Tips To Live Pain-free With Pelvic Girdle Pain


Pelvic girdle pain is common for women in the childbearing years. The pelvic girdle makes a circle with two hip bones attached in the front at the symphysis pubis and in the back attached to the base of the spine, the sacrum. Pain can be located anywhere within the girdle. The sacroiliac (SI) joints are located where the spine and pelvis connect on each side, directly behind the cecum and sigmoid colon. The job of the SI joint is to transmit forces from the lower limbs to the torso in what is known as "load transfer."

SI joint dysfunction is a source of problems for most women at some point in the childbearing years. According to Canadian physiotherapist Diane Lee, this is due to the inherent difference in form closure compared to males. Form closure is the structural support offered by the bones and skeletal system. Force closure is the muscular and ligamentous support. In addition to structural differences between men and women, there are fluctuating hormones every menstrual cycle, that influence the laxity of ligamentous support and create instability, requiring more force closure. Progesterone is one of these hormones with lower levels at the beginning of the monthly cycle and higher levels starting with ovulation, in the second half of the cycle. Progesterone is also in high concentrations during pregnancy. It is the hormone thought to cause food cravings, especially carbs, and create a rise in core temperature to make the womb hospitable for human life. Other hormones also influence joint laxity and the function of ligamentous support. Without help from ligaments, the core muscles have to work harder to stabilize the pelvis. This instability can be even worse for women who are multiparous, or who have had more than one pregnancy, and this instability can last a lifetime.

Symptoms of pelvic girdle dysfunction can include:

  • symphysis pubis/ pubic bone pain

  • low back pain, usually one-sided

  • hip pain or stiffness

  • urinary urgency, frequency or leaking

  • pain with penetration

  • discomfort with bending over or standing after prolonged sitting

  • pain during transitional movements, such as rolling in bed, shifting weight, standing on one leg, climbing stairs and walking, especially on an incline

The joints are most stable in a closed-packed or weight-bearing position and least stable in an open-packed or non weight-bearing position. For example, lying on the back with legs in the air is less stable than standing or kneeling. The following tips are recommended for women with recurring SI joint issues and pelvic girdle instability.

DOs:

1. Stabilize the pelvic girdle with deep core and gluteal strengthening. (see BLOG titled "Top Three Exercises For Women of Childbearing Age".)

2. Keep the angle between your torso and legs at least 90 degrees at all times.

3. Use ice on the low back near the SI joints and/or between the shoulder blades.

4. Modify positions, such as during sexual activity (better to be on top with weight through the pelvis), and use a pillow between your legs or for your top leg when lying on your side.

5. Walk more, sit less. Use a smaller stride and stick to flat surfaces instead of hilly terrain.

DON'Ts:

1. Don't Cross your legs.

2. Don't do repetitive asymmetrical activities, such as lunges or stair climbing or walk uphill.

3. Don't use heat on the low back near the SI joints, but rather ice.

4. Don't stand on one leg, such as when shaving while standing.

5. Don't do sit-ups or crunches or attempt to get out of bed in one motion, as shown below.

Sacroiliac join pain and dysfunction is real and is treatable with help from a physical therapist that specializes in pelvic girdle dysfunctions. Learn how to manage pelvic girdle instability and live a life free of pain, with a HEALTHY CORE! Contact us to schedule an evaluation at 330-528-0034.

References:

Lee L-J, Lee D. 2011. Chaper 7: Clinical Practice - The Reality For Clinicians. The Pelvic Girdle, 4th edition. Elsevier, Edinburgh.

Weschler, Toni. Taking Charge of Your Fertility, 28th anniversary edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health (2015). tcoyf.com

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