Pelvic girdle pain during pregnancy and puerperium

Dear Sir,

We read with interest the paper by Keriakos et al. (2011), which reviewed current guidance on pregnancy-related pelvic girdle pain. We would like to expand on several points contained within this article.

Contrary to the published abstract, pelvic girdle pain is not a term specific to pregnancy. The internationally recognised nomenclature is ‘pregnancy-related pelvic girdle pain’ (Vleeming et al. 2008), which is often abbreviated to PGP. Similarly, relaxin is no longer thought to cause PGP in most women; more recent evidence has found pelvic joint asymmetry to be a strong predictive indicator of PGP (ACPWH 2011).

In clinical practice, core stability exercises are not a ‘one size fits all’ treatment for PGP – they should only be given to women with an identified motor control dysfunction. An experienced obstetric physiotherapist is well placed to make this assessment. Treatment must be individualised, and may rely on manual therapy to treat the underlying musculoskeletal dysfunction (ACPWH 2011). TENS may be a useful adjunct for a few women; national guidance should be utilised (ACPWH 2007). Postnatally, hands-on physiotherapy is essential and utilises similar techniques to those performed antenatally.

Contrary to this paper, we know of no current evidence to demonstrate that forced abduction of the hips during labour causes PGP, although it has been linked to diastasis symphysis pubis (DSP) (ACPWH 2011). It is imperative to current obstetric practice to note that although care must be taken to avoid abduction of the hips beyond the pain-free range in symptomatic women with PGP, this may be obstetrically indicated, e.g. shoulder dystocia. It should be recognised that the health of the infant may be a higher priority than maternal musculoskeletal conditions in an emergency situation.

A little further information is required to accurately perform the tests described in this paper – although the symphysis pubis may be tender to palpate, this should only be considered as a positive test for PGP if pain lasts more than 5 s after removal of the examiner's fingers (Vleeming et al. 2008). On its own, DSP may not require medical intervention as it has no correlation to pain (Björklund et al. 1999). This is diagnosed postnatally by standing in the ‘flamingo’ position for an X-ray (demonstrates instability in a superior/inferior direction, which may benefit from surgical fusion).

We hope that this information is beneficial to clinicians working with women with PGP.

Clair Jones and Martin Cameron

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.