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Randomized Trial

The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle Pain After Pregnancy: A Randomized Controlled Trial

Stuge, Britt MSc, PT*; Lærum, Even PhD†; Kirkesola, Gitle PT‡; Vøllestad, Nina PhD*

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Abstract

Study Design. A randomized controlled trial with stratified block design.

Objectives. To evaluate a treatment program focusing on whether specific stabilizing exercises for patients with pelvic girdle pain after pregnancy reduce pain, improve functional status, and improve quality of life.

Summary of Background Data. The evidence of effectiveness of treatment for pelvic girdle pain is weak. Recent research has focused on the importance of activation of muscles for motor control and stability of the lumbopelvic region. To the authors’ knowledge, the efficacy of applying these principles for pelvic girdle pain has not previously been evaluated in a randomized controlled trial.

Methods. Eighty-one women with pelvic girdle pain were assigned randomly to two treatment groups for 20 weeks. One group received physical therapy with a focus on specific stabilizing exercises. The other group received individualized physical therapy without specific stabilizing exercises. Assessments were administered by a blinded assessor, at baseline, after intervention and 1 year post partum. Main outcome measures were pain, functional status and quality of life.

Results. There were no dropouts. After intervention and at 1 year post partum, the specific stabilizing exercise group showed statistically and clinically significant lower pain intensity, lower disability, and higher quality of life compared with the control group. Group difference in median values for evening pain after treatment was 30 mm on the Visual Analog Scale. Disability was reduced by more than 50% for the exercise group; changes were negligible in the control group. Significant differences were also observed for physical tests, in favor of the specific exercise group.

Conclusion. An individualized treatment approach with specific stabilizing exercises appears to be more effective than physical therapy without specific stabilizing exercises for women with pelvic girdle pain after pregnancy.

Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) are common in many countries. The prevalence rates vary depending on the criteria used for diagnosing or classifying the pain syndrome. However, several studies have shown that approximately 50% of women experience some kind of lumbopelvic pain during pregnancy. 1–4 Most often the pain disappears within 1 to 3 months after delivery. 5,6 However, a substantial number of the women do not recover after delivery. 7,8 Lumbopelvic pain, especially after delivery, may be a serious problem for the individual, her family, and society. This is reflected by the inability to perform daily activities or to earn a living and by a reduced health-related quality of life. 9–11 Effective management to relieve pain and prevent a chronic condition thus becomes an issue of importance for all concerned with women’s health.

A wide range of conservative interventions is offered for the treatment of PGP. However, few clinical trials have evaluated the effectiveness of these treatments. A recent systematic review revealed nine controlled trials of physical therapy for women with pregnancy-related back pain and PGP. 12 Because the trials selected in the review were considered heterogeneous with regard to study design, population, intervention, outcome, and varying methodologic quality, it was not possible to draw definite conclusions about the effectiveness of physical therapy. In only one trial were women with postpartum pelvic pain studied. 13 Clearly, there is a need for more studies of treatments based on well-founded principles in this specific patient population.

Recent research has focused on the importance of activation of muscles for motor control and stability of the lumbopelvic region, 14,15 and a theoretic model of pelvic function has been developed on the basis of anatomic and biomechanical studies. 16 This model introduces the self-locking mechanism of the sacroiliac joints with the principles of form and force closure. Form closure refers to a stable situation with closely fitting joint surfaces that allow the sacroiliac joint to be resistant to shear forces. Force closure refers to the additional compressive force necessary for maintaining stability of the pelvis. In this dynamic process, muscle slings are in connection with ligamentous and fascial structures described to contribute to stability. Furthermore, some evidence for a specific role and a crucial role of the transversely oriented abdominal muscles in providing stability to the lumbopelvic region exists. 17–19 Recently, clinical approaches to the management of lumbopelvic pain, based on these principles, have been proposed. 20,21 However, the efficacy of applying these principles to the treatment of women with pregnancy-related PGP has not been evaluated in a randomized controlled trial, to the authors’ knowledge.

The aim of the present study was to evaluate whether specific stabilizing exercises in the treatment of patients with PGP after pregnancy reduced the women’s pain, improved functional status, and improved health-related quality of life after the treatment period and 1 year after delivery, better than physical therapy without specific stabilizing exercises.

© 2004 Lippincott Williams & Wilkins, Inc.

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