The Core of "Symptomatic Pelvic Girdle Relaxation"

Physical Therapy Can Improve Pelvic Bone and Joint Health for Women

Physical Therapy Can Improve Pelvic Bone and Joint Health for Women

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.

References :

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 

Back In Action With Painless Satisfaction

Did you know your lower back is the core that links together all the parts of your body?  Think of it as your body's intersection and all the body's nerve impulses and blood flow has to travel through it. This is your internal highway that drives vital nerve messages and cellular nutrition, from the brain and heart.  So basically when we have lower back problems it drastically slows down our vital transport system and adversely impacts energy, strength, and activity levels in the body. 

The back is the most common area of stress and pain in an average adult.  The American Association of Neurological Surgeons state:  “An estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime.  Although low back pain can be quite debilitating and painful, in about 90 percent of all cases, pain improves without surgery.  However, 50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year.”

Did you know there are 100,000 billion cells, approximately 640 skeletal muscles, 360 joints, and 202 bones that make up the adult human body?  Our bodies are designed to feed off of regular movement to nourish the multitude of our cellular make-up.  We are intended to live an active and full lifestyle daily.  Instead many of us are stuck sitting or standing for hours at school or work every day.   

Did you know that those billions of cells are like microscopic puzzle pieces that connect to form all the thousands of structures and systems that make-up our existence?  These structures and organs all require movement to trigger an on switch for our bodies to activate for life. 

Every system in our body plays a role in processing fuel to give the energy to move our joints.  Unfortunately on a larger scale our body is fragile and has to endure enormous stresses from the outside world around us.

We are in a constant struggle to keep moving while protecting our bodies from injury.  Unfortunately many of us have a daily routine that creates greater stress and reduces proper mobility.


Poor Postural Habits Start Early in Life, Leading to Back Pain Later in Life

Poor Postural Habits Start Early in Life, Leading to Back Pain Later in Life

Activities that cause low back stress:

  •       Sitting for hours non-stop at your computer desk aka “Coach Potato” 
  •       Driving in the proverbial rush hour traffic daily or weekly aka "Bumper to Bumper"
  •       Walking with heavy back packs all day for school aka "Hunchback"
  •       Women carrying weighted handbags all day aka “Cement Bags”
  •       Standing bent over while brushing teeth, shaving, or doing make-up aka "Giraffe Back"
  •       Bending down with your back to pick up items while keeping your knees locked aka “The Back Breaker”
  •       Carrying your baby in one arm all the time aka “Rocking The Cradle”
  •        Looking down while texting or using your cellular device aka "The Rubber Necker"


Exercise Supplies the Body with Nutrients and Lubrication for Muscles, Bones and Joints  

Exercise Supplies the Body with Nutrients and Lubrication for Muscles, Bones and Joints  

How to reduce low back stress

  • Perform a simple exercise activity 4 days a week.

  • Straighten your back when sitting and use lower back support in the chair.  Get up, stretch and move at least 1 time an hour.
  • When driving it’s important to have a lumbar cushion in your seat if it’s not built into your car.  Perform small back and pelvic roll exercises.  It’s easy.  Simply lean and roll forward and then backwards with your shoulders and upper back always down to your lower back.  Keep the motions small and repeat 10 times for every 20 minutes driving.
  • Students always need to be prepared for school but by planning ahead and keeping duplicate supplies at home and school can lighten your load.  If that’s not possible then pack the heaviest items closes to your body and get rid of extra unnecessary items that you don’t absolutely need for that day.  Wear bags that evenly distribute the weight on both shoulders, such as back packs.  
  • Women should always plan to take the bare essentials when packing their handbags.  When going to an all-day outing with friends or family consider finding a more durable and light weight bag that is easy to carry with straps and change arm side every 15-20 minutes.  When standing in lines take time to hold the bag with both hands in front and close to your body or thighs with elbows fully extended down.
  • While performing those tedious grooming tasks at your bathroom sink consider stepping back with one foot and your knee locked straight and the other leg forward with the knee half bent.  Try to keep your back straight while looking in the mirror.  An alternative is half squatting to be closer to the sink while limiting the bend in your back.
  • Always squat with your feet apart, knees bent, and lower back straight when lifting things from low levels.  Think of how Sumo wrestlers stand.  If this bothers your hips or knees then face towards the object and modify with a lunge squat with your strong leg forward and weaker leg back while squatting.  If something is too heavy then always get help.
  • If you are carrying your child for greater than a few minutes consider holding them in front and close to you with both arms or switching between arms every 5-10 minutes.  This will balance the stresses.
  • One of today's biggest offenders of back stress is the cellular phone.  Well not actually the phones but how we sit and stand to use them.  A simple solution to this postural epidemic is simply hold your phone at eye level when texting, surfing the web or viewing social media.

Apply these tips to improve and maintain a healthy back.  


"According to a 2012 survey by the American Physical Therapy Association (APTA), 61 percent of Americans said they have experienced low back pain, and of those 69 percent felt it has affected their daily lives.

The good news is that most cases of low back pain are not serious and will respond well to conservative, proven treatments such as physical therapy.

Physical therapy is a cost effective first choice in an era when all too often back pain is over-treated with narcotics or unhelpful imaging scans that lead to  higher costs."

In reality our bodies are organic in nature and go through natural wear and tear so the more affection we give it is the longer it'll last and love us "Back".



by HID Fit Therapy