Pelvic girdle pain can be a prominent issue after giving birth. Maybe you had outrageous low back pain during pregnancy? Or maybe you have been struggling with a lot of SI joint and pelvic girdle pain postpartum? How about pubic symphysis or crotch pain? Read on to learn how treatment can be helpful AND what you can do at home to help yourself. 

What is Pelvic Girdle Pain?

Low back and pelvic pain can be a real problem during pregnancy. After giving birth it is not uncommon for this pain to linger postpartum. We call all of these pains that happen on and around the pelvis generically 'pelvic girdle pain'. There are certain risk factors, like prolonged labor and SI joint dysfunction, that can increase the chances of having pain after delivery. It is also common for women to experience pelvic pain in conjunction with another pelvic floor diagnosis like prolapse. 

The pelvis is actually a circle when you look at it from the top. There are three joints that hold that circle together. The two sacroiliac joints (SI joints) on the back side and the pubic symphysis located centrally on the front. Because they are all connected, pain or dysfunction in one area can contribute to pain or dysfunction in another area.

Pelvic Girdle Pain Postpartum Exercises

So how do we treat pelvic girdle pain postpartum? I always think about the mobility before stability. We need muscles to be at a good resting length in order to function properly. If a muscle is too tight, it can often be painful AND we can’t strengthen a tight muscle effectively. This is where being assessed by a pelvic floor physical therapist can be helpful after giving birth. Your pelvic floor PT can help find your tight spots! 

Useful Tools for Low Back & Pelvic Pain

Tools I like to have around for mobility work and tissue release include :

• A Foam Roller
• Yoga Tune Up Balls
• An Alpha Ball

On the back side of the pelvis we can think about loosening (or at least assessing for tension) quadratus lumborum, spinal extensors, glutes, as well as the sacrotuberous ligament. On the front of the pelvis we can think about assessing hip flexors as well as adductors. The videos on this mobility playlist can help you figure out how to release these muscle groups. But really we just want to press on those tight spots in the muscles with our mobility tools. We find a tight spot, hold it for 1-2 minutes until the tissue loosens, and then move to the next spot. 

Strengthening & Stabilizing Exercises for Pelvic Pain

Once we have mobility, then we can think about strengthening and stabilizing around the pelvis. We not only want to think about core strengthening, but also about strengthening all around the pelvis. This includes the transverse abdominus [deep core], pelvic floor, glutes, and adductors.

Strengthening exercises from this core/pelvic floor playlist as well as lower extremity strengthening playlist can be a good place to start.

Changing Habits to Improve Back & Pelvic Pain Postpartum

Once we have mobilized and strengthened, we have to think about how we use our bodies day to day. If you're not using your body efficiently, the efforts you invest in mobility and strength won't be beneficial, as you'll still be stressing your tissues during everyday activities.

1. Improve Your Posture

Your body and base of support is going to change a lot during pregnancy and postpartum. We end up having a lot of weight on the front with baby (either in the belly or holding your baby postpartum). As such, a lot of times we shift our pelvis forward, our glutes are tucked under, and our rib cage shifts back. This is going to put a lot of strain on joints and ligaments which can contribute to pain. If we think about our body as a stack of blocks with head, ribcage, pelvis, and feet/ankles, we want all of our blocks to be stacked on top of each other. That way when gravity acts down we are stable and our muscles are able to stabilize us, not our joints and ligaments.

That being said, our posture isn’t always going to be perfect. But if we use pain as our guide, this can help. If you are feeling pain, try to shift your body and stack up your ‘blocks’, to help reduce pain.

2. Activate Your Core 

In terms of being mindful of how we use our bodies, thinking about how we engage our muscles throughout the day can be useful. Abdominals and hip/glute musculature are going to help stabilize the pelvis and offload joints [like the lumbar spine and SI joints]. So, making sure these muscles are being used throughout the day is important.

Many times, people have a hard time finding the time to do a physical therapy home exercise program. But in reality, we would much rather have you be intentional with engaging your core and glutes with daily activities as that gives you 16 hours during the day to give your muscles a workout, compared to a 10 minute home exercise program.

In terms of core/abs, we want to have these muscle engage in proportion to the amount of activity we are doing. If you are just standing quietly, maybe we need 10% activation. Holding the baby maybe we need 30% activation. Picking up the car seat may require 50% core activation. And if you are exercising and doing a plank or other hard core work, maybe you would engage your core 80%. So we can think about engaging with these sort of daily tasks. With glutes, I like to think about engaging with going up the stairs, picking up toys, or getting a pan from a low drawer.

3. Use Proper Lifting Mechanics

The last thing to think about in terms of how we use our body in daily tasks is our lifting mechanics. It can be important to learn how to keep a neutral spine when bending and lifting. We like to have patients practice doing a hip hinge to learn how to keep a neutral spine. You can then apply this to daily tasks. Although it is not unsafe to bend your spine, if you are in pain or if you are going to lift something, keeping your spine in a neutral position is going to be helpful. So tasks like brushing teeth, washing your face, lifting your toddler, and unloading the dishwasher can all be done in a neutral spine position.

You do not have to have pain during your pregnancy or after giving birth. There are things that can be done to help you have a comfortable pregnancy and postpartum period. If you are struggling, reach out for help!