Pelvic girdle pain during and after pregnancy

• Placenta releases a hormone called RELAXIN from the fourth month onwards of pregnancy. This hormone relaxes the ligaments that hold the bones of the pelvis together and makes it easier for the head of the baby to pass through during childbirth. As a result of relaxed ligament, movement of bones becomes less controlled. This further increases the stress on surrounding muscles.
• POSTURAL changes during pregnancy are another reason for pelvic pain/discomfort. As the size of the belly grows, the body's center of gravity changes and the lumbar arch becomes more pronounced. This in turn increases the workload on surrounding ligaments and muscles.
• MODE OF DELIVERY i.e. c-section vs vaginal delivery: Patients with PGP during pregnancy who had c-section were more likely to experience persistent pain 6 months after the delivery as compared to patients who delivered vaginally, says research. If there are no medical reasons for c-section, findings suggest that vaginal delivery is the safest option for women presenting with severe PGP.

• Pain may or may not radiate/refer to lower abdomen, back, groin, perineum, thigh and/or leg.
• Pain with transition movements like lying to getting up, sitting to standing, using stairs, prolonged walking, weight bearing on one leg.
• Pain is relieved with rest.
• Click/snapping/grinding sound at symphysis pubis.
• Dyspareunia
• Occasional difficulty in voiding urine.

• Radiate to back of thigh or side of thigh.
• Tenderness at SI joint one side more than other.
• Worsened by prolonged sustained posture.
• Catching sensation in leg while walking.
• Characterized by positive pelvic pain provocative tests.
• In severe form can cause limp while walking.
• PGP tends to be more severe with subsequent pregnancies.

• Round ligament pain is felt as a short, sharp or stabbing pain during sudden change of position, such as getting out of bed or a chair, roll over in bed. May also be felt while coughing.
• Dull ache after a particularly active day, after prolonged walking or doing some other physical activity.
• Any abdominal pain during pregnancy which continues after rest should be consulted with health care provider.

• Avoid prolonged postures: eg take a break from sitting or standing after every 20 mins.
• Use good body biomechanics during sitting, bending, sit to stand or while exercising.
• Support the belly with both hands underneath during coughing/sneezing/laughing/transitions, like sit to stand
• Support the belly when lying on sides, also add a pillow between the knees.
• Be as active as possible within the pain limits.
• Avoid activities that increase pain, eg lifting.

• Exercise therapy to gain initiation, strength and motor control of core muscle & pelvic floor muscle group.
• Manual therapy to mobilize and/or stabilize the joints.
• Pelvic support belts.
• Ice Packs /heat packs to ease pain.

I was introduced to Vardan in 2019. Hesitantly, I started treatment here for my back under Namrata's guidance. Over a few sessions, I not only gained confidence but the continued exercise regime recommended proved very useful.

Then in 2021 I came back with a severe shoulder injury that I encountered in 2020. But COVID had kept me away from Delhi. I did guided exercises, again with Namrata over video sessions which helped. But the physical therapy with Namrata has been amazing. It took a while but her patience and understanding of what the body can take and where to push, has been phenomenal. In fact, she has taught me a lot about anatomy and muscles and their function. I am today , a devout advocate of FMT and of it's application to corrective and preventive health. The diagnosis of the source of the problem has also been very correct; an extremely important part of treatment. My deepest thanks to Vardan and the very polite and helpful managers and of course, the therapists. In my case, Namrata.

- Varsha Bedi