Physiotherapy; assessment and treatment of PGP
A physiotherapist’s role is firstly to assess the mechanics of your pelvis, in a similar way that you would get the tracking on your car assessed. The physio looks at the joints and the muscles around the pelvis and assesses how they are working.
A physio is looking for symmetrical movement occurring particularly in the sacroiliac joints at the back of the pelvis. The importance of symmetrical mechanics can be seen when you come to stand up. As the sacrum (the triangular bone that sits between the large pelvic bones) has to “nod” forwards as your spine straightens up. It is this movement that helps the pelvis to open at the front (across the symphysis pubis) allowing the strong ligaments across your pubis symphysis to stabilise. This then allows your body weight to be transmitted efficiently though your hip joints and down to your feet. Ultimately, this allows you to step, walk and generally function; yes it really should be that simple!
Obviously, when things go wrong this simple mechanical system starts to malfunction. During pregnancy the increased laxity and changed position of the abdominal (stomach), pelvic floor and gluteal (bottom) muscles, as well as postural changes, can then cause an alteration in the mechanics of your pelvic girdle. When one of the sacroiliac (or SI) joints gets ‘stuck’, this prevents the sacrum from nodding forwards and doesn’t allow the pelvis to stabilise and function normally. This is a bit like when a bearing goes on your car. This loss of normal mechanics is what leads to pain in one or more of the pelvic joints and therefore an inability to achieve normal function e.g. walking, climbing stairs, lifting, turning in bed, etc. Having identified the mechanical problem, the physio then mobilises and adjusts the ‘stuck’ joint to restore the normal mechanics of the pelvis. If this is not done, like a car bearing, (where the car will eventually stop moving), it will gradually become increasingly difficult for you to move normally.
Unfortunately it does not stop here as the muscular system has an important part to play.
As a result of the mechanical breakdown, certain muscle groups have to work harder to allow you to continue to function in your daily life (these are often the wrong muscle groups). These muscles become tight, overactive and sore, often becoming a source of pain in themselves. A physio will have to work hard to release these muscles and allow them to work normally again.
The final part of the jigsaw is to then assess the postural muscles known as the ‘core muscles’ (pelvic floor, deep abdominals and gluteal muscles) to make sure that they work normally to assist the stability of the pelvic girdle. This is achieved by gentle muscle contractions, and often equipment such as a gym ball helps to recruit these muscle groups.
This whole process can be a complicated equation of mobilising the right joint at the right point while releasing the right tight muscle and trying to work the right core muscles; meanwhile the patient continues with the 101 other things going on in their busy lives – so it’s no surprise that it sometimes takes a little fine tuning to get things sorted. With ‘hands on’ treatment, however, you should expect to make continual gradual improvement, both with the pain and the loss of function and with the aim of a full recovery.
Many thanks to Clare for taking the time to write this helpful article. Clare treats a large number of women each year with pregnancy – related PGP and has a wealth of experience on the subject. Clare is based in Tewkesbury at Back into Action; for more information please visit www.backintoaction.co.uk.