Pregnancy related Pelvic Girdle Pain (PPGP)

Understand the anatomy of your pelvis and the changes in your body

Your body goes through many changes when you’re pregnant and it is important to understand this as your baby grows. Pregnancy hormones can soften some of the tissues around your pelvis in
order to make room for your baby to grow and to prepare you for giving birth. This is completely normal and is in fact a very useful change. Research has shown that this change does not mean you will develop symptoms of PPGP.

Your pelvis is made up of two main joints:

• Your Sacroiliac joints at the back
• Your Pubic symphysis joint at the front

These joints are supported by ligaments, tendons and muscles which help to give the pelvis stability.

The base of your pelvis is supported by the pelvic floor muscles. These muscles connect from the bottom of your spine at your sacrum and tail bone to the front of your pelvis at the pubic bone.

The pelvic floor muscles support your:

• bladder
• womb
• bowel
• they provide strength and structure to your vaginal walls and pelvis.
• they help you to control when you pass urine and open your bowels.

Myth -‘My pelvis is unstable’

Fact – Your pelvis is made up of some of the strongest joints in your body and the muscles around about it help to keep it strong and stable.

Myth – ‘My pelvis is out of alignment’

Fact – Your pelvis DOES NOT move out of alignment in pregnancy. It stays strong and robust

Modify daily activities

To help you manage your symptoms, it is important that you are as active as possible. However, you may need to make changes to some of your day-to-day activities that make your symptoms worse.
Plan your day and do activities like walking the dog or shopping when you feel you have the energy.

Sleep

Try to get 8-10 hours’ sleep over a 24-hour period – this helps to dampen down your nervous system so that you don’t get so many
painful symptoms. If you have a broken night sleep for any reason, try and nap throughout the day.

It is important that you ask for help and accept it when it is offered. If you have young children at home, pregnancy can be challenging.

• Accept help with childcare and nursery/school drop offs/pick-ups.
• Get others to help you with the housework

Other advice

• sit down to get dressed/undressed
• avoid standing favouring one leg
• avoid sitting with your legs crossed or in a basket
• try going up- and downstairs one step at a time using handrails for support
• when getting in and out of the car keep both legs together or taking small steps round
• if you’re sitting down for long periods of time, try and take regular breaks by standing up and sitting down in your chair every 20 minutes. You can also change to sit on your gym ball at frequent intervals

Eating and Drinking

Make sure you are eating a healthy balanced diet at the same time each day. If you are struggling with nausea and vomiting, then eat regular small snacks throughout the day.
It is important to keep hydrated in pregnancy so try to drink 1.5-2litres of fluid per day.

Back to top

Your energy system is directly linked with your nervous system. If you are feeling tired this can often make our symptoms seem worse. It is important that you listen to your body.

Top tips

• try to slow down as much as possible
• avoid having too much planned in one day
• avoid being on your feet for long periods
• take regular breaks if possible
• be kind to yourself
• prioritise sleep and rest
• arrange a meeting at work to complete your risk assessment and discuss any changes to your duties

Taking some time out during your day to complete some relaxation or mindfulness as this can help make your nervous system less sensitive. Try to set aside some time for:

• deep breathing exercises
• visualisation, meditation and mindfulness
• yoga
• do something that you enjoy
• meet with friends
• spend time in nature or with your pet

Watch this Laura Mitchell Relaxation video below.

Current evidence shows us that regular exercise has lots of benefits for pregnant women and their babies and can also reduce symptoms of pregnancy related pelvic girdle pain. The government
recommends that you complete up to 150 minutes of moderate intensity exercise per week. This means an activity that makes you breathe faster, while you’re still able to hold a conversation.

Activities like:

• cardiovascular exercise to raise your heart rate for example walking or cycling
• strength and resistance training to strengthen your muscles
• mobility based exercise like Yoga or Pilates.

If you were not very active before you were pregnant then you should start off gradually and work up to exercising.
Try starting with 10 minutes of moderate exercise a week and work up to 150 minutes a week. You may need to do a bit less though – listening to what your body tells you is very important.

Please see this NHS page for further support and advice about exercising in pregnancy. 

You can view the Government Infographic on physical activity for pregnant women here.

Gym ball exercises

Gym ball exercises can help improve symptoms of Pelvic Girdle Pain. These exercises are proven to reduce stiffness in the joints around your pelvis and are a safe, gentle way of exercising
throughout your pregnancy. Please ensure to buy a gym ball which is an anti-burst type and is the right size for your height and weight.

• height of 5ft to 5ft 2inches (around 160cm) – use a 55cm gym ball
• height of 5ft 2inch – 5ft 6inch (between 160cm and 170cm) – use a 65cm gym ball
• height of 5ft 6inch – 6ft (between 160cm and 180cm) – use a 75cm gym ball

See a Gym ball exercises video below

If you are having a high risk pregnancy, or are not keeping well please speak to your obstetric team before exercising. We recommend if struggling with symptoms of PPGP you consider doing some:

• pregnancy yoga or Pilates
• swimming

Both these type of exercises are low impact, calming and great for reducing sensitivity in your nervous system. This is the best way to reduce pain.

Pregnancy puts a lot of pressure on your pelvic floor muscles and it is normal for the pelvic floor muscles to stretch during pregnancy. Your muscles may be weaker and you may feel more pressure vaginally and around your pelvis, so it is very important to strengthen your pelvic floor muscles.

How do I strengthen my pelvic floor muscles?

Start these exercises lying on your back or side. Then progress to doing them in sitting or standing. Do not hold your breath when completing these exercises:

• Step 1: Tighten the muscles around your back passage as though you are holding in wind (without squeezing your buttocks)
• Step 2: At the same time as you squeeze your back passage also squeeze the muscles around the opening to your vagina to lift them. Try and, think about stopping yourself from passing urine.
• Exercise 1: Lift and squeeze your pelvic floor muscles quickly 10 times
• Exercise 2: Lift and squeeze your pelvic floor muscles for up to 10 seconds 10 times. Relax for 4 seconds between each squeeze

Try and do these exercises three to four times every day.

Another way of strengthening your pelvic floor muscles is to do a pelvic floor lift before you do things like lifting, coughing or going from sitting to standing.

Watch NHS Highland’s pelvic floor exercises video below

• Download the NHS Pelvic Floor Squeezy App here.

Pain relief

It is useful to explore other options to manage your pain. You might find applying heat or ice helpful but just remember not to put this directly on to your skin or near your bump. You may need to discuss pain medication with your GP if you have tried other things that have not worked for you.

You can also try some alternative techniques which might give you some short term relief:

• massage therapy
• TENs machine
• mcupuncture
• relaxation techniques
• elbow crutches
• maternity support belt

If you are finding it difficult to walk you may find using elbow crutches can help. Please see our self-refer walking aid form.  

The information and advice we’ve given you here is a very important part of your treatment and can make a huge difference to your symptoms if you do it regularly. We really encourage you to follow as much of it as possible.

Please try not to worry – we know that 9 out of 10 women (90%) who have PPGP find their symptoms get much better within 3 months of having their babies.