A 33 year old client came to the clinic complaining of strong sharp pain in the front of the pelvis and dull aching pain in her lower back. She was 20 weeks pregnant with her first baby and had never experienced any pain in her pelvic region or back in the past. The pain was an intense stabbing pain in the front of her pelvis when she walked, which would radiate down her inner thigh and between her legs. She would also get pain and a loud clicking or grinding sound between her legs, when she walked or rolled over in bed.
After doing some muscle testing and active movements, I was able to ascertain that she had a lot of weakness through her gluteus medius and hip rotators, muscles very important for hip stabilisation. In pregnancy, a hormone named Relaxin is released. This hormone helps to prepare the body for birth, by relaxing or softening ligaments around joints. In particular, the joints that hold the pelvis in place.
Unfortunately for my client, the combination of existing muscular weaknesses through her pelvis and the relaxin hormone making the joints of the pelvis ‘looser’ and thus less stable, a condition call Symphysis Pubis Dysfunction (SPD) had occurred. SPD is essentially pain coming from inflammation, caused by excessive movement of the pubic symphysis.
Treatment centred on restoring the muscles in the pelvis to the ‘normal’ state, by reducing myofascial trigger points with dry needling. She was also given information on better ways to roll over in bed and particular activities to avoid completely if possible, such as breaststroke swimming, standing on one leg, and excessive stairs. I gave her daily exercises to do at home to help strengthen her weak pelvic muscles. I also advised her to get a pregnancy support belt to wear during the day, to help stabilise her hips until she had increased her strength.
The combination of the soft tissue treatment, the pregnancy belt and the corrective exercises remarkably improved her pain within one week. Her SPD will need to be monitored right through pregnancy and often worsens in late pregnancy, however, in the majority of cases usually completely resolves post-partum. It will be very important for my client to continue to work at strengthening her pelvis after she had her baby.
Lani Watt – Elite Myotherapist
