Avoiding pelvic girdle pain through exercise



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However happy the end story, pregnancy is no walk in the park. The seemingly endless list of health problems associated with child-bearing, however, may have just been made a little shorter. According to a new report published in the British Journal of Sports Medicine, exercising regularly in the weeks leading up to pregnancy may help to stave off pelvic girdle pain — a term used to describe any type of pain associated with the joint and ligament changes prompted by a baby's development.


Low-down joints


The pelvic girdle is a structure made up of several bones in the hip area that supports the legs. When one of the joints in this arch becomes stiff or unstable it can irritate the others and cause pain — usually in the front or back of the pelvis — known as pelvic girdle pain (PGP). Such pain in the rear part of the pelvis, where the pubic bones meet at the front of the pelvis — the symphysis pubis — is relatively common during pregnancy, and can last anywhere up to 12 months after a birth, affecting around 2 to 3 percent of women. The condition was formerly known as symphysis pubis joint dysfunction (SPD).

According to WebMD, there are a number of contributing factors that can lead to PGP: uneven movement of the pelvic girdle joints or changes in the muscles during pregnancy, such as those in the stomach, pelvic girdle, hip and pelvic floor, make the joints less stable. In addition, the hormone relaxin — as well as other hormones — can affect the ligaments in the pelvic girdle, allowing for increased movement of the pelvic joints. The condition can also actually occur in people who are not pregnant as a result of a previous injury to the pelvis. Arthritis or osteoarthritis can also lead to PGP, though, in some cases, the cause can remain undiagnosed.


A safe level


The discomfort associated with pelvic girdle pain, the researchers say, has been linked to a reduction in physical activity during pregnancy. This too is a risk factor for complications of pregnancy. Keeping up a safe level of exercise during pregnancy can be greatly beneficial to both mother and baby — reducing lower back pain, lowering blood pressure, lowering the chances of blood clots and varicose veins and reducing the risk of pre-eclampsia as well as contributing to general mental well-being.

The new report, authored by Dr. Katrine Mari Owe from the Norwegian Institute of Public Health in Oslo, suggests that exercise in the weeks before pregnancy can also reap rewards during those months ahead. The researchers looked at more than 39,000 women to see whether whether regular exercise before pregnancy might affect the risk of developing pelvic girdle pain. The women — who were all expecting their first child between 2000 and 2009 — were part of the larger Norwegian Mother and Child Cohort Study, which has been tracking the health and wellbeing of a cross section of Norwegian women and their children and who were recruited between 1999 and 2008.


Asking questions


The women, who all attended the clinic for routine ultrasound scans, were asked, during their 17th week of pregnancy, about the type and frequency of the exercise they took in the three months before becoming pregnant. The frequency of reported exercise was scored from zero (no exercise) up to 3 (activity at least three times a week) and took into account 13 different types of exercise: brisk walking, jogging or orienteering, cycling, training in fitness centers, swimming, aerobics, dancing, cross-country skiing, ball games and horse riding.

In their 30th week of pregnancy, they were asked about the frequency and intensity of pelvic girdle pain they might have experienced. Around one in 10 women (10.4 percent) said they had experienced pelvic girdle pain by their 30th week of pregnancy and this figure rose to around one in eight (12.5 percent) among those who said they didn't exercise in the run-up to their pregnancy. The researchers also noted that those who had pelvic girdle pain were more likely to be young (under 25), to smoke, be overweight and to have a history of depression and lower back pain. Those who did not report pain were more likely to have exercised between three and five times a week before they got pregnant.


Healthy routines


After factoring in influential personal criteria — such as age, weight (BMI), educational attainment, smoking and a previous history of back pain — the results appear to suggest that high impact exercising between three and five times a week can mean a 14 percent lower risk of developing pelvic girdle pain by the thirtieth week of pregnancy. Those women who included high impact exercise, such as jogging, high impact aerobics and ball games in their pre-pregnancy workout or exercise routines were less likely to report PGP. Though the women were asked about the 12 weeks leading up to pregnancy, the researchers say no additional benefit was observed for an exercise frequency of more than five times a week.

This, they say, was an observational study so no definitive conclusions about cause and effect can be drawn. But they do point to the well known analgesic effects of exercise among people who are not pregnant or who have chronic pain — the so-called "feel-good" endorphins produced by regular, healthy exercise. "Acknowledging the limitations of our study," the researchers conclude, "these results emphasize the importance of promoting regular exercise among women of childbearing age." We're always happy to report the ways in which healthy diet and exercise can equal strong reproductive health.