The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health

Debunking Myths About Pregnancy-Related Pelvic Girdle Pain

• Christina Prevett

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Pregnancy doesn't have to mean suffering through pain until delivery day. In this myth-busting episode, pelvic floor physical therapist Christina Prevett tackles one of pregnancy's most common yet misunderstood challenges: pelvic girdle pain.

Between 50-75% of pregnant individuals experience muscle aches and pain, particularly around the pelvis. But the common advice to "just wait until the baby comes" or dismissing it as "normal pregnancy discomfort" prevents many from finding the relief they deserve. Christina systematically dismantles four harmful myths about pregnancy-related pelvic girdle pain, including the widespread misconception that the hormone relaxin is solely to blame.

What's really happening when pregnancy causes pelvic pain? Christina explains how pregnancy shifts the balance between our body's static supports (ligaments) and dynamic supports (muscles), requiring our hip, inner thigh, and pelvic floor muscles to work harder. This understanding transforms how we approach treatment—instead of resting completely, strategic strengthening becomes crucial.

Through practical modification strategies, supportive equipment recommendations, and specific strengthening exercises, Christina provides a comprehensive approach to managing pain during pregnancy. She shares her personal experience with pelvic girdle pain during both her pregnancies, demonstrating how active management rather than passive waiting led to quick relief.

Whether you're currently pregnant and struggling with pain or a fitness professional working with pregnant clients, this episode delivers actionable strategies to transform the pregnancy experience from one of endurance to empowerment. Your pregnancy journey doesn't have to include unmanaged pain—there are evidence-based solutions waiting for you.

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Speaker 1:

Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everybody and welcome to the Barbell Mamas podcast. Christina Previtt here, and I hope you all are having a wonderful time and you are not too stressed out preparing for the holiday season.

Speaker 1:

It is always such a busy time in December. It can be super challenging to get your exercise and fitness in, and traveling can be a nightmare. We were just I was teaching a pelvic health course this weekend and we were in Halifax, nova Scotia. So it's really fun to be able to do a Canadian course and I had both my kiddos with me with my mother-in-law. Thankfully my mother-in-law was there. It was just so wonderful to have an extra set of hands. But traveling with two kiddos is unreal, like the real four and two. They're very busy. I honestly my my mother-in-law joke that we look like Sherpas because he just had so much that was packed onto our person because my son wanted his own backpack, my daughter wanted their own backpack and of course they dumped them as soon as they got to the airport and we were trying to get a two-year-old to have to stay in his seat. And it was just the lovely things that we do to make memories for our kiddos and, just like you, end up on but just the top things that we do to make memories for our kiddos and, just like you, end up on the just the top of the anxiety and stress chain by the time you get to your final destination. But it was really great to be able to speak to our Canadian audience of pelvic health clinicians and we had some nurse practitioners and fitness people in the crowd as well as our physiotherapist, so it was really cool to be able to see that.

Speaker 1:

So, as we are kind of getting into the holiday season, I wanted to mention briefly that we have some things coming up with the barbell mamas. So if you are or you know a person who is pregnant or postpartum or who are going to be having a baby in the near future or are going to be delivering and coming back or hoping to come back to exercise in the near future, we are going to be putting out some gift certificates for two and three months of the Barbell Mamas, or maybe we'll do one, two and three months for the Barbell Mamas programming. If you are looking for a gift for an individual, we're also going to be putting out the capacity to book for, or get gifted, a consult. So this is not physiotherapy. It's a discussion about exercise prescription by some of our teams. So some of it will be me, but we have some team members that may be able to come in and help us out. So we are going to be posting about those on our social media platforms and we'll send out an email with some of the specifics for that. So look into your email and we'll have some of that coming.

Speaker 1:

Okay, today's podcast, I wanted to do a bit of a deep dive into pregnancy related pelvic girdle pain. When we think about pregnancy, a lot of people between 50 and 75% of pregnant individuals will complain about some type of muscle ache and pain, and the extent of that discomfort, the amount in which it impacts a person's day-to-day life, is different and variable, and one of the most common areas is in the low back, in the pubic joint, kind of that spot in the middle of our pelvis, in the front, or our SI joints, which are our low back pelvis area, but over towards the middle of our butt cheeks on either side, all of these areas together into the anywhere in and around the pelvis, so the top of our hip bones at the back all the way to the bottom of our butt and into the front. If you have pain in any of that region, that is considered pregnancy. In your pregnant it's pregnancy related pelvic girdle pain and from a research perspective that's a little bit challenging because there's a lot of muscles, there's a lot of joints, there's a lot of stuff that's going on in our pelvis but it's kind of lumped in together and the research is kind of including all of those things but pregnancy related pelvic girdle pain. There's a lot of myths around it. It really impacts a person's quality of life and how comfortable they feel in their pregnancy. Like, let's face it, towards the end of pregnancy most people are not that comfy, and I always joke that our bodies make us really uncomfortable towards the end of pregnancy so that you're begging for labor to happen Otherwise. If you were comfortable during pregnancy, you would not be looking forward to birthday, and so you know it can make an individual really uncomfortable. It's also one of the leading causes of individuals losing work time during their pregnancies, and so it's something really important for us to be talking about when individuals go to their obstetrical providers.

Speaker 1:

There's a couple of different myths that I want to talk about when it comes to a person's experience of pelvic girdle pain, and then we're going to finish off or close off this podcast with well, what are we going to do about it? And so the the four kind of myths I'm going to talk about, the the fourth one is not as common, but I want to just make sure we touch on it is one you have to wait until the baby comes out for your pain to get better. Two it's because you're pregnant and kind of this dismissal or gaslighting of how a person is experiencing pain during their pregnancy is something that they should just expect because they're pregnant. The third myth is that the reason why they're experiencing pain is because of relaxin. And the fourth thing is that we should back off our exercise because you're experiencing pain is because of relaxin. And the fourth thing is that we should back off our exercise because you're experiencing pelvic girdle pain and just rest or do more lower intensity. That's kind of the answer to fixing or alleviating pain from pelvic girdle pain. Okay, so let's kind of go through each of these myths.

Speaker 1:

So, number one you have to wait until the baby comes out. That is absolutely not true when we are thinking about our experiences of musculoskeletal pain and discomfort. While, yes, pelvic girdle pain does increase and happens most frequently when individuals are pregnant, that does not mean that we cannot change the perception or the expression of pain in your body. And it does not mean that we cannot change the perception or the expression of pain in your body and it does not mean that we cannot alleviate or completely remove that pain that you are experiencing at any point in your pregnancy. It can be challenging for individuals who are having to, you know, stand for their job when they are 16 weeks pregnant and they're experiencing pelvic girdle pain, and then they go to a provider and they say, oh well, this is just something. You're going to have to wait until the baby comes out, until it gets better, and or, don't worry, once the baby comes out it'll feel better. Because then people are thinking, well, I got like 24 weeks left to go and I'm going to get bigger Baby's going to get bigger, so this is going to get worse, and then you can start spiraling. So that is absolutely not true.

Speaker 1:

Um, we have a lot of rehabilitation providers who can be really helpful when it comes to pregnancy related pelvic girdle pain. Chiropractors and physical therapists can both be incredible resources if you have the capacity to go and see some of these providers to be able to modulate or change your pain. And so that kind of leads us into our second myth is it's because you're pregnant. And, yes, pregnancy related pelvic girdle pain, or pelvic girdle pain in general, is definitely heightened in pregnancy, and part of that is because, you see, our pelvis widens, our our, we tilt a little bit more forward, our back arches a bit more and then we're putting a lot of strain on our body. Being pregnant is no joke athletically, but it's not a argument that we can use to dismiss individuals experience of pain in order for them to not get or seek the care that they are looking for.

Speaker 1:

And this kind of goes into our third piece and I'm going to kind of stay here a little bit longer and that is it's relaxin. What is relaxin? Relaxin is a circulating hormone within our body that is released during pregnancy in order to help the pelvis widen, in order to prepare the body for delivery. As we get more pregnant, our rib angle changes, which means that our ribs actually get a little bit wider, and the same thing happens to our pelvis. So individuals may experience things like their bra is fitting a little bit differently, and it has nothing to do with the weight that you are gaining during pregnancy and everything to do with the fact that our ribs get a little bit wider and our pelvis gets a little bit wider in order to make room for baby and prepare your body for labor. When we think about relaxing, a lot of people think about the fact that it has this influence on our ligaments that makes us a bit more bendy and stretchy. When you are a barbell athlete, you may notice that your squat or your technique is a bit better, or your depth is a bit better when you're pregnant. I remember my weightlifting coach and I was pregnant with my first with Maya. He took a look at my snatch balance and he was like what is going on with you? Those pregnancy hormones are doing wonders for you. So it was actually something that was really positive.

Speaker 1:

But for individuals with pelvic girdle pain, relaxin is oftentimes seen as the culprit or the reason why individuals are experiencing pain. And when we look at some of the research, this was from a study that was done a long time ago and saw a kind of a correlation between relaxin concentrations and incidents of pelvic girdle pain. But since then, we kind of had a collection study that was done in 2012, a systematic review that didn't show a connection between absolute amounts of concentration circulating through your body and the risk for developing pelvic girdle pain. I kind of want to put a caveat to this, because there's obviously something going on from a physiology perspective that makes this type of pain, this pain around the pelvis, so much more prevalent during pregnancy Our hypothesis or theory and we still have to do more work in the research to try and see if this is true is that there is.

Speaker 1:

When we think about our body's physiology, we have dynamic supports, which are our muscles, and then we have static supports, like our ligaments and our bones, and the two of them together help to support the joints and muscle or the joints and movements in our body to keep us strong, keep us resilient and keep us moving in the way that we want to right. If we didn't have our bones and ligaments, we'd kind of be this wet noodle that had no structure and we didn't have our muscles. We wouldn't feel strong and capable of generating force or being able to put some power behind our activities when we have relaxed and circulating through our body. In pregnancy it brings down some of our static supports in our ligaments and what that means is there can be this shift towards this maybe 50, 50 of dynamic and static support to like 70% on our dynamic supports in 30% on our ligaments. I'm making up those numbers.

Speaker 1:

But if we are getting weaker during pregnancy or we don't have a lot of like kind of reserve strength coming into our pregnancy, it may cause us to have pain as a result, because most of the time. When we think about pain, it's a representation of us doing things that our body isn't ready for right. So when we think about pain and when we think about overuse injuries, it's if your body isn't strong enough to handle what you're asking it to do. It breaks down. And in pregnancy we are asking a lot of our body and we are also shifting a lot of that stress a good stress, like the stress and strain on our body onto our muscles and what we see is that when we get further towards the end of our pregnancy, our pelvic floor muscles, our adductors or the muscles on the inside of our thighs and all of our glute and hip muscles have to work harder or the amount of activation on them is higher as we get towards the end of pregnancy. If we don't have a lot of reserve in those muscles, then it may be that we are more vulnerable or our risk is higher of developing pelvic girdle pain, and it may not be that you get it or not, but the extent to which you get pelvic girdle pain is higher for those that don't have as much muscular strength in those muscles around the pelvis.

Speaker 1:

Now, when we think about and this is why I kind of, have been gently pushing against some of these ideas around the narrative that in pregnancy, your muscles are already under so much strain, so don't strain them more. That goes against everything we do in rehab. Right, because when we are having an individual who's experiencing pain, it's usually because that joint isn't strong enough to handle what we're asking it to do. So our entire goal in rehab is to bring the pain down with some of our manual therapy or our braces or supports, some of our techniques or tools in our toolbox, in order to be able to make those joints stronger so that they can meet the demand of what we're asking it to do. And so for pregnant individuals, that means that if we know that our pelvic floor muscles, our hip, inside thighs and our glutes have to work harder during pregnancy, then we should make it a priority during our pregnancy to try and keep up or even build more strength in those muscles that need it.

Speaker 1:

And where we have some support for this in the research is that we know that individuals who are more active going into pregnancy they may have the same amounts that they describe. They have some aches and pains during pregnancy, but the amount of pain that they are in the length of time that they're in that pain and the amount of disability they're experiencing is less than our individuals who are more sedentary or move less. And so you know we're not saying that exercise or working out is a hundred percent protective against, you know, having pelvic girdle pain. But it definitely starts to stack the deck in our favor where it can be something that maybe we only have temporarily or the extent of it is a bit more manageable than those who are less active, and it's going to be a really important part of the management of pelvic girdle pain. So, as much as it's not relaxed and I want to say it's not relaxed in asterisk sign, it's creating this increased need on the muscles in our pelvis and we need to be strong enough. Or our goal is to make our body strong enough to handle that increase in need and then hopefully we won't experience as many symptoms.

Speaker 1:

And examples of that that I've seen kind of in clinical practice is individuals, for example, who had more pain in their subsequent pregnancies, especially if those pregnancy windows were smaller. Right, if we had. We were really active going into our first pregnancy, didn't have that much pain and then maybe you didn't get back as much of your strength in between pregnancy one and pregnancy two? Was that maybe one of the contributing factors? If you had more pain in your second pregnancy, that could be one of the reasons it's one of the contributing factors. If you had more pain in your second pregnancy, that could be one of the reasons. It's one of the talking points to give us justification of why we're going to be really focusing on strengthening in part of your rehab plan.

Speaker 1:

If I was to be seeing you one-on-one for rehab and then that kind of goes into the last part, which kind of you know you're going to see why I'm saying this is a myth is that not working out is not going to help our pain. You know, in general for most things we're seeing that lack of movement is not helping that problem. You know, not doing anything is not maybe like kind of in the short term, bring that pain down, especially if we were exercising in a way that irritated our pain. But having to stop working out in general is not. I'm not going to say probably is not the answer, but we want to make sure that we're modifying or moving around that pain so that we're not making that pain worse, and so we want to respect where your pain is, how much pain you're in on a scale of zero to 10, how long it takes, when you're really flared up with your pain, for it to come down to a more manageable level. Does it come down to a manageable level? All of those things are going to be questions that we're going to be asking you about the way that we kind of interact with your pain when it comes to rehab, kind of with those four myths.

Speaker 1:

The next thing that we want to talk about is what do we do about it? So, where there's a couple of buckets that we can go in, when we are thinking about managing pelvic girdle pain, one is going to be do we have to make any modifications or temporary reductions in some of your movement activity or the way that you are doing your exercise in order to let your body come down from that flare up in pain? Would you be someone that would be a candidate for a support belt or an SI joint belt during your pregnancy? Is that something that is going to be helpful? What are ways that we can find exercise that actually feels good for you, that's going to allow you to get your blood pumping and help with some of that healing and then how do we create more strength and support around your pelvis to give you that extra little bit of reserve that you need to help you get through your day. So those are kind of the four things that we are looking for With the first thing around reducing our or kind of modifying around our activity.

Speaker 1:

When you are in a really big flare up, it can be tough for you to exercise at all and those would be individuals who are kind of on the high irritability side of the spectrum. And so when we are thinking about that in the gym for all of our Barbell Mamas programs we have a pelvic pain filter in pregnancy. If you're on our CrossFit powerlifting, weightlifting program and you are experiencing pelvic girdle pain, you can go into the notes section of our programs and say, okay, this is the way that we're going to modify around that to try and make any flare ups in pain during your exercise minimal or hopefully non-existent. So in the gym there's a variety of different ways that we can modify. Some individuals are going to experience, for example, pain and discomfort with lunges or step-ups, especially bigger step-ups, and we can change some of those to squat variations If individuals are having pelvic pain because they're in the very bottom of the squat. It's making their back feel a bit cranky.

Speaker 1:

Can we do a box squat variation? There are lots of different ways. Even getting into and out of the car, can we kind of stick those knees together and pivot you out, versus having you go one leg at a time. If it's turning in bed, can we put a couple of pillows in between your knees? Squeeze those knees together as you roll? There's lots of different ways that we would be talking through and brainstorming ways to just bring that irritability down when you're kind of in the thick of high pain area or high pain experiences of pelvic girdle pain during your pregnancy, and what that's going to do is temporarily we're not saying don't do exercise and completely rest and shut your body down, but what are ways that we can allow you to move and do as much as you can from a work perspective, from a exercise perspective, from a home life perspective, but keep your pain lower or try and get your pain lower so that we can start building you back up from a strength perspective. So we're going to talk about those different ways to modify.

Speaker 1:

The second thing is that we're going to talk about is a SI joint belt something that is beneficial, and if you were in the U S, the Sorolla belt is one that we recommend a lot because it's easy, it's simple, it's a simple strap and we can kind of figure out if this is something that is going to be helpful for you. So if you have, you know, someone compress your hips or someone helped lift your belly and you feel some relief, that might be a sign that the SI joint belt would be something that would be especially helpful for you. In the short term it can be for a lot of my clients who have to spend time walking all day I'm thinking nursing or in factory work or those types of things nursing or in factory work or those types of things it really can allow them to still be doing their jobs. Some individuals will use it for exercise. So it's not a weightlifting bell, it's kind of going across the lower part of your, your belly, it's going to go underneath, it's going to create a little bit of compression and can oftentimes give some temporary or sustained relief. And so by reducing our or modifying the way that we're doing different activities that are flaring up our pain and adding in the belt, those are two ways on your own that we can start thinking about bringing that pain down.

Speaker 1:

This is also an area where if, especially if you're in a big flare up, that reaching out to a rehab provider, if that's possible for you, would be super beneficial because they can help bring that pain down. The idea behind bringing that pain down is to be able to get you to move, and so if I have a person who's in a really big flare up for experiencing pregnancy related pelvic girdle pain, their first exercise session or their movement with me, I'm going to try and find anything that they can do from a movement perspective that gets your heart rate up that does not hurt. That might mean that I get you doing an arm bike, or I get you doing a seated skier, or I get you on the concept two at a very low intensity without any resistance, and you're sitting upright instead of leaning forward. There are a lot of different options arm only row, which probably sounds miserable, but you know just what is a way that I can get you getting your heart rate up, because you will feel better getting that heart rate up. That does it, especially when we're figuring out exercises that do not flare up your symptoms, being able to do something, that getting all of that anti-inflammatory, all those good anti-inflammatory chemicals going through your body when you're in pain can be so beneficial and helpful for individuals experiencing pregnancy related pelvic girdle pain. So that's very general, and then the specific kind of strengthening is going to come in after that where we're going to try and strengthen the muscles of the inner thighs, the adductors or the glutes and the hip. There are tons of different exercises that you can use for this. We can do kind of a low intensity slider when you're standing. You're standing and you have kind of a slippy surface underneath your foot and you bring your foot out into a side lunge and then we're going to get back into center. You can be standing with a band and doing some abductions, bringing your foot from being out at an angle in towards your midline with a light band. We love using things like Copenhagen planks. Those can be really helpful for individuals who are experiencing pubic symphysis pain, and it was something that we can do to build the strength of the inner thighs because they are under more strain during pregnancy. Exercises for our glutes can be things like bridges, if we can handle it, some clamshells that have some hopefully banded resistance after a little bit, some sideline hip abductions, get people into a side plank with a hip lift. Those are tons of great exercises that you can do to start working on some hip muscle stuff. And then hopefully we can get you doing some step ups or lunge variations as pain starts to go down.

Speaker 1:

And then the third kind of clump of exercises is the pelvic floor, and we do have some research that says that doing Kegels or pelvic floor muscle contraction can be really beneficial, not necessarily for pain. And we do have some research that says that doing Kegels or pelvic floor muscle contraction can be really beneficial, not necessarily for pain. We don't have as much specific research in that area, but it is under. The pelvic floor is under more strain and so building up some of that reserve may be helpful. We can kind of use this trial and error type of model. The important thing obviously when you're doing pelvic floor muscle training during pregnancy is, as we've talked about in other episodes is that you have to also be able to relax your pelvic floor, and so the pelvic floor muscle training is not only going to be focusing on a contraction and trying to get a good, strong contraction, but also getting a full and complete relaxation when it comes to your experience of that range of motion in the muscles of the pelvic floor. So those are kind of all things that we can be working on.

Speaker 1:

When it comes to pregnancy-related pelvic girdle pain. If you gain nothing else from this lecture, I kind of tried to really get in there and talk about the way that we handle it. Where we come into this is that there is just so much that we can do to try and help your experience of pain during pregnancy, and I hope that you are not navigating around your pregnancy in pain and thinking that there is absolutely nothing that I can do about it, because that is not true. If, if, even if we cannot get your pain completely eliminated, we can absolutely help to modify and amend it and make it a little bit more tolerable. Um, and there is just so much that we can do right, so you do not have to wait until the baby comes out because you are pregnant. We are not just going to blame hormones circulating around our bodies during pregnancy, because that makes it seem like there's nothing that we can do about it, because we can't change our relaxing concentrations. But that's not the answer. There is so much that we can do in terms of modifying the way that you're doing certain exercises or movements in the short term to bring your irritability down. Give you the SI joint joint support If we trial it out and it's something that's beneficial. And then, from a movement perspective, getting into the gym and doing something that reduces your pain super helpful. And then working on doing some of that hip adductor, pelvic floor strengthening to get really into the areas where we're experiencing pain and discomfort.

Speaker 1:

I'm going to finish off this episode with kind of a personal anecdote. In both of my pregnancies I had one incident that ended up lasting for a couple of days of pelvic girdle pain, and it was interesting because both of them was between 17 and 18 weeks during my pregnancy. I don't know why I like would like layer up something with my SI joint. And the first thing that I had to remember, cause I've had a I had a history of low back pain long before I had kids and I did power lifting in order to bulletproof my back because I never wanted to experience that amount of discomfort again lifting in order to bulletproof my back because I never wanted to experience that amount of discomfort again.

Speaker 1:

But when I experienced it during my pregnancy. The first thing I tried to do is to not get myself really overwhelmed that like, oh my gosh, this is something that I'm going to be experiencing all the time. That was number one is trying to calm my body down. The second thing is that I tried to get myself into the gym and do things that were relatively pain managed, so things that were in the gym that were a two to three out of 10. And at first that was a bit of stretching and movement and mobility, some upper body focused stuff. And then I was able to get on a bike and spin my legs for 20 or 30 minutes and then from there I gradually started introducing different activities. I did an RDL into a little bit of discomfort and I stood up. I did a bunch of clamshells, hip abduction, side planks to just try and bring that irritability down. But I did not rest it and thankfully I did have a lot of reserve. I was able to get a lot of my strength in between pregnancies back and it really was kind of a blip on the radar of my pregnancy where it only lasted a couple of days.

Speaker 1:

Now, this is not to minimize anybody else's experience, especially if you were really active and experienced a lot of pain and discomfort, and I hope that if you had more significant or no really substantial pain, that you had somebody in your corner that was making it helpful. You know, for example, sometimes individuals are experiencing pelvic girdle pain because their baby is just kind of in this weird position that's putting a really additional stress on their bodies and there are certain things that are, you know, really tough to be able to control. But, um, we do have some evidence in these areas that, um, there is a lot that we can do to support you and, um, I hope that you get somebody in your corner or that you can use some of these techniques that we talked about in today's podcast to be able to, um, get a little bit of relief If you're that person in pregnancy that's experiencing pain right now. If you have any other questions, please let us know. It's getting really close to Christmas. I'm really excited. Actually, we are doing an interview with Meg Squats next week, so I'm really excited for that episode to come out. She's amazing and I've had a really fun time kind of getting to know her over social media over the last several years.

Speaker 1:

If you have any other guests that you are interested in having on the podcast, just let me know. I do not have access to any Thoris Otter to you clear to me, though I would love that if anyone could hook me up, please let me know. But if you have any other guests that you're really interested in us having a conversation with, let me know. We have a couple more guests kind of lined up for the end of 2023, into 2024, but, um, we are always open to suggestions of who else we can hang out and talk to. All right, I hope you all have a wonderful week and we will see you all next time.

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Christina Prevett

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