About Pelvic Joint Instability and Pelvic Pain During Pregnancy

pregnant woman with back pain
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What Causes Pelvic Joint Instability?

Pelvic joint instability is often pregnancy related, occurring either during pregnancy or after childbirth. Pelvic pain in pregnancy can be related to the pelvic girdle muscle (the pelvic girdle refers to bones that make up the pelvis) or ligament laxity. While the cause of these lax tissues is not completely known, researchers suspect that it has to do with a hormone called relaxin.

This hormone allows the pelvic bones to shift enough to make way for a baby.

Usually, the pelvic bones barely move. However, pelvic joint instability may cause them to shift out of alignment. Instability can also be caused by injury during childbirth.

Symptoms of Pelvic Joint Instability:

Pelvic pain in pregnancy or after childbirth can present in any of the following ways:

  • low back pain
  • pubic pain
  • pain that radiates to the groin or hips
  • pain that is worse when rolling or getting up from a low surface
  • pain when climbing stairs

Research suggests that as many as 25% of pregnant women experience pelvic pain. For approximately 7% of these women, pain from pelvic joint instability persists after childbirth.

Diagnosing Pelvic Joint Instability

If you suspect pelvic joint instability is causing your pelvic pain, you can expect any of the following at your physician's office:

  • A verbal history. Your physician may ask if you have pain during certain activities if you have ever had pelvic pain before, and what relieves your pain.
  • Palpation of the pelvic joints. Your physician may push on your pubic or sacroiliac joints to see whether they are tender.
  • Manual muscle testing. Your physician may push on your legs and ask you to resist, to measure your strength and to assess your pain.
  • Passive range of motion. Your physician may check to see if you have limitations in your hip mobility or pain during movement.

    Treating Pelvic Joint Instability:

    Don't be surprised if your physician sends you to a physical therapist (PT). A PT who specializes in women's health can teach you core stabilization exercises to strengthen the muscles surrounding your pelvis. You may be prescribed a supportive belt, or the PT may tape your pelvis for increased stability during activities. You may be asked to avoid movements that exacerbate the problem, such as lunging, heavy lifting or climbing stairs. NSAIDs may be prescribed as well, to control your pain.

    Pelvic Joint Instability Prognosis

    Most women recover well from pelvic pain during pregnancy. In about 7% of women, however, pelvic pain may persist after childbirth. In some women, pelvic pain may return during their next pregnancy, regardless of how much time passes.

    For most, a regimen of physical therapy and supportive taping will do the trick in controlling pelvic pain during and after pregnancy. In general, the earlier pelvic joint instability is diagnosed, the better the outcome.

    Sources:

    Cook Chad, Massa Lisa, Harm-Ernandes Ingrid et al. Interrater Reliability and Diagnostic Accuracy of Pelvic Girdle Pain Classification. May 2007. 30:4 pp 252-258

    Mitchell DA, Esler DM. Pelvic Instability - Painful Pelvic Girdle in Pregnancy. Australian Family Physician. 2009 Jun;38(6):409-10

    National Pain Foundation. Pelvic Pain: Causes. Accessed 8/21/09. http://www.nationalpainfoundation.org/articles/717/causes?PHPSESSID=fdd14ca5f9533763da35ceecf20d33e1

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