PELVIC GIRDLE PAIN (PGP) back
Pregnancy related Pelvic Girdle Pain (PGP) causes pain, instability and limitation of mobility and functioning in any of the three pelvic joints. PGP has a long history of recognition, mentioned by Hippocrates [1] and later described in medical literature by Snelling[2]. PGP can be either specific (trauma or injury to pelvic joints or genetical i.e. connective tissue disease) or non-specific.
 
PGP is complex and multi-factorial and likely to be also represented by a series of sub-groups driven by pain varying from peripheral or central nervous system, [3a] altered laxity/stiffness of muscles, [4] laxity to injury of tendinous/ligamentous structures [5] to ‘mal-adaptive’ body mechanics. [3b] "The classification between hormonal and mechanical pelvic girdle instability is no longer used. For treatment and/or prognosis it makes no difference whether the complaints started during pregnancy or after childbirth." (Mens, 2005) [6]
 
For most women PGP resolves in weeks after delivery but for some it can last for years resulting in a reduced tolerance for weight bearing activities of daily living. Post partum PGP is typically felt in the posterior superior iliac spines and in the symphyseal region. Running  the most provocative activity, followed by domestic work and by activities involving pushing and pulling. Duration of the activity has a great impact on the tolerance for all activities, and for the majority of the women, menstruation and ovulation caused an exacerbation of the symptoms. [26]
 
Overall, about 45% of all pregnant women and 25% of all women postpartum suffers from PGP. [7a] During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of women. After pregnancy, problems are serious in about 7%. [7b] There is no correlation between age, culture, nationality and numbers of pregnancies that determine a higher incidence of PGP.[8] [9]  
 
Definition of a Concept; Pelvic Girdle Pain back
Pelvic type 1: The pelvic ligaments support the pelvis sufficiently. Even when the muscles are used incorrectly, no complaints will occur when performing everyday activities. This is the most common situation in persons who have never been pregnant, who have never been in an accident, and who are not hyperactive.
 
Pelvic type 2: The ligaments alone do not support the joint sufficiently. A coordinated use of muscles around the joint will compensate for ligament weakness. In case the muscles around the joint do not function, the patient will experience pain and weakness when performing everyday activities. This kind of pelvic often occurs after giving birth to a child weighing 3000 grams or more, in case of hyperactivity, and sometimes after an accident involving the pelvis. Pelvic type 2 is the most common form of pelvic instability. Treatment is based on learning how to use the muscles around the pelvis more efficiently.
 
Pelvic type 3: The ligaments do not support the joint sufficiently. This is a serious situation whereby the muscles around the joint are unable to compensate for ligament weakness. This type of pelvic instability usually only occurs after an accident, or occasionally after a (small) accident in combination with giving birth. Sometimes a small accident occurring long before giving birth is forgotten so that the pelvic instability is attributed only to the childbirth. Although the difference between Type 2 and 3 is often difficult to establish, in case of doubt an exercise program may help the patient. However, if pelvic type 3 has been diagnosed then invasive treatment is the only option: in this case parts of the pelvic are screwed together.
(Extract: About pelvic girdle instability….by Jan M.A. Mens, physician for Orthopaedic Medicine.)
 
 
Pelvic Girdle Assessment Tools [10] back
The level of severity in PGP can be adequately assessed by a combination of specific tests. Five of the most reliable assessment tools are:
 
References back
1. Pubic Symphysis Separation. Fetal and Maternal Medicine Review (2002), 13: 141-155 Kelly Owens, Anne Pearson, Gerald Mason
2. Pain In Childbearing, Key Issues In Management. Margaret Yerby, Lesly Page.  
3a/b. Diagnosis and classification of pelvic girdle pain disorders— Part 1: A mechanism based approach within a biopsychosocial framework. Manual Therapy, Volume 12, Issue 2, May 2007, PB. O’Sullivan and DJ Beales.
4. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008 Feb 8, A Vleeming, HB Albert, HC Ostgaard, B Sturesson, B Stuge.
5. Possible role of the long dorsal sacroiliac ligament in women with peripartum pelvic pain. Acta Obstetricia et Gynecologica Scandinavica, Volume 81, Issue 5 , Page 430-436, May 2002, A Vleeming, HJ de Vries, JM Mens, J-P van Wingerden
6. About Pelvic Girdle Instability. Definition and Concept. Jan M.A. Mens, physician for Orthopaedic Medicine.
7a/b . Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. European Spine Journal Vol 13, No. 7 / Nov. 2004, WH Wu, OG Meijer , K Uegaki, JM A Mens, JH van Dieën, PI J Wuisman, HC Östgaard.
8. Is Pelvic Pain a Welfare Complaint? Acta Obstet Gynecol Scand. 2000 Jan, 79(1):24-30 Department of Women’s and Children, HK Bjorklund, S Bergstrom.
9. Pelvic Girdle Pain in Pregnancy. BMJ 2005, 331:249-250 (30 July), doi:10.1136/bmj.331.7511.249 Editorial, RW Stones, K Vits.  
10. 13. Physical characteristics of women with severe pelvic girdle pain after pregnancy: a descriptive cohort study. Spine 2008, Vol 33, No 5, pp 145-151. I; Ronchetti, A Vleeming, JP van Wingerden
26. Clinical findings, pain descriptions and physical complaints reported by women with post-natal pregnancy-related pelvic girdle pain.
Acta Obstet Gynecol Scand, September 1, 2010; 89(9): 1187-91.  LL Nielsen  
 
 
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