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The diagnosis of PGP can be made based on the symptoms alone: if you have pelvic joint pain and it is related to a pregnancy, it is likely to be PGP and likely to respond to being actively treated. However, you need to be assessed by a manual therapist who will exclude any other possible diagnoses. If you have had a fall or another trauma to your pelvis (including a difficult birth) and if the symptoms do not get better with treatment, it can be helpful to have further investigations to exclude Diastasis Symphysis Pubis (DSP).

This is a condition where the ligaments are permanently damaged, often by a trauma such as a fall or by forced abduction (moving apart) of the legs at a previous birth, for example, if feet are put on a midwife's hips or shoulders. In DSP there is a larger than normal gap (usually over 10mm) at the symphysis pubis which does not get better with treatment. The gap can be either horizontal (which will show on a plain pelvic X-ray) or vertical (which will only show on a stork X-ray, where you are standing on one leg). Remember that even DSP may improve with treatment by an experienced manual therapist. It does not automatically require an operation.

Stork X-rays

These are pelvic X-rays where you stand on one leg, have an X-ray taken and then stand on the other leg and have another X-ray taken. This shows how much the pelvis moves on each side when you are taking weight (so it shows whether it will be moving while you walk, for example). A normal pelvic X-ray does not show any movement, and therefore if women have this taken it is often not very helpful.

The normal range of movement (vertical shift) is 0-3mm, and moderately abnormal is 3-10mm. Women can still function very well with this amount of movement, but it may need to be taken more into account when looking at types of exercises in the rehabilitation phase of treatment. If the shift is over 10mm this can be more difficult to manage, but if you have not yet had any manual treatment you should discuss the options with a therapist before deciding on further treatment, and it is usually worth trying this before resorting to more invasive treatment such as steroid injections or surgery.

MRI scans

These show any inflammation in the joints more clearly, which can also confirm why you have pain, as inflammation is usually painful. Some inflammation can sometimes be seen on X-rays, but is usually clearer on an MRI scan. They will also show any bony changes more clearly, and may show any severe muscle or ligament damage. Even if this is indicated, manual treatment may alleviate your symptoms as it helps the joints to work properly together, which reduces the irritation and inflammation over time.

 

 
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