Prenatal Pelvic Pain: Symptoms, Strategies to prevent & Exercises
During pregnancy, a women’s body undergoes many structural and hormonal changes to accommodate for the growing baby and prepare for birth. These changes cause muscle imbalance and joint relaxation, ie. instability, which can ultimately show up as discomfort or pain.
Pelvic pain is one such discomfort. You may have heard of pregnancy-related Pelvic Girdle Pain (PGP) or Symphysis Pubis Dysfunction (SPD). These terms are sometimes used interchangeably however PGP describes pain at both the back and front of the pelvis while SPD centers at the front in the symphysis pubis, please refer to the diagram below.
PGP and SPD are not harmful to your baby, however as the name suggests it can be painful as well as restricting your ability to move with ease.
Around 16-25% of women experience PGP however the good news is that some studies report numbers as high as 76%-93% of pregnancy related PGP experience spontaneous recovery six months postpartum.[1]
Treatment of Pelvic Pain
A chiropractor or women’s health physiotherapist can help relieve or ease pain, improve muscle function, and improve your pelvic joint position and stability through manual treatments and/ or exercise and movement recommendations. Each woman experiences pelvic pain differently, a professional would be able to assist with your individual case.
Symptoms of Pelvic Pain include but are not limited to:
Sharp pain at the front of the pelvis.
Pain that can also often extends to the rest of the hip, the lower back, down the legs, or into the lower abdomen.
You may feel or hear a clicking or grinding in the pelvic area.
Increased pain when performing everyday activities. These include walking, going up or down stairs, standing on 1 leg (ie when getting dressed), turning over in bed or moving your legs apart (ie when getting out of a car). Click here for a video on how to navigate some of these everyday movements pain-free.
Exercises To Decrease or Avoid
As mentioned above there are some daily movement patterns that can contribute to pelvic pain. While exercising if you experience pelvic pain you should try to decrease or avoid completely certain movements, these and their modifications are as follows:
Single leg standing exercises such as lunges, standing side leg lifts or single leg deadlifts. Modify with double leg for deadlifts and side lying leg lifts, don’t force your leg or go too high. This goes for everyday movements such as getting out of bed or the car. Rather than pushing off with one leg, turn your whole body to the edge of the bed or car seat, place both legs on the ground and then get up.
Avoid wide legged exercises such as sumo squats or lateral lunges. Modify with hip-width and narrow squats or narrow stance static lunges if possible.
Avoid breast stroke when swimming. Other strokes are generally ok.
Avoid heavy weight lifting or loading too much weight on your hips, especially on one side. And this doesn’t end at the gym. We all tend to carry our toddlers or laundry baskets on one hip.
Avoid high impact exercises such as running or plyometrics as they may stress your joints.
Strategies to Prevent or Manage Pelvic Pain
1. Maintain proper alignment
During pregnancy, postural adaptations shift our center of gravity and puts us off balance. A neutral position increases core and pelvic stabilization. Optimal alignment in standing entails stacking the rib cage over the pelvis (See below diagram). This doesn’t mean you have to spend all your time in a neutral position but it is important to do so under load, when exercising or completing challenging daily activities.
Tip: practice pelvic tilts standing, supine and on all fours to find pelvic neutral.
2. Bring awareness to your pelvic floor
The increasing weight of the uterus coupled with the shift in body alignment puts increased pressure on the pelvic floor which may contribute to pelvic pain. Often during pregnancy, we are encouraged to strengthen our pelvic floor muscles with kegels however we often overlook lengthening the pelvic floor focusing more on the contraction. If you are not relaxing the muscle correctly, this creates a tight muscle which is in fact a weak muscle. Consulting a pelvic floor physiotherapist would be worthwhile to have your pelvic floor not only checked but for tailored pelvic floor exercises.
Tip: when practicing kegels, bring awareness to the release stage of your kegel. See here for a more detailed description.
3. Focus on 360 breathing and correct engagement during exercise
It all comes back to the breath. Correct breathing encourages proper alignment and pressure management in the core and pelvic floor.
Do you hold your breath when exercising or completing challenging daily activities? Are you having trouble taking a deep breath and getting a full inhale? Are you bearing pressure downward as you exhale? Breathing affects core function and the surrounding muscles including hip muscles.
Tips:
Maintain thoracic or mid-back mobility to enable rib movement with each breath while minimizing movement in the hips and lumbar spine or low back. The crossbody row exercise shown in the below circuit is a great one to try. Other exercises we love are wall slides for thoracic extension (much harder than they look!) and the wood chop for thoracic rotation. Some great stretches include the thoracic rotation or Cat Cow. Foam rolling is also a great tool.
During exercise or specific tasks in our daily lives, exhale to engage and lift pelvic floor and stabilize your core before and during the hardest part of a movement to encourage core stability. If you haven't read this post yet (linked in point 2), check it out for a more detailed description.
4. Maintain glute and core strength
Keeping the muscles surrounding and supporting the hips and pelvis strong and active is one way to prevent or decrease pelvic pain. The glutes are big stabilizing muscles that often fall asleep due to our sedentary lifestyle but also postural changes. Maybe you’ve notices a sway back posture or that you chronically clench your glutes? We've included plenty of glute work and sneaky core in the featured workout.
In a nutshell, we want to focus on breathing, posture, glute strength and core and hip stability. The below workout will demonstrate some great exercises you can incorporate but remember everyone is different and if something doesn’t feel good to you, swap it out for something that does and don’t hesitate to leave a comment below or email us with any questions you may have.
Workout Circuit
Equipment: Resistance bands (light or medium and heavy) and a pilates ball, if you don’t have one you can use a block or pillow between the legs, just over the knees. This is great for increasing stability in the pelvis as you squeeze the prop; squeeze on the exhale as you engage your core and pelvic floor.
Format: perform each exercise for 10-12 reps one after the other for a full round. Repeat the circuit 1-3 times.
1) Squat & band pull apart
Muscles worked: quadriceps, hamstrings, glutes, shoulders, back and core
How to: start in standing with feet hip width apart or in a narrow stance (option to add a ball between the legs) and arms straight out in front of you at shoulder height. Sit back in your squat making sure your knees are over your toes and knees pointing forward or slightly out, not inwards. Come back up to standing and pull the edges of the resistance band apart bringing your shoulders blades together. Come back to starting position and repeat.
Tip: to sit back in your squat, bend from the hips first as if trying to touch the back wall with your glutes then bad your knees to come down into a squat.
2) Staggered Romanian deadlift & single arm row (each side)
Muscles worked: Back, hamstrings, glutes, core
This version of a deadlift works one leg at a time. However, the staggered position with opposite foot on the ground creates stability, allowing us to perform unilateral movements and correct imbalances pain-free.
How to: Place one foot a foot-length in front of the other so your stance is staggered. Place a heavy resistance band under the front foot and grab the other end in the opposite hand. Stand up straight to start. Now hinge from your hips and slightly bend your knees in a slow controlled movement allowing the resistance band to pull you down. Keep your back straight and core tight. Your torso should be almost parallel to the floor. At the bottom of the movement, perform a single arm row bringing your elbow straight up toward the ceiling. Bring your hand back down and push through your heel to stand up straight. Pause at the top and engage your glutes. Repeat.
3) Bridge with ball squeeze & band pull apart
Muscles worked: glutes, hamstrings, inner thighs, core, shoulders
How to: place a pilates ball, yoga block or pillow between your knees and lay on your back, feet on the floor. Grab a light to medium resistance band and hold it up over your chest with straight arms. As you exhale, engage your core and glutes and come up into a bridge. At the top of the movement perform a band pull apart, further engaging your core muscles. Remember to keep your ribs down. Come back down and repeat.
4) Crossbody row (each side)
Muscles worked: obliques, mid-back.
How to: sit on the floor with your legs extended in front of you. Place a heavy band around one foot and grab it with the opposite hand. As you exhale, perform a row slight twisting your torso. The twist should come from the ribs and mid-back, not the lumbar spine or lower back. Keep your hips facing forward towards your toes.
5) Bear hold with ball squeezes
Muscles worked: Transverse abdominis (low abs), obliques, inner thighs
How to: Place a ball, block or pillow between your knees and get into all fours with hips over knees and shoulders over writs. Keep your spine should be neutral and engage your core. Exhale as your lift your knees slightly off the ground. Back stays flat. Hold for 3 to 5 breath squeezing the ball to get that extra core, pelvic floor and inner thigh engagement with every exhale.
6) Bent knee fallout
Works: the transverse abdominis (deep core muscles), hip stability
How to: lay on your back with your feet on the floor. Take a few round of 360 breathing & pelvic floor activation. When you are ready, exhale as your let one knee fall out. Only go as far as you can keep your hips squared and stable. Come back to center and repeat on opposite side.
Happy Workout!
Sources:
https://pogp.csp.org.uk/publications/pregnancy-related-pelvic-girdle-pain-mothers-be-new-mothers
https://pogp.csp.org.uk/system/files/publication_files/POGP-PGP%28Pat%29%28UL%29.pdf
Sarah Duvall Pregnancy & Postpartum Corrective Exercise Specialist Course.
[1] Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update.BMC Medicine.