Pregnancy-related pelvic girdle pain: the influence of pain science on the understanding of its causes and treatment choices

Author(s): A. Frankham, S. Dufour & M. Clark-Smith - Pages: 49-60

Abstract

Physiotherapists have historically considered pregnancy-related pelvic girdle pain (PPGP) to be caused by  biomechanical issues that are the result of hormonally mediated pelvic instability. There is mounting evidence that all musculoskeletal pain, including PPGP, is multifaceted in aetiology. This suggests that PPGP presents more as nociplastic pain rather than peripheral nociception caused by altered biomechanics. The aim of this study was to examine the influence of pain science on UK physiotherapists’ understanding of the causes of PPGP and their treatment choices. This was a cross-sectional quantitative survey involving the collection of anonymized opinion data. Descriptive statistics and frequency distributions were calculated for each survey question using Microsoft Excel. One hundred and five physiotherapists completed the online survey. The demographic data were evenly
distributed. Chosen by 90% and 92% of the participants, respectively, biomechanical and psychosocial causes for PPGP were almost equally popular. Just under 40% of respondents believed that pelvic joint distortion was a cause of the condition, but 60% indicated that stability of the pelvis is an important factor in PPGP. Less than half considered the autonomic nervous system to be a cause. Treatment choices following a biomechanical paradigm of increasing stability and biopsychosocial factors (e.g. explaining pain) achieved equally high levels of consensus.
Physiotherapists almost equally recognize psychosocial and biomechanical issues as factors that can cause PPGP. However, there is less understanding of the involvement of the autonomic nervous system in pain. Treatments such as core stability training, addressing biomechanics and motor control remained popular choices for treating PPGP. While the reasoning behind this was not identified in the cross-sectional survey, it may imply a difficulty in translating a pain science view of causation to pain science management of PPGP, i.e. addressing other aspects of
the person’s life that may be contributing to their pain.
Keywords: biopsychosocial model, contemporary pain science, pregnancy-related pelvic girdle pain.