Management of Pelvic Girdle Pain in Pregnancy
The most effective management approach for pelvic girdle pain (PGP) in pregnancy includes non-pharmacological interventions such as activity modification, pelvic support garments, physiotherapy with stabilizing exercises, and acetaminophen for pain relief when necessary. 1, 2
Prevalence and Impact
- Pelvic girdle pain affects nearly 20% of pregnant women, with prevalence peaking in the 6th and 7th months of pregnancy 1
- PGP can cause significant physical disability and has important psychosocial impacts on pregnant women and their families 2
- PGP is often under-reported and poorly managed, leading to poorer outcomes, reduced quality of life, and risk of chronic pain 2
- Severe cases can trigger sleep disturbances, impair daily activities, and increase the risk of depression 1
Diagnosis
- PGP can be diagnosed through specific pain provocation tests including:
- P4/thigh thrust test
- Patrick's Faber test
- Gaenslen's test
- Modified Trendelenburg's test 3
- The active straight leg raise (ASLR) test is recommended as a functional assessment 3
- Pain palpation tests including the long dorsal ligament test and palpation of the symphysis can help confirm the diagnosis 3
Management Options
Non-pharmacological Approaches (First-line)
- Activity modification to avoid aggravating activities, particularly heavy lifting (10-20 kg or 22-44 lb) more than 20 times per week 4, 1
- Pelvic support garments/belts to provide stability to the pelvis and reduce pain 5, 2
- Physiotherapy focusing on stabilizing exercises for the pelvic girdle 6
- Application of heat or ice to painful areas 5
- Patient education about the condition and self-management strategies 2
Exercise Recommendations
- Individualized stabilizing exercises have shown benefit in reducing pain and improving quality of life when performed regularly 6
- Aquatic exercises can be beneficial due to reduced weight-bearing 7
- Tailored postpartum exercises help prevent persistent pain 7
Pharmacological Management
- Acetaminophen (650 mg every 6 hours or 975 mg every 8 hours) is the safest first-line medication for pain management 5
- NSAIDs should be avoided during pregnancy due to potential risks to the developing fetus 5
Risk Factors and Prevention
- Previous history of low back pain and previous trauma to the pelvis are significant risk factors 3
- Obesity increases risk due to chronic overloading of connective tissue structures 1
- Early intervention and management may help prevent progression to chronic pain 2
Prognosis
- For most women, pain resolves spontaneously after delivery 1
- Women at highest risk for persistent postpartum pain include those who:
- Had back pain prior to pregnancy
- Experienced early onset of symptoms
- Had higher pain severity during pregnancy
- Experienced both low back pain and PGP simultaneously 1
Common Pitfalls to Avoid
- Dismissing PGP as a normal part of pregnancy rather than a condition requiring management 8
- Underreporting: Women often don't report PGP to their prenatal providers, leading to insufficient clinical attention 4, 5
- Inadequate activity modification, especially related to heavy lifting 4, 1
- Ignoring persistent symptoms, which may indicate risk for chronic postpartum pain 1
- Overuse of medications when non-pharmacological approaches might be effective 5