A recent survey of 1,000 women aged 35 to 60, conducted by SI-BONE, Inc. (SIBN), a Silicon Valley-based medical device company focused on solving musculoskeletal disorders of the sacropelvic anatomy. They found that 86% of respondents were unaware that sacroiliac (SI) joint dysfunction is a leading cause of chronic lower back pain for women over 35 who have been pregnant.1 SI‐BONE, the firm that conducted the research is a medical device company that pioneered minimally invasive surgery of the SI joint with the iFuse Implant System. While these new medical breakthroughs should be applauded, they should also be considered as a last resort. So what can you do about SI Joint Pain?
Below is a simple guide to one of the most common pregnancy conditions that causes low back pain and pelvic pain during pregnancy. We encourage you to seek physiotherapy treatment for pain symptoms earlier rather than later and it is also important to dispel the myth that pregnancy pain is an unavoidable part of pregnancy. Before you seek out the skills of Physiotherapists working with pregnant and postpartum women it will be helpful to understand some basics to be able to better describe your symptoms to your physiotherapist or another health care professional.
The sacroiliac joints are located in the pelvis and their objective is to transfer weight and forces between the upper body and legs during activities such as walking, running and jumping. During certain movements of the spine and hips, stretching or compressive forces are placed on the sacroiliac joints and surrounding ligaments. If these forces are excessive and beyond what the sacroiliac joint can withstand, injury to the sacroiliac joint may occur. This is known as SI Joint Pain or dysfunction.2
However, Sacroiliac Joint Pain is one of the 3 possible causes of pain during pregnancy, which is called Pelvic Girdle Pain and it’s more useful to discuss this more general term until a proper diagnosis is made.
Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.
Pelvic girdle pain (PGP) in pregnancy can arise from the 3 main joints of the pelvis and the muscles, ligaments and nerves associated with them. There are 2 sacroiliac joints (SIJ) at the back of the pelvis. The SIJ exist between the sacrum and the side pelvic bone called the ilium. Pelvic Girdle Pain may come from:
Symptoms of pelvic girdle pain in pregnancy can be a combination of the following:
It is possible for the pain pattern to shift day to day or week to week, where it may be just one sided, or it alternates, or the pain is only felt at the front or the pain is only at the back of the pelvis. Varying levels of pain can be felt in different areas, which may include the pubic symphysis, groin, lower abdomen, inner thigh, hip, buttock, outer thigh, entire leg or low back.
Pain may be constant or intermittent often described as an ache. Pelvic girdle pain can also be felt as a shooting/stabbing pain in the buttock, down the leg or at the front of the pelvis. Weight-bearing on the leg/s may be quite difficult because of this painful experience.
Pregnancy pelvic girdle pain can occur early in the first trimester or at any time during the second and third trimesters.4
SI Joint Pain is one of the most common sources of pain for pregnant women. Sacroiliac joint pain often affects the back of your pelvis, hips and can also travel down your legs. "Most musculoskeletal pain in pregnancy is related to relaxin, a hormone that causes your muscles and ligaments to relax…This allows your pelvic musculature to relax to allow for your growing fetus. However, relaxin also can cause other muscles and ligaments to relax causing impingement on nerves and pain. Because the ligaments within and surrounding your pelvis are stretching and relaxing, your joints don't have as much support as they normally do…Ligaments provide stability, so if the ligaments are relaxed it can lead to joint instability which can lead to too much joint mobility or can cause other surrounding muscles to compensate, usually by tightening, and this can cause pain" 3
Despite diagnostic advances, women often see multiple doctors for their chronic back pain before finding a cause or treatment option that works for them. The survey by SI-BONE found that 87% of respondents who suffer from chronic lower back pain have seen up to four doctors for treatment.1 The survey revealed a serious quality of life struggles due to lower back pain:
A physiotherapy assessment is crucial in determining the course of treatment and advice for women experiencing PGP. You should consult an experienced Physiotherapist who has expert clinical skills in treating pelvic girdle pain. The physiotherapy examination will establish what pelvic joint, ligament and muscle tissue are not functioning properly. Specific movement testing and specialised clinical tests should l be conducted to discount any problems that may need further medical investigation. Physiotherapy treatment for pregnancy pelvic girdle pain may include one or a combination of the following:
Your physio will provide you with postural correction, from back support whilst sitting to how to improve your movement during everyday activity for example how to carry or lift safely. Here's a great video from Michelle Kenway a Physiotherapist, internationally renowned author and exercise instructor for women, whose educational videos have been viewed over 45 million times on YouTube.
Tight muscles require stretching to improve flexibility, and you need to understand which stretches to perform, when and how they should be performed to avoid injury or make a particular condition worse.
Reducing ligament pain in your pregnant pelvis requires strengthening of weak glutes, lower abdominal and pelvic floor muscles to improve stability of the sacroiliac, pubic symphysis and spinal joints and your physiotherapist will provide you with safe exercises tailored to your specific needs and abilities.
Training of pelvic floor and transversus abdominis muscle is important in developing core muscle support around your pelvis and lumbar spine and your physiotherapist will provide you with exercises safe and appropriate for you.
To alleviate pain or to soften/relax tight muscles prior to treatment or exercise, hot or cold treatments are easy, convenient and cheap, they can be used safely and effectively. You can check out the SRC Femme-Eze Heat and Ice Packs here. Electrical treatments using TENS machines can also be beneficial.
Soft tissue massage and trigger point release for tight, sore muscle groups is also useful for immediate relief and will often form part of an integrated treatment of Pelvic Girdle Pain.
Many physiotherapists still recommend wearing a pregnancy pelvic belt that needs to be correctly fitted to support the pelvis, especially in severe cases of Pelvic Girdle Pain.
Wearing pregnancy compression support garments such as SRC Pregnancy Shorts or Leggings during pregnancy will assist with pelvic and low back support in daily activities and at work without any of the hindrances caused by pregnancy support belts.
Should the symptoms of SI joint pain or Pelvic Girdle Pain continue after delivery the SRC Recovery Shorts or SRC Recovery Leggings will provide the required support for the lower back and pelvis whilst assisting the healing of DRAM (abdominal muscle separation), C-section wounds, perineal trauma and episiotomy wounds.
SRC Health has produced the largest range of compression garments for both pregnancy and recovery after childbirth. SRC compression garments have been shown to activate muscle at rest7 while wearing the garment. The continuous gentle compression allows the muscle to remain active without trying or being deactivated. The muscles that support the joints of the pelvis are under stress during pregnancy and research has also shown that 26% of women suffer with SI joint pain postpartum which is unreported.8
Wearing an SRC Health compression garment during and after pregnancy creates muscle activity and therefore stability to the joint that is supported by its surrounding muscles. Activity of these muscles is the key to reducing pain (read a Bond University Study Here) and discomfort of pelvic girdle pain (read Case Study Here) and providing strength and stability to the pelvis.