Pelvic Girdle Pain (PGP) certainly makes us REALLY SLOW DOWN and we find we HAVE to pay attention to our bodies. If it strikes, it can make almost all movement almost impossible. The good news is that it can be all but completely reversible with awareness. It’s also known as symphysis pubis dysfunction (SPD) when it manifests as instability or pain in the groin.
Be body aware: keep the focus as much as possible and also be patient with yourself! Get all the help and supports that are going. You certainly can get better and go on to be pain free. Many of these tips, health-promoting practices that are worth sticking to even if there is no pelvic girdle pain present.
ALIGNMENT AND POSTURE
The theme is grounding ourselves evenly into both feet, so we’re not putting extra weight or work or pressure onto one leg versus the other and thus one hip or side of the pelvis versus the other.
- Start with your feet: look down at them, make sure they are hip distance apart, and parallel (pointing straight forward, ie not out to the sides like Charlie Chaplin). Use a mirror or enlist a friend for practice, and we will work on this lots in class of course.
- Ground down your heels, balls of your feet and into the outside edges of your feet as evenly as you can (lift the arches if they’re falling inwards)
- Notice if you are swaying yourself onto the balls of your feet: you might need to rock your weight back into your heels more. Perineum above the space between your ankles.
- Keep legs in alignment with hips: not moving knees wider than hips, or too far forward from hip midline: though you have to do this to walk obviously!
- RELAX your abdomen
- RELAX your buttocks (Kim at Vaginacoach.com calls this blossoming your butt and vulva!) You can wobble bum to help!
- VISUALISE: strong and rooted legs and glute (backside) muscles (not tense). Try not to default to the joints: two feet grounded, knees not locking.
DON’T LOCK YOUR KNEES!
I emphasise this so much in my yoga classes! When we don’t lock the knees, we’re taking the burden and responsibility off of the joints and letting the leg muscles to start to do the work which thereby helps stabilise the pelvis. Yay!
I always think pelvic pain brings us to a different, slower time dimension. We have to move in slow motion. AS if we really do have all the time in the world. KEEP IT SIMPLE. Go easy on yourself. Rest right now as much as you feel you need to.
WALK LIKE A GEISHA
Small steps until you start to feel better. Walk like a Geisha. Walking is great, and kind of essential! but only doing what you have to, for now. Be patient and hopefully you will be lively and lithe on your feet again soon. Do obsess about the knees and not locking them as you walk.
PELVIC FLOOR MUSCLE EXERCISES
Both types: We practice these in classes. I can talk a LOT more about this (and I do: here! Check it out)
But for now:
- slowly, with breath synchronisation
- and rapid “squeeze releases”
- Holding a pelvic floor engagement
- and finally and importantly RELAXING pelvic floor.
STABLISE THE JOINT
An exercise called “Shotgun release” by author Isa Herreras I’ve also seen it called Pelvic Stablizer by Gail Tully (Spinning Babies Daily Essentials).
Seated on a sturdy or at the edge of the couch, two feet flat on the floor, shins vertical. Position the fists to the inside of the thighs.
Inhale, get ready: exhale, press the legs into the hands and the hands into the legs – but nothing moves (isometric contraction of the muscles). Bring the awareness to the pubic joint; visualise or feel as though the muscles on either side of it are activating. If you notice that you CAN feel these muscles firing, you can recall this feeling or this awareness when transitioning in and out of chairs or toilet, or when you are getting in and out of the car, or when you are driving, or climbing the stairs.
You can practise this in two stages: firstly, with the fists positioned inside the knees; and secondly, with the fists inside the inner thighs closer in to the groin.
You can also use a soft ball instead of your fists.
We have a special approach to yoga for PGP sufferers! Be absolutely sure to talk to your yoga teacher if you are suffering. It might feel like there are suddenly a lot of poses you have to avoid but that’s OK. The few we do focus on will hopefully be just the muscle strengthening and awareness that you need to get you mobile again. Be patient with yourself, listen for the instructions for PGP. Tune into yourself and don’t mind what anyone else is doing on their yoga mats!
- Maybe stay off couches for now: slouchy, destabilising things! Sit on the floor, or a hard dining chair for a time. Try sitting on it backwards (lean over the back of it). Don’t cross your legs: keep both feet flat on the ground.
- Notice: are you sitting down onto your vulva and sitz bones? Or behind them?
- Use transitioning in and out of chairs & toilets as an opportunity to Chair Pose! Every time!
- Position yourself in front of chair/toilet with feet parallel; ground into feet ; vertical shins, slowly sit down onto it. Sitz bones and sacrum pointing down (not under or out behind) – think of it as a stretch for the backside aswell. Visualise strong and rooted legs and glute muscles. Try to come up the same way. Vertical shins, press down strong into the feet, strong legs and glutes to come up. Again, visualise strong and rooted legs and glute muscles. (You can lean onto table for help if at table; or position a chair in front of the toilet to help come up when at toilet.)
Plant yourself in chair pose with back to the car seat. Sit down into the car seat like in Chair Pose, with feet still on the ground outside the car. Once the bum is seated, lift both knees at the same time and swivel the legs into the footwell of the car. Imagine there’s a plastic bag under your bum to help you swivel. Better still, use a plastic bag under the bum to swivel.
Getting in and out of bed: as with getting in and out of the car. Plant yourself in chair pose with back to the bed. Sit down onto the bed like in Chair pose, with feet still on the ground. Once the bum is seated, lift both knees at the same time, keep the knees together and swivel the legs up and onto the bed. Imagine there’s a plastic bag under your bum to help you swivel. Better still, use a plastic bag under the bum to swivel. Roll onto one side to lie down.
TO get out of bed: Roll onto one side, use a hand in front to press yourself up and around to seated, lift the head up last. Keep the knees together, and swivel your legs over the edge of the bed and onto the floor. Press into the feet to come to standing. Don’t jack-knife up off the bed.
Received wisdom is that left-side lying is optimal in pregnancy: if you do want to turn over in bed from one side to the other, come up onto all-4s first (we practice this position LOTS in class of course)
If it hurts to go up and down stairs limit or avoid them till you start to feel better. Take the lift. Delay going up or down a stairs until you absolutely have to. And when you do, take them one step at a time. Try to take the steps up and downstairs with torso erect: not leaning forward into the knee bend each time. Use the integrity of the thighs to lift the leg to the next step; again, visualising strong legs and glutes
- When taking stuff out of low cupboards, taking out the ashes of the fire, sweeping dust into a dustpan, plugging out your phone from a low socket, using the washing machine: come down slowly as if into Chair Pose or a high squat (feet parallel, vertical shins) to do it
- Use a chair to lean onto if you need to, to come down and get back up.
- Consider coming all the way down to kneeling or sitting on the floor if you have to. As if you have all the time in the world!
A sacro-illiac joiont belt helps stabilise until the muscles can do it themselves. And have faith that they will!
WOMEN’S PHYSIOTHERAPIST: get all the hands on help you can!
Go have your pelvic floor mechanically checked. I’m writing at the time of COVID-19 lockdown and many physios have necessarily not been able to take clients: reach out to them! Recommendations below. This can be necessarily intimate – it’s internal – and is amazing. A Women’s Physiotherapist will be able to make sure there is no hypertonic pelvic floor (too toned! Happens athletes and yogis!) or weak pelvic floor; basically help to sort out any imbalances in the pelvic floor, and the core. We can’t strengthen properly until the muscles are balanced out first. Alignment and our own awareness is everything but there is nothing like getting the hands on help too! They can advise about or provide a supportive belt too.
- Laura Carroll at LiveWell Waterford: I have attended her myself and can personally recommend her https://www.livewellwaterford.ie/
- I have heard that the two physiotherapists in Wexford General Hospital are great: contact your midwives for referral
- I have also heard that https://www.physiosoutheast.ie/ are great
- See: Ending Pain in Pregnancy by Isa Herreras
- Check out: Daily Essentials by Spinning Babies