Lumbopelvic and pelvic girdle pain (PGP) in pregnancy is estimated to occur in 20-30% of women, with prevalence as high as 50%. (Elden et al., 2013; Gutke et al., 2006; Mens & Pool-Goudzwaard, 2012; Ostgaard, 1991; Vleeming et al., 2008) One in four women who develop PGP in pregnancy develop chronic postpartum pain. (Ostgaard, 1991) According to Albert et al., 2006, risk factors for developing pelvic girdle pain in pregnancy include history of prior low back pain, back or pelvic trauma, high levels of stress, multiparity, and low job satisfaction. Non-risk factors include contraceptive medications, time since past pregnancy, height, weight, and smoking. (Vleeming et al., 2008) Fortunately, there is a trend for PGP to decrease within the first 3 months of delivery. (Elden et al., 2008) For pain that does persist, guidelines for treating pelvic girdle pain include providing individualized exercise prescription. (Vleeming et al., 2008) What type of individualized exercise or other intervention is appropriate?
A recent study by Elden and colleagues (2013) assessed the effect of including craniosacral therapy to standard treatment for pregnant women with pelvic girdle pain. In the multicenter, randomized, single blind, controlled trial, 123 patients were treated, with 60 in the control group and 63 in the intervention group. Standard treatment included education about the condition and anatomy of the back and pelvis, instruction in concepts of load demand and rest, activities of daily living advice, instruction in use of pelvic support belt, and exercises to stretch and strengthen the trunk, hip and shoulder muscles. Women in the intervention group received, in addition to the above, craniosacral manual releases to the pelvis. To see the program utilized, access the full article here.
Outcome measures included frequency of sick leave, morning and evening pain on visual analog scale, the Oswestry Disability Index scale, Disability Rating Index, European Quality of Life measure, intensity of discomfort of PGP, and blinded examiner assessment of recovery. The authors conclude the following: "Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group…treatment effects were small and clinically questionable…"