Should all women with pregnancy-related pelvic girdle pain be treated with exercise?

Abstract

This paper presents the main findings of a systematic literature review that was undertaken to investigate whether physiotherapist-guided exercise is effective in reducing the severity of pregnancy-related pelvic girdle pain (PPGP). Seven electronic databases were systematically searched. Studies that met the inclusion criteria were assessed for methodological quality and internal validity. Five primary randomized controlled trials (RCTs) and one post-partum follow-up study were included in the review. The authors of all six studies incorporated advice and physiotherapist-guided exercise, either in a group setting or as part of an individualized exercise programme, into at least one of their intervention groups, with or without the addition of a pelvic support belt, acupuncture or other physiotherapy treatment modality. Two of the primary RCTs found that exercise and advice effectively reduced pre-partum PPGP. One study concluded that exercise had no additional value beyond simply supplying a pelvic support belt and advice. The results of another trial supported the use of physiotherapist-guided stabilization exercises for the treatment of post-partum PPGP. Yet another study did not find any differences between the intervention groups involved. The works included in this review all reported that PPGP reduced over time, regardless of the intervention used to treat it, suggesting that the greatest factor influencing the resolution of PPGP is time rather than exercise. The findings do not support the routine use of physiotherapist-guided exercise in the treatment of all women with PPGP. Advice, information and a non-elastic pelvic support belt should be offered to women with pre-partum PPGP, whereas patients with persistent symptoms of post-partum PPGP should receive individualized physiotherapist-guided exercise aimed at stabilizing the pelvic area as part of a wider package of physiotherapy treatment.