What is PGP?
Pelvic girdle pain (PGP) is a condition which affects up to one in five 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.
There is a wide range of symptoms and the severity of the symptoms also varies between women. It is important to remember that PGP is a common and, in most cases, treatable condition. It can be safely treated at any stage during or after pregnancy. So if you have pelvic pain during or after a pregnancy, ask for manual therapy treatment.
Can PGP occur at any stage during or following pregnancy?
PGP may come on suddenly, or start gradually. It usually starts during pregnancy, but it can 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 giving birth, sometimes weeks or months later.
PGP is assessed, managed and treated in the same way, whatever the cause and whenever it started.
Is it hormonal or a joint problem?
The pelvis is made up of a ring of three bones. They join together at the sacroiliac joints (at the back) and the symphysis pubis joint (at the front). These joints normally move a little bit to allow you to walk, turn over in bed, climb stairs, etc. PGP can cause pain in any or all of the three pelvic joints, causing difficulty moving and doing your usual activities.
With PGP, often one joint becomes stiff and stops moving normally and causes irritation and pain in the other joints and surrounding muscles which have to compensate for its lack of movement. There is a subtle hormonal change during pregnancy which softens the ligaments throughout the body, though this is not the primary cause of PGP. The pain is caused by one or more of the following:
- An underlying joint stiffness or previous pelvic or back problem or injury that is irritated by the hormonal changes or when the baby grows larger later in pregnancy.
- A slip, fall or other accident during pregnancy at any stage.
- Postural problems which irritate a joint – this may be a work-related or hobby-related repetitive movement or position.
- Underlying joint hypermobility or a hypermobility syndrome which can make you more susceptible to PGP due to already less stable joints. Please see our ‘Hypermobility and PGP’ page for more information.
PGP is unlikely to go away without the right treatment, and manual therapy is effective because of the mechanical joint problem – if it were purely hormonal, manual therapy would have no effect on your pain. Traditionally, it was thought that PGP was caused by hormones such as relaxin during pregnancy, and many women are still told that it is a hormonal problem and “It will get better as soon as you have the baby”. However, the reason that the Pelvic Partnership exists is that many women have found out that this is not the case. They have missed out on effective treatment and experienced pain and mobility problems for much longer than necessary.
Is it treatable?
YES! It is important to remember that PGP is a common and, in most cases, treatable condition. PGP can usually be treated effectively by ‘hands-on’ manual therapy from a physiotherapist, osteopath or chiropractor with experience in treating the pelvis and back. The therapist gently uses their hands to release stiff or ‘stuck’ pelvic joints and relieve painful muscles to allow them to work normally 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 how this can be treated. Often the joint causing the problem is not particularly painful, so treating the painful point is unlikely to sort out the underlying problem.
You may then be given some exercises specific to your own PGP to work on between treatment sessions when your pain has reduced. It is important to remember that pain stops your muscles from working correctly, so exercising when you are in a lot of pain is unlikely to help or make the muscles stronger, and often makes it worse.
You should walk out of each treatment feeling some improvement in either pain or function and preferably in both. Please see our ‘Treatment section’ for more information.
Other names for PGP
PGP, formerly known as Symphysis Pubis Dysfunction (SPD), is also often called Osteitis Pubis, and Pelvic Girdle Relaxation. The name really depends on whom you talk to about it. In fact, the name is not very relevant. What matters most is that it is recognised as a mechanical joint problem and treated as early as possible, and that it can be safely treated in pregnancy.
Diastasis Symphysis Pubis (DSP)
DSP is a true separation at the symphysis pubis joint where the bones move more than 1 cm apart, either horizontally or vertically. It can happen if you have had a fall or another trauma to your pelvis (including a difficult birth or one where you have been asked to put your feet on a midwife’s hips or shoulders, something which they should never ask you to do). The majority of women with PGP do not have DSP. If your PGP symptoms do not get better with good manual therapy treatment from an experienced practitioner (remembering it can take time to find the right practitioner and you may need to try more than one to find the right person), it can be helpful to have further investigations to exclude DSP.
The normal range of movement (vertical shift or horizontal gap) is 0-3 mm, and a moderately excessive gap is 3-10 mm. Women can usually still function very well with this amount of movement after treatment, but it may need to be taken more into account when looking at types of exercises in the rehabilitation phase of treatment. If the shift is over 10 mm this can be more difficult to manage, but if you have not yet had any manual treatment you should discuss the options with an experienced practitioner before deciding on further treatment, and it is usually worth trying this before exploring more invasive treatment such as steroid injections or surgery.
PGP also occurs in sportsmen, such as rugby players, and they are treated quickly and effectively with the same range of techniques as those used for pregnancy-related PGP.