Women's health is a specialized area in skilled physical therapy that addresses pelvic musculoskeletal disorders. An experienced licensed physical therapist can address minor to moderate mechanical related pelvic dysfunction, experienced by women.
While the pelvis serves as the central intersection between our body's upper and lower highway, it can also be a source of pain and dysfunction for, many women.
Have you given birth over recent months or have you noticed changes over time including low back pain, feeling of descent of the pelvic floor, heaviness of upper thighs, and or weakness in urinary control? If you answered yes then it is possible you may be suffering from symptomatic pelvic girdle relaxation.
The term symptomatic pelvic girdle relaxation (SPGR) was originally developed in 1990 to describe pelvic girdle weakness, laxity, and or pain in women. It is a condition characterized by uterine prolapse or stress incontinence. The pathogenesis or biological mechanisms that may lead to this disorder are: •childbirth soft tissue and ligament stresses, •poor conditioning, prenatally or post-partum, •pelvic and sacro-iliac joint stresses due to excessive weight gain and •aging.
The proper assessment to determine if SPGR is truly the problem can be determined by a skilled licensed health expert, such as your obstetrician, gynecologist, licensed midwife, licensed nurse practitioner, and licensed physical therapist. Seeking an assessment from a professional instead of self diagnosing can prevent long-term and worsening of your symptoms, that can manifest into a more severe problem. This will also prevent misdiagnosis of a problem that is more severe and that may require immediate medical attention.
- The diagnosis is made on the basis of a detailed medical history, pain localization and positive clinical tests. The best tests for identifying SPGR are posterior pelvic pain provocation test and active straight leg raise test.
- Difficulties walking, standing, and sitting over an extended period of time are characteristic features.
- The pains are typically located under the posterior superior iliac spine, the gluteal region, the back of the thigh, and/or at the public symphysis.
- Imaging diagnostics are not recommended. "
There are other mechanical disorders that can mimic symptoms of SPGR. It is important to differentiate and rule out other disorders. These can include :
- Acute muscular strain with low back pain
- Pressure on nerve roots i.e. sciatica
- Rhematologic disorders
- Pelvic venous thrombosis
Managent of SPGR is usually determined by the severity or stage of its presentation. Initially, skilled physical therapy can be used to manage balancing of soft tissue and mechanical dysfunction through 1. skilled manual therapy with soft tissue release, 2. lumbar and hip mobilization, 3. pub repositioning or mobilization, 4. sacral repositioning or mobilization, 5. ilial repositioning or mobilization, 6. specific exercises for muscle lengthening or re-education, and 7. postural correction training, that can improve pain, mobility, stability and restore overall function. Pelvic and sacro-iliac support belts may also be an option, to provide temporary active stability support. This can help to protect and reduce further injury, until muscles have been re-educated and strengthened. A T.E.N.S (transcutaneous electrical nerve stimulator) unit can be a conservative option to help temporarily relieve painful periods.
In more severe cases where physical therapy is not effective or indicated then less conservative medical intervention can be sought. This may include prescribed medications to manage pain and inflammation, pessaries device inserted for urinary incontinence, or surgical immobilization of the pelvic joints.
Always consider a licensed physical therapist for a conservative approach to managing musculoskeletal pelvic disorders when indicated.
The Norwegian Association for Women with Pelvic Girdle Pain (LKB), B. Stuge, S. Morkved, A. Danielsson
Functional Analysis and Management of the Lumbo-Pelvic Hip Complex, R. Nyberg, University of St. Augustine for Health Sciences