The Pelvic Girdle Musculoskeletal (PGM) Method: A Comprehensive Approach to Pelvic Girdle Dysfunction

Pelvic Girdle Dysfunction (PGD) is a common yet often misunderstood condition affecting the sacroiliac joints, symphysis pubis, ligaments and muscles of the pelvic region. It can cause significant discomfort and impact daily function, especially in pregnancy and postpartum individuals. The Pelvic Girdle Musculoskeletal (PGM) Method, developed by Deborah Riczo, offers a structured and evidence-based approach to assessing and managing Pelvic Girdle Pain (PGP). This method provides physiotherapists and healthcare professionals with a systematic framework for identifying, treating and rehabilitating individuals with pelvic girdle dysfunction.

 

Core Principles of the PGM Method

The PGM Method is built on six key principles:

• Identifying Pelvic Girdle Dysfunction - utilizing clinical assessment tools to differentiate pelvic girdle pain from other conditions such as low back pain, hip dysfunction or leg pain.
• Biomechanical Analysis - evaluating muscle imbalances, joint restrictions and faulty movement patterns contributing to dysfunction.
• Targeted Interventions - implementing evidence-based treatments such as manual therapy, core activation, strengthening and functional movement retraining.
• Patient Education - teaching proper body mechanics, postural modifications and lifestyle adjustments to aid in symptom management.
• Use of External Supports - when needed, incorporating sacroiliac belts and assistive tools to stabilize the pelvis.
• Special Considerations for Pregnancy & Postpartum - addressing challenges such as hormonal changes, diastasis recti and pelvic floor dysfunction in pregnant and postpartum individuals.

 

Assessment in the PGM Method

This step-by-step evaluation enables clinicians to tailor interventions for each patient's unique needs.

 

Intervention Strategies in the PGM Method

To restore normal pelvic function, the PGM Method incorporates:

• Manual therapy - addressing joint and soft tissue restrictions
• Core activation and strengthening - enhancing pelvic stability through deep core muscle training
• Muscle retraining - targeting deep stabilizers like the transversus abdominis and pelvic floor muscles
• Stretching and mobility exercises - reducing tension in overactive muscles
• Functional retraining - improving movement patterns in daily activities

 

Clinical Applications of the PGM Method

The PGM Method is particularly effective in managing:

• Sacroiliac joint dysfunction
• Pregnancy-related pelvic pain
• Postpartum pelvic instability
• Diastasis recti abdominis (DRA)
• Pelvic floor muscle dysfunction
• Recurrent low back and hip pain linked to pelvic instability

 

Key Considerations in Pelvic Girdle Pain Management

Core Activation & Muscle Balance

• Before activating deep core muscles, it is essential to ensure pelvic girdle muscle balance.
• Therapeutic exercises should be individualized and relevant to the patient's needs.

Benefits of Exercise for Pelvic Girdle Pain (PGP)

• Reduces pain intensity and disability.
• Recommended in pregnancy by clinical guidelines.
• Prevents recurrence of PGP during and after pregnancy.
• Early intervention improves long-term outcomes.

Deep Core Muscles Targeted

• Transversus Abdominis
• Pelvic Floor
• Diaphragm
• Multifidus

Progression of Core Stability Exercises

• Stable, symmetric static positions (neutral pelvis)
• Asymmetrical static positions (adding extremity movement)
• Mobility-based exercises (roller/ball)
• Agility-based exercises (balance training, lunges)

 Core Activation Technique

• Inhale: Relax abdominal muscles, expand rib cage and lengthen pelvic floor muscles.
• Exhale (through pursed lips): Engage transversus abdominis, activate pelvic floor.

Clinical Considerations

• Exhaling through pursed lips enhances pelvic floor contraction.
• If pelvic pain increases, the patient may have hypertonic pelvic floor muscles - focus on relaxation instead.
• Repetition guidelines - 10 reps per set, performed in various positions (supine, standing, kneeling).
• Progress exercises gradually, ensuring muscle fatigue without overloading.

Restoring Automatic Core Activation

• Core muscles should function automatically, but PGP can disrupt activation patterns.
• The goal is to retrain natural core activation through consistent practice.

 

Targeted Stretching and Strengthening for Pelvic Girdle Dysfunction

1. Stretching for Pelvic Girdle Pain

• Muscle flexibility assessment is crucial in PGP.
• Tight muscles are often found on the painful side.
• Stretching should be individualized and unilateral based on patient tolerance.

Key Muscles to Stretch:

• Hip muscles (extensors, flexors, rotators, adductors, abductors)
• Leg muscles (quadriceps, hamstrings)
• Core & back muscles (lumbar rotators, latissimus dorsi)

2. Strengthening for Pelvic Girdle Dysfunction

• Weakness and poor balance are common in PGP.
• Strengthening exercises should be progressive (e.g., use of theraband, bridging).
• Core activation must be integrated into all strengthening exercises.

Identifying Weakness:

• If one side is harder to activate or balance, it likely needs strengthening.

Understanding Pelvic Girdle Pain (PGP)

It is a musculoskeletal disorder affecting the pelvis, sacroiliac joints, symphysis pubis, ligaments and muscles.

Occurrence & Risk Factors

• Common in pregnancy, but also occurs outside pregnancy.
• Can severely impact daily function and quality of life.
• Risk factors include gait abnormalities, trauma, scoliosis, lumbar fusion, pregnancy-related changes (e.g., increased joint laxity).

Physiotherapy Management Approaches

• Passive treatments - manual therapy, acupuncture, pelvic belts.
• Active treatments - specific exercise therapy, muscle activation strategies.
• Biopsychosocial approaches - addressing psychosocial factors and patient education.

Assessment Methods for PGP

• SIJ pain - diagnosed using multiple pain provocation tests.
• LBP - assessed based on movement direction and contributing factors.
• Multifactorial nature - similar to non-specific LBP, requiring a biopsychosocial model approach.