Pelvic girdle pain: examination, treatment, and the development and implementation of the European guidelines

Pelvic girdle pain (PGP) is experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joints. The pain may radiate in the posterior thigh, and can also occur in conjunction with or separately in the symphysis. The pain or functional disturbances that are related to this condition must be reproducible by specific clinical tests for a definitive diagnosis to be made. Despite the fact that pregnancy-related PGP is a common ailment, it is still poorly described and understood. Studies have shown that it is a relatively common problem in many countries. It has been estimated that approximately 20–25% of all pregnant women suffer from PGP that is sufficiently serious to require medical help. The majority of women with the condition recover spontaneously soon after delivery; however, 7% report serious problems resulting from persistent PGP that last for many years. The aetiology and pathogenesis of pregnancy-related PGP is unclear. In diagnosing this condition, a thorough history and physical examination should be carried out in order to differentiate between low back pain and PGP, assess the underlying pain disorder and disability, and formulate an individualized management plan. The European guidelines for the diagnosis and treatment PGP recommend individualized exercises in pregnancy, an adequate supply of information about the condition, and reassurance for patients as part of a multifactorial treatment focusing on specific exercises for motor control and stability postpartum. In order to improve the quality of treatment, physiotherapists must have evidence-based skills, listen attentively and individualize treatment. Outcome measures are needed to adequately evaluate interventions. The Pelvic Girdle Questionnaire, a conditionspecific measure, has recently been developed for pregnant and non-pregnant women with PGP.