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European Spine Journal : Official... Jun 2008A guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management",... (Review)
Review
A guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management", issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick's Faber, Gaenslen's test, and modified Trendelenburg's test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.
Topics: Europe; Female; Guidelines as Topic; Humans; Low Back Pain; Male; Pelvic Pain; Pregnancy; Pregnancy Complications
PubMed: 18259783
DOI: 10.1007/s00586-008-0602-4 -
Australian Journal of General Practice Jul 2018Pelvic girdle pain (PGP) in pregnancy is a common condition that can cause significant physical disability and has an important psychosocial impact on pregnant women and...
BACKGROUND
Pelvic girdle pain (PGP) in pregnancy is a common condition that can cause significant physical disability and has an important psychosocial impact on pregnant women and their families. It is often under-reported and poorly managed by obstetric caregivers, and this can result in poorer outcomes, reduced quality of life and chronic pain.
OBJECTIVE
The objective of this article is to discuss the practical assessment and management of PGP in pregnancy.
DISCUSSION
Conservative management that includes activity modification, pelvic support garments, management of acute exacerbations, physiotherapy and exercise programs can alleviate symptoms and prevent progression of symptoms. General practitioners are an integral part of the multidisciplinary team to help manage PGP.
Topics: Adult; Bed Rest; Chronic Pain; Female; Humans; Pain Management; Pain Measurement; Pelvic Girdle Pain; Physical Therapy Modalities; Pregnancy; Quality of Life
PubMed: 30114872
DOI: 10.31128/AJGP-01-18-4467 -
Physical Medicine and Rehabilitation... Aug 2017Understanding the anatomic relationship of the pelvic floor muscles with the pelvic girdle, spine, and hips aids the rehabilitation provider in diagnosis, management,... (Review)
Review
Understanding the anatomic relationship of the pelvic floor muscles with the pelvic girdle, spine, and hips aids the rehabilitation provider in diagnosis, management, and appropriate referrals. The bony anatomy of the pelvic girdle consists of 3 bones and 3 joints. The pelvic floor muscles are comprised mainly of the levator ani muscles with somatic innervation from the lumbosacral plexus. The bony and muscular pelvis is highly interconnected to the hip and gluteal musculature, which together provide support to the internal organs and core muscles. Pelvic floor physiology is centered on bladder and bowel control, sexual functioning, and pregnancy.
Topics: Female; Humans; Lumbosacral Plexus; Muscle, Skeletal; Pelvic Floor; Pregnancy; Referral and Consultation
PubMed: 28676358
DOI: 10.1016/j.pmr.2017.03.003 -
Obstetrical & Gynecological Survey Jun 2023Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years,... (Review)
Review
IMPORTANCE
Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies.
OBJECTIVE
The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain.
EVIDENCE ACQUISITION
Electronic databases (PubMed and Embase) were searched from 1980 to 2021 with the only limitation being that the articles were in English. Studies were selected that examined associations between pelvic pain/pelvic girdle pain and pregnancy.
RESULTS
There were 343 articles identified. After reviewing the abstracts, 88 were used in this review. Pelvic girdle pain is a common condition of pregnancy, affecting a reported 20% of pregnant women. The pathophysiology is poorly understood and likely multifactorial, involving both hormonal and biomechanical changes that occur during pregnancy. Several risk factors have been identified. This diagnosis is most commonly made based on symptoms related to pelvic pain during pregnancy. Treatment should be multimodal, including pelvic girdle support, stabilizing exercises, analgesia, and potentially complementary therapies. The effects on future pregnancies are uncertain, although some limited information suggests an increased risk of recurrent PGP in subsequent pregnancies.
CONCLUSIONS
Pelvic girdle pain in pregnancy is a common condition that is often overlooked as a normal part of pregnancy but has a significant impact on quality of life during, after, and in subsequent pregnancies. Multimodal therapies are available and are largely low cost and noninvasive.
RELEVANCE
Our aim is to increase the awareness of pelvic girdle pain in pregnancy as a common but often underdiagnosed and undertreated condition.
Topics: Pregnancy; Female; Humans; Pelvic Girdle Pain; Quality of Life; Pregnancy Complications; Exercise Therapy; Risk Factors
PubMed: 37322996
DOI: 10.1097/OGX.0000000000001140 -
The Journal of the American Academy of... Sep 2015Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in... (Review)
Review
Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low back. The most common musculoskeletal complaints in pregnancy are low back pain and/or pelvic girdle pain. They can be diagnosed and differentiated from each other by history taking, clinical examination, provocative test maneuvers, and imaging. Management ranges from conservative and pharmacologic measures to surgical treatment. Depending on the situation, and given the unique challenges pregnancy places on the human body and the special consideration that must be given to the fetus, an orthopaedic surgeon and the obstetrician may have to develop a plan of care together regarding labor and delivery or when surgical interventions are indicated.
Topics: Delivery, Obstetric; Female; Humans; Low Back Pain; Obstetric Labor Complications; Patient Care Team; Pelvic Girdle Pain; Pregnancy; Pregnancy Complications
PubMed: 26271756
DOI: 10.5435/JAAOS-D-14-00248 -
Journal of Midwifery & Women's Health Jul 2018Pelvic floor dysfunction is defined as abnormal function of the pelvic floor and includes conditions that can have significant adverse impacts on a woman's quality of... (Review)
Review
Pelvic floor dysfunction is defined as abnormal function of the pelvic floor and includes conditions that can have significant adverse impacts on a woman's quality of life, including urinary incontinence (stress, urge, and mixed), fecal incontinence, pelvic organ prolapse, sexual dysfunction, diastasis recti abdominis, pelvic girdle pain, and chronic pain syndromes. Women's health care providers can screen for, identify, and treat pelvic floor dysfunction. This article examines the case of a woman with multiple pelvic-floor-related problems and presents the evidence for the use of pelvic floor physical therapy (PFPT) for pregnancy-related pelvic floor dysfunction. PFPT is an evidence-based, low-risk, and minimally invasive intervention, and women's health care providers can counsel women about the role that PFPT may play in the prevention, treatment, and/or management of pelvic floor dysfunction.
Topics: Adult; Female; Health Promotion; Humans; Pelvic Floor; Pelvic Floor Disorders; Pelvic Organ Prolapse; Physical Therapy Modalities; Pregnancy; Pregnancy Complications; Quality of Life; Women's Health
PubMed: 29778086
DOI: 10.1111/jmwh.12736 -
British Journal of Sports Medicine Jan 2019The purpose of this review was to investigate the relationship between prenatal exercise, and low back (LBP), pelvic girdle (PGP) and lumbopelvic (LBPP) pain. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this review was to investigate the relationship between prenatal exercise, and low back (LBP), pelvic girdle (PGP) and lumbopelvic (LBPP) pain.
DESIGN
Systematic review with random effects meta-analysis and meta-regression.
DATA SOURCES
Online databases were searched up to 6 January 2017.
STUDY ELIGIBILITY CRITERIA
Studies of all designs were eligible (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone ["exercise-only"] or in combination with other intervention components [eg, dietary; "exercise + co-intervention"]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (prevalence and symptom severity of LBP, PGP and LBPP).
RESULTS
The analyses included data from 32 studies (n=52 297 pregnant women). 'Very low' to 'moderate' quality evidence from 13 randomised controlled trials (RCTs) showed prenatal exercise did not reduce the odds of suffering from LBP, PGP and LBPP either in pregnancy or the postpartum period. However, 'very low' to 'moderate' quality evidence from 15 RCTs identified lower pain severity during pregnancy and the early postpartum period in women who exercised during pregnancy (standardised mean difference -1.03, 95% CI -1.58, -0.48) compared with those who did not exercise. These findings were supported by 'very low' quality evidence from other study designs.
CONCLUSION
Compared with not exercising, prenatal exercise decreased the severity of LBP, PGP or LBPP during and following pregnancy but did not decrease the odds of any of these conditions at any time point.
Topics: Exercise Therapy; Female; Humans; Low Back Pain; Pelvic Girdle Pain; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 30337344
DOI: 10.1136/bjsports-2018-099400 -
European Journal of Obstetrics,... Oct 2021The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed... (Review)
Review
The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed cortically and reflexly from various levels of the nervous system. Such holistic integration is essential for the system's multiple functions, for example, pelvic girdle stability, continence, voiding/defecation, and sexuality. Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation. Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction (s) of Chronic Pelvic Pain Syndrome (CPPS), pelvic girdle pain, sexual problems, Lower Urinary Tract Symptoms (LUTS), dysfunctional voiding, constipation, prolapse and incontinence. The interpretation of pelvic floor biomechanics is complex and involves multiple theories. Non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training. The aims of this review are to analyze pelvic function and dysfunction. Because it is a holistic and entirely anatomically based system, we have accorded significant weight to the Integral Theory's explanations of function and dysfunction.
Topics: Constipation; Humans; Pelvic Floor; Pelvic Floor Disorders; Sexual Dysfunction, Physiological; Urinary Incontinence
PubMed: 34492609
DOI: 10.1016/j.ejogrb.2021.08.026 -
Journal of Back and Musculoskeletal... 2019Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women.
OBJECTIVE
This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP.
METHODS
Forty postpartum women participated in the study. Their age ranged from 25-35 years and their body mass index (BMI) was 25-29.9 kg/m2. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively.
RESULTS
Both groups (A and B) revealed a significant decrease (p= 0.001) in pain and functional disability and a significant increase (p= 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p= 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A).
CONCLUSIONS
PFM training should be an essential part in rehabilitation programs of PGP postpartum.
Topics: Activities of Daily Living; Adult; Exercise Therapy; Female; Humans; Muscle, Skeletal; Pain Measurement; Pelvic Floor; Pelvic Girdle Pain; Postpartum Period; Treatment Outcome; Visual Analog Scale
PubMed: 30636728
DOI: 10.3233/BMR-181258