Pelvic girdle pain

Did You Know?

• Paracetamol (acetaminophen) has not been found effective for PGP but is safe; NSAIDs should not be used after 30 weeks of pregnancy.
• Some pelvic joint trauma may require orthopedic surgery if conservative treatments fail.

Differentiation from low back pain

Pelvic girdle pain is a separate condition from low back pain that occurs during pregnancy, though a person can experience both at the same time. Low back pain usually stems from the lumbar spine and its nearby muscles, while pelvic girdle pain comes from the joints forming the pelvic ring, especially the sacroiliac joints and the pubic symphysis. Where and how the pain feels can help tell them apart. Pelvic girdle pain is typically felt between the back of the iliac crest and the gluteal fold, or in the front of the pelvis near the pubic symphysis. It often gets worse with weight-bearing or uneven movements like walking, climbing stairs, turning in bed, or standing on one leg. Lumbar pain, on the other hand, is more linked to spinal motions and staying in fixed positions for a long time. Diagnosis relies mainly on a person’s history and a physical exam, and specific pain provocation tests are frequently used to separate pelvic girdle pain from lumbar spine issues.

Signs and symptoms

Pelvic girdle pain, or PGP, arises from a mix of factors during pregnancy: shifts in posture, the baby’s growing size and position, pelvic joints that become unstable due to pregnancy hormones, and a changed center of gravity. These can cause varying levels of discomfort. Sometimes the pain starts suddenly after a fall, a quick and wide opening of the thighs, or any movement that strains the joint. PGP can appear as early as the first three months of pregnancy. The pain is typically felt low down over the front pelvic joint, which may be very sore to the touch. It can also spread to the hips, groin, and lower belly, and may travel down the inner thighs. Women might develop a waddling or shuffling walk and notice an audible clicking sound from the pelvis. The condition can develop slowly, getting worse as the pregnancy goes on.

During pregnancy and after birth, the gap at the front of the pelvis can feel like it’s moving or straining during activities like walking, climbing stairs, or turning over in bed. These tasks can become difficult or even impossible. The pain might stay in one spot, like a feeling of being kicked in the front of the pelvis, or it may start in one area and move to another. Some women experience a mix of these symptoms. Any activity that puts weight on the pelvis can aggravate the instability, limiting daily life. Pain may occur with dressing, getting in or out of the bath, rolling in bed, climbing stairs, or sexual activity. Lifting, carrying, pushing, or pulling can also trigger pain.

Symptoms vary widely in type and severity. They can include swelling or inflammation over the joint, trouble lifting a leg, pain when pulling the legs apart, an inability to stand on one leg, or difficulty transferring weight through the pelvis and legs. Hip pain or restricted hip movement, nerve pain shooting down the leg, and bladder or bowel issues may also occur. Some women feel like the pelvic joint is giving way, have a stooped back when standing, or notice misalignment in the pelvic or back joints. Sitting or standing can be a struggle. Pain may radiate down the inner thighs, and a waddling or shuffling gait is common, along with an audible clicking from the pelvis.

The severity of pelvic instability is measured on a three-level scale. In pelvic type 1, the ligaments support the pelvis well enough.

Causes

Pelvic girdle pain (PGP) often has no single clear cause, but it usually stems from a mix of factors. These can include uneven movement in the pelvic joints, changes in how the muscles of the pelvis, hips, abdomen, back, and pelvic floor work, or a past injury to the pelvic area. During pregnancy, the baby’s position may shift the stress on pelvic ligaments and joints. Other contributing factors are strenuous work, a history of lower back pain, or having had PGP in a previous pregnancy. Some people have hypermobility, a genetic trait allowing joints to stretch beyond their normal range. An injury or strain to the pelvic joints during pregnancy or birth, or a rupture of the fibrocartilage, can also play a role.

Certain factors make PGP more likely during pregnancy. These include having had PGP in an earlier pregnancy, prior low back pain, and hypermobility or loose connective tissue. Obstetric factors like carrying twins, being in a first pregnancy, or being older at the time of a first pregnancy also raise the risk. Physically demanding jobs, past pelvic trauma, and activities that involve repetitive or uneven pressure on the pelvis can contribute as well. However, the presence or absence of any one of these factors does not reliably predict how severe or long-lasting the pain will be. No single factor is enough to explain PGP on its own, and the condition is understood to be caused by multiple interacting elements.

Mechanism

Pelvic girdle pain during pregnancy can be classified as either specific or non-specific. Specific cases stem from direct trauma or injury to the pelvic joints, or from genetic factors such as connective tissue disease. Non-specific cases have no clear single cause. This condition is complex and arises from multiple factors, likely involving several subgroups. Pain may originate from the peripheral or central nervous system, from changes in muscle stiffness or laxity, from injury to tendons or ligaments, or from the body adopting maladaptive movement patterns. Pregnancy triggers a series of physiological changes driven by hormones and cell signaling, which begin remodeling soft tissues, cartilage, and ligaments. Over time, ligaments can be stretched too far due to injury or excessive strain, potentially leading to pelvic girdle pain.

The pelvis is the largest bone structure in the skeleton and contains three joints: the pubic symphysis at the front and two sacroiliac joints at the back. These joints are surrounded by a very strong network of ligaments, giving them considerable stability. The pubic symphysis is a fibrocartilage joint that may contain a fluid-filled cavity and lacks its own blood supply; it is supported by the superior and arcuate ligaments. The sacroiliac joints are synovial joints, but their movement becomes more restricted with age and they are gradually filled with adhesions. Because the pelvic bones form a ring with these three joints, none of them can move independently of the other two.