Pelvic girdle pain (abbreviated PGP) can be described as a pregnancy discomfort for some women and a severe disability for others. PGP can cause pain, instability and limitation of mobility and functioning in any of the three pelvic joints. PGP has a long history of recognition, mentioned by Hippocrates and later described in medical literature by Snelling.
Classification
Prior to the 20th century, specialists of pregnancy-related PGP used varying terminologies. It is now referred to as Pregnancy Related Pelvic Girdle Pain that may incorporate the following conditions:
Diastasis of the symphysis pubis (DSP) Symphysis pubis dysfunction (SPD) Pelvic Joint Syndrome Physiological Pelvic Girdle Relaxation Symptom Giving Pelvic Girdle Relaxation Posterior Pelvic Pain Pelvic Arthropathy Inferior Pubic Shear/ Superior Pubic Shear /Symphyseal Shear Symphysiolysis Osteitis pubis (usually postpartum) Sacroiliitis One-sided Sacroiliac Syndrome /Double Sided Sacroiliac Syndrome Hypermobility
"The classification between hormonal and mechanical pelvic girdle instability is no longer used. For treatment and/or prognosis it makes no difference whether the complaints started during pregnancy or after childbirth." Mens (2005)
Signs and symptoms
A combination of postural changes, the position and weight of the baby, unstable pelvic joints under the influence of pregnancy hormones, and changes in the centre of gravity can all add to the varying degrees of pain or discomfort. In some cases it can come on suddenly or following a fall, sudden abduction of the thighs (opening too wide too quickly) or an action that has strained the joint.
PGP can begin as early as the first trimester of pregnancy. Pain is usually felt low down over the symphyseal joint, and this area may be extremely tender to the touch. Pain may also be felt in the hips, groin and lower abdomen and can radiate down the inner thighs. Women with PGP may begin to waddle or shuffle, and may be aware of an audible clicking sound coming from the pelvis. PGP can develop slowly during pregnancy, gradually gaining in severity as the pregnancy progresses.
During pregnancy and postpartum, the symphyseal gap can be felt moving or straining when walking, climbing stairs or turning over in bed; these activities can be difficult or even impossible. The pain may remain static, e.g., in one place such as the front of the pelvis, producing the feeling of having been kicked; in other cases it may start in one area and move to other areas. It is also possible that a woman may experience a combination of symptoms.
Any weight bearing activity has the potential of aggravating an already unstable pelvis, producing symptoms that may limit the ability of the woman to carry out many daily activities. She may experience pain involving movements such as dressing, getting in and out of the bath, rolling in bed, climbing the stairs or sexual activity. Pain may also be present when lifting, carrying, pushing or pulling.
The symptoms (and their severity) experienced by women with PGP vary, but include:
Present swelling and/or inflammation over joint. Difficulty lifting leg. Pain pulling legs apart. Inability to stand on one leg. Inability to transfer weight through pelvis and legs. Pain in hips and/or restriction of hip movement. Transferred nerve pain down leg. Can be associated with bladder and/or bowel dysfunction. A feeling of the symphysis pubis giving way. Stooped back when standing. Malalignment of pelvic and/or back joints. Struggle to sit or stand. Pain may also radiate down the inner thighs. Waddling or shuffling gait. Audible 'clicking' sound coming from the pelvis.
Severity
The severity and instability of the pelvis can be measured on a three level scale.
Pelvic type 1:The pelvic ligaments support the pelvis sufficiently. Even when the muscles are used incorrectly, no complaints will occur when performing everyday activities. This is the most common situation in persons who have never been pregnant, who have never been in an accident, and who are not hypermobile.''
Pelvic type 2:The ligaments alone do not support the joint sufficiently. A
coordinated use of muscles around the joint will compensate for ligament weakness. In case the muscles around the joint do not function, the patient will experience pain and weakness when performing everyday activities. This type often occurs after giving birth to a child weighing 3000 grams or more, in cases of hypermobility, and sometimes after an accident involving the pelvis. Type 2 is the most common form of pelvic instability. Treatment is based on learning how to use the muscles around the pelvis more efficiently.