There are many women with PGP who respond well to treatment initially, but struggle to get that last 10% of ‘normal’ back.
There are a few common reasons why progress slows, including;
- Pelvic Floor Dysfunction (PFD) - a very common condition associated with PGP.
- You may be overdoing things at home/work; try to slow down and pace your activities and be realistic about what you can and cannot do.
- Your pain levels may be impacting on how you respond to hands-on treatment so you may need to explore ways of managing your pain before you can respond well to manual therapy treatment.
- The muscles supporting your pelvis are likely to need re-educating through specific exercises in order to support your joints in the correct position rather than in the incorrect position. You will need to work harder at this the longer you have experienced PGP, as your muscles will have been working incorrectly for a long time.
- If you are particularly hypermobile, this can slow recovery.
- A second opinion from another experienced manual therapist may offer new perspectives and help you to progress further.
Please visit our ‘What to do if treatment is not helping’ page for more information about these reasons and others which may be impacting on your recovery, and what you can do or explore to get you back on track. It is important to remember that we are all different, what works for one woman may not work for another.
Some women find that despite trying some of the suggested strategies above they still need on-going maintenance treatments to proactively maintain good function and prevent a return of disabling symptoms. The frequency of treatments will depend on your symptoms and the length of time you have experienced PGP – we are all different. Another option is to consider whether other pelvic pain conditions could be contributing to your pain. Please see our ‘If it’s not PGP, then what could it be?’ page for more information.
Every woman’s body changes during pregnancy and some of these changes are irreversible and have to be accepted, e.g. stretch marks, shape and consistency of breasts and body shape. If you have thoroughly exhausted all of the options above, have received good manual therapy, and looked after yourself well but still have some PGP symptoms, you may need to accept that this is your ‘new normal’. Adjusting to a ‘new normal’ can be helpful for you to accept your current situation and feel more liberated to plan for the future and move on. It can be helpful to appreciate and focus on what you are now able to do rather than dwelling on the things you were once able to do that you now find difficult. However, this is a grieving process that can take time. This is something that a pain clinic or counsellor may be able to help you to explore. The Pelvic Pain Support Network holds a list of pain clinics in the UK: http://www.pelvicpain.org.uk/index.php?page=resources-and-clinics.
Janet’s experience of on-going PGP symptoms and making adjustments:
“I first developed PGP during my first pregnancy 21 years ago, a second pregnancy four years later was horribly painful. I had crutches and a wheelchair and needed a lot of help to manage daily activities. Following the birth I had good manual treatment and got a lot better, but not quite fully better. My pelvis has always been my weak spot, and anything out of the ordinary seemed to bring on symptoms. It was rarely agonising but it was painful and annoying. I could pretty much do whatever I wanted to do but I wasn't 100% pain free and periods, over-exerting myself, wearing high heels, sitting or standing still for long periods of time all caused discomfort and occasional mobility issues (spasms. dragging of one leg or limping mainly). For many years I paid for regular manual therapy treatments and this was great, it largely kept my symptoms under control. But life sometimes gets in the way, and for one reason and another, I neglected the treatments and the exercises, put on a bit of weight, rushed around, got a bit stressed and depressed and wallop! The PGP came back with a vengeance and I realised it is something that will always require active management on my part.
Accepting my PGP as part of me has been a long process. For many years I tried to ignore it, thinking I was making a fuss about nothing. At other times I felt guilty and that the treatment would have "fixed" me if only I were thinner, or had tried harder or did more exercises. I think the reality for me is that it will never really go totally away (I am hypermobile) but that there is a lot I can do to manage the situation well. So I now have regular treatment (currently having a course of excellent treatment on the NHS, including pelvic floor treatment), I no longer wear high heels unless I really want to, I wear a Serola belt if I feel particularly unstable and I pace my activities, especially around the time of my period, and I ask for help when I need it. These adjustments have made a huge difference.
For example, last year we had an evening out in London. I rushed from work to the train station, stood in heels on a busy train, by the time we were there I was in quite a bit of pain but I carried on regardless, hopping on and off tubes (never getting a seat) trying to get to the theatre in time. We were up in the gods so had to climb what felt like hundreds of stairs. My pelvis felt worse and worse and by the time of the interval I was in so much pain I could barely stand. My muscles were in spasm and it was difficult to lift my right leg. But still I didn't want to spoil anyone's night so soldiered on. It took a long time (and some expensive hands-on treatment) to fully recover. This year we went to London again, and had quite a full itinerary of what we wanted to do. But I was more prepared, I booked seats on the train, left more time to get from A to B, wore my Serola belt and took my painkillers. When things got a bit sore, I listened to my body and rested for a while. This gave me the energy for the next adventure. I even took a folding walking stick with me to lean on if needed. This was great as it gave other people a sign that I might need more space or a seat on the Tube. All in all it was a much more positive experience. A little forward planning and being kind to myself made a big difference.”
Content added in 2017.