Postpartum Pelvic Girdle Pain Research Articles

Characteristics and effects on daily lives of pelvic girdle pain during early postpartum in Beijing women, China

ABSTRACT Pelvic girdle pain (PGP) is a common problem during pregnancy and postpartum and negatively affects women’s well-being. Yet it is not well known in China. This study assessed PGP’s intensity, location, and quality and the status of daily activities on postpartum women with pain, and explored the relationship between pain and the prevalence of depressive symptoms. A cross-sectional study recruiting 1,038 eligible women at 6 weeks postpartum from the obstetric clinic of a hospital was conducted in Beijing, China. Data were collected using self-reported questionnaires, including Introductory information form, Body chart, Number Rating Scale, McGill Pain Questionnaire-2, Pelvic Girdle Questionnaire, and Edinburgh Postnatal Depression Scale. In this study, 32.2 percent women experienced pain. The mean (SD) pain intensity score was 3.07 ± 1.60. About 50.6 percent women experienced sacroiliac joint pain, and 25.5 percent women experienced pain in a combination of locations. About 73.1 percent women experienced aching pain, and 57.5 percent experienced more than one kind of pain quality. The mean total score, which assesses activity and symptom limitations, was 21.93 ± 17.35 (percent), of which a normal sex life (1.29 ± 0.94) was made more challenging due to pain. In mental health, the prevalence of depressive symptoms coincided with the prevalence of pain (p = 0.008). Postpartum PGP still needs to be taken seriously, and women with pain require further support. The above knowledge offers information to manage pain, daily lives and depressive symptoms, contributes to think about strategies to better promote postpartum women physical and mental health in the future.

Research on the Different Frequencies of Transcutaneous Electrical Acupoint Stimulation for Postpartum Pelvic Girdle Pain

Objective: To observe the clinical effect of different frequencies of transcutaneous electrical acupoint stimulation in treating postpartum pelvic girdle pain and promoting postpartum rehabilitation. Methods: From January to September 2022, 300 patients with pelvic girdle pain after spontaneous delivery in a hospital in Shaanxi Province were selected and randomly divided into three groups, low frequency, high frequency, and alternating frequency, with 100 cases in each group. In addition to routine postpartum care and psychological counseling, the three groups received transcutaneous electrical acupoint stimulation at low-frequency (2 Hz,) high-frequency (100 Hz), and alternating frequency (2/100 Hz), respectively. The differences in initial pain, pain scores before and after treatment, satisfaction with analgesic effect, and postpartum rehabilitation effect were evaluated among the three groups of patients. Results: There was a significant correlation between maternal age and postpartum pelvic girdle pain (P < 0.001), but no correlation was observed between newborn birth weight and postpartum pelvic girdle pain (P > 0.05). After 1d/2d of treatment, the pain scores and rehabilitation effect of patients in the alternating-frequency group and low-frequency group were significantly better than those in the high-frequency group, and the postpartum curative effect of patients in the alternating-frequency group was the best, followed by the low-frequency group, and the high-frequency group; the differences were statistically significant (P < 0.001). Among the three groups, the alternating-frequency group had the highest satisfaction with the analgesic effect and the highest rate of selecting the same analgesic regimen the next time; the differences were statistically significant (P < 0.001). Conclusion: Transcutaneous electrical acupoint stimulation at different frequencies is safe and effective in treating postpartum pelvic girdle pain and beneficial to postpartum rehabilitation. Sparse-dense wave stimulation is effective in treating postpartum pelvic girdle pain. It has the best effect in promoting postpartum rehabilitation and the highest patient satisfaction. Therefore, its application in clinical practice is highly recommended.

Can Clinical Postpartum Muscle Assessment Help Predict the Severity of Postpartum Pelvic Girdle Pain?A Prospective Cohort Study.

The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3months postpartum, with a higher prediction of a middle to high PGQ score (β = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.

Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study

BackgroundPelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland.MethodsThis was a prospective, observational study. In phase 1, 411 women were recruited 24–72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report.ResultsIn phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43–48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04–4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01–1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34–48.72).ConclusionAlthough the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum.

The Efficacy of Lumbar Support on Pain, Disability, and Motor Control in Women With Postpartum Pelvic Girdle Pain: Protocol for a Randomized Controlled Trial.

BackgroundPregnancy-related posterior pelvic girdle pain (PPGP) is one of the most important clinical manifestations of postpartum back pain. Those affected often complain of discomfort during daily activities. It is hypothesized that altered motor control is associated with perceived pain. Pelvic support can regulate possible underlying altered motor control mechanisms and decrease pain. However, the influence of a lumbosacral orthosis, which is broader support that allows for a wider contact area and more skin sensory stimulation to restore proper motor function, has not yet been investigated in women with postpartum PPGP.ObjectiveThis study investigates the efficacy of broader lumbar support and narrower pelvic support on pain, proprioception, disability, and muscle strength in women with pregnancy-related PPGP.MethodsThis study will be a single-center, 3-armed, participant-blinded, randomized controlled trial. In total, 84 women diagnosed with pregnancy-related PPGP will be recruited and randomly assigned into 3 groups. Intervention groups A and B will receive pelvic and lumbar supports, respectively. Group C (control) will receive only a patient education leaflet containing advice on strengthening exercises, comfortable positions, and other practical information. The study outcomes are pain, effort score during the active straight leg raising test, maximum isometric hip flexion force, maximum isometric hip external rotation force, maximum isometric trunk rotation force, and joint position reproduction of hip abduction. The study outcomes will be measured at 4 time points: baseline (T1), immediately after the intervention (T2), 4 weeks following interventions began (at this time, the intervention period is completed) (T3), and 1 week after discontinuing the interventions (T4) to evaluate the possible lasting effects of wearing supports. Multivariate analysis of variance will be used to test between- and within-group differences.ResultsRecruitment for this study will be started in summer 2022 and is expected to be completed by the end of fall 2022.ConclusionsThis study will examine the efficacy of broader lumbar support as an early rehabilitative treatment for women receiving postpartum posterior pelvic pain support compared to those receiving a narrower pelvic support. We expect the broader lumbar support to impact pain management and disability better than the current narrower pelvic belt. Long-term follow-up studies will help determine whether such lumbosacral orthosis reduces pain and improves daily activities in women with pregnancy-related PPGP.Trial RegistrationIranian Registry of Clinical Trials IRCT20150210021034N11; https://www.irct.ir/trial/54808International Registered Report Identifier (IRRID)PRR1-10.2196/40553

The Association between Postpartum Pelvic Girdle Pain and Pelvic Floor Muscle Function, Diastasis Recti and Psychological Factors-A Matched Case-Control Study.

There is uncertainty regarding the association between abdominal morphology, pelvic floor function, and psychological factors in women with postpartum pelvic girdle pain (PGP). The aim of this case-control study was to evaluate the differences between women with and without persistent PGP regarding pelvic floor function, diastasis recti, and psychological factors 6–24 weeks postpartum. Pelvic floor manometry, palpation examination of abdominal muscles, the International Consultation on Incontinence Questionnaire Short Form, The Depression, Anxiety and Stress Scale—21, and the Pain Catastrophizing Scale were used. The PGP group presented with lower vaginal resting pressure (p < 0.001), more tenderness (p = 0.018) and impaired voluntary activation of pelvic floor muscles (p ≤ 0.001). Women with pain also had more distortion on the level of the anterior abdominal wall (p = 0.001) and more severe diastasis recti (p = 0.046) when compared to pain-free controls. Lower vaginal resting pressure was the strongest factor explaining PGP (OR 0.702, 95%CI 0.502–0.981). There were no differences in terms of the pelvic floor strength, endurance, severity of urinary incontinence and reported distress between the groups. Women with PGP 6–24 weeks postpartum differ in pelvic floor and abdominal muscle function from the pain-free controls. Vaginal resting pressure may be an important factor in pelvic girdle pain shortly postpartum. Further studies are needed to see a trend in changes over time.

Pelvic-sacral tendon-regulation needling technique of acupuncture combined with manipulative reduction in treatment of postpartum pelvic girdle pain: a randomized controlled trial

To observe the effect on postpartum pelvic girdle pain treated with the combined therapy of pelvic-sacral tendon-regulation needling technique of acupuncture and manipulative reduction and the simple manipulative therapy. A total of 80 patients with postpartum pelvic girdle pain were randomized into an observation group and a control group, 40 cases in each one. In the control group, the manipulative reduction was simply adopted. In the observation group, on the base of the treatment as the control group, the pelvic-sacral tendon-regulation needling technique of acupuncture was applied at Mingmen (GV 4), Dachangshu (BL 25), Yaoyangguan (GV 3), Ciliao (BL 32), Zhongliao (BL 33), Huantiao (GB 30) and Yanglingquan (GB 34). In either group, the treatment was given once every two days, three times a week and 3 treatments taken as one course. Totally, 3 courses of treatment were required. The clinical therapeutic effect was compared in the patients between the two groups. The changes in the scores of the pain visual analogue scale (VAS), Oswestry dysfunction index (ODI) and Japanese Orthopaedic Association (JOA), as well as the pelvic floor distress inventory-short form 20 (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7) and the sex life index (the frequency of intercourse and orgasm) were recorded in the patients of the two groups before and after treatment. The total effective rate was 95.0% (38/40) in the observation group, higher than 77.5% (31/40) in the control group (P<0.01). After treatment, the scores of VAS, ODI, PFDI-20 and PFIQ-7 were lower than those before treatment respectively in the patients of the two groups (P<0.01). JOA score and the sex life index were increased after treatment as compared with those before treatment in the two groups (P<0.01). The difference value of each of the above indexes in the observation group was higher than the control group (P<0.01). The combined therapy of pelvic-sacral tendon-regulation needling technique of acupuncture and manipulative reduction effectively alleviates pain and improves the muscle strength of pelvic floor muscle fibers in the patients with postpartum pelvic girdle pain. Its therapeutic effect is better than that of the simple manipulative therapy.

Relationship Between Pubic Symphysis Separation and Postpartum Pelvic Girdle Pain: A Retrospective Study of 32 Cases.

Pain severity of postpartum pelvic girdle pain (PGP) does not seem closely related to the symphysis gap. To determine the relationship between the pubic symphysis gap and postpartum PGP in women treated with the squeeze-and-clap maneuver. Retrospective study. Hospital Clinic PATIENTS: 32 patients with postpartum PGP. The patients were grouped by the pubic symphysis gap as: group A (6-11 mm), group B (12-20 mm), and group C (21-30 mm). GP severity was measured by visual analogue scale (VAS). The symphysis gap was measured on radiographs. All patients were treated with the squeeze-and-clap maneuver. The VAS scores and the symphysis gaps at the first clinic visit and the second clinic visit 4-8 weeks later were analyzed. There was no significant difference in VAS scores between the three groups at the first clinic visit and the second clinic visit. VAS scores of the three groups were all significantly decreased at the second clinic visit compared with the first clinic visit (all P < .001). The symphysis gap was significantly decreased in group C at the second clinic visit (P = 0.004), but not in group A and group B. Pubic symphysis separation was not associated with pain severity of postpartum PGP.

Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial.

Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women. This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP. Forty postpartum women participated in the study. Their age ranged from 25-35 years and their body mass index (BMI) was 25-29.9 kg/m2. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively. Both groups (A and B) revealed a significant decrease (p= 0.001) in pain and functional disability and a significant increase (p= 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p= 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A). PFM training should be an essential part in rehabilitation programs of PGP postpartum.

Are Pelvic Stabilizing Exercises Effective for Postpartum Pelvic Girdle Pain? A Literature Review

The effectiveness of exercises to prevent or relieve postpartum pelvic girdle pain (PGP) has been investigated for decades. Although multiple treatment options are available, evidence supporting specific forms of intervention for PGP remains limited. Thus, the effectiveness of exercises and treatments for persistent postpartum PGP has not yet been established. The aim of this literature review was to clarify the effectiveness of exercises based on a review of randomized controlled trials including postpartum women with persistent PGP. We performed a broad search for eligible studies published before May 1, 2018 using the following electronic databases; PubMed, Medline, Pedro, Sage Journal, Google Scholar and the Cochrane Library. Comprehensive combinations of key words were utilized for these searches. Data were evaluated using a review process. The initial online search identified 184 potential studies and six of these studies met the specified criteria. All studies investigated the interventional effects of pelvic stabilizing exercises by assessing pain intensity, physical examination and disability questionnaires. In terms of effectiveness, a significant positive impact on pelvic pain intensity was reported as a result of stabilizing exercise programs for postpartum PGP. There were no adverse events reported in any of these studies. This review demonstrates the paucity of methodologically rigorous research to help healthcare practitioners make reliable decisions regarding the effectiveness of physical exercises for postpartum PGP. An individually tailored program with stabilizing exercises involving all relevant muscles delivered under the guidance of a therapist achieved high patient compliance and was shown to be effective for PGP. J Clin Gynecol Obstet. 2019;8(2):33-38 doi: https://doi.org/10.14740/jcgo552

Does Women's Health Matter?

It's an interesting question. I bet a lot of people think that women get the same quality of care as men. The evidence would say something different. I could bore you with data to support this claim, but, with politicians denigrating science and treating evidence as opinion, why bother. Some of us still trust the power of science to transform the way we perceive the world. I wouldn't have taken on the editorship of the Journal of Women's Health Physical Therapy (JWHPT) if I wasn't one of them. Which brings me around to the name change that was voted on from the Section on Women's Health to the Academy of Pelvic Health. I get it. As an emerging clinician in this speciality area, you want to forge your professional identity and establish your “brand.” You may think that identifying yourself as a “Pelvic Health PT” will distinguish you from the pack, grow your practice, and announce to the world what you do professionally. As you promote your distinctive skills, why do your patients/clients trust you? They have confidence in your skills because your practice is based on the best evidence available. Without research to back up your work, you are standing on a house of cards. A name designates who you are and what you are about. At JWHPT, we want to be expansive. We are your bridge to the information you need to help your practice flourish. We want to be the place where all physical therapists look for information, not only about pelvic health, but also for all aspects of women's health. We choose to keep our name to help correct the underrepresentation of health care research on women. For the continued progress of the journal, we need to keep the scope of the journal open to new avenues of research while providing you with the evidence to advance your practice. The Section on Women's Health, that will officially become the Academy of Pelvic Health, has always been helpful to those new to this area of PT with continuing education, residencies, and specialty certification. All of this support has been terrific at facilitating specialty practice and entrepreneurship. I am truly grateful for the continued backing from the section/academy for the success of this journal. Yet, I challenge the transition to the Academy of Pelvic Health to make research and scholarship on par with their support of practice. Each and every member of the Academy has an opportunity to promote scholarship. What can you, as a clinician, do? Include JWHPT in your social media posts. Invite those who are involved in research to submit their work to us because the JWHPT has wide-ranging, engaged readership. Research published here will be noticed and used by enthusiastic clinicians. Most importantly, read; read and tell people what you are reading and why. The articles included in this volume represent some of these sweeping interests. Dr Hafer et al examine gait biomechanics in postpartum runners. A systematic review of risk factors for postpartum pelvic girdle pain is provided by Dr Christopher et al. Dr Bussey and colleagues present an in-depth case on posture and balance following TRAM flap breast reconstruction in a breast cancer survivor. Dr Russell and associates provide a meta-analysis on the use of yoga in women with chronic pelvic pain. What do these articles have in common? They share a contribution to a better understanding of health care for women. If you ask me, women's health does still matter. This was powerfully expressed by the former first lady, Michelle Obama, as she spoke at the Elizabeth G. Anderson School in 2009. Communities and countries and ultimately the world are only as strong as the health of their women ....1 —Cynthia M. Chiarello, PT, PhD Editor-in-Chief

Trajectories of lower back, upper back, and pelvic girdle pain during pregnancy and early postpartum in primiparous women.

Objective:Most studies about truncal pain during and after pregnancy focus on low back pain, few prospectively define change in pain, and even fewer evaluate pain in all three major truncal areas: upper back, lower back, and pelvic girdle. Thus, the objective of this prospective cohort study was to describe, in primiparous women delivered vaginally, prevalence rates and severities of upper back, lower back, and pelvic girdle pain during pregnancy and 6–10 weeks postpartum and to describe the trajectory of pain constellations between time points.Study design:Participants completed questionnaires at each time point. Pain intensity was rated on a visual analogue scale ranging from 0 to 100.Results:Of the 288 participants, 94% reported truncal pain during pregnancy, while 75% did so postpartum. Prevalence rates of upper back, lower back, and pelvic girdle pain with or without other types of pain during pregnancy were 42%, 77%, and 74% and postpartum were 43%, 52%, and 41%, respectively. Pain severity was highest for women endorsing pain in three locations (median 55–60). Of women with the most common pain constellation during pregnancy, lower back and pelvic girdle (32%), 18% had persistent low back and pelvic girdle pain postpartum, 20% had no pain, and the remainder had pain in a different location. Of women with pain in all three locations during pregnancy (27%), 34% had persistent pain in three locations postpartum, 13% had no pain, and the remainder had pain in at least one location.Conclusion:More women experience pain in a constellation of locations than in a single location. Severity increases as number of pain sites increase. Women with pain in three sites during pregnancy are least likely to have pain resolve. Interventions should focus on the entire trunk and not simply one site of pain.

Are Pelvic Stabilizing Exercises Effective for Postpartum Pelvic Girdle Pain? A Literature Review

Are Pelvic Stabilizing Exercises Effective for Postpartum Pelvic Girdle Pain? A Literature Review

Altered musculoskeletal mechanics as risk factors for postpartum pelvic girdle pain: a literature review.

[Purpose] The aim of this literature review was to detect the factors associated with pelvic girdle pain persisting for over 3 months in the postpartum period. [Methods] We performed a broad literature search for eligible studies published before May 1, 2018 using electronic databases and processed the data using a review process. [Results] In the initial online search, we identified 12,174 potential studies. Finally, 22 studies met the specified criteria and were included for examination of risk factors for persistent pelvic girdle pain after delivery. Pain intensity and disability during pregnancy were risk factors for pelvic girdle pain persisting for over 6 months after delivery. The active straight leg raising test predicted the risk of persistent pelvic girdle pain after delivery. Dysfunction of the pelvic floor muscles was also a risk factor for persistent pelvic girdle pain. [Conclusion] Pain intensity and disability during pregnancy, positive provocation tests, active straight leg raising test, and musculoskeletal mechanics were positively associated with pelvic girdle pain persisting for over 3 months after delivery.

Nausea and vomiting in pregnancy \u2013 association with pelvic girdle pain during pregnancy and 4-6\xa0months post-partum

BackgroundTo better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum.MethodsFifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used.ResultsWomen experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70–2.71, and aOR = 2.83, 95% CI 2.25–3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women.ConclusionsWomen with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP.

Management of chronic post-partum pelvic girdle pain: evaluating effectiveness of combined physiotherapy and a dynamic elastomeric fabric orthosis

Purpose: Pelvic girdle pain (PGP) during pregnancy occurs in approximately 70% of females, and 38% of women continue to suffer PGP symptoms beyond 12 weeks following delivery. PGP post-partum causes pain during everyday activities that impacts negatively on health related quality of life and is associated with significant healthcare and societal costs. These women are often referred to physiotherapy, however management is difficult and there is a weak evidence base for its management.

Clinical Practice Guidelines

Clinical practice guidelines (CPGs) have been utilized in the practice of medicine for more than 20 years. Comparatively, their use in physical therapy (PT) remains limited to date. To ensure that our clinical practice is driven by evidence-based medicine, as opposed to “alternative facts,” CPGs are written summary recommendations based upon the most recent, quality, and scientific evidence available on a given topic.1 The Institute of Medicine defined CPGs as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of the evidence and an assessment of the benefits and harms of alternative care options.”2 The foundation of the CPG is a systematic review of the evidence of a condition. The process has a major focus on the strength of the evidence by which clinical decision-making for that condition is based. The guideline also includes a set of recommendations based on the evidence and the value judgments regarding benefits and harms of alternative care options to address patient management.2 The recommendations presented within a given CPG cover a wide variety of practice areas including, but not limited to, diagnosis, examination, and intervention strategies. Each of these recommendations is given a grade based upon the strength of available evidence as it relates to that recommendation. Very commonly, multiple grades of recommendation can be found within a single CPG and directly relate to areas with the greatest supporting evidence and, conversely, reveal areas requiring further study. Each CPG development group should contain a group of diverse and relevant stakeholders including content experts, health care professionals, and consumers. The proposed guideline clearly describes the methods used for development in detail. Systematic review methods are used to identify and evaluate evidence related to the condition. Each recommendation is rated for the quality and reliability of the strength of the evidence. Once the clearly stated guideline recommendations are developed, they are based on scientific evidence of benefits, harm, and costs. A complete review by external stakeholders must be completed prior to publication. Each completed guideline also contains information on financial support as well as the process of revision.3 The American Physical Therapy Association (APTA) has a process for endorsing the creation of CPGs as they relate to PT topics. As stated by the APTA practice department, this process exists to ensure that each CPG is accessible, current, and consistent with APTA policy.4 The Orthopedics and Sports Sections created CPGs on topics such as heel pain, low back pain, and ankle sprains. The Pediatric Section published a CPG on the topic of torticollis. Thanks to Clinical Practice Guideline Steering Committee, the first CPG cosponsored by the Section on Women's Health (SoWH) has been accepted for print and online publication in the Journal of Women's Health Physical Therapy. The SoWH is now taking its place among the development of CPGs on conditions related to pregnancy and pelvic girdle pain, postpartum pelvic girdle and low back pain, mixed urinary incontinence, constipation, chronic pelvic pain, and inflammatory bowel disease. The development of a CPG is a 5-year process from start to publication, requiring further revision every 5 years thereafter. There are multiple steps to ensure a quality publication at the end of the first 5-year journey. The purpose of this CPG is the establishment of concise, evidence-based recommendations on the scope of pelvic girdle pain in the antepartum population. The scope of the CPG includes etiology, risk factors, examination, evaluation, and intervention as it relates to the PT management of this condition. The CPG will impact PT practice by identifying knowledge gaps, providing a clinical framework for PT management, and recommending directions for future research. The impact will extend to other disciplines including obstetricians, primary care practitioners, nurse practitioners, midwives, and especially the consumer. Finally, it will promote physical therapists' role in the management of this condition

Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study

BackgroundThe relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. MethodsSixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. FindingsNo significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P=0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P=0.01) and the muscles of the lower lateral abdominal wall (P<0.01). InterpretationWe suggest that disturbed motor activation patterns influence women's ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements.

Pelvic girdle pain affects the whole life--a qualitative interview study in Norway on women's experiences with pelvic girdle pain after delivery.

BackgroundThe aim of this study was to explore how pelvic girdle pain after delivery influences women’s daily life in Norway. Knowledge about living with post-partum pelvic girdle pain is lacking.MethodA phenomenological–hermeneutical design with qualitative semi-structured interviews was used. A strategic selection procedure was chosen to recruit participants from physiotherapy clinics and a regional hospital in Norway. Five women with clinically verified pelvic girdle pain after delivery were included. Data were imported into NVivo9 and analysed in three steps: naïve reading, structural analysis and comprehensive understanding of the text.ResultsThree themes influencing the women’s daily life were identified: 1) activity and pain, 2) lack of acknowledgment of pain and disability, and 3) changed roles. A daily life with pain and limited physical activity was difficult to accept and made some of the women feel discouraged, isolated and lonely. Despite this, the women had a positive attitude to their problems, which may have positively increased their ability to cope. The findings also revealed the importance of a reciprocal influence between the woman and her environment, and that social support was crucial.ConclusionsPelvic girdle pain may influence women’s lives for months and years after delivery. Health care professionals should appreciate and focus on the patient’s knowledge and skills. Understanding the daily experiences of women with pelvic girdle pain might help improve rehabilitation strategies for these patients.

Pregnancy-related Lumbopelvic Pain

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