Anatomy

Bones & Joints

The pelvis comprises three bony segments: two ‘hip bones’ (the fused bones of the ilium, pubis & ischium) and the sacrum. Between the three bony segments are three joints; two sacroiliac joints posteriorly and the pubic symphysis anteriorly.

Ligaments

Muscles

Deep muscles work to ‘stabilise’ the bones of the pelvis: transversus abdominis, multifidus, pelvic floor muscles and respiratory diaphragm. Gluteus medius and minimus are important muscles that contribute to control of the pelvis.

Function

The pelvis needs to be simultaneously mobile and stable for optimum function. The pelvis gains stability from the shape of the joints (how the joints fit together), the ligaments that cross the joints, and the deep and superficial muscles.

Dysfunction

Pregnancy-related pelvic pain (PPP) is pain in and around the pelvis experienced during and/or after pregnancy. It is also known as pelvic girdle pain or ‘pelvic instability’. During pregnancy relaxin is released to soften the ligaments of the pelvis to prepare the pelvis for labour and childbirth. In some women, the softening of the ligaments causes excessive laxity of the joints of the pelvis, resulting in excessive movement at these joints, irritation, inflammation and pain.  Pain can be experienced in any or all of the pelvic joints. 

The symptoms of PPP include a sense of pelvic instability, pain in the back of the pelvis, the front of the pelvis, the low back, hips or upper legs.  Women often have trouble walking and may have a “waddling” walk.  They also have trouble with activities that require them to stand on one leg, such as dressing, walking, walking up and down stairs, getting into and out of a car. 

What to do

If a woman is experiencing PPP, she can consult a healthcare practitioner with experience treating this condition. The treatment options may include massage of tight muscles, mobilisation of painful joints, strengthening exercises for the deep stabilising muscles with the use of real time ultrasound, general strengthening of the pelvic girdle muscles and postural re-education. 

A woman experiencing PPP may be provided with a sacroiliac joint (SIJ) belt or a compression garment such as Tubigrip^TM or a pregnancy/post-partum compression garment (shorts or leggings). The SIJ belt or compression garment provides the pelvis with an external force that provides ‘core stability’ to help stabilise the pelvis and reduce pain. Pilates, yoga and hydrotherapy can be beneficial for women with PPP. Occasionally, if the PPP is severe, the woman may need to use crutches or even a wheelchair in extreme cases.