Some women need one or two treatment sessions to recover from PGP, but others need regular hands-on treatment throughout their pregnancy as the correct joint position cannot be maintained. There are various possible reasons for this, such as a delay in starting treatment, muscles which tighten (spasm) quickly between treatments and, later in the pregnancy, the size of your growing baby. Do not despair if this happens to you. It sometimes takes a while for your therapist to work out why these compensations are happening and stop them, so do persist with treatment. Postnatally, you need to carry on with treatment until you feel better; this takes varying lengths of time and often depends on how long you have experienced symptoms.
The most important thing to remember is that you should notice some improvement after each treatment (in pain and/or function) even if your joint stability cannot be maintained for long. If this is the case or you are noticing little improvement then it may be worth exploring the following:
It can take time to find the right practitioner to help you – many women have reported trying two or three practitioners before finding the one that helped them to progress. You should expect to make continuous improvement and if this stops at any stage, discuss it with your therapist or seek another opinion, but never be reassured that you “just have to wait” for recovery – there is always a reason why things don’t move forward, and usually something can be done to get recovery back on track.
Charlene’s blog article shows how it can take time and perseverance to find the right practitioner to help.
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. There can be different challenges at each stage of pregnancy, postnatally and beyond. Some women find that they start to make a recovery but key stages in family life might bring a return of the painful symptoms. For example, manual therapy when the baby is still tiny may reduce the PGP symptoms but when the baby turns into an active and heavy toddler, PGP symptoms may return.
Each woman will have her own triggers such as using the vacuum cleaner or pushing a heavy shopping trolley. Similarly, with a return to work, more time driving, taking on some sport, or becoming pregnant again, etc, it is possible that the PGP symptoms may return. However, bringing knowledge and understanding about what movements or tasks can prompt your PGP symptoms again, most women can usually find ways to avoid such flare-ups or manage by having another few treatment sessions. It is usually possible to adapt slight changes to day-to-day tasks to reduce any instances of the symptoms recurring again. You may find our ‘Practical suggestions’ section a helpful resource during flare-ups.
Once the underlying pelvic joint problem has been treated and your pelvis is moving normally you will need to strengthen the muscles supporting your pelvis. Some women find that they can maintain the joint corrections between treatments with home strengthening and stretching exercises prescribed by your manual therapist. As with other activities, if exercise increases your pain, you may be doing the wrong type of exercise, trying to do too much too soon, or not doing enough. It is helpful to review your exercise choices with your manual therapist to make sure they are suitable for you. Please see our ‘Exercise and PGP’ page for more information.
Pelvic floor over-activity can have an impact on recovery. The pelvic floor attaches to the sacrum (at the back) and round the symphysis pubis (at the front), so if the pelvic floor is tight or painful, this can pull on the joints and have an effect on recovery. This is also very treatable, so if you are not making progress with your recovery, it is well worth having your pelvic floor assessed by a specialist women’s health physiotherapist. Please see our ‘Pelvic floor and PGP’ section for more information.
If the level of pain you are experiencing means you are struggling to tolerate ‘hands-on’ treatment, you may need to explore ways of managing pain before treatment. This is often the case if you have been experiencing symptoms for a long time without effective treatment. Some women find taking pain relief medication before a treatment helps and others find the use of acupuncture or dry needling during their treatment session helpful to release tight muscles and reduce pain prior to manual therapy.
Visit our ‘Pain in PGP’ section for more information about pain and the pain relief options available.
Emotions, depression, stress, other physical illness and hormones can all impact on our perception of pain so you may find you are experiencing increased pain in your pelvis at times when you are feeling particularly low or during your period. Our ‘Understanding chronic pelvic pain’ page explains this in more detail.
Some women find that they respond very well to manual therapy but cannot maintain this improvement for long between treatments despite participating in exercise rehabilitation. This can be due to a true instability at the pelvic joints where the ligaments have been overstretched. Ligaments are different from muscles, and once significantly overstretched, sometimes cannot return to their normal length. In this situation some women have found prolotherapy injections helpful. Please see our ‘Prolotherapy’ page for more information.
Over the years volunteers covering our helplines have heard from many women who are particularly hypermobile or have a suspected or diagnosed hypermobility syndrome. Please see our ‘Hypermobility and PGP’ page for more information about hypermobility and hypermobility syndromes and how to treat and manage PGP in these populations.