Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence

Abstract

Pregnancy-related lumbopelvic pain has puzzled medicine for a long time. The present systematic review focuses on terminology, clinical presentation, and prevalence. Numerous terms are used, as if they indicated one and the same entity. We propose “pregnancy-related pelvic girdle pain (PPP)”, and “pregnancy-related low back pain (PLBP)”, present evidence that the two add up to “lumbopelvic pain”, and show that they are distinct entities (although underlying mechanisms may be similar). Average pain intensity during pregnancy is 50 mm on a visual analogue scale; postpartum, pain is less. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. The mechanisms behind disabilities remain unclear, and constitute an important research priority. Changes in muscle activity, unusual perceptions of the leg when moving it, and altered motor coordination were observed but remain poorly understood. Published prevalence for PPP and/or PLBP varies widely. Quantitative analysis was used to explain the differences. Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PPP and/or PLBP. These values decrease by about 20% if one excludes mild complaints. Strenuous work, previous low back pain, and previous PPP and/or PLBP are risk factors, and the inclusion/exclusion of high-risk subgroups influences prevalence. Of all patients, about one-half have PPP, one-third PLBP, and one-sixth both conditions combined. Overall, the literature reveals that PPP deserves serious attention from the clinical and research communities, at all times and in all countries.

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References

  1. 1.

    Abramson D, Roberts SM, Wilson PD (1934) Relaxation of the pelvic joints in pregnancy. Surg Gynecol Obstet 58:595–613

    Google Scholar 

  2. 2.

    Albert H, Godskesen M, Westergaard J (2000) Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Eur Spine J 9:161–166

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Albert H, Godskesen M, Westergaard J (2001) Prognosis in four syndromes of pregnancy-related pelvic pain. Acta Obstet Gynecol Scand 80:505–510

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Altman DG (1993) Practical statistics for medical research. Chapman & Hall, London

  5. 5.

    Alvarez R, Stokes IA, Asprinio DE, Trevino S, Braun T (1988) Dimensional changes of the feet in pregnancy. J Bone Joint Surg Am 70:271–274

    CAS  PubMed  Google Scholar 

  6. 6.

    Berezin D (1954) Pelvic insufficiency during pregnancy and after parturition. Acta Obstet Gynecol Scand 33 [Suppl 3]:1–101

    Google Scholar 

  7. 7.

    Berg G, Hammar M, Möller-Nielsen J, Lindén U, Thorblad J (1988) Low back pain during pregnancy. Obstet Gynecol 71:71–75

    CAS  PubMed  Google Scholar 

  8. 8.

    Bird AR, Menz HB, Hyde CC (1999) The effect of pregnancy on footprint parameters: A prospective investigation. J Am Podiatr Med Assoc 89:405–409

    CAS  PubMed  Google Scholar 

  9. 9.

    Björklund K, Bergström S (2000) Is pelvic pain in pregnancy a welfare complaint? Acta Obstet Gynecol Scand 79:24–30

    Article  PubMed  Google Scholar 

  10. 10.

    Björklund K, Naessén T, Nordström ML, Bergström S (1999) Pregnancy-related back and pelvic pain and changes in bone density. Acta Obstet Gynecol Scand 78:681–685

    Article  PubMed  Google Scholar 

  11. 11.

    Björklund K, Nordström ML, Odlind V (2000) Combined oral contraceptives do not increase the risk of back and pelvic pain during pregnancy or after delivery. Acta Obstet Gynecol Scand 79:979–983

    Article  PubMed  Google Scholar 

  12. 12.

    Bombardier C, Kerr MS, Shannon HS, Frank JW (1994) A guide to interpreting epidemiologic studies on the etiology of back pain. Spine 19:2,047S–2,056S

    Google Scholar 

  13. 13.

    Breen TW, Ransil BJ, Groves PA, Oriol NE (1994) Factors associated with back pain after childbirth. Anesthesiology 81:29–34

    CAS  PubMed  Google Scholar 

  14. 14.

    Brynhildsen J, Ekblad S, Hammar M (1995) Oral contraceptives and low back pain: Attitudes among physicians, midwives and physiotherapists. Acta Obstet Gynecol Scand 74:714–717

    CAS  PubMed  Google Scholar 

  15. 15.

    Brynhildsen J, Hansson Å, Persson A, Hammar M (1998) Follow-up of patients with low back pain during pregnancy. Obstet Gynecol 91:182–186

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Bullock JE, Jull GA, Bullock MI (1987) The relationship of low back pain to postural changes during pregnancy. Aust J Physiother 33:10–17

    Google Scholar 

  17. 17.

    Butler R, Fuller J (1998) Back pain following epidural anaesthesia in labour. Can J Anaesth 45:724–728

    CAS  PubMed  Google Scholar 

  18. 18.

    Carson RG, Swinnen SP (2002) Coordination and movement pathology: Models of structure and function. Acta Psychol (Amst) 110:357–364

    Google Scholar 

  19. 19.

    Cherry N (1987) Physical demands of work and health complaints among women working late in pregnancy. Ergonomics 30:689–701

    CAS  PubMed  Google Scholar 

  20. 20.

    Commissaris DA, Nilsson-Wikmar LB, Van Dieën JH, Hirschfeld H (2002) Joint coordination during whole-body lifting in women with low back pain after pregnancy. Arch Phys Med Rehabil 83:1279–1289

    Article  PubMed  Google Scholar 

  21. 21.

    Cooper H, Hedges LV (1994) The handbook of research synthesis. Russell Sage, New York

  22. 22.

    Crawford JS (1972) Lumbar epidural block in labour: A clinical analysis. Br J Anaesth 44:66–74

    CAS  PubMed  Google Scholar 

  23. 23.

    Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ (2001) Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand 80:1019–1024

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Deyo RA (2000) Personal communication

  25. 25.

    Dietrichs E, Kogstad O (1991) “Pelvic girdle relaxation”: Suggested new nomenclature. Scand J Rheumatol 20 [Suppl 88 ]:3

  26. 26.

    Driessen F (1987) Postpartum pelvic arthropathy with unusual features. Br J Obstet Gynaecol 94:870–872

    CAS  PubMed  Google Scholar 

  27. 27.

    Dumas GA, Reid JG, Wolfe LA, Griffin MP, McGrath MJ (1995) Exercise, posture, and back pain during pregnancy. Clin Biomech (Bristol, Avon) 10:104–109

    Google Scholar 

  28. 28.

    Endresen EH (1995) Pelvic pain and low back pain in pregnant women: An epidemiological study. Scand J Rheumatol 24:135–141

    CAS  PubMed  Google Scholar 

  29. 29.

    Erici I, Sjövall A (1963) Lumbago-sciatica and pregnancy. Acta Obstet Gynecol Scand 42 [Suppl 6]:42

  30. 30.

    Farbrot E (1952) The relationship of the effect and pain of pregnancy to the anatomy of the pelvis. Acta Radiol 38:403–407

    CAS  PubMed  Google Scholar 

  31. 31.

    Fast A, Shapiro D, Ducommun EJ, Friedmann LW, Bouklas T, Floman Y (1987) Low-back pain in pregnancy. Spine 12:368–371

    CAS  PubMed  Google Scholar 

  32. 32.

    Fast A, Weiss L, Parikh S, Hertz G (1989) Night backache in pregnancy: Hypothetical pathophysiological mechanisms. Am J Phys Med Rehabil 68:227–229

    CAS  PubMed  Google Scholar 

  33. 33.

    Fast A, Weiss L, Ducommun EJ, Medina E, Butler JG (1990) Low-back pain in pregnancy: Abdominal muscles, sit-up performance, and back pain. Spine 15:28–30

    CAS  PubMed  Google Scholar 

  34. 34.

    Foti T, Davids JR, Bagley A (2000) A biomechanical analysis of gait during pregnancy. J Bone Joint Surg Am 82:625–632

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Fung BK, Kwong CM, Ho ES (1993) Low back pain of women during pregnancy in the mountainous district of central Taiwan. Chin Med J (Taipei) 51:103–106

    Google Scholar 

  36. 36.

    Genell S (1949) Studies on insufficientia pelvis (gravidarum et puerperarum). Acta Obstet Gynecol Scand 28:1–37

    Google Scholar 

  37. 37.

    Golomer E, Ducher D, Arfi GS, Sud R (1991) [Simple locomotion during load carrying in pregnant women]. J Gynecol Obstet Biol Reprod (Paris) 20:406–412

    Google Scholar 

  38. 38.

    Grove LH (1973) Backache, headache and bladder dysfunction after delivery. Br J Anaesth 45:1,147–1,149

    Google Scholar 

  39. 39.

    Hainline B (1994) Low-back pain in pregnancy. Adv Neurol 64:65–76

    CAS  PubMed  Google Scholar 

  40. 40.

    Hansen A, Jensen DV, Wormslev M, Minck H, Johansen S, Larsen EC, Wilken-Jensen C, Davidsen M, Hansen TM (1999) Symptom-giving pelvic girdle relaxation in pregnancy, II: Symptoms and clinical signs. Acta Obstet Gynecol Scand 78:111–115

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Heckman JD, Sassard R (1994) Musculoskeletal considerations in pregnancy. J Bone Joint Surg Am 76:1,720–1,730

    Google Scholar 

  42. 42.

    Howell CJ, Kidd C, Roberts W, Upton P, Lucking L, Jones PW, Johanson RB (2001) A randomised controlled trial of epidural compared with non-epidural analgesia in labour. BJOG 108:27–33

    Article  CAS  PubMed  Google Scholar 

  43. 43.

    Howell CJ, Dean T, Lucking L, Dziedzic K, Jones PW, Johanson RB (2002) Randomised study of long-term outcome after epidural versus non-epidural analgesia during labour. BMJ 325:357

    Article  PubMed  Google Scholar 

  44. 44.

    Kristiansson P, Svärdsudd K (1996) Discriminatory power of tests applied in back pain during pregnancy. Spine 21:2,337–2,343; [discussion 2,343]

    Article  Google Scholar 

  45. 45.

    Kristiansson P, Svärdsudd K, Von Schoultz B (1996) Back pain during pregnancy: A prospective study. Spine 21:702–709

    Article  CAS  PubMed  Google Scholar 

  46. 46.

    LaBan MM, Rapp NS (1996) Low back pain of pregnancy: Etiology, diagnosis, and treatment. Phys Med Rehabil Clin N Am 7:473–486

    Google Scholar 

  47. 47.

    Lamoth CJ, Meijer OG, Wuisman PI, Van Dieën JH, Levin MF, Beek PJ (2002) Pelvis-thorax coordination in the transverse plane during walking in persons with nonspecific low back pain. Spine 27:E92–E99

    Article  PubMed  Google Scholar 

  48. 48.

    Larsen EC, Wilken-Jensen C, Hansen A, Jensen DV, Johansen S, Minck H, Wormslev M, Davidsen M, Hansen TM (1999) Symptom-giving pelvic girdle relaxation in pregnancy, I: Prevalence and risk factors. Acta Obstet Gynecol Scand 78:105–110

    Article  CAS  PubMed  Google Scholar 

  49. 49.

    Lindsel H, Irgens S (1984) [Pelvic instability: It is all about relief and avoiding pain]. Sygeplejersken (Danish) 84:4–8

  50. 50.

    Lynch FW (1920) The pelvic articulations during pregnancy, labor, and the puerperium: An X-ray study. Surg Gynecol Obstet 30:575–580

    Google Scholar 

  51. 51.

    MacArthur A, MacArthur C, Weeks S (1995) Epidural anaesthesia and low back pain after delivery: A prospective cohort study. BMJ 311:1,336–1,339

    PubMed  Google Scholar 

  52. 52.

    MacArthur AJ, MacArthur C, Weeks SK (1997) Is epidural anesthesia in labor associated with chronic low back pain? A prospective cohort study. Anesth Analg 85:1,066–1,070

    Google Scholar 

  53. 53.

    MacArthur C, Lewis M, Knox EG, Crawford JS (1990) Epidural anaesthesia and long-term backache after childbirth. BMJ 301:9–12

    CAS  PubMed  Google Scholar 

  54. 54.

    MacArthur C, Knox G, Lewis M (1993) Epidural analgesia during childbirth: Association with backache is real. BMJ 307:64

    CAS  Google Scholar 

  55. 55.

    MacEvilly M, Buggy D (1996) Back pain and pregnancy: A review. Pain 64:405–414

    Article  CAS  PubMed  Google Scholar 

  56. 56.

    MacLennan AH, MacLennan SC, The Norwegian Association for Women with Pelvic Girdle Relaxation (Landforeningen for Kvinner Med Bekkenløsningsplager) (1997) Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and developmental dysplasia of the hip. Acta Obstet Gynecol Scand 76:760–764

    CAS  PubMed  Google Scholar 

  57. 57.

    Mannion AF, Taimela S, Munterer M, Dvorak J (2001) Active therapy for chronic low back pain, Part I: Effects of back muscle activation, fatigability, and strength. Spine 26:897–908

    Article  CAS  PubMed  Google Scholar 

  58. 58.

    Mannion AF, Taimela S, Munterer M, Dvorak J (2001) Poor back muscle endurance: A psychological or physiological limitation? Abstracts of the 28th Annual Meeting of the International Society for the Study of the Lumbar Spine, Edinburgh, Scotland, June 19–23, 2001, pp 147

    Google Scholar 

  59. 59.

    Mantle MJ, Greenwood RM, Currey HL (1977) Backache in pregnancy. Rheumatol Rehabil 16:95–101

    CAS  PubMed  Google Scholar 

  60. 60.

    Mantle MJ, Holmes J, Currey HL (1981) Backache in pregnancy, II: Prophylactic influence of back care classes. Rheumatol Rehabil 20:227–232

    CAS  PubMed  Google Scholar 

  61. 61.

    Melzack R, Bélanger E (1989) Labour pain: Correlations with menstrual pain and acute low-back pain before and during pregnancy. Pain 36:225–229

    Article  CAS  PubMed  Google Scholar 

  62. 62.

    Melzack R, Schaffelberg D (1987) Low-back pain during labor. Am J Obstet Gynecol 156:901–905

    CAS  PubMed  Google Scholar 

  63. 63.

    Mens JM, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ (1996) Understanding peripartum pelvic pain: Implications of a patient survey. Spine 21:1,363–1,369; [discussion 1,369–1,370]

    Article  PubMed  Google Scholar 

  64. 64.

    Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ (2001) Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine 26:1167–1171

    Article  CAS  PubMed  Google Scholar 

  65. 65.

    Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ (2002) Validity of the active straight leg raise test for measuring disease severity in patients with posterior pelvic pain after pregnancy. Spine 27:196–200

    Article  PubMed  Google Scholar 

  66. 66.

    Mens JM, Vleeming A, Snijders CJ, Ronchetti I, Ginai AZ, Stam HJ (2002) Responsiveness of outcome measurements in rehabilitation of patients with posterior pelvic pain since pregnancy. Spine 27:1,110–1,115

    PubMed  Google Scholar 

  67. 67.

    Mens JM, Vleeming A, Snijders CJ, Ronchetti I, Stam HJ (2002) Reliability and validity of hip adduction strength to measure disease severity in posterior pelvic pain since pregnancy. Spine 27:1,674–1,679

    PubMed  Google Scholar 

  68. 68.

    Mens JMA (2000) Pregnancy-related low back pain. Erasmus University, Rotterdam, The Netherlands

  69. 69.

    Moir DD, Davidson S (1972) Postpartum complications of forceps delivery performed under epidural and pudendal nerve block. Br J Anaesth 44:1197–1199

    CAS  PubMed  Google Scholar 

  70. 70.

    Moon WN, Kim MY, Oh HJ, Suh SW, Kim IC, Choi YH, Ahn JY (2000) [Incidence and risk factors of pelvic pain in pregnancy]. J Korea Spine Surg (Korean) 7:259–263

    Google Scholar 

  71. 71.

    Mooney V, Pozos R, Vleeming A, Gulick J, Swenski D (2001) Exercise treatment for sacroiliac pain. Orthopedics 24:29–32

    CAS  PubMed  Google Scholar 

  72. 72.

    Mulholland RC (1999) Reviewer’s comment. Eur Spine J 8:474

    Article  PubMed  Google Scholar 

  73. 73.

    Nagy LE, King JC (1983) Energy expenditure of pregnant women at rest or walking self-paced. Am J Clin Nutr 38:369–376

    CAS  PubMed  Google Scholar 

  74. 74.

    Nilsson-Wikmar L, Harms-Ringdahl K, Pilo C, Pahlback M (1999) Back pain in women post-partum is not a unitary concept. Physiother Res Int 4:201–213

    CAS  PubMed  Google Scholar 

  75. 75.

    Norén L, Östgaard S, Johansson G, Östgaard HC (2002) Lumbar back and posterior pelvic pain during pregnancy: A 3-year follow-up. Eur Spine J 11:267–271

    Article  PubMed  Google Scholar 

  76. 76.

    Nwuga VCB (1982) Pregnancy and back pain among upper-class Nigerian women. Aust J Physiother 28:8–11

    Google Scholar 

  77. 77.

    Nyska M, Sofer D, Porat A, Howard CB, Levi A, Meizner I (1997) Plantar foot pressures in pregnant women. Isr J Med Sci 33:139–146

    CAS  PubMed  Google Scholar 

  78. 78.

    Orvieto R, Achiron A, Ben-Rafael Z, Gelernter I, Achiron R (1994) Low-back pain of pregnancy. Acta Obstet Gynecol Scand 73:209–214

    CAS  PubMed  Google Scholar 

  79. 79.

    Östgaard HC (1996) Assessment and treatment of low back pain in working pregnant women. Semin Perinatol 20:61–69

    Google Scholar 

  80. 80.

    Östgaard HC, Andersson GB (1991) Previous back pain and risk of developing back pain in a future pregnancy. Spine 16:432–436

    Google Scholar 

  81. 81.

    Östgaard HC, Andersson GB (1992) Postpartum low-back pain. Spine 17:53–55

    Google Scholar 

  82. 82.

    Östgaard HC, Andersson GB, Karlsson K (1991) Prevalence of back pain in pregnancy. Spine 16:549–552

    Google Scholar 

  83. 83.

    Östgaard HC, Andersson GB, Wennergren M (1991) The impact of low back and pelvic pain in pregnancy on the pregnancy outcome. Acta Obstet Gynecol Scand 70:21–24

    Google Scholar 

  84. 84.

    Östgaard HC, Zetherström G, Roos-Hansson E (1994) The Posterior Pelvic Pain Provocation test in pregnant women. Eur Spine J 3:258–260

    Google Scholar 

  85. 85.

    Östgaard HC, Zetherström G, Roos-Hansson E, Svanberg B (1994) Reduction of back and posterior pelvic pain in pregnancy. Spine 19:894–900

    Google Scholar 

  86. 86.

    Östgaard HC, Roos-Hansson E, Zetherström G (1996) Regression of back and posterior pelvic pain after pregnancy. Spine 21:2,777–2,780

    Google Scholar 

  87. 87.

    O’Sullivan PB, Beales DJ, Beetham JA, Cripps J, Graf F, Lin IB, Tucker B, Avery A (2002) Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test. Spine 27:E1–E8

    Article  PubMed  Google Scholar 

  88. 88.

    Padua L, Padua R, Bondi R, Ceccarelli E, Caliandro P, D’Amico P, Mazza O, Tonali P (2002) Patient-oriented assessment of back pain in pregnancy. Eur Spine J 11:272–275

    Article  CAS  PubMed  Google Scholar 

  89. 89.

    Paul JA, Van Dijk FJ, Frings-Dresen MH (1994) Work load and musculoskeletal complaints during pregnancy. Scand J Work Environ Health 20:153–159

    CAS  PubMed  Google Scholar 

  90. 90.

    Percy-Lancaster R (1969) Pelvic arthropathy. S Afr Med J 43:551–557

    CAS  PubMed  Google Scholar 

  91. 91.

    Perkins J, Hammer RL, Loubert PV (1998) Identification and management of pregnancy-related low back pain. J Nurse Midwifery 43:331–340

    Article  CAS  PubMed  Google Scholar 

  92. 92.

    Renckens CN (2000) Between hysteria and quackery: Some reflections on the Dutch epidemic of obstetric ‘pelvic instability’. J Psychosom Obstet Gynaecol 21:235–239

    CAS  PubMed  Google Scholar 

  93. 93.

    Reynolds F, Russell R (1998) Epidural analgesia does not cause long-term backache. BMJ 316:69–70

    CAS  Google Scholar 

  94. 94.

    Rungee JL (1993) Low back pain during pregnancy. Orthopedics 16:1,339–1,344

    Google Scholar 

  95. 95.

    Russell R, Groves P, Taub N, O’Dowd J, Reynolds F (1993) Assessing long-term backache after childbirth. BMJ 306:1,299–1,303

    PubMed  Google Scholar 

  96. 96.

    Russell R, Dundas R, Reynolds F (1996) Long-term backache after childbirth: Prospective search for causative factors. BMJ 312:1,384–1,388

    PubMed  Google Scholar 

  97. 97.

    Sands RX (1958) Backache of pregnancy: A method of treatment. Obstet Gynecol 12:670–676

    CAS  PubMed  Google Scholar 

  98. 98.

    Saugstad LF (1991) Is persistent pelvic pain and pelvic joint instability associated with early menarche and with oral contraceptives? Eur J Obstet Gynecol Reprod Biol 41:203–206

    CAS  PubMed  Google Scholar 

  99. 99.

    Saugstad LF (1991) Persistent pelvic pain and pelvic joint instability. Eur J Obstet Gynecol Reprod Biol 41:197–201

    CAS  PubMed  Google Scholar 

  100. 100.

    Sihvonen T, Huttunen M, Makkonen M, Airaksinen O (1998) Functional changes in back muscle activity correlate with pain intensity and prediction of low back pain during pregnancy. Arch Phys Med Rehabil 79:1,210–1,212

    Article  PubMed  Google Scholar 

  101. 101.

    Slate WG (1960) Pelvic girdle relaxation. Obstet Gynecol 16:625–670

    Google Scholar 

  102. 102.

    Snelling FG (1870) Relaxation of the pelvic symphyses during pregnancy and parturition. Am J Obstet Dis Women Child 2:1–37

    Google Scholar 

  103. 103.

    Sturesson B, Udén G, Udén A (1997) Pain pattern in pregnancy and “catching” of the leg in pregnant women with posterior pelvic pain. Spine 22:1,880–1,883; [discussion 1,884]

    Article  PubMed  Google Scholar 

  104. 104.

    Suputtitada A, Wacharapreechanont T, Chaisayan P (2002) Effect of the “sitting pelvic tilt exercise” during the third trimester in primigravidas on back pain. J Med Assoc Thai 85 [Suppl 1]:S170-S179

  105. 105.

    Svensson HO, Andersson GB, Hagstad A, Jansson PO (1990) The relationship of low-back pain to pregnancy and gynecologic factors. Spine 15:371–375

    CAS  PubMed  Google Scholar 

  106. 106.

    Taves C, Charteris J, Wall JC (1982) The kinematics of treadmill walking during pregnancy. Physiother Can 34:321–324

    Google Scholar 

  107. 107.

    Thomas IL, Nicklin J, Pollock H, Faulkner K (1989) Evaluation of a maternity cushion (Ozzlo pillow) for backache and insomnia in late pregnancy. Aust N Z J Obstet Gynaecol 29:133–138

    CAS  PubMed  Google Scholar 

  108. 108.

    Thompson JF, Roberts CL, Currie M, Ellwood DA (2002) Prevalence and persistence of health problems after childbirth: Associations with parity and method of birth. Birth 29:83–94

    Article  PubMed  Google Scholar 

  109. 109.

    Turgut F, Turgut M, Çetinsahin M (1998) A prospective study of persistent back pain after pregnancy. Eur J Obstet Gynecol Reprod Biol 80:45–48

    Article  CAS  PubMed  Google Scholar 

  110. 110.

    Van Dongen PW, De Boer M, Lemmens WA, Theron GB (1999) Hypermobility and peripartum pelvic pain syndrome in pregnant South African women. Eur J Obstet Gynecol Reprod Biol 84:77–82

    Article  PubMed  Google Scholar 

  111. 111.

    Vleeming A, De Vries HJ, Mens JM, Van Wingerden JP (2002) Possible role of the long dorsal sacroiliac ligament in women with peripartum pelvic pain. Acta Obstet Gynecol Scand 81:430–436

    Article  PubMed  Google Scholar 

  112. 112.

    Wagenaar RC, Van Emmerik REA (1996) Dynamics of movement disorders. Hum Mov Sci 15:161–175

    Article  Google Scholar 

  113. 113.

    Wergeland E, Strand K (1998) Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scand J Work Environ Health 24:206–212

    CAS  PubMed  Google Scholar 

  114. 114.

    Wickstrom J, Haslam ET, Hutchinson RT (1955) Backache during pregnancy: Its etiology and management. J La State Med Soc 107:490–494

    CAS  PubMed  Google Scholar 

  115. 115.

    Wormslev M, Juul AM, Marques B, Minck H, Bentzen L, Hansen TM (1994) Clinical examination of pelvic insufficiency during pregnancy: An evaluation of the interobserver variation, the relation between clinical signs and pain and the relation between clinical signs and physical disability. Scand J Rheumatol 23:96–102

    CAS  PubMed  Google Scholar 

  116. 116.

    Wu W, Meijer OG, Jutte PC, Uegaki K, Lamoth CJ, De Wolf SG, Van Dieën JH, Wuisman PI, Kwakkel G, De Vries JI, Beek PJ (2002) Gait in patients with pregnancy-related pain in the pelvis: An emphasis on the coordination of transverse pelvic and thoracic rotations. Clin Biomech (Bristol, Avon) 17:678–686

  117. 117.

    Young G, Jewell D (2002) Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev CD:001139

    Google Scholar 

  118. 118.

    Young J (1939) Pelvic osteo-arthropathy of pregnancy. Proc R Soc Med 32:1591–1597

    Google Scholar 

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Acknowledgements

Financial support was obtained from Stryker/Howmedica, the Dutch Society of Exercise Therapists Mensendieck (NVOM), and the Mensendieck Development Foundation (SOM). An earlier version of this paper was published in the Nederlands Tijdschrift voor Oefentherapie-Mensendieck [Dutch Journal for Exercise Therapy Mensendieck], 2001 (1), pp 25–34, and the authors thank the editors for their permission to use the material, Lisette Hamersma (Amsterdam) and Rolf van den Langenberg (Amsterdam) for their contribution to this earlier version, as well as Claudine J.C. Lamoth (Amsterdam), G. Sander de Wolf (Amsterdam), Richard A. Deyo (Seattle), and Liesbeth van der Weerd (Zeist) for their comments on an earlier draft of the present paper

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Wu, W.H., Meijer, O.G., Uegaki, K. et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J 13, 575–589 (2004). https://doi.org/10.1007/s00586-003-0615-y

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Keywords

  • Pregnancy
  • Pelvic girdle
  • Low back pain
  • Prevalence
  • Review