Pelvic girdle pain: Are we missing opportunities to make this a problem of the past?
Pelvic girdle pain (PGP) continues to cause morbidity for a significant number of pregnant women (around one in five). Although research into the causes of PGP has not identified significant or preventable causes, the understanding of contributing factors has evolved significantly in recent years. It was previously thought that PGP was a hormonal problem caused by relaxin production and subsequent ‘loosening’ or laxity of pelvic joints; current evidence suggests that it is an asymmetry of mobility of the pelvic joints, in particular the sacroiliac joints. Treatment has evolved to provision of manual, hands-on therapy treatment, restoring symmetry of pelvic joint movement and function, rather than rest, crutches and support belts; hence the woman's overall biomechanical function and her mobility and independence are restored. This article seeks to raise awareness of this change of focus regarding treatment and promote its adoption across the UK, in line with national guidelines, with the goal of reducing the significant morbidity experienced by many women. Midwives are ideally placed to identify women with PGP early and make the most of the opportunity to access effective treatment, as well as supporting birth-planning that takes PGP into account, thus avoiding long-term physical and psychological morbidity.
Pelvic girdle pain (PGP), formerly known as symphysis pubis dysfunction (SPD), was first described in the time of Hippocrates (Snelling, 1870). Until recently, quantitative research, much of which has been undertaken in Scandinavia and the Netherlands, has focused on trying to establish the causes of PGP (Bjorklund et al, 2000; Vleeming et al, 2008), and to identify the frequency of incidence and diagnostic criteria (Albert et al, 2000; 2001; Laslett et al, 2005). It is estimated that around one in five pregnant women is affected (Hansen et al, 1996; Larsen et al, 1999; Wu et al, 2004). These studies concur on frequency of incidence, and more recent research has moved to consider issues around treatment and management options (Wedenburg et al, 2000; Stuge et al, 2003; 2004; Asian and Fynes, 2007; Elden et al, 2008) and breastfeeding (Bjelland et al, 2014). Guidelines have been developed on management and treatment (Vleeming et al, 2008; Health Service Executive (HSE), 2012; Pelvic Obstetric and Gynaecological Physiotherapy, 2014a). Qualitative research has explored the physical and psychological consequences of the condition (Shepherd and Fry, 1996; Shepherd, 2005; Wellock and Crichton, 2007; Crichton and Wellock, 2008).
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