SOLVING THE MYSTERY OF PELVIC PAIN
Written by Amanda Poulakowski, PT
Pelvic pain is very common and often misunderstood as it can present with many different symptoms, especially low back pain. Many people associate pelvic pain with women, however, pelvic pain can be an issue for anyone with a pelvis. Some of the most common areas for pelvic pain are at the pubic symphysis, the sacroiliac (SI) joint, and the tailbone. In this article I will go through common signs and symptoms, in addition to some tips for management and pain relief.
Pubic Symphysis Pain
One of most common causes of pubic symphysis pain, or SPD, includes pregnancy-related hormone changes, muscle imbalances, postural changes, and weight distribution changes. Pain is often exacerbated by walking or climbing stairs, getting into and out of a car, single-leg activities such as putting on pants, and moving or changing positions in bed. In order to help manage and improve this pain, I would recommend the following:
Maintain symmetry
- Sleeping positions: pillow between both legs, maintain neutral spine
- Sitting positions: equal pressure on both sitz bones with pelvis, ribcage, and head/shoulder all stacked; back support as needed in a chair
- With change of positions: keep the pelvis as neutral as possible and avoid wide leg positions if they increase pain
Strengthening: gentle core and lower body strengthening
- Begin seated or on side lying position with a ball/yoga block between knees
- Next, gently squeeze the ball/block with inner thighs while activating deep core/ transverse abdominis
- Note: this exercise should decrease pain and some individuals might benefit from emphasizing the right or left side
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Sacroiliac Joint Pain
This type of pain is often the most complex as there are many causes like an injury or fall, muscle weakness or instability, pregnancy, arthritis, or leg-length discrepancies. Symptoms and pain locations can vary from the center of the back of the pelvis (sacrum), or to the left or right. Sacral pain can also radiate into the groin or be associated with numbness/tingling. Pain is often sharp, stabbing, or shooting and increases with activities such as walking, running, climbing stairs, bending, or lifting. Prolonged inactivity such as sitting or standing in one place for a long period of time can also make the pain worse.
If experiencing these symptoms, I would recommend the following:
- Avoid asymmetrical movements and maintain symmetry as able, especially during transitions
- Posture: focus on neutral pelvis position and stacking
- Sleep positioning: pillow between knees and ankles to keep hips aligned
- Look into getting a supportive belt to wear during the day to carry out daily activity with less pain
- Gentle strengthening that does not increase symptoms (examples below):
- Deep core/transverse activation with gentle backward pelvic tilt
- Inner thigh or outer thigh squeezes
- Note: Sacroiliac joint pain is often accompanied by muscle imbalances and asymmetries in the pelvis (i.e., one hip higher or rotated more than the other) that would need to be corrected before strengthening.
Tailbone Pain
Tailbone pain, also known as coccydynia, can occur as a result of trauma to the area, whether from a fall, during pregnancy or after delivery of a baby, or prolonged sitting on a hard surface. Pain is typically located directly over the tailbone, surrounding the tailbone on the right or left sides, or can even refer to the low back. Common findings and complaints include pain when pressing directly on top of the tailbone, pain with sitting for long periods, and difficulty with prolonged walking. Additionally, pain can be reported when going from sitting to standing as the tailbone feels like it gets “stuck”, as well as difficulty/pain with or after bowel movements.
If experiencing these symptoms, I would recommend the following:
- Adjust posture: avoid leaning backwards, avoid tucking pelvis under & sitting directly on tailbone
- Avoid prolonged sitting: stand up or adjust position about every 30 min. Use a cushion with the back portion cut out. Donut cushions can make the pain worse.
- Seek out a Pelvic PT for a more in-depth assessment of posture, mobility, and strength to identify and address any other impairments that might be contributing to the pain.
Remember that pain can be related to instability, weakness, flexibility restrictions or lifestyle and is often challenging to isolate. Many of the symptoms overlap and can present like different conditions. Seeking assistance from a Pelvic health physical therapist could be helpful in determining where the dysfunction is stemming from. A Pelvic health PT assessment can provide more of an individualized approach to managing pain, improving symptoms, and allowing for participation in all preferred activities.
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