One of the issues we treat regularly at our clinics is prenatal and postnatal pain. Although discomfort or pain during and after pregnancy is an extremely common problem, like other pelvic pain syndromes, it’s often mistreated, misunderstood, or ignored by the medical community.
So you can imagine my delight when I came across an article this month on the topic in the U.K.’s Daily Mail. I was further delighted to discover that the article—titled “How Expectant Mothers can be Left in Crippling Pain without the Right Treatment,” and written by Louise Atkinson—gave some on point information about pregnancy pain and the treatment options available for it.[To read the article in its entirety before reading my commentary, click here.]
There are a variety of musculoskeletal issues that can occur with pregnancy, but this particular article focuses on one fairly common condition called pelvic girdle pain or PGP, formerly known as Symphysis Pubis Dysfunction (or SPD) .
As the article explains: “The condition occurs when pregnancy hormones cause the tendons and ligaments that secure and stabilize the pelvis to become more lax, leaving the bones susceptible to sheering out of place.
The pelvis is made up of two bones that are joined to the base of the spine in two places, and then at the front to the pubic bone. The structure is designed to be strong enough to support the body, but flexible enough to absorb the impact of feet hitting the ground.
PGP occurs when the bones become misaligned at the pelvic joints. Sometimes these can lock, leaving the woman temporarily unable to move one or both legs.”
According to research by the Chartered Society of Physiotherapists, PGP occurs in a whopping 20 percent of pregnant women, and for an estimated 7 to 8 percent, it results in severe disability.
Despite the high occurrence of the condition, and the fact that it is treatable, more often than not, patients are getting “the wrong type of treatment, leaving them at risk of the condition with future pregnancies, and vulnerable to long-term back and pelvic problems,” the article points out.
According to the article, when women seek treatment, more often than not, they are simply prescribed “paracetamol” (acetaminophen!), and told to “rest because you’ll feel better once the baby is born.” Unacceptable!
For one thing, I believe it’s not acceptable to leave a woman in pain during pregnancy, and for some women, not treating PGP correctly can lead to future pelvic floor issues down the line.
Proper PT is the best treatment for PGP as it can allow a woman to become more functional and experience less pain during the course of the pregnancy as well as during her labor and delivery.
However, as the article shows, patients who are sent to PT are often receiving incomplete or incomprehensive treatment. They’re given exercises to strengthen their abdominal muscles and are instructed to wear supportive belts, the article says. While these treatments could be helpful, they’re more helpful when used in combination with the strategies I’ll expand on in more detail below.
The article goes on to describe successful treatment for PGP when a PT who specializes in treating it discusses the success she has with manual PT. She describes her treatment methodology as “‘manual realignment’ — an expert technique of gentle massage, rocking and manipulation,” and explains that this strategy can “put the pelvis back in the correct position and get the joints working properly once more.”
I totally agree with these treatment methods, but I believe they should be used in addition to stabilization techniques to help decrease the source of pain (commonly trigger points and the joints) and maintain the therapeutic changes.
Overall, I think the article is well-done.
The manual PT described at the end of the article is accurate. However, here is a comprehensive list of all the strategies that can be used to treat PGP: They are:
- manual therapy techniques for soft tissue issues and joint dysfunction,
- stabilization exercises,
- stabilization tools such as orthotics and sacro-iliac joint belts,
- and patient education for lifestyle and biomechanical modifications.
However, as with pelvic pain, it’s important to know why the symptoms are present and treat the impairments, not just to administer a one-size-fits-all treatment approach.
The article also points to steroid injections and prolotherapy as possible treatment for PGP. (Prolotherapy is a treatment for pelvic girdle instability whereby a solution is injected into a ligament with the aim of causing the growth of collagen tissue, the main component in ligaments, in an effort to provide additional stability to hypermobile joints.)
In addition, the article says that “the final recourse for a very small number of women is pelvic fusion surgery, where metal plates and sometimes bone grafts are used to permanently stabilise the pelvis.”
I believe the need for surgery is EXTREMELY rare, however, the injections may help if conservative measures fail. Obviously, the time either of these measures should be considered is AFTER the birth of the baby and a failure of more conservative measures.
As I mentioned earlier, PGP is just one type of pregnancy pain that we treat at our clinics. In future posts, we’ll discuss the slew of other prenatal and postnatal issues we’ve had success treating.
Please let me know if you have any questions about PGP.
Also, please share your experiences with PGP or any other prenatal or postnatal pelvic pain issues.
All the best,