Posterior Pelvic Pain – Exercises you can do to relieve the pain

The arched back posture isn’t the only culprit causing lower back pain during pregnancy. A weak and unstable pelvis also contributes to lower back and pelvic pain, often described as Posterior Pelvic Pain.

In the second edition of our Pregnancy & Pain series, our principal physiotherapist, Sylvia Ho shares some strengthening exercises that you can do at home if you have posterior pelvic pain. If you are unsure, please seek the advice of a medical professional before commencing on the exercises.

Pregnancy problem: posterior pelvic pain

One of the most “invisible” and overlooked ailments faced by expectant mothers is posterior pelvic pain, felt in the lower back and pelvic area caused by a growing load, i.e. your baby. In some cases, the pain extends to the buttocks and the back of the thigh.

The pelvis is made up of three bones: the sacrum bone flanked by two illium bones, held together by ligaments. It is a platform to transfer weight from one leg to the other, with the three bones working as one to facilitate daily activities efficiently, such as walking.

How does posterior pelvic pain occur during pregnancy?

Pelvic pain is usually felt in the sacrum — the middle plate — where the joints form. When these ligaments are loose, weight transfer cannot be performed properly, causing pain and imbalance.

During pregnancy, these ligaments become more relaxed due to a hormone relaxin as the body prepares for childbirth. As a result, the pelvis is no longer stable, leading to pain.

How can I treat or prevent posterior pelvic pain during pregnancy?

Thankfully, there are ways to minimise posterior pelvic pain, as long as you start early in your pregnancy. Main exercises, guided by a physiotherapist target and strengthen the transverse abdominus (or corset muscle) and the pelvic belt itself. Stronger muscles increase the stability of the joints, therefore reducing the pain as the muscles are able to support the movement.

Physiotherapy treatment and exercises

In physiotherapy service for posterior pelvic pain, it is best to consult with a physiotherapist on how to correctly perform these exercises before you conduct them at home.

1. Basic position: lie on your back, knees upright, and feet firmly on the ground. Here, you will learn to be aware of your transverse abdominus and perform targeted pelvic exercises.
2. Supine march: from the basic position, lift your legs into a 90-degree angle with your shin parallel to the ground. Alternate with the other leg, lifting and dropping the suspended leg slowly.
3. Leg extensions: from the basic position, lift your legs up perpendicular to the ground and bring them down, activating your pelvic and transverse abdominus muscles to power your movements.

References

1. Mens, J. M., Vleeming, A., Snijders, C. J., Ronchetti, I., Ginai, A. Z., & Stam, H. J. (2002). Responsiveness of outcome measurements in rehabilitation of patients with posterior pelvic pain since pregnancy. Spine,27(10), 1110-1115.
2. Mens, J. M., Vleeming, A., Snijders, C. J., Koes, B. W., & Stam, H. J. (2001). Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine, 26(10), 1167-1171.
3. Wu, W. H., Meijer, O. G., Uegaki, K., Mens, J. M. A., Van Dieen, J. H., Wuisman, P. I. J. M., & Östgaard, H. C. (2004). Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal, 13(7), 575-589.
4. Stuge, B., Hilde, G., & Vøllestad, N. (2003). Physical therapy for pregnancy?related low back and pelvic pain: a systematic review. Acta obstetricia et gynecologica Scandinavica, 82(11), 983-990.