase of equipment created and sold by a woman who also had PGP and featured in a previous article about PackaPouch™. Having a baby is often a very expensive time for new mums but I think this product is worth its weight in gold because it helped me to avoid overdoing practical tasks (i.e. bending and twisting to do chores really brought on my PGP symptoms) …but I am getting ahead of myself!

PGP symptoms

My PGP symptoms were not spotted during my first pregnancy four years ago and when I gave birth, the symptoms were made worse with a forceps delivery where a well-meaning but misguided midwife opened my legs too wide, beyond a width that I could tolerate. My experience of PGP had been very challenging ahead of the birth but afterwards, I found my legs just wouldn’t support me and I had severe pain around my pelvis and sometimes shooting down my legs. To get me out of the hospital, my husband found a wheelchair and it was such a relief not to try and walk that we hired one the next day from the Red Cross. I was appalled at the idea of needing to use a wheelchair to get around but it did help. I think the horror was that I had visions of having to use one for the rest of my life. Luckily, my sister-in-law is a GP and when she and my brother came to visit us and meet my baby, Amy, she recognised the symptoms of PGP and put me in touch with the Pelvic Partnership. This was a lifeline for me as it gave me real hope that my situation wasn’t down to rough handling during childbirth but was due to a recognised biomechanical problem from which I had a very good chance of making a full recovery.

The charity helps me to regain my hope

The Pelvic Partnership told me about the importance of manual therapy to release the stiff joints of my pelvis and help me to start walking without pain again. I had a few false starts with physios at the local hospital before finding a private physio who has been wonderful. I’d read in the charity information that a sports physio can often provide much needed manual therapy and there was a clinic just down the road from me so I was desperate to try them out. The only woman sports physio was Gillian, who hadn’t come across PGP before, but was very excited at the challenge and really worked hard to sort out my pelvis. In our first session she asked a lot of questions and then gently made me bend and move around while she examined how my pelvic joints were working. I almost didn’t return for the second session a week later because I felt even worse the next day and didn’t feel up to doing much. It was as if I had bruises all over my pelvis and lower back but thankfully, these subsided after a couple of days and I realised that my legs didn’t give out when I put my weight on them.

The skills of the sports physio I consulted

The next week I went back to the clinic. I had also read somewhere that the site and level of pain isn’t really needed in any diagnosis of the problems, so I took a painkiller ahead of the session, which took some of the sharp pain away when sore areas of my pelvis were being manipulated. Gillian had brought in a colleague who was also a sports physio from their clinic some miles away in Bedford but one who had more experience of women’s health issues and knew about PGP. Together they agreed that my pelvis was slightly misaligned and probably resulted from my sacroiliac joints being very stiff at the back. I experienced some odd muscle spasms during and after that treatment session but already I was finding I could manage walking more successfully and without as much pain. I also found that I could sit down and stand up carefully without shooting pains down my legs. Probably like most women, as soon as I started to glimpse some progress, I over did it and found myself in agony. My mum had stayed to help with Amy initially but she had to return home and my husband was often away on business. This is when I realised that I had to pace myself and avoid any twisting or lifting which seemed to aggravate my difficulties and make my sore back even worse.

The amazing PackaPouch™ product

I read about PackaPouch™ in one the charity’s articles and realised that it would help me when I used the wheelchair every time I was out and about. In some respects it resembles a rucksack which you wear on your front with a wide aperture and a drawstring to hold items inside. Having said that, it was waterproof and much prettier – but best of all – it could swallow much more than the average rucksack. I used it a great deal when I was in the wheelchair because it left my hands free. In addition, it helped with a multitude of tasks in and around home. It was great carrying washing or transferring it or groceries around the kitchen. Where it was particularly good was carrying items with the weight evenly balanced between both sides of my body; any carrying to one side on my hip or twisting seemed to make the symptoms flare up again.

How this product helped me

The PackaPouch™ means that weight is carried very evenly because the pouch is supported by straps around my shoulders. It was amazing just what I managed to carry around: the range of items and the amount of stuff I could cram in! I don’t think it was advertised for the purpose but often the baby Amy would sit on my lap, sitting in the PackaPouch™ with the drawstring around her head and arms, keeping her secure as I chatted to friends over a cup of tea.

One of the things that really appealed to me was that it removed my worry and fear of pain when I lifted a heavy load or bent for cumbersome items. I knew that if I was careful, didn’t rush, bend or do too much, the PackaPouch™ would help me to move and get myself around the house without the searing pain that I had felt before. Best of all, I have two hands free if I am carrying washing or toys upstairs or perhaps taking work stuff out to the car. I know my PGP symptoms were not as severe after I started using it and I had much less back pain. I was very good about having regular manual therapy sessions but even so, I am positive that this amazing purchase contributed to my recovery. When I no longer needed the wheelchair and used crutches for a while, the PackaPouch™ was a godsend for household chores and very versatile. Even though my PGP is really very much better now, I still use the PackaPouch™ every day and wouldn’t be without it. I wore one out (just from so much usage – it’s a good, well-made product) and bought a Deluxe version to replace it! I have been buying them for friends who are pregnant and regardless of whether they have had PGP or not – they can all benefit and have found it really useful. There’s more good news with the price: it may have gone up since but my most recent version cost around £20.

Thanks, Anita, for sharing the benefits of the PackaPouch™ and how you believe it has helped in your recovery from PGP (together with good manual therapy sessions) because it is the need to bend and twist which really irritated your PGP symptoms.  For more information about PackaPouch, please visit Mary Campbell’s Facebook page:

Charity Registered in England: 1100373 

The Pelvic Partnership consists of volunteers who have had pelvic girdle pain (PGP) and wish to support other women. We aim to pass on information based on both research and the experience of other women with PGP. We are not medical professionals and cannot offer medical advice and the information we provide should not take the place of advice and guidance from your own health-care providers. Material on this site is provided for information and support purposes only.

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We would also like to acknowledge the support of the National Lottery's Corononavirus Community Support Fund, which funded our COVID-19 Response Project. 

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