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Sacroiliac Joint Pain or Posterior Pelvic Pain During Pregnancy

Posterior pelvic pain (PPP) is a specific pain that is experienced near your pelvis/pelvic sacroiliac joints, and is caused by sacroiliac joint (SIJ) dysfunction.

These joints are the joints that is located at the two dimples of your lower back, and posterior pelvic pain (PPP) is usually very deep inside the lower back and can occur on one of both sides of the back. Sometimes, the pain can travel down to the buttock too.

For some pregnant ladies, it may happen anytime during the pregnancy, but generally, posterior pelvic pain begins on the 18th week of pregnancy and usually becomes more intense as pregnancy progresses. Good news is that this pain usually spontaneously disappears/resolves within three (3) months of delivery.

...but in some cases, the pain may linger and becomes long term, and in some cases, disabling.

What are the Sacroiliac joints?

So our sacroiliac joints are the joints that connect the:

1. sacrum (it's a triangular-shaped bone at the bottom tip of the spine)
2. left ileum (of the pelvis)
   
3. right ileum (of the pelvis)

Our sacroiliac joint is a very strong and stable weight/load-bearing joint that doesn't allow much movement (due to its structure, location, function), and it's main function is to allow loads, weight and forces to be transferred, transmitted safely through the body (it absorbs/transmits force safely from legs to spine during activities).

Our sacroiliac joint is kept stable with two main mechanisms:

• The rough connecting surfaces of the sacrum and ileum interlock and help to stabilize the sacroiliac joint (sort of like jigsaw puzzle/Lego)
• The complex ligaments and muscles such as core stabilizers (transversus abdominis and multifidus) that surrounds the SIJ and behaves as active stabilizers, like if you hold a golf ball in your hand and grip it tightly.
  

Posterior pelvic pain is caused by sacroiliac joint dysfunction ie when the stability of SIJ is compromised.

Why does posterior pelvic pain occur?

So during pregnancy, the two mechanisms that supports/stabilizes the sacroiliac joint can be destabilized, which increases mobility in the SIJ (a detrimental effect). This is caused by a double whammy of:

• pregnancy hormones that are exuded by the body to prepare the body for pregnancy and delivery, will/may cause ligaments to become lax, and this may cause the SIJ ligaments to also become lax, hence increasing its instability
• the growing baby and uterus stretches out and weakens the core muscles, weakening the pelvis and core muscles.
  

This is further compounded if

• pregnant mother doesn't exercise as much or is more sedentary in nature
• the additional weight alters the walking pattern to be more unnatural load on the SIJ
  

What are the symptoms of posterior pelvic pain?

Posterior pelvic pain is the most common type of pain related to pregnancy, and some of the usual symptoms include:

• Deep pain in the back of the pelvis (near the dimples of sacroiliac joints)
• Pain may occasionally travel to buttock and thigh.
• This pain is generally aggravated with load/weight eg activities that involve standing, walking, climbing stairs, resting on one leg, getting in and out of a low chair, rolling over and twisting in bed, and lifting. The pain improved when sitting, resting or lying down.

If you have inflammation in your sacroiliac joint, you may experience stiffness in your back and/or pelvis.

Diagnosing Sacroiliac Joint Dysfunction in pregnancy

Your

• gynae and/or
• women's health physiotherapist

will do a thorough series of clinical, historical and physical exam to diagnose and determine the core problems and its severity.

That may include trying to understand you:

• symptoms and its intensity/frequency
• test sacroiliac stability/movement/pain

The doctor may request for imaging such as X-ray or CT scan to diagnose better, however, any procedures or imaging that may expose you and baby to radiation is generally to be avoided.

Treatment and Management of posterior pelvic pain

Gynae, doctors and women's health physiotherapist will often recommend women's health physiotherapy and exercises that targets

• core strengthening
• pelvic girdle stability
• trunk stability

We may sometimes prescribe a specific sacroiliac belt to help provide quick pain relief and give some support, but compliance to exercise will be most of the treatment. Sometimes, our women's health physio may prescribe gentle joint/soft tissue mobilization of your:

• hip
• back
• pelvis

to loosen any tight joints and to correct any dysfunctions. Sometimes we may employ myofascial release too to release tight/very tight muscles which may cause deep ache and pains.

Please note that you are highly recommended to see a women's health physiotherapist (a skilled/experienced senior physiotherapist who is experienced in dealing/treating pregnancy-related pains) to ensure that she is able to treat your condition very specificly and effectively.

There are two other options eg direct injections into the sacroiliac joint or oral anti-inflammation medicine, but during pregnancy, is again generally avoided. Consulting a women's health physiotherapist is the best option moving forward.