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Introduction

Another condition that I came across during my pregnancy was pelvic girdle pain (PGP). Luckily, I had some knowledge regarding how to manage PGP during pregnancy and was able to address it before it became a problem in my postpartum recovery period. So, I thought I would share some of the exercises and management strategies that were beneficial to me in case you are experiencing PGP during or after pregnancy as well. Your quality of life and ability to move pain free postpartum are important!

What is Pelvic Girdle Pain (PGP)?

Pregnancy-related pelvic girdle pain is described as pain experienced between the posterior iliac crest and the gluteal fold, especially around the sacroiliac (SI) joint or pubic symphysis areas. The diagram to the right demonstrates where these pain sites can potentially be located.

Many pregnant women experience PGP, usually starting around 6-9 months of pregnancy, and can continue experiencing it up to a year after delivery. Signs of PGP include pain with walking, pain with weight bearing through one leg (climbing stairs, putting on pants), pain turning in bed, clicking/popping in the pelvic area, pain with sleeping/lying, and pain with sitting.

Why Does PGP Occur?

During pregnancy, a hormone called relaxin is released to relax the ligaments surrounding the pelvic area. This allows the hip and pelvic bones to shift to create room for the growing baby and to prepare for delivery. However, this ligament laxity can sometimes cause the joints to move dysfunctionally, causing pain.

Additionally, the growing belly shifts the mom’s center of gravity, putting pressure on the joints. Addressing stability in the surrounding pelvic girdle muscles and structures can limit the discomfort and pain caused by these structural changes.

How do I treat PGP?

The best way to address PGP is to provide stability to the pelvic girdle, and there are a few ways to do so. One way is to wear a pelvic girdle support belt. Talk to your PT or doctor about using this kind of physical support to reduce pain.

Another helpful strategy I used to prevent pain while sleeping during pregnancy was to sleep with a pillow in between my knees. This position helps to maintain a neutral alignment of the pelvis and prevent shearing of the SI joint and pubic symphysis.

Furthermore, if you have pain or difficulty turning in bed, try squeezing the pillow between your knees and engaging your gluteal muscles as you turn for additional support. Engaging and strengthening the pelvic/gluteal muscles is one of the best ways to stabilize the pelvic girdle.

See the exercises below for some examples. Lastly, avoid excessive unilateral movements like carrying a baby on one hip more than the other, crossing your legs, taking excessive stairs, etc. It may be helpful to try to keep your knees together when getting in/out of the car or getting dressed sitting down to keep the pelvis neutral as well.

Again, these are all tips to help reduce symptoms of PGP, but if you are experiencing persistent pain or functional limitations, discuss a referral to a physical therapist to help give more individual assessment and treatment regarding building strength in your pelvic girdle/pelvic floor/spine/hips, pain control methods, motor control rehabilitation, or manual therapy interventions.

Exercise 1: Pelvic Tilt with Pelvic Floor Activation

1. Begin by lying on your back with your knees bent and feet resting on the floor.
2. Slowly tilt your pelvis so your low back sinks into the floor as you contract your pelvic floor muscles (like a kegel), then return to the starting position and repeat.
3. Make sure to only move your pelvis and low back and keep the rest of your body relaxed.
4. Relax and repeat.

Note: Make sure to continue breathing evenly and focus on keeping your pelvic floor muscles active during the exercise.

Exercise 2: Bridge with Adductor Squeeze

1. Begin lying on your back with your legs bent, feet resting on the floor, and a ball (or pillow) between your knees.
2. Engage your abdominals as you gently squeeze the ball between your knees and lift your hips off the ground into a bridge position.
3. Hold briefly, then lower back down to the ground and repeat.

Note: Make sure to keep your core engaged and your movements slow and controlled. Do not let your hips rotate to either side during the exercise.

Exercise 3: Bird Dog

1. Begin on all fours, with your arms positioned directly under your shoulders.
2. Inhale in this position, then as you exhale engage your core muscles and straighten one arm and your opposite leg at the same time until they are parallel to the floor.
3. Hold briefly, then return to the starting position.

Note: Try to keep the pelvis and low back still as you move your arm/legs and especially as you shift your weight to alternate to the other side.

Resources

1. Fiani, B., Sekhon, M., Doan, T., Bowers, B., Covarrubias, C., Barthelmass, M., De Stefano, F., & Kondilis, A. (2021). Sacroiliac joint and pelvic dysfunction due to symphysiolysis in postpartum women. Cureus. https://doi.org/10.7759/cureus.18619
2. Puri, S. N., Fating, T., & Dhage, P. P. (2023). The impact of functional stability exercises on alleviating pelvic girdle pain in pregnancy: A Review. Cureus. https://doi.org/10.7759/cureus.48769
3. Simonds, A. H., Abraham, K., & Spitznagle, T. (2022). Clinical practice guidelines for pelvic girdle pain in the postpartum population. Journal of Women's Health Physical Therapy, 46(1). https://doi.org/10.1097/jwh.0000000000000236

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