The sacroiliac joint (SIJ) combines the sacrum bone (the tailbone) and the ilium bone (the bone above your hip in your bottom). The long dorsal ligament travels over the SIJ, while other nearby ligaments include the sacrotuberus ligament, the iliolumbar ligaments and the sacroiliac ligaments. Key muscles is this area include the gluteus medium, gluteus minimus, pelvic floor muscles. These ligaments, muscles and joints are placed under strain during pregnancy as they are stretched while your baby grows and your stomach gets bigger.
During pregnancy, a hormone called relaxin is secreted through the body which loosens and weakens the above mentioned ligaments, joints and muscles throughout the body, but in particular around the sacrum, pelvis, hip and lumbar spine regions. This weakening is the body preparing itself for labour and the birthing process, however this causes significant instability in these areas during pregnancy, contributing to pain and dysfunction. Additionally, the extra weight carried by women due to not only their baby but also the amniotic fluid places additional stress on these areas.
Usually pelvic/sacral/lumbar/hip instability during pregnancy is diagnosed clinically by a physiotherapist by performing a thorough subjective and objective assessment. Scans such as an MRI or ultrasound are usually unnecessary to diagnose the problem. While these scans are not harmful to the unborn baby, such scans are often unnecessary as they often do no show any problems and even when problems are found, these findings usually do not change the treatment plan.
Treatment and Physiotherapy
Treatment focuses on reducing the feelings of pain, discomfort and instability, using treatment modalities such as massage, gentle mobilisation, taping and re-strengthening muscles and ligaments which have become weakened over the course of the pregnancy. Rehab exercises plays an important role in stabilising your pelvic/lumbar/hip regions. Occasionally a lumbar brace is required to support the affected area. Medications such as anti-inflammatories (NSAIDs) or Panadol are generally safe to take, however any concerns in regards to this should be discussed with your Physio, General Practitioner, Midwife or Obstretrician.
The aim of treatment ideally is to get you painfree and functioning as well you can (given you are pregnant!). In some cases treatment may be aimed at keeping your symptoms at a low and manageable level as sometimes the extra weight carried is the key factor in your pain and keeping you as comfortable as possible until you lose the extra weight (and get your baby!) is the goal. Ultimately, the goal is to get you painfree which is usually achievable. It is common that physiotherapy is still needed after the birth of your baby in order to not only get you completely painfree but also to enable you to return to activity and exercise in the months after your baby is born. The problems experienced during pregnancy do not always disappear immediately once your baby is born.
Your physiotherapist will discuss these treatment options with you to ensure you get the best possible outcome for your problem as well as making sure all care and safety is provided to you and your baby.
Blog By Ben Jaffe