|
 |
| Pelvic Girdle Pain (PGP) back |
| Pelvic girdle pain can begin the early weeks (wk 14-22) and then remains fairly constant
until the increase of size and weight of the fetus as the pregnancy nears term. PGP disorder is complex and
multi-factorial and likely to be represented by a series of sub-groups with different underlying pain drivers from
peripheral or central nervous system , altered laxity/stiffness of muscles laxity to injury of tendinous/ligamentous
structures to ‘mal-adaptive’ body mechanics.
Pregnancy begins the physiological changes through a pattern of
hormonal secretion and signal transduction thus initiating the remodelling of soft tissues, cartilage and ligaments.
Over time, the ligaments could be stretched either by injury or excess strain and in turn may cause pelvic girdle
instability.
For most women PGP resolves in weeks after delivery but for some it can last for years resulting in
a reduced tolerance for weight bearing activities. Overall, about 45% of all pregnant women and 25% of all
women postpartum suffer from PGP. During pregnancy, serious pain
occurs in about 25%, and severe disability in about 8% of patients . After pregnancy, problems are serious in about 7%.There is no
correlation between age, culture, nationality and numbers of pregnancies that determine a higher incidence of PGP.
After delivery instability/pelvic pain can take from 11 weeks, 6 months or even to 2 years
postpartum to subside. (174)
If you experience these symptoms in one pregnancy, it is more likely
to reoccur earlier in a subsequent pregnancy, and, may or may not be more severe. Healthcare
professionals advise letting the symptoms from one pregnancy settle before trying for another baby.
Pelvic pain can develop slowly during pregnancy gradually
gaining in severity as the pregnancy progresses. A combination of
postural changes, the growing baby, unstable pelvic joints under the
influence of pregnancy hormones and changes in the centre of gravity
can all add to the varying degree of pain or discomfort. In some
cases it can come on suddenly following a fall, sudden abduction of
the thighs (opening to wide too quickly!)
|
| Causes of Pelvic Girdle Pain
back |
| Sometimes there is no oblivious explanation for the cause of Pelvic Girdle Pain. Usually there is a combination of factors causing this condition but the levels of the hormone relaxin are not a predictor of pelvic instability.
Factors such as:
Hypermobility, genetical ability to hyper flex and over extend joints. (About 1 in 4 women with laxity in their joints have pelvic girdle pain.
The position of the baby altering the loading stresses on the pelvic ligaments and joints.
An event during the pregnancy or birth that caused injury or strain to the pelvic joints or rupture of the symphysis pubis.
A change in the activity of the pelvic muscles and/or hip, abdominal, back and pelvic floor.
Previous pelvic girdle pain during pregnancy.
Higher age at first pregnancy.
The pelvic joints moving unevenly.
A history of pelvic trauma.
Strenuous work, previous low back pain.(179)
Twin pregnancy.
|
| |
|
Definition of a Concept; Pelvic Girdle Pain
back |
|
Pelvic type 1: The pelvic ligaments support the pelvis sufficiently. Even when the
muscles are used incorrectly, no complaints will occur when performing everyday activities. This is
the most common situation in persons who have never been pregnant, who have never been in
an accident, and who are not hyperactive.
Pelvic type 2: The ligaments alone do not support the joint sufficiently. A coordinated
use of muscles around the joint will compensate for ligament weakness. In case the muscles around
the joint do not function, the patient will experience pain and weakness when performing everyday
activities. This kind of pelvic often occurs after giving birth to a child weighing 3000 grams or more,
in case of hyperactivity, and sometimes after an accident involving the pelvis.
Type 2 is the most common form of pelvic instability. Treatment is based on learning how to use the muscles around the
pelvis more efficiently.
Pelvic type 3: The ligaments do not support the joint sufficiently. This is a serious
situation whereby the muscles around the joint are unable to compensate for ligament weakness.
This type of pelvic instability usually only occurs after an accident, or occasionally after a (small)
accident in combination with giving birth. Sometimes a small accident occurring long before giving
birth is forgotten so that the pelvic instability is attributed only to the childbirth. Although the
difference between
Type 2 and 3 is often difficult to establish, in case of doubt an exercise program may help the patient.
However, if pelvic type 3 has been diagnosed then invasive treatment is the only option: in this case
parts of the pelvic are screwed together.
|
| (Extract: About pelvic girdle instability….by Jan
M.A. Mens, physician for Orthopaedic Medicine |
|
|
|
| Symptoms
back |
|
A combination of postural changes, the growing baby, unstable pelvic joints under
the influence of pregnancy hormones and changes in the centre of gravity can all add to the varying degree of pain
or discomfort. In some cases it can come on suddenly or following a fall, sudden abduction of the thighs (opening
to wide too quickly), an action that has strained the joint.
Pain is usually felt low down over the symphyseal joint,
this area may be extremely tender to the touch. Pain may also be felt in the hips, groin and lower abdomen and
can radiate down the inner thighs. You may waddle or shuffle, and may be aware of an audible clicking sound
coming form the pelvis. Pelvic pain can develop slowly during pregnancy, gradually gaining in severity as the
pregnancy progresses.
During pregnancy and after, the symphyseal can gap can be felt moving and/or straining
when walking, climbing stairs and turning over in bed. These activities can be difficult or even impossible.
Pain
may remain static, i.e. in one place such as the front of the pelvis producing the feeling of having been kicked,
in other cases it may start in one area and move to other areas, you may experience a combination of symptoms.
Any weight bearing activity has the potential of aggravating an already unstable pelvis, and daily activities
such as turning over in bed, getting in and out of a car or bath and climbing the stairs can all prove to be
problematic.
Some women may find they need a referral to a physiotherapist in order to obtain crutches,
a walking frame or in more severe cases a wheelchair to help them get about. For any woman who were
physically active prior to pregnancy, to then suddenly become grounded by pelvic pain can be very frustrating
and disabling. Anger, or resent towards the pregnancy or baby could occur. Other risk factors associated with
woman experiencing PGP include higher level of stress, low job satisfaction and poorer relationship with spouse.
If this happens seek help, talk to your Health Provider about these feelings and if necessary gain referral to a
counsellor to help you cope.
Symptoms of Pelvic Girdle Pain
Symphysis Pubis pain, extremely tender to the touch.
Present swelling and/or inflammation over joint.
Difficulty lifting leg and pain pulling legs apart.
Unable to stand on one leg.
Unable to transfer weight through pelvis and legs.
Pain in hips and/or restriction of hip movement.
Transferred nerve pain down leg.
Can be associated with bladder and/or bowel dysfunction.
A feeling of symphysis pubis giving way.
Standing with a stooped over back.
Malalignment of pelvic and/or back joints.
Struggle to sit or stand.
Pain may also radiate down the inner thighs.
You may waddle or shuffle and be aware of an audible ‘clicking’ sound coming form the pelvis.
|
|
Self Help Management back |
Self help management techniques include
When getting into bed sit on the edge keeping knees close
together, lie down on your side, lifting both legs at the same time.
Reverse this to get up.
Try not to attempt to pull yourself up from lying on your back.
Keep knees together when rolling over in bed.
Sleep with a pillow between the legs; add more in other areas for
support.
When getting into a car: Sit down first and then swing legs
keeping them together.
Avoid sofas and chairs that are too low or too soft.
Try to reduce the stress on the joint.
Avoid any movement with your knees apart.
Take smaller steps when walking.
Avoid stairs if possible.
Take breaks.
Move within the limits of pain.
Avoid twisting, bending or squatting.
|
|
Conditions Associated with Pelvic Girdle Pain
back
|
|
Diastasis Symphysis Pubis (DSP)
back
Diastasis Symphysis Pubis means an abnormally wide gap
or separation between the two pubic bones at the symphysis
pubis joint situated at the front of the pelvis.
Symphysis Pubis Dysfunction (SPD)
back
The fibrocartilage holding the symphysis pubis together
lengthens during pregnancy to prepare for the forces of
childbirth. If the joint does not function sufficiently and
causes pain and or instability this is symphysis pubis
dysfunction.
Pelvic Joint Syndrome (PJS) | Physiological Pelvic Girdle Relaxation (PPGR) | Symptom Giving
Pelvic Girdle Relaxation (SGPGR) back
Relaxation that causes considerable pain and/or pelvic
instability during pregnancy and/or postpartum; daily
function is impaired. The symptoms appear in the first
trimester. Pain in the symphysis pubis, sacroiliac joints
and sometimes include the lower back.
Pelvic Arthropathy (PA)
back
Inflammatory and/or non inflammatory disease of
the pelvic joints.
Inferior Pubic Shear (IPS) | Superior Pubic Shear (SPS) | Symphyseal Shear (SS)
back
The action or force causing or tending to cause the two parts of the symphysis
to slide relative to each other in a direction parallel to their plane of contact; it is usually found in
an inferior/superior direction but is occasionally found to be in an anterior/posterior direction.
Symphysiolysis back
Separation or slipping of symphyses, especially the symphysis pubis.
Osteitis Pubis back
Osteitis pubis, which means an inflammation of the pubic bone, it is a self limiting
non-bacterial inflammatory process. Go to Osteitis pubis for more information
Sacroiliitis / One-sided Sacroiliac Syndrome / Double Sided Sacroiliac Syndrome
back
It is important to remember that the sacroiliac joints are equally affected by the hormones of
pregnancy and become slightly looser. It is very common to find that although a woman might
be complaining of groin and pubic pain, the main cause of the symptoms is actually at one or
both of the sacroiliac joints and this puts extra stress on the symphysis. Any type of back or
sacroiliac problem that causes excessive movement of the pelvis can result in
excessive movement in the pubic symphysis and its ligaments. Sometimes an obvious limp is present
due to one or both of the joints locking. There is a relation between asymmetric laxity of the sacroiliac
joints and pregnancy related pelvic pain. This condition can begin either pre or post partum.
Hypermobility back
Hypermobility is an increase in the range of motion beyond the normal range. The hyperlaxity in
movements cannot be actively controlled.
|
| Pelvic Girdle Assessment Tools
(180)
back |
| The level of severity in PGP can be adequately
assessed by a combination of specific tests. Five of the most
reliable assessment tools are:
Quebec Back Pain Disability Scale
PDF
The active straight leg raise (view
treatments)
Posterior pelvic pain provocation (view
treatments)
Long dorsal sacroiliac ligament test
Hip abduction and adduction (view
treatments)
|
| Difference between Back Pain and Posterior Pelvic Pain(143) back |
Back pain
A pain drawing with markings drawn
from the sacrum.
Back pain experienced when in forward flexion.
Decreased motion in the lumber spine.
Pain from palpation of the erector spina muscle.
Negative posterior pelvic pain provocation test.
(to view image got to
treatments / orthopaedic tests)
Posterior pelvic pain
A pain drawing with well-defined markings of stabbing in the buttocks distal
and lateral to the L5-S1 area, with or without radiating pain to the posterior thigh or knee,
but not into the foot.
A history of time and weight-bearing pain in the posterior pelvis, deep in the gluteal area.
Pain free intervals.
Free range of motion in the hips and spine and no nerve root syndrome.
Positive posterior pelvic pain provocation test results.
|
|
|
|
|
|
|
|