Back and Pelvic Girdle Pain in Pregnancy Advice and Exercise

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About 1 in 5 pregnant women are affected by pelvic girdle pain to some degree.

It is important to remember it may not get worse and with treatment early in pregnancy it can be managed well. It does not mean you cannot have a normal labour and delivery.
This leaflet is designed to provide you with advice and practical measures to assist you in reducing your pain and symptoms.

Causes of back pain and pelvic girdle pain in pregnancy

Pregnancy causes numerous changes in your body. These include changes in your posture and centre of gravity, lengthening of muscles around the tummy, increased weight and the ligaments around your joints softening and become more elastic. These can lead to changes in the symmetry of your pelvis which in turn may cause pain.

Common presenting signs and symptoms

The signs and symptoms can vary greatly between patients.

Some of the activities which can produce pain are:

• Weight bearing especially during asymmetrical movements (eg walking,
  negotiating stairs, in/out of the car or bath)
• Pain on sit to stand or turning over in bed
• Difficulty walking
• Clicking or grinding in the joints
• Sensation of joints being ‘stuck’
• Sometimes limited abduction (moving your legs apart)

The site of pain can vary. It can include the lower back, buttocks, groin, front or back of thighs, over the hips, around the pelvic floor/perineum and in the lower abdomen.

During Pregnancy:

• Remain as active as possible within the limits of pain, taking regular breaks
• Rest when necessary
• Gentle heat or ice packs for pain relief (remember to wrap ice pack in a damp cloth
  before applying to the skin to prevent ice burn – use for 5-10mins max)
• Ask for help with activities that increase pain
• Keep your knees together when turning over (or turn under) in bed. Also when getting in/out of a car, bed or bath
• Plan ahead to limit extra trips up and down stairs
• Exercise your tummy muscles and pelvic floor muscles regularly
• Gently pull in your lower tummy and pelvic floor when changing position or lifting
• Wear flat supportive shoes

Try to avoid:

• Standing on one leg (e.g. get dressed sitting down).
• Standing or sitting for long periods of time
• Twisting and bending to lift.
• Carrying a toddler on one hip.
• Heavy lifting – (i.e. using the vacuum, shopping, wet washing, heavy toddler).
• Cross legged sitting.
• Pushing heavy supermarket trolleys (try online shopping).

During labour:

Inform the midwife that you have had pelvic or back pain
Try to avoid positions which are asymmetrical or result in wide leg separation
(squatting or stirrups)
Do not put your feet up on the midwife’s hips to push

Do…

• Use gravity to help the baby move downwards by staying as upright as you can
  (kneeling/standing or on all fours)
• Find a comfortable position for your pelvis using pillows to support your legs.
• Kneeling and leaning over a bean bag can allow you to relax and rest without any
  pressure on your pelvis.
• Or, try side lying if you have to stay on the bed.

Following delivery:

The good news is that the vast majority of women find the symptoms resolve on their own after the birth. However, if symptoms persist, continue with the advice given during pregnancy and
seek advice from your GP at your post-natal check. You may need further physiotherapy. Be aware of your back when feeding, changing & lifting to prevent further pain.

Useful websites:

• www.thepogp.co.uk/patient_infomation/womens_health/pregnancy_pgp_lbp.aspx
• www.pelvicpartnership.org.uk

Go to ‘useful information’ page to download the Pelvic Pain booklet.