Pregnancy & Lumbopelvic Pain

pregnantWomanDuring pregnancy, the pelvic girdle has shown to exhibit excessive mobility secondary to relaxation of the ligaments in the sacroiliac joints and the pubic symphysis. This is the result of the hormone, relaxin that affects the collagen in the ligaments allowing it to become more elastic in preparation for birth. This sounds like a good thing but occasionally some pregnant women develop joint problems in the sacroiliac and/or pubic symphysis secondary to loss of kinetic function. This results in pelvic pain that may occur as early as the 12th week and can continue post partum while breastfeeding.

A patient with an unstable pelvis would present with the following:

  • Pain localized to the sacroiliac joint or pubic symphysis.
  • Pain may radiate to the knee, abdomen or groin.
  • Difficulty bending forward, standing on one leg (e.g. dressing), walking, prolonged activity, lifting, changing positions – rolling in bed or clicking in the joints.

The pelvis normally gets its stability from “form closure” and “force closure”. Form closure is the natural stability that one gets from their anatomy, the structure of the joints and their opposing surfaces. The sacrum is wedged firmly in between the two ilia with strong ligaments holding it in place. Forced closure is the extra stability one gets from external forces to keep the joints in place such as the surrounding layers of muscles.

At Cornell Physiotherapy, we are experienced in assessing and treating patients with unstable pelvis (both peripartum and postpartum). A consultation would include a thorough assessment of the lower quadrant. Treatment would include education, SI Belt – external support (if indicated) and most importantly stabilization exercises. There are two important groups of muscles: the inner unit (core) and the outer unit (sling systems) that contribute to the stability of the pelvic girdle. Stabilization exercises begin with the activation of “core” inner unit muscles: transverse abdominus, multifidus, pelvic floor and diaphragm. We then gradually progress these exercises and apply it to their daily activities.

Advanced Manual Therapy and Sacral Iliac (SI) Belt
The SI joint can be manually assessed by Physical Therapists at Cornell Physiotherapy for laxity and/or asymmetry. If indicated, the SI joint would be mobilized in the right direction in order for the SI belt to provide and maintain relief. The belts are relatively inexpensive and can significantly enhance function during pregnancy and post-partum.

Physiotherapy intervention during pregnancy Spine. 27 (24): 2820-4

  • A 1997 Swedish study of 135 women randomly allocated to either a control group (no physiotherapy) or an intervention group (maximum of 5 session of individualized education on anatomy, posture, ergonomics, abdominal, pelvic floor and relaxation training).
  • The number of sick leave during pregnancy in the intervention group was approximately half the number of days.
  • The physiotherapy intervention program was also shown to be highly cost effective.