By Gabrielle Brennan from G.LORRI LABOUR BODYWORK

NURSE/MIDWIFE & PERSONAL TRAINER | MALVERN EAST, VIC

Pelvic girdle pain (PGP) is a common discomfort experienced by pregnant individuals, characterized by pain in the pelvic region. While statistics vary, some studies report up to 76% of pregnant people experience PGP, and from my experience working with pregnant people, I am inclined to agree. The good news is that 93% of women with pregnancy-related PGP experience spontaneous recovery after six months postpartum, indicating that PGP is a temporary condition. However, the question remains: why does PGP occur during pregnancy?

Previously, the hormone relaxin was thought to be the culprit behind PGP, but recent research suggests it may exacerbate the condition rather than cause it. Instead, the primary cause of PGP appears to be biomechanical changes in the body during pregnancy. As the body adapts to the growing baby, muscles may be forced to perform tasks outside of their intended function, leading to fatigue, tightness, and pain. Without intervention, this can become a vicious cycle of compensatory behaviors, resulting in increasing discomfort.

Understanding the mechanics of PGP is crucial to managing it effectively. By addressing the underlying biomechanical issues through targeted bodywork, individuals can alleviate pain and prevent further complications. Don't let PGP take away from the joys of pregnancy and childbirth – take action to regain comfort and mobility.

Lower Back Pain

Lower back pain is a common discomfort experienced during pregnancy due to the extra weight of the baby, changes in the center of gravity, and increased pressure on the spinal support system as the core stretches and weakens. This causes a change in the lumbar curve, known as a high hinge point, which is present in people with sore backs, necks, tight hips, and weak cores, pregnant or not. However, the good news is that working to improve the hinge point can help manage pain.

This can be achieved through various techniques such as ensuring proper diaphragm expansion during breathing, an all-fours position to work on breathing and expanding through the hinge point, improving posture and alignment by stacking ribs over hips, and stretching and strengthening muscles like the psoas, quadratus lumborum, and latissimus dorsi, which plays a critical role in posture. Additionally, using foam rollers or massage balls to roll out lower back muscles can provide relief from pain. With these strategies, you can effectively manage lower back pain and enjoy a more comfortable pregnancy.

Sacroiliac joint pain

Dealing with pain in the sacroiliac joint (SIJ) during pregnancy can be a challenging experience. This is where having a chiropractor or physiotherapist who specialises in pregnancy can be a real game changer. The SIJ is a crucial connection point between the upper and lower body, and if it's causing you discomfort, you may feel a deep central glute pain that's tricky to relieve. But don't despair, there are ways to address the issue! One key focus should be on improving alignment by addressing muscular imbalances, through strength work or release work.

Limiting aggravating movements or positions, maintaining thoracic rotation, and ensuring a 360 degree diaphragm expansion when breathing can also make a big difference. And don't forget to work on your abdominal and hip strength - even in pregnancy, it's important to focus on strengthening your transverse abdominis. Finally, check for any bad postural habits, such as forward head posture, shallow breathing, glute clenching, foot pronation and flared ribs, that could be contributing to your discomfort. By making these adjustments, you can better manage your SIJ pain and enjoy a more comfortable pregnancy.

Symphysis Pubis Dysfunction

When it comes to symphysis pubis pain, the causes are often similar to those of SIJ pain. Ligaments are working harder to provide stability because muscles are imbalanced and are pulling everything into a position that is not favourable for their function. What we often see with this kind of pelvic girdle pain are the abductors compensating for weakness elsewhere in the hips, causing them to become tight and overworked, leading to aches and pain. The key is finding out what they're trying to compensate for. The common culprits are the glutes, abs, iliacus, and pelvic floor. If you can find the weak link, you can address the pain. A pregnancy-specific chiropractor or physiotherapist can do this investigative work for you, as a tailored plan is always best.

To give you a rough idea, these are often what I start with for clients who have PGP and SPD: Limit aggravating movements or positions, such as moving legs apart or standing on one leg. Assess the strength of the anterior pelvic floor through anterior muscle chain movements. Work on evening out the lower transverse abdominis strength. Work on relaxing the posterior pelvic floor through stretches, movements, and release work. (I’ve often found this one to have the fastest improvement of symptoms.)

Addressing symphysis pubis pain requires a targeted approach that considers the unique needs of your body during pregnancy. But with the right guidance and care, you can find relief and work towards a pain-free pregnancy.

**Is there the potential for PGP to impact your baby’s position and what does this mean for labour?**

Understanding that PGP can be caused by misalignment, imbalances, and postural habits rather than solely pregnancy hormones, it's important to consider how this can affect your baby's position before and during labour. As your baby moves through your soft tissue structures during the birthing process, they will navigate the path of least resistance to be born. If you have been experiencing PGP, it is likely due to something being out of alignment or a muscle doing a job it was not intended to do, signaling to your body that there's an issue. This change in soft tissue tone can impact how your baby sits in your pelvis, as a baby will choose the path of least resistance. If you're holding tension as a result of PGP, this can alter your baby's position. It's important to note, however, that this does not mean you won’t be able to labour or your baby will struggle to be born. Instead, it means that your body must work harder, especially during early labor, to ensure your baby is well positioned first.

People often experience early labor for days or feel "stuck" in prodromal/spurious labor when they are holding tension as a result of PGP. Our bodies are brilliant at troubleshooting, but it takes time. If there is an issue with fetal position, your body will not allow you to progress through labor. Instead, your body will guide you to correct the problem. Therefore, listening to your body is vital during labor. Intuitive-based positioning is how you work with your body to birth your baby. However, this can take time and energy, making it important to do the work during pregnancy to address any imbalances.

Bodywork is a valuable tool in birth preparation as it can restore or at least improve soft tissue balance, tone, and positioning. This means that there’s less work for your body to do during early labor, encouraging unhindered labor progress. As a midwife with years of experience both before and after utilizing bodywork, I cannot stress the difference it makes. Soft tissue plays a significant role in improving labor progress, making it crucial to focus on improving alignment and reducing pain during pregnancy to improve soft tissue and potentially reduce soft tissue issues arising during labor.

This can come in the form of:

Practicing 360 diaphragm expansion.
Daily stretches.
Visiting a pregnancy specific chiropractor, physiotherapist or bodyworker.
Exercising during pregnancy.
Release work.
Remedial massage.
Acupressure and/or acupuncture.

In essence, any approach that targets improving alignment to alleviate soft tissue tension and strain can have a significant impact on optimising the space for your baby and reducing the amount of troubleshooting your body needs to perform during labour.

References:

Aldabe, D., Ribeiro, D. C., Milosavljevic, S., & Dawn Bussey, M. (2012). Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 21(9), 1769–1776. https://doi.org/10.1007/s00586-012-2162-x

Hungerford, B., Gilleard, W., & Hodges, P. (2013). Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine, 28(14). 1593-1600. doi: 10.1097/00007632-200307150- 00022 Kanakaris, N. K., Roberts, C. S., & Giannoudis, P. V. (2011). Pregnancy-related pelvic girdle pain: An update. BMC Medicine, 9, 15. https://doi.org/10.1186/1741-7015-9-15

If you're interested in experiencing the benefits of labour bodywork, we invite you to reach out to us.

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