Pelvic Girdle Pain – the sacroiliac joint
What is pelvic girdle pain?
Pelvic girdle pain typically describes pain in the sacroiliac joint (SIJ) region which may also include referred pain into the back of the thigh, or in some cases to the pubic symphysis at the front. It is rare for pelvic pain to spread below the knee.
The pelvic girdle’s main role is to form a link between the spine and the legs for the transfer of weight as we move; however it also helps to support the abdomen and pelvic organs.
What are the symptoms?
Common symptoms of pelvic girdle conditions are pain during loading and weight transfer activities- these may include getting up from a chair, negotiating stairs and getting in and out of the car. There can be a sensation of instability with the pain and lying flat on the back may be an uncomfortable position.
What is the cause?
Pelvic girdle pain can be acute or chronic in nature. In acute cases this can be a result of trauma (ie falling on the buttock, missing a step) but more commonly seen are cases related to pregnancy. In the peripartum period there is increased joint laxity due to hormonal changes, there are also rapid changes in body weight and posture which can all place unaccustomed strain onto the SIJ.
It is also important to identify any specific medical causes of pelvic girdle pain such as stress fractures, inflammatory sacrolitis or ankylosing spondylitis. Interestingly, family history and psychosocial factors do have an influence on pelvic girdle pains.
“My pelvis is unstable!”
The pelvis is actually one of the most stable joints in the body. There is less than 5mm of translational movement, and less than 3 degrees of rotation in the SIJ! Furthermore there is gradual stiffening of the joints with age. The sacroiliac joint itself can be stiff or hypermobile (usually in the case of pregnancy), but more commonly, pelvic girdle pain relates to muscle control and the suboptimal movement patterns. This may give the feeling of “instability”.
What does Physiotherapy involve?
A comprehensive assessment includes an evaluation of the joints and muscles in the pelvic region, as well as the tasks that are reported as problematic. A closer look at the biomechanics may highlight causes for cumulative microtrauma to the affected joints.
The Physiotherapist will make it a priority to rule out any concurrent lower back and nerve related symptoms which can form part of the presentation.
Physiotherapy management commonly comprises of therapeutic exercise and manual therapy. Depending on assessment findings, exercises are prescribed to strengthen specific hip and low back muscles, improve flexibility and movement patterns.