A Pain in the Girdle

by Dr. Emily Smith

My first experience with Pelvic Girdle Pain (PGP) was 10 years ago after my sister gave birth to her first child. It was a natural birth at a birthing center and my niece was 8.12 lbs. My sister labored in all sorts of positions and for delivery was seated in a corner tub with her knees spread wide. She didn’t have any pain in her pelvis prior to the birth or during the birth but immediately afterward she noted a great amount of pain in the pelvis, especially in the front. Since this was her first child, she had no way of knowing that this amount of pelvic pain was out of the ordinary. She had great difficulty getting in/out of bed and  walking and climbing stairs. At first she thought she was just “stiff” from a long labor and tried to “walk it off”. This just seemed to make things worse and left her in complete agony. Then she discovered the cause to her pain, PGP, and more specifically for her, a subset of PGP known as Symphysis Pubis Dysfunction (SPD).

In order to understand PGP more, it’s important to understand the structural make-up of the pelvis. The pelvis is made up of three bones: right ilium, left ilium and the centralized sacrum/tailbone. The ilium meets up with the sacrum on the right and left at the Sacroiliac (SI) joints. The ilium meet together in the front at the Symphysis Pubis. These three joints go through a lot of strain during pregnancy and birth as the ligaments that hold the bones together loosen with pregnancy hormone changes, especially at the end of pregnancy. However, pain through the SI joints and Symphysis Pubis doesn’t have to wait until the end of pregnancy. PGP can begin early in pregnancy as well, especially if the mom has had prior symptoms (such as with prior pregnancies/births) or injuries (falls/accidents). Symptoms can vary quite a bit, ranging from occasional/mild pain to severe/debilitating pain. The type of pain can also vary from achy and sore to sharp and stabbing in the SI joints and symphysis pubis. Some women describe the SPD pain as feeling like they’ve been “kicked” in the front of their pelvis, without such cause. The pain will often cause a limp or “waddle” that is unavoidable when walking, especially if walking for a long time or distance. It can also be difficult and painful to transition between sitting and standing. Typically, PGP will go away within a couple weeks after birth but there are cases of PGP that may take years to resolve. This can be very frustrating for pregnant women and those who are nursing because medication options are limited during these times and they may feel at a loss of what to do. What many women, as well as their medical providers, don’t know is that chiropractic care can be helpful for symptoms of PGP. Chiropractic adjustments to the pelvis and pubic bone are completely safe during pregnancy and can help to offer relief from this pain and provide the woman with a much more enjoyable pregnancy. It is important to have pelvic alignment maintained during pregnancy, not only for the relief of pain, but proper fetal/baby positioning is vital in order for labor and delivery to progress normally. PGP can be a sign that the pelvic bones are not aligned and that can interfere with the baby’s ability to get into position, delaying birth, or ending with more invasive procedures such as c-section. Chiropractic adjustments are also extremely important during the post-partum 6-8 weeks, when the body is attempting to re-establish its “normal” positioning while still under the influence of ligament loosening hormones. Issues that are not corrected during this time may persist for months or years to come.

Pregnancy is an amazing time in a woman’s life. It is unfortunate when PGP/SPD make pregnancy less enjoyable. Be your own advocate during pregnancy and birth, looking for opportunities to do what is best for you. If you are experiencing this pain, find a provider, such as a chiropractor, who is familiar with the condition to help you along the way.

How to Prevent PGP/SPD:
• Keep legs/knees “glued” together when getting out of bed, the shower/tub, car, etc.
• Don’t carry/lift older siblings while pregnant.  Encourage them to climb in/out of chairs and carseats by themselves.
• When getting dressed, sit down in order to put on underwear, socks, and pants/skirts.  Avoid putting all of your weight on one leg.
• Stairs can be particularly troublesome if you are having SPD. Try to climb one stair at a time and if symptoms are really bad, go up/down on your bottom.
• Take frequent breaks to stand if your job requires lots of sitting and breaks to sit if your job requires lots of standing or walking.
• Make sure to use a pillow between your knees when sleeping or resting in order to maintain proper spinal alignment.
• Using ice can be helpful to reduce pain over areas of inflammation (SI and symphysis pubis).
• Modify your daily activities immediately!

Dr. Emily Smith is a Diplomate in Chiropractic Pediatrics, specializing in chiropractic care for children and pregnant women. She has enjoyed nearly 12 years of practice at her Eau Claire office, Smith Chiropractic. She can be reached at 715-833-3505 or www.myECchiro.com

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