Pelvic girdle pain can be debilitating throughout pregnancy and the postpartum period. Common symptoms could include pain or discomfort with single-leg movements, as simple as just walking, and with pivoting movements, such as rolling in bed or getting out of your car.
What causes pelvic girdle pain? And what causes SPD?
1. Pelvic Positioning
When we move, the pelvis and surrounding musculature work together to stabilize the pelvic joints (sacroiliac (SI) joints, and the pubic symphysis). Bony structures form closure on the joints to keep them from moving too much; the muscles and tissues force closure on the joints to keep them from moving too much, and then we have our neuromuscular connection that is coordinating the action of all these players.
When we move our body, the pelvic bones respond to this movement by shifting their position to better transfer force from the upper to the lower body, and vice versa.
When you are walking, when you put weight into one leg and begin to move your body forward, that half of the pelvis shifts posteriorly (backward), adducts (moves towards the midline), and internally rotates (the pelvis moves onto the fixed femur).
As the other leg swings forward in your stride, that half of the pelvis shifts anteriorly (moves forward), abducts (moves away from the midline), and externally rotates (the pelvis moves on the fixed femur). Then this alternates from side to side. This torque is the pelvic position that helps to force closure on the pelvic joints, to aid in stability.
If the pelvis does not shift in position or is stuck in a certain position (sometimes emphasizing external rotation or favoring one leg more so than the other), then the pelvic bones and surrounding musculature may not be able to force closure on the pelvic joints = decreases stability = increased movement = pain or discomfort.
Find comfort and relief from pelvic girdle pain throughout your pregnancy and postpartum period! This program incorporates myofascial sling focused exercises to stabilize across the pelvic girdle joints.
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2. Relaxin
Relaxin is a hormone that increases joint laxity, however, higher relaxin levels are not necessarily associated with increased occurrence of pelvic girdle pain. Increased laxity in the joints does not automatically equal increased pain. This is important to understand that increased joint laxity is not an automatic reason for discomfort throughout your pregnancy. Rather, biomechanically, how you alter your motor control, postural tendency, and altered movement and stabilization patterns may contribute more so to pelvic girdle pain.
There is an increase in movement of the joints due to relaxin, but if the surrounding musculature is coordinated and strong enough to counter this increased laxity, you should find relief from pelvic girdle pain.
3. Activity Levels
Something that I discovered for myself during my pregnancies, and a trend with my own clients, is that inactivity seemed to increase pelvic girdle pain. Whenever I had SJD during my last pregnancy, it was usually linked to a period of time that I didn’t work out and was fairly inactive. Once I resumed my workout routine (particularly the strength training and pelvic stability programming), I found relief from my SJD pain. The same applied for Roxanne, when she was less active, she found her pubic symphysis dysfunction (SPD) tended to flare up more after periods of inactivity.
In periods of inactivity, we may find that muscles become deconditioned and less ready to perform to stabilize the pelvis. Different muscles also experience different timeframes of atrophy. The multifidus, for example, experiences atrophy faster than the surrounding musculature. The multifidus is a part of our deep core stabilization system, helping to stabilize the spine vertebrae to vertebrae. When it is not functioning as well as the rest of the system, we can see compensation patterns, and sometimes increased lower back pain.
What are some solutions and approaches to managing SPD?
1. Pelvic Positioning
Many of us favor a postural pattern where the left side is more oriented forward, while the right side is more oriented backward. This postural tendency can make it more challenging for the surrounding musculature to have force closure on the pelvic joints, so when we shift around the pelvic joint is not stable and can cause pain. We don’t necessarily need to be in neutral, since our pelvis does shift as we walk, but if we are compensating and “stuck” in an orientation, when we try to step into one leg and the pelvis has not shifted to adjust to the shift in weight, we may feel pain.
We can use different strategies to help find more of a neutral pelvic position, such as drive the hip crease back (usually the left side) and then add some adductor emphasis to it. We can squeeze a yoga block or foam roller between the thighs to add adductor emphasis if a staggered or split stance is too challenging/painful! Watch the video below for more of a breakdown.
2. Strengthening: The Anterior Oblique Sling
Now that the pelvis is in a better position, we can focus on strengthening the myofascial sling that supports the pelvic joint on the front: the anterior oblique sling! The anterior oblique sling runs from the oblique to the opposite adductor and is emphasized with co-activation or co-contraction on both ends of the sling. Think the shoulder and opposite knee are moving towards the midline, and this would be activating this sling. We incorporate exercises like these in all of our fitness programs, especially our 3-week pelvic stability accessory program.
Watch the video below for some exercise ideas that strengthen this sling.
Feel strong and move comfortably throughout your entire pregnancy. Our program syncs to your current week of pregnancy, so you can start at any time!
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3. Mobility or Release Techniques
The tension of the pelvic floor can also be affecting how the pelvis is positioned and the activation of the musculature. We can release tension in the pelvis floor with different breathing drills, but one of our favorites is the side-lying drill. Watch the video below to follow along!
Join us for on-demand prenatal yoga classes specific to each trimester!
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Our 40-Week Prenatal Strength & Conditioning Program & 3-Week Pelvic Stability Accessory Program incorporate myofascial sling exercises meant to support pelvic stability throughout pregnancy. You can stay comfortable and move with ease throughout pregnancy.