Posterior Pelvic Pain (sacroiliac joint pain) in pregnant women

Posterior pelvic pain (PPP) is pain in the sacroiliac joints close to your pelvis as a result of sacroiliac joint dysfunction. These joints are located in 2 pits of the lower back. The pain often feels deep in the lower back and can occur on one or both sides of the back. In some cases, pain radiates into the buttocks and the back of the thigh.

While pain may begin at any time during pregnancy, on average, PPP starts in the 18th WeeksPregnancy and becomes more intense as the progression of pregnancy. The pain is usually resolved spontaneously within 3 months after delivery. But in some cases it can become chronic and disabling it.

What are the sacroiliac joint?

The sacroiliac joint (SIJ) are between the sacrum, a triangular bone formed at the bottom of the spine and the right and left ilium of the pelvis. The SIG is a strong and stable joints loaded, very Permitslittle movement because of its natural structure. The main task of the SIG is to be efficiently transmitted forces through the body, absorbing effect of the legs of the spine during activities such as hiking, running and jumping.

The SIG is kept stable by two mechanisms:

First, the rough surfaces such as groove connection between the sacrum and hip bones interlock and stabilize the joint, like two pieces of Lego together.
Second, the SIG is still enhanced byNetwork of tendons and muscles, as the core stabilizers. These core muscles like the transversus abdominis and multifidus SIG, act as active stabilizers, by creating an active contracting a compressive force on the SIG about, haunting joints together surrounded. They seem like a natural corset, by that compression to the lower back and pelvic area, much packaging as your fingers around the two Lego bricks, solid and holds tight.

PosteriorPelvic pain arises from sacroiliac joint dysfunction, in other words, if the stability of the SIG is at risk.

Why did it happen?

During pregnancy affects the mechanisms for stabilization of the SIG. This instability can be used for enhanced movement, said the SIG.

Hormones released during pregnancy, the ligaments of the body relax, so that the pelvis enlarge in preparation for childbirth
Due to the growing uterus, which in part, at the core musclesthe pelvis get 'stretched and weakened.

In addition, the added weight and altered gait pattern may be associated with pregnancy in significant mechanical stress on the sacroiliac joints, which can be in SIJ inflammation, what a deep pain in the posterior pelvis.

What are the symptoms?

Of all experienced back pain during pregnancy posterior pelvic pain is the most common - they are four times more likely to experience low back as a PPPPain.

You can posterior pelvic pain / sacroiliac joint dysfunction if you have:

Deep, boring pain in the back of the pelvis (around the sacroiliac joints)
The pain can sometimes radiate to the groin and thigh.
The pain is usually worse with increased standing, walking, stairs, resting on one leg, and disembarking from a low chair, rolling over and twisting in bed, and lifting. The pain improved when lying down.
Inflammation and arthritisin the SI joint stiffness you may experience a burning sensation in the pelvis.

Diagnostic Sacroiliac

Making Joint Dysfunction in pregnancy, your doctor and / or physical therapist for a thorough history and physical examination to determine the underlying disease for your pain. This is looking at your description of symptoms, a series of tests on the stability, movement, and include pain in the sacroiliac joints and the surrounding areaStructures. Imaging, such as computed tomography (CT) and X-ray can also help in the diagnosis. Another method is to reliably diagnose an anesthetic injection into the SI joint by an X-ray machine, anesthesia for the irritated area, which led to identify the source of pain. Because of concerns of fetal radiation exposure is diagnostic procedures, avoiding radiation in general.

Treatment and Management

The first-line treatment ofPregnancy-related sacroiliac joint dysfunction is physical therapy and exercises that focus on the core stability of the trunk and pelvic girdle. Sometimes a sacroiliac belt is compulsory in order to complement the core stability exercises and provide fast pain relief. Exercises will form a large part of the treatment and in some cases, mobilization (a gentler form of manipulation of the hip, back or pelvis) are used to correct the underlying movement dysfunction. Other manualTechniques include muscle energy techniques (MET) and myofascial release. It is important to a physiotherapist, which is in the treatment of pregnancy-related pain qualified as it is aware of the studies that support the use of specific stabilizing exercises and other methods of treatment, thereby preventing an escalation of dysfunction in a chronic to commit state.

Other alternative treatments include anesthetic and steroid injections in the SIG, that in pain relief to help, can takefrom one day or more long term. Oral anti-inflammatory medications are often effective in pain relief as well. However, these two processes may be contraindicated during pregnancy has not been disclosed.

Posterior Pelvic Pain Home Advice

Here are some tips for pregnant women with posterior pelvic pain is ..

Lie

Avoid lying on your back for a long time, especially after the 19th Week of pregnancy.
Try lying on your side (preferably the left side) with aPillow between your knees and put another under your belly.
If your waist sags down lies in the bed lay a small towel rolled up under the waist.

Turning in bed

To turn on the right side, lying on his back, arch your lower back, tighten your pelvic floor muscles and lower abdominal muscles and bend both knees one by one.
Turn your head to the right and take the left arm to the right of your body. Hold down on the side of your bed if you can.
To turn, pull withTake your left hand and both knees to the right so that you roll to the right. As soon as possible, bend your knees as high as it helps to go - so, you lock your pelvis and relieve pain.
Reverse turn it to the left.

Getting out of bed

Roll on the side with your knees bent, move your feet over the edge of the bed and press on the side with the poor.
Reverse the process when you lie down.

Standing from a seated position.

Sit on theEdge of the chair.
Keep your knees slightly apart and forth until your head is lean directly over the knees, keep your back straight.
Stand up by holding down with your arms straight back and stomach in this way their hips in their stable position and can significantly reduce your hidden pain.

Reference:

Fitzgerald, CM, and J. Le back pain during pregnancy is practical creativity. Biomechanics. 2007 November
Ostgaard HC, Andersson GB,Karlsson K. Prevalence of back pain during pregnancy. Spine. 1991, 16:549-552.
Ostgaard HC, Zetherstrom G, Roos-Hansson E, Svanberg B. Reduction of back and posterior pelvic pain during pregnancy. Spine. 1994, 19:894-900.
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