Please read through our frequently asked questions, you may find the answer to your question here:
What causes Pelvic Girdle Pain (PGP)?
Please read our 'What is PGP?' page
My GP/midwife has told me there is nothing I can do to about my PGP and I should just put up with it, is this right?
No! Your GP or midwife should refer you to a physiotherapist immediately. It is important to remember that PGP is a common and, in most cases, treatable condition. The sooner you start treatment, the sooner you will start to recover. Delaying treatment can mean that the symptoms continue to get worse and can make it more difficult to treat. PGP can usually be treated effectively by 'hands-on' manual therapy from a physiotherapist, osteopath or chiropractor. An individual assessment is important in order to look at the position, symmetry and movement of your pelvic joints, and to find out which joints are causing the problem and decide how this can be treated. You should walk out of each treatment feeling some improvement in either pain or function, and preferably in both.
If you are not making improvement after several sessions, you may decide to seek a second opinion (which you are entitled to on the NHS).
Printing off some pages from the Pelvic Partnership website and bringing them to appointments may be useful if your health professionals refuse to refer you. If you would like an information booklet to bring with you, please visit our publications page to purchase any of our publications or click here to order two free copies of our 'Stickmum' leaflet for healthcare professionals.
The POGP (Pelvic Obstetric and Gynaecological Physiotherapy) has a leaflet designed for health professionals: POGP leaflet Also, the Royal College of Obstetricians and Gynaecologists’ leaflet may be useful: RCOG leaflet
Can I be treated during pregnancy?
PGP can be safely treated during pregnancy by a therapist with expertise in manual therapy and alignment of the pelvic joints, and women usually find that the deterioration can be halted and, in many cases, your joints will improve during pregnancy.
This then increases choices for birth as your mobility is likely to be better and your pain less. It also seems to speed up your recovery after you have had your baby. If your pelvis is well aligned for birth, recovery can be much more rapid than if you have had no treatment and have to start it once the baby is born, when you have a baby to feed and care for as well as sorting out your own recovery. Day-to-day life can be made easier with some simple changes to your home and also to your expectations of what you should be able to do (see our 'practical suggestions' pages for managing PGP).
Can you recommend a manual therapist (physiotherapist/osteopath/chiropractor) in my area?
We have a list of practitioners who have been recommended by other women with PGP. Please note that these practitioners have not been vetted or recommended by the Pelvic Partnership, and as an organisation we cannot confirm their quality. Please see our 'recommended practitioners' page.
I am seeing a manual therapist but my condition isn’t improving, what should I do?
You should start to see improvement after a couple of sessions; if not, you may wish to seek a second opinion (you are entitled to do this under the NHS).
Some women need only one session to get better, particularly if they are treated soon after symptoms start, but some need more sessions of hands-on treatment throughout their pregnancy as, for various reasons, the corrections cannot be maintained. If you have had pain for a long time, your muscles may have tightened in the wrong places (muscle compensation) and so they pull your joints back out of alignment after a short time, which is why the treatment may make you feel better at first but it gradually gets worse again over the next few days. Do not despair if this happens to you. It sometimes takes some time to work out why this is happening and prevent it from occurring, so persist with treatment. The treatment usually includes releasing any tight muscles which are causing this kind of recurrence of the problem, often using trigger point muscle release techniques.
Generally speaking though, you should be making gradual progress, with relapses happening less frequently and with less intensity.
Do support belts help?
Support belts can help if they are worn after you have had manual therapy to release stiff/stuck pelvic joints that cause PGP. The belt can help to keep things in place and prevent joints from moving out of position again. If a belt is worn without you receiving the right treatment, it can just hold bones in the wrong place, which can irritate the joints more, so receiving treatment to align your joints is key. If you do need a belt, this should be as part of, not instead of, treatment, and usually the belt is not needed after a few treatment sessions as your joints and muscles start to move normally again. Most women find that the Serola sacroiliac belt is the most useful. Tubigrip is often provided instead of treatment, but it is uncomfortable to take on and off and does not support the relevant joints specifically enough, and is not a substitute for hands-on treatment.
I have been referred to a physiotherapist, but I am told it will take weeks to get an appointment. The baby will be here by then, what can I do?
You can ask your GP to refer you as an emergency case. If they cannot do this at the nearest centre you can ask them to refer you to see someone in a neighbouring town. If you are unhappy with the way you have been dealt with, you can complain through PALS. Alternatively, you can find a private therapist who will usually be able to offer you a more urgent appointment. You do not need a referral from your GP to see a private practitioner.
Can you recommend any exercises or stretches?
Unfortunately, we cannot recommend any exercises as the ones you need are specific to your particular situation and should be recommended to you by a qualified practitioner. Exercises are good for strengthening muscles once manual therapy has been given to restore good pelvic girdle function, but trying to do them without getting corrective treatment can be painful.
Often women are given exercises without any treatment of the joints, and they report that this is ineffective. There are two reasons for this:
- If you have a lot of pain, the muscles around that pain do not function normally (called inhibition) and so no matter how much exercise you do, it is unlikely to be effective.
- The pain is not caused by muscle weakness, but by joints not functioning properly. Even strong muscles will not realign a joint that is sitting in the wrong place.
Many women want to keep fit during pregnancy (as recommended in glossy magazines) but if you have a lot of pain, you can make this worse by exercising without addressing the cause of your pain first.
I want to phone a private physiotherapist/chiropractor/osteopath to enquire about treatment, what sort of questions should I ask?
If you need treatment, it is always worth asking your midwife or GP for a local NHS referral first (as it is free and often nearer to your home). It also raises the profile of the condition and encourages local service provision.
If you choose to see a private therapist, these questions may be helpful when you call before you go for a consultation:
- What will you do if I come to see you for my PGP? (You should expect to be asked to undress to your underwear for an assessment and a diagnosis before any treatment starts.)
- Do you treat people with PGP regularly and how many people with PGP have you seen over the last three years? (You should expect that they see many women with PGP, not that they think it is unusual.)
- How do you treat it? (They should tell you about the manual therapy – hands-on – treatment that they routinely use.)
- How soon would you expect to see some improvement, even a little bit? (They should expect to improve your symptoms, either your function such as standing and walking or your pain, or both, within every session.)
What you should expect from the discussion you have on the phone with a manual therapist ahead of going to see them, and from each treatment session you attend:
You should be told that the manual therapist intends to examine you, looking for symmetry of movement at the sacroiliac joints and the position of your symphysis pubis (i.e. not looking for pain at this stage).
- They should explain what they have found during the assessment and why you have pain.
- They should explain what they are going to do about the pain and how they are going to physically treat you to make you better.
- They should carry out the treatment. Expect to receive manual treatment, not just a list of exercises.
You should walk out feeling better, through an improvement either in your function or in your pain (or, hopefully, both).
Exercises tend to work best once you have had some manual therapy and the pain has improved. Manual treatment involves mobilising ‘stiff’ or ‘stuck’ joints and gently moving your limbs and joints to help realign the pelvis if it is moving asymmetrically; it may also treat tight muscles using techniques such as trigger point treatments.
Sometimes after manual treatment you may feel sore for a day or two, particularly if you have had PGP for some time prior to treatment, but if you are not seeing overall improvements after a couple of treatments you may want to seek another opinion.
If you can’t see any member recommendations for your area but want to start manual therapy quickly (sometimes NHS physiotherapy departments take some weeks to arrange an appointment for you and you may be on a waiting list for some weeks too), you might consider seeing a private physiotherapist. Most women find that a sports or musculoskeletal physiotherapist is the most effective in treating PGP; to find one in your area you can visit sites such as the Physio First website
What should I expect from treatment?
See above and read our 'What to expect from treatment' page.
How can I manage my PGP during birth?
Please read our 'How will I get my baby out?' page.
If I have another baby will I get PGP again?
It is common for PGP to return in subsequent pregnancies, but it doesn’t always happen. If you receive good manual therapy as soon as possible and have it regularly throughout your pregnancy until the pain is completely better, the condition can be managed very well. Visiting a manual therapist before you get pregnant to ensure your pelvic joints are functioning well is a good idea! Going into a pregnancy with a strong set of core muscles including a strong pelvic floor can help to minimise symptoms.
I’ve seen many physiotherapists now but nothing has helped, should I consider surgery?
Rarely, and only in very severe cases, is surgery necessary. If you are considering this, you may find it helpful to find out lots of detail about what the surgery being proposed involves. You can ask your surgeon about how many operations s/he has performed in the past, what their personal success rates were, and what they define as a successful outcome. It is also useful to find out about how long recovery is expected to take after the surgery. Ask what alternatives they would suggest in order to avoid surgery.
We have heard from a number of women who have been advised that surgery is their only option and who have found that seeing an expert in manual therapy has enabled them to make a full recovery without surgery. In each case, women have told us that manual therapy was not an option they had previously been aware of, or that they had seen a physiotherapist who had given them advice and exercises or belts and crutches, and they had not known that any alternative was available or might be effective.
We are happy to talk through your alternatives if you are considering or being advised to consider surgery. Remember that in the unlikely event that manual therapy is not effective, you can always have surgery later, but once you have had surgery it cannot be reversed so it is important to explore all the manual therapy options first.
For healthcare professionals: do you have any recommendations of courses/workshops about treating PGP with manual therapy?
For information and training about treating PGP manually, you may be interested in attending a training workshop such as those provided by ‘PGP Workshops’. This group was set up by the Chair of the Pelvic Partnership but is independent of the charity. Please visit the website at www.pgpworkshop.org.uk.
We have packed our website with up-to-date information about the treatment and management of PGP, to help empower women to seek appropriate treatment and to recognise when this is being offered. So please take time to have a good read of the information most relevant to your needs, including the frequently asked questions (FAQs) above.
If you have any further questions or would like to hear a friendly voice of support you can contact our telephone helpline and leave a message. Please note that we are unable to provide a prompt response as this helpline is managed by volunteers and is checked fortnightly. We recognise that many women have emotional issues as a result of experiencing physical symptoms of PGP so If you feel you need to speak to someone urgently please visit the Samaritans website, because this charity runs a helpline 24 hours a day:
Pelvic Partnership telephone helpline - 01235 820921
To order our FREE information pack please click here.
If you would like to recommend a practitioner please complete our 'Practitioner recommendation' form.
Please note, the Pelvic Partnership consists of volunteers who have had Pelvic Girdle Pain and wish to support other women. We aim to pass on information based on research evidence where available. We are not medical professionals and cannot offer medical advice. The Pelvic Partnership takes no responsibility for any action you do or do not take as a result of reading this information.