Pelvic girdle pain
Encyclopedia
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 and later described in medical literature by Snelling.
is the largest bony part of the skeleton and contains three joints: the pubic symphysis
, and two sacroiliac joints
. A highly durable network of ligament
s surrounds these joints giving them tremendous strength.
The pubic symphysis has a fibrocartilage joint
which may contain a fluid filled cavity and is avascular; it is supported by the superior
and arcuate ligaments
. The sacroiliac joints are synovial
, but their movement is restricted throughout life and they are progressively obliterated by adhesions
. The nature of the bony pelvic ring with its three joints determines that no one joint can move independently of the other two.
"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)
PGP can begin as early as the first trimester of pregnancy. Pain is usually felt low down over the symphyseal joint, and this area may be extremely tender to the touch. Pain may also be felt in the hips, groin and lower abdomen and can radiate down the inner thighs. Women suffering from PGP may begin to waddle or shuffle, and may be aware of an audible clicking sound coming from the pelvis. PGP can develop slowly during pregnancy, gradually gaining in severity as the pregnancy progresses.
During pregnancy and postpartum, the symphyseal gap can be felt moving and/or straining when walking, climbing stairs and turning over in bed. These activities can be difficult or even impossible. Pain may remain static, i.e. in one place such as the front of the pelvis producing the feeling of having been kicked, in other cases it may start in one area and move to other areas, you may even experience a combination of symptoms. Any weight bearing activity has the potential of aggravating an already unstable pelvis producing symptoms that may limit the ability for the woman to carry out many daily activities. She will experience pain involving movements such as dressing, getting in and out of the bath, rolling in bed, climbing the stairs and sexual activity. Pain will also be present when lifting, carrying, pushing or pulling.
The symptoms (and their severity) experienced by women with PGP vary, but include:
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. 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 pelvis are screwed together. (Mens 2005)
In some cases women with PGP may also experience emotional problems such as anxiety over the cause of pain, resentment, anger, lack of self-esteem, frustration and depression
; she is three times more likely to suffer postpartum depressive symptoms
. Other psychosocial risk factors associated with woman experiencing PGP include higher level of stress, low job satisfaction and poorer relationship with spouse.
) and non-specific. PGP disorder 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
,
altered laxity/stiffness of muscle
s, laxity to injury of tendinous
/ligamentous structures to ‘mal-adaptive’ body mechanics.
Pregnancy
begins the physiological changes
through a pattern of hormonal secretion and signal transduction
thus initiating the remodelling of soft tissues, cartilage and ligaments. Over time, the ligaments could be stretched either by injury or excess strain and in turn may cause PGP.
is a hormone
produced mainly by the corpus luteum
of the ovary and breast, in both pregnant and non-pregnant females. During pregnancy it is also produced by the placenta
, chorion
, and decidua
. The body produces relaxin during menstruation that rises to a peak within approximately 14 days of ovulation and then declines. In pregnant cycles, rather than subsiding, relaxin secretion continues to rise during the first trimester and then again in the final weeks. During pregnancy relaxin has a diverse range of effects, including the production and remodelling of collagen
thus increasing the elasticity of muscles, tendon
s, ligaments and tissues of the birth canal in view of delivery.
Although relaxin's main cellular action in pregnancy is to remodel collagen by biosynthesis
(thus facilitating the changes of connective tissue) it does not seem to generate musculoskeletal problems. European Research has determined that relaxin levels are not a predictor of PGP during pregnancy.
". The step lengthens as the pregnancy progresses due to weight gain and changes in posture. Both the length and height of the footstep shortens with PGP. Sometimes the foot can turn inwards due to the rotation of the hips when the pelvic joints are unstable. On average, a woman's foot can grow by a half size or more during pregnancy. Pregnancy hormones that are released to adapt the bodily changes also remodel the ligaments in the foot. In addition, the increased body weight of pregnancy, fluid retention and weight gain lowers the arches, further adding to the foot's length and width. There is an increase of load on the lateral side of the foot and the hind foot. These changes may also be responsible for the musculoskeletal complaints of lower limb pain in pregnant women.
During the motion of walking, an upward movement of the pelvis, one side then the other, is required to let the leg follow through. The faster or longer each step the pelvis adjusts accordingly. The flexibility within the knees, ankles and hips are stabilized by the pelvis. Normal gait tends to minimize displacement of centre of gravity whereas abnormal gait through pelvic instability tends to amplify displacement. During pregnancy there may be an increased demand placed on hip abductor, hip extensor, and ankle plantar flexor muscles
during walking. To avoid pain on weight bearing structures a very short stance phase and limp occurs on the injured side(s), this is called Antalgic Gait
.
, physiotherapy, osteopathy
, chiropractic
, psychologist
, prolo therapy or platelet-rich plasma therapy, massage therapy, acupuncture
and alternative medicine
. Mobility aids such as a wheelchair
, walker, elbow crutches
and walking stick
can be very useful. Medication
dispensed by a qualified health care provider
can also be used to manage:
Some pelvic joint trauma will not respond to conservative type treatments and orthopedic surgery
might become the only option to stabilize the joints.
Many women find floating in a heated pool relieves the pain.
activities. PGP can take from 11 weeks, 6 months or even up to 2 years postpartum to subside. However, some research supports that the average means to complete recovery is 6.25 years, and the more severe the case is, the longer recovery period.
Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PGP. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. There is no correlation between age, culture, nationality and numbers of pregnancies that determine a higher incidence of PGP.
If a woman experiences PGP during one pregnancy she is more likely to experience it in subsequent pregnancies; but the severity cannot be determined.
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
, instability and limitation of mobility and functioning in any of the three pelvic joints. PGP has a long history of recognition, mentioned by Hippocrates and later described in medical literature by Snelling.
Anatomy
The pelvisPelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
is the largest bony part of the skeleton and contains three joints: the pubic symphysis
Pubic symphysis
The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...
, and two sacroiliac joints
Sacroiliac joint
The sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis, which are joined together by strong ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side...
. A highly durable network of ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
s surrounds these joints giving them tremendous strength.
The pubic symphysis has a fibrocartilage joint
Fibrocartilage
White fibrocartilage consists of a mixture of white fibrous tissue and cartilaginous tissue in various proportions. It owes its flexibility and toughness to the former of these constituents, and its elasticity to the latter...
which may contain a fluid filled cavity and is avascular; it is supported by the superior
Superior pubic ligament
The superior pubic ligament connects together the two pubic bones superiorly, extending laterally as far as the pubic tubercles....
and arcuate ligaments
Inferior pubic ligament
The inferior pubic ligament is a thick, triangular arch of ligamentous fibers, connecting together the two pubic bones below, and forming the upper boundary of the pubic arch.Above, it is blended with the interpubic fibrocartilaginous lamina; laterally, it is attached to the inferior rami of...
. The sacroiliac joints are synovial
Synovial fluid
Synovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its yolk-like consistency , the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement.-Overview:The inner membrane of synovial joints...
, but their movement is restricted throughout life and they are progressively obliterated by adhesions
Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...
. The nature of the bony pelvic ring with its three joints determines that no one joint can move independently of the other two.
Classification
Prior to the 20th century, specialists of pregnancy-related PGP used varying terminologies. It is now referred to as Pregnancy Related Pelvic Girdle Pain that may incorporate the following conditions:- Diastasis of the Symphysis PubisDiastasis symphysis pubisDiastasis symphysis pubis is the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture.- Diagnosis :...
(DSP) - Symphysis pubis dysfunctionSymphysis pubis dysfunctionSymphysis Pubis Dysfunction is most commonly associated with pregnancy and childbirth. It is a condition that causes excessive movement of the pubic symphysis, either anterior or lateral, as well as associated pain, possibly because of a misalignment of the pelvis. SPD is a dysfunction that is...
(SPD) - Pelvic Joint Syndrome
- Physiological Pelvic Girdle Relaxation
- Symptom Giving Pelvic Girdle Relaxation
- Posterior Pelvic Pain
- Pelvic Arthropathy
- Inferior Pubic Shear/ Superior Pubic Shear /Symphyseal Shear
- Symphysiolysis
- Osteitis pubisOsteitis pubisSince 1924, osteitis pubis has been known as a noninfectious inflammation of the pubis symphysis causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery and remains a well-known complication of invasive...
(usually postpartum) - SacroiliitisSacroiliac jointThe sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis, which are joined together by strong ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side...
- One-sided Sacroiliac Syndrome /Double Sided Sacroiliac Syndrome
- HypermobilityHypermobilityHypermobility describes joints that stretch farther than is normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or other contortionist performances...
"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)
Symptoms
A combination of postural changes, the growing baby, unstable pelvic joints under the influence of pregnancy hormones and changes in the centre of gravity can all add to the varying degrees of pain or discomfort. In some cases it can come on suddenly or following a fall, sudden abduction of the thighs (opening too wide too quickly)or an action that has strained the joint.PGP can begin as early as the first trimester of pregnancy. Pain is usually felt low down over the symphyseal joint, and this area may be extremely tender to the touch. Pain may also be felt in the hips, groin and lower abdomen and can radiate down the inner thighs. Women suffering from PGP may begin to waddle or shuffle, and may be aware of an audible clicking sound coming from the pelvis. PGP can develop slowly during pregnancy, gradually gaining in severity as the pregnancy progresses.
During pregnancy and postpartum, the symphyseal gap can be felt moving and/or straining when walking, climbing stairs and turning over in bed. These activities can be difficult or even impossible. Pain may remain static, i.e. in one place such as the front of the pelvis producing the feeling of having been kicked, in other cases it may start in one area and move to other areas, you may even experience a combination of symptoms. Any weight bearing activity has the potential of aggravating an already unstable pelvis producing symptoms that may limit the ability for the woman to carry out many daily activities. She will experience pain involving movements such as dressing, getting in and out of the bath, rolling in bed, climbing the stairs and sexual activity. Pain will also be present when lifting, carrying, pushing or pulling.
The symptoms (and their severity) experienced by women with PGP vary, but include:
- Present swelling and/or inflammation over joint.
- Difficulty lifting leg.
- Pain pulling legs apart.
- Inability to stand on one leg.
- Inability to transfer weight through pelvis and legs.
- Pain in hips and/or restriction of hip movement.
- Transferred nerve pain down leg.
- Can be associated with bladder and/or bowel dysfunction.
- A feeling of symphysis pubis giving way.
- Stooped back when standing.
- Malalignment of pelvic and/or back joints.
- Struggle to sit or stand.
- Pain may also radiate down the inner thighs.
- Waddling or shuffling gait.
- Audible ‘clicking’ sound coming from the pelvis.
Severity
The severity and instability of the pelvis can be measured on a three level scale.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. 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 pelvis are screwed together. (Mens 2005)
Psychosocial impact
PGP in pregnancy seriously interferes with participation in society and activities of daily life; the average sick leave due to posterior pelvic pain during pregnancy is 7 to 12 weeks.In some cases women with PGP may also experience emotional problems such as anxiety over the cause of pain, resentment, anger, lack of self-esteem, frustration and depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
; she is three times more likely to suffer postpartum depressive symptoms
Postpartum depression
Postpartum depression , also called postnatal depression, is a form of clinical depression which can affect women, and less frequently men, typically after childbirth. Studies report prevalence rates among women from 5% to 25%, but methodological differences among the studies make the actual...
. Other psychosocial risk factors associated with woman experiencing PGP include higher level of stress, low job satisfaction and poorer relationship with spouse.
Causes
Sometimes there is no obvious explanation for the cause of PGP but usually there is a combination of factors such as:- The pelvic joints moving unevenly.
- A change in the activity of the muscles in the pelvis, hipHip (anatomy)In vertebrate anatomy, hip refer to either an anatomical region or a joint.The hip region is located lateral to the gluteal region , inferior to the iliac crest, and overlying the greater trochanter of the femur, or "thigh bone"...
, abdomen, back and pelvic floorPelvic floorThe pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
. - A history of pelvic trauma.
- The position of the baby altering the loading stresses on the pelvic ligaments and joints.
- Strenuous work.
- Previous lower back painLow back painLow back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...
. - Previous pelvic girdle pain during pregnancy.
- HypermobilityHypermobilityHypermobility describes joints that stretch farther than is normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or other contortionist performances...
, genetical ability to stretch joints beyond normal range. - An event during the pregnancy or birth that caused injury or strain to the pelvic joints or rupture of the fibrocartilage.
- The occurrence of PGP is associated with twin pregnancy, first pregnancy and a higher age at first pregnancy.
Mechanism
Pregnancy related Pelvic Girdle Pain (PGP) can be either specific (trauma or injury to pelvic joints or genetical i.e. connective tissue diseaseConnective tissue disease
A connective tissue disease is any disease that has the connective tissues of the body as a target of pathology. Connective tissue is any type of biological tissue with an extensive extracellular matrix that supports, binds together, and protects organs...
) and non-specific. PGP disorder is complex and multi-factorial and likely to be also represented by a series of sub-groups driven by pain varying from peripheral
Peripheral nervous system
The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...
or central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...
,
altered laxity/stiffness of muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s, laxity to injury of tendinous
Tendon
A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other...
/ligamentous structures to ‘mal-adaptive’ body mechanics.
Pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
begins the physiological changes
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
through a pattern of hormonal secretion and signal transduction
Signal transduction
Signal transduction occurs when an extracellular signaling molecule activates a cell surface receptor. In turn, this receptor alters intracellular molecules creating a response...
thus initiating the remodelling of soft tissues, cartilage and ligaments. Over time, the ligaments could be stretched either by injury or excess strain and in turn may cause PGP.
Relaxin hormone
RelaxinRelaxin
Relaxin is a protein hormone first described in 1926 by Frederick Hisaw.The relaxin-like peptide family belongs in the insulin superfamily and consists of 7 peptides of high structural but low sequence similarity; relaxin-1 , 2 and 3 , and the insulin-like peptides, INSL3, INSL4, INSL5 and INSL6...
is a hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
produced mainly by the corpus luteum
Corpus luteum
The corpus luteum is a temporary endocrine structure in mammals, involved in production of relatively high levels of progesterone and moderate levels of estradiol and inhibin A...
of the ovary and breast, in both pregnant and non-pregnant females. During pregnancy it is also produced by the placenta
Placenta
The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...
, chorion
Chorion
The chorion is one of the membranes that exist during pregnancy between the developing fetus and mother. It is formed by extraembryonic mesoderm and the two layers of trophoblast and surrounds the embryo and other membranes...
, and decidua
Decidua
Decidua is the term for the uterine lining during a pregnancy, which forms the maternal part of the placenta. It is formed under the influence of progesterone and forms highly-characteristic cells.-Etymology:...
. The body produces relaxin during menstruation that rises to a peak within approximately 14 days of ovulation and then declines. In pregnant cycles, rather than subsiding, relaxin secretion continues to rise during the first trimester and then again in the final weeks. During pregnancy relaxin has a diverse range of effects, including the production and remodelling of collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
thus increasing the elasticity of muscles, tendon
Tendon
A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other...
s, ligaments and tissues of the birth canal in view of delivery.
Although relaxin's main cellular action in pregnancy is to remodel collagen by biosynthesis
Biosynthesis
Biosynthesis is an enzyme-catalyzed process in cells of living organisms by which substrates are converted to more complex products. The biosynthesis process often consists of several enzymatic steps in which the product of one step is used as substrate in the following step...
(thus facilitating the changes of connective tissue) it does not seem to generate musculoskeletal problems. European Research has determined that relaxin levels are not a predictor of PGP during pregnancy.
Gait changes
The pregnant woman has a different pattern of "gaitGait analysis
Gait analysis is the systematic study of animal locomotion, more specific as a study of human motion, using the eye and the brain of observers, augmented by instrumentation for measuring body movements, body mechanics, and the activity of the muscles. Gait analysis is used to assess, plan, and...
". The step lengthens as the pregnancy progresses due to weight gain and changes in posture. Both the length and height of the footstep shortens with PGP. Sometimes the foot can turn inwards due to the rotation of the hips when the pelvic joints are unstable. On average, a woman's foot can grow by a half size or more during pregnancy. Pregnancy hormones that are released to adapt the bodily changes also remodel the ligaments in the foot. In addition, the increased body weight of pregnancy, fluid retention and weight gain lowers the arches, further adding to the foot's length and width. There is an increase of load on the lateral side of the foot and the hind foot. These changes may also be responsible for the musculoskeletal complaints of lower limb pain in pregnant women.
During the motion of walking, an upward movement of the pelvis, one side then the other, is required to let the leg follow through. The faster or longer each step the pelvis adjusts accordingly. The flexibility within the knees, ankles and hips are stabilized by the pelvis. Normal gait tends to minimize displacement of centre of gravity whereas abnormal gait through pelvic instability tends to amplify displacement. During pregnancy there may be an increased demand placed on hip abductor, hip extensor, and ankle plantar flexor muscles
Ankle
The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus bone in the foot...
during walking. To avoid pain on weight bearing structures a very short stance phase and limp occurs on the injured side(s), this is called Antalgic Gait
Gait abnormality
Gait abnormality is a deviation from normal walking . Watching a patient walk is the most important part of the neurological examination. Normal gait requires that many systems, including strength, sensation and coordination, function in an integrated fashion...
.
Treatment
Once a diagnosis of PGP has been made there are various treatments that can be applied. One of the main factors in helping women cope with the condition is with education, information and support. Other coping strategies include physical medicine and rehabilitationPhysical medicine and rehabilitation
Physical medicine and rehabilitation , physiatry or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a...
, physiotherapy, osteopathy
Osteopathy
Osteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
, chiropractic
Chiropractic
Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
, psychologist
Psychologist
Psychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...
, prolo therapy or platelet-rich plasma therapy, massage therapy, acupuncture
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
and alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
. Mobility aids such as a wheelchair
Wheelchair
A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...
, walker, elbow crutches
Crutch
Crutches are mobility aids used to counter a mobility impairment or an injury that limits walking ability.- Types :There are several different types of crutches:...
and walking stick
Walking stick
A walking stick is a device used by many people to facilitate balancing while walking.Walking sticks come in many shapes and sizes, and can be sought by collectors. Some kinds of walking stick may be used by people with disabilities as a crutch...
can be very useful. Medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
dispensed by a qualified health care provider
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
can also be used to manage:
- Chronic painChronic painChronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
- AnxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
- Depression
- Post Traumatic Stress Disorder(resulting from birth trauma/ pregnancy)
- Musculo-skeletal disorders.
Some pelvic joint trauma will not respond to conservative type treatments and orthopedic surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
might become the only option to stabilize the joints.
Self help management
Self help management techniques include:- When getting into bed sit on the edge keeping knees close together, lie down on your side, lifting both legs at the same time. Reverse this to get up.
- Try not to attempt to pull yourself up from lying on your back.
- Keep knees together when rolling over in bed.
- Sleep with a pillow between the legs; add more in other areas for support.
- When getting into a car: Sit down first and then swing legs keeping them together.
- Avoid sofas and chairs that are too low or too soft.
- Try to reduce the stress on the joint.
- Avoid any movement with your knees apart.
- Take smaller steps when walking.
- Avoid stairs if possible.
- Take breaks.
- Move within the limits of pain.
- Avoid twisting, bending or squatting.
Many women find floating in a heated pool relieves the pain.
Prognosis and epidemiology
For most women PGP resolves in weeks after delivery but for some it can last for years resulting in a reduced tolerance for weight bearingWeight bearing
In orthopedics, weight-bearing is the amount of weight a patient puts on the leg on which surgery has been performed. In general, it is described as a percentage of the body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.After...
activities. PGP can take from 11 weeks, 6 months or even up to 2 years postpartum to subside. However, some research supports that the average means to complete recovery is 6.25 years, and the more severe the case is, the longer recovery period.
Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PGP. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. There is no correlation between age, culture, nationality and numbers of pregnancies that determine a higher incidence of PGP.
If a woman experiences PGP during one pregnancy she is more likely to experience it in subsequent pregnancies; but the severity cannot be determined.
See also
- ChildbirthChildbirthChildbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
- Coccyx (tailbone)CoccyxThe coccyx , commonly referred to as the tailbone, is the final segment of the vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between...
- Diastasis symphysis pubisDiastasis symphysis pubisDiastasis symphysis pubis is the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture.- Diagnosis :...
- EstrogenEstrogenEstrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
- Greater pelvisGreater pelvisThe greater pelvis is a portion of the cavity surrounded by the skeleton of the pelvis, situated above and in front of the pelvic brim...
- Lesser pelvisLesser pelvisThe lesser pelvis is that part of the space enclosed by the skeleton of the pelvis which is situated between the pelvic inlet and the pelvic floor. Some authors call this cavity the pelvic cavity...
- Osteitis pubisOsteitis pubisSince 1924, osteitis pubis has been known as a noninfectious inflammation of the pubis symphysis causing varying degrees of lower abdominal and pelvic pain. Osteitis pubis was first described in patients who had undergone suprapubic surgery and remains a well-known complication of invasive...
- Pelvic cavityPelvic cavity-External links:* * *...
- Pelvic fracturePelvic fracturePelvic fracture is a disruption of the bony structure of the pelvis, including the hip bone, sacrum and coccyx. The most common cause in elderly is a fall, but the most significant fractures involve high-energy forces such as a motor vehicle accident, cycling accidents, or a fall from significant...
- PregnancyPregnancyPregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
- HypermobilityHypermobilityHypermobility describes joints that stretch farther than is normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or other contortionist performances...
- Sacroiliac jointSacroiliac jointThe sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis, which are joined together by strong ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side...
- PelvimetryPelvimetryPelvimetry is the assessment of the female pelvis in relation to the birth of a baby. Traditional obstetrical services relied heavily on pelvimetry in the conduct of delivery in order to decide if natural or operative vaginal delivery was possible or if and when to use a cesarean...
- RelaxinRelaxinRelaxin is a protein hormone first described in 1926 by Frederick Hisaw.The relaxin-like peptide family belongs in the insulin superfamily and consists of 7 peptides of high structural but low sequence similarity; relaxin-1 , 2 and 3 , and the insulin-like peptides, INSL3, INSL4, INSL5 and INSL6...
- Symphysis pubis
- Terms for anatomical location
External links
- Pelvic Instability Network Support (PINS)
- Pelvic Partnership Support Group
- Recommendations for the Nomenclature of Receptors for Relaxin Family Peptides Pharmacol Rev 58:7-31,2006 Ross A. Bathgate, Richard Ivell, Barbara M. Sanborn, O. David Sherwood and Roger J. Summers
- European Guidelines on the Diagnosis and Treatment of Pelvic Girdle Pain (pdf)
- Guidance for Healthcare Professional Pregnancy Related Pelvic Girdle (pdf)
- Guidance for Mothers and Mothers to be with Pregnancy Related Pelvic Girdle Pain (pdf)
- A historical perspective on pregnancy related lower back pelvic girdle pain