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Health - Pelvic Girdle Pain

Tuesday, 23 September 2008

Pelvic Girdle Pain / Symphysis Pubis Dysfunction (PGP/SPD) is the name given to pain and mobility problems caused by instability of the pelvis during pregnancy. This then leads to patients having to take time off work and employers having to deal with loss of office staff. Patients can't get out doing their daily activities after having their baby and return to work can be delayed. They can have to walk with crutches, be hospitalised for bed rest and pain management .This can lead to social isolation, depression and a feeling of "I hate this pregnancy".

Who are the guests?
. Dr Valerie Donnelly- chief Obstetrician in Mt Carmel Hospital

. Andrea Fitzgerald- Andrea is due on the 1st of October and is on her third pregnancy. She has had PGP on both previous pregnancies, worse on the first than second. It started at 21/40 weeks this time. Her aggravating factors included walking and turning in the bed. Andrea works part time as a dermatology nurse in Our Ladies Hospital for sick children and had to stop work early. Andrea has been receiving regular treatment which has given her relief week to week. Andrea has also implemented lifestyle management strategies such as more rest periods, avoiding heavy work in the house etc.

What is Pelvic Girdle Pain?
Pelvic Girdle Pain / Symphysis Pubis Dysfunction is the name given to pain and mobility problems caused by instability of the pelvis during pregnancy.

During pregnancy pain can develop in the joints in and around the pelvis. This is usually caused by altered position of the joints (asymmetry). The pelvis is a closed system of bone and muscle so any change in movement at one joint will affect the function of all the others. The combination of unstable joints, the growing baby and changes in the centre of gravity and posture can result in varying degrees of pelvic pain.

The pelvis can also be damaged by trauma eg. A fall or a blow to the area, or by labour itself, although that is quite unusual.
The pain may remain static, or may increase as the pregnancy progresses. However, it is important to seek treatment early, as checking the alignment of the joints and realigning them can greatly reduce pain during pregnancy. Members of the group have also found that this treatment speeds up recovery postnatally.

What are the symptoms?
The primary symptom is discomfort/pain in the pelvic region. Most commonly the pain is centred on the joint at the front of the pelvis (the pubis symphysis) but can also be felt in the lower back (sacro-iliac) joints, hips, groin and lower abdomen, radiating down the inner thighs.
The severity of the pain differs greatly from woman to woman. Some women will experience only mild discomfort from time to time, whilst others suffer prolonged and extreme pain. Some women can hear their pelvis 'click' as they walk or turn over in bed.

Who is at Risk?
Risk factors include previous trauma such as fall, injury to coccyx which could be previous labour. Previous history of low back pain and previous symptoms on pregnancy. No other definite identifiable risk factors. It can t be prevented but it can be managed through hands on treatment and early diagnosis. Pilates can improve core strength which will have a positive influence on pelvis and typically physiotherapists can teach these and when happy that the patient is painfree will advise a Chartered Physiotherapist run pilates class

What are the effects?
SPD can be mild or it can be extremely debilitating. All weight bearing activities have the potential to cause pain. Many women with SPD have difficulty walking. Even standing for any length of time can prove to be extremely painful. It may indeed be necessary to use a walking aid such as crutches. a walking frame or a wheelchair.

Even for those not so severely affected, pelvic instability can have a profound effect on day-to-day life. Previously simple activities such as getting in and out of bed, climbing stairs, getting in and out of the bath, driving, standing up, dressing, bending down, turning over in bed etc can become difficult and painful.
The effects of SPD are not only physical, they can also have psychological effects. It can be hard to admit you need help with the most basic of tasks. The woman may resent or feel guilty about her condition; she may feel that she is a burden to her family and friends. If she is housebound she could feel very isolated and lonely. Relationships too can suffer as everyone deals with this sudden change in circumstance.

Pregnancy is traditionally regarded as a time of great joy and anticipation so it can be difficult to reconcile this with the reality of feeling awful. Some women feel a sense of failure; they feel that their bodies have betrayed them and the delight of expecting a new baby can be tainted by the fear of not recovering after the birth.
Almost all women with SPD will find it difficult to part their legs without severe pain.

Tips for recovery:
It is important to seek treatment from a professional experienced in treating SPD as early as possible when you develop symptoms. This is to check alignment of your pelvis, and have this treated and realigned as necessary. They will also show you specific exercises for pelvic stability to help to strengthen the area. You may find a Chartered Physiotherapist, or an Osteopath or Chiropractor with experience in treating pelvic joint problems is most appropriate, or a Women's Health physiotherapist at your local hospital may be able to treat you.

You may also need to be referred to an Occupational Therapist for assessment for equipment to help you at home if you have more severe symptoms

. Keep your legs together - be ladylike
. Keep symmetrical when you move, sit, stand or lay down
. Avoid lifting
. Avoid twisting movements
. Avoid things you know will hurt you
. Allow the joints to heal while remaining as active as possible
. Be extremely careful not to slip, as your pelvis is very vulnerable
. Place a folded towel or pillow between your knees at night
. How can you make it easier?
. Do you have everything you need ready before you start?
. Do you really need to do it at all, or can someone else help?

For further information see

Mt Carmel Hospital is hosting a one day Pelvic Girdle Pain conference in the Tara Towers Hotel on 11th October 2008.