Skip to main content

Abstract

Pelvic girdle pain (PGP), defined as musculoskeletal pain between the posterior iliac crest and the gluteal fold, is a common occurrence during pregnancy. The etiology of the pain is likely multifactorial but due in large part to the ligament laxity, instability, and biomechanical dysfunction of the pelvic joints and muscles that occur during pregnancy. As a result of these changes, patients can experience pain in the region of the sacroiliac joint and/or the pubic symphysis. Posterior PGP often radiates down the posterior thigh and is associated with transitional movements. Due to limitations on the use of imaging and diagnostic injection modalities in pregnant patients, a thorough history and physical are the keys to diagnosis. Knowledge of risk factors for pregnancy PGP, reviewed in this chapter, informs the history taking, which can in turn help guide the physical examination. A combination of specific clinical tests that reproduce the pain or functional disturbances should be performed to differentiate PGP from other sources of pain in the region. We describe the way to perform each of these tests, provide images of them, and review their sensitivity and specificity for PGP in pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Albert HB, Godskesen M, Westergaard JG. Incidence of four syndromes of pregnancy-related pelvic joint pain. Spine. 2002;27(24):2831–4.

    Article  PubMed  Google Scholar 

  2. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794–819.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Larsen EC, Wilken-Jensen C, Hansen A, Jensen DV, Johansen S, Minck H, et al. Symptom-giving pelvic girdle relaxation in pregnancy. I: prevalence and risk factors. Acta Obstet Gynecol Scand. 1999;78(2):105–10.

    CAS  PubMed  Google Scholar 

  4. Dorheim SK, Bjorvatn B, Eberhard-Gran M. Sick leave during pregnancy: a longitudinal study of rates and risk factors in a Norwegian population. BJOG. 2013;120(5):521–30.

    Article  CAS  PubMed  Google Scholar 

  5. Gutke A, Josefsson A, Oberg B. Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms. Spine. 2007;32(13):1430–6.

    Article  PubMed  Google Scholar 

  6. Carlson HL, Carlson NL, Pasternak BA, Balderston KD. Understanding and managing the back pain of pregnancy. Curr Womens Health Rep. 2003;3(1):65–71.

    PubMed  Google Scholar 

  7. Stapleton DB, MacLennan AH, Kristiansson P. The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey. Aust N Z J Obstet Gynaecol. 2002;42(5):482–5.

    Article  PubMed  Google Scholar 

  8. Yoshimoto M, Kawaguchi S, Takebayashi T, Isogai S, Kurata Y, Nonaka S, et al. Diagnostic features of sciatica without lumbar nerve root compression. J Spinal Disord Tech. 2009;22(5):328–33.

    Article  PubMed  Google Scholar 

  9. Katirji B, Wilbourn AJ, Scarberry SL, Preston DC. Intrapartum maternal lumbosacral plexopathy. Muscle Nerve. 2002;26(3):340–7.

    Article  PubMed  Google Scholar 

  10. Delarue MW, Vles JS, Hasaart TH. Lumbosacral plexopathy in the third trimester of pregnancy: a report of three cases. Eur J Obstet Gynecol Reprod Biol. 1994;53(1):67–8.

    Article  CAS  PubMed  Google Scholar 

  11. Bastiaanssen JM, De Bie RA, Bastiaenen CH, Essed GG, Van Den Brandt PA. A historical perspective on pregnancy-related low back and/or pelvic girdle pain. Eur J Obstet Gynecol Reprod Biol. 2005;120(1):3–14.

    Article  PubMed  Google Scholar 

  12. Marnach ML, Ramin KD, Ramsey PS, Song SW, Stensland JJ, An KN. Characterization of the relationship between joint laxity and maternal hormones in pregnancy. Obstet Gynecol. 2003;101(2):331–5.

    CAS  PubMed  Google Scholar 

  13. Charlton WP, Coslett-Charlton LM, Ciccotti MG. Correlation of estradiol in pregnancy and anterior cruciate ligament laxity. Clin Orthop Relat Res. 2001;387:165–70.

    Article  Google Scholar 

  14. Bjorklund K, Bergstrom S, Nordstrom ML, Ulmsten U. Symphyseal distention in relation to serum relaxin levels and pelvic pain in pregnancy. Acta Obstet Gynecol Scand. 2000;79(4):269–75.

    CAS  PubMed  Google Scholar 

  15. Schoellner C, Szoke N, Siegburg K. [Pregnancy-associated symphysis damage from the orthopedic viewpoint—studies of changes of the pubic symphysis in pregnancy, labor and post partum]. Z Orthop Grenzgeb. 2001;139(5):458–62.

    Article  CAS  Google Scholar 

  16. Weinreb JC, Wolbarsht LB, Cohen JM, Brown CE, Maravilla KR. Prevalence of lumbosacral intervertebral disk abnormalities on MR images in pregnant and asymptomatic nonpregnant women. Radiology. 1989;170(1 Pt 1):125–8.

    Article  CAS  PubMed  Google Scholar 

  17. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991;16(5):549–52.

    Article  CAS  PubMed  Google Scholar 

  18. Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieen JH, Wuisman PI, et al. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med. 2011;9:15.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gjestland K, Bo K, Owe KM, Eberhard-Gran M. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br J Sports Med. 2013;47(8):515–20.

    Article  PubMed  Google Scholar 

  21. Eberhard-Gran M, Eskild A. Diabetes mellitus and pelvic girdle syndrome in pregnancy–is there an association? Acta Obstet Gynecol Scand. 2008;87(10):1015–9.

    Article  PubMed  Google Scholar 

  22. Bjelland EK, Eberhard-Gran M, Nielsen CS, Eskild A. Age at menarche and pelvic girdle syndrome in pregnancy: a population study of 74 973 women. BJOG. 2011;118(13):1646–52.

    Article  CAS  PubMed  Google Scholar 

  23. Bjelland EK, Kristiansson P, Nordeng H, Vangen S, Eberhard-Gran M. Hormonal contraception and pelvic girdle pain during pregnancy: a population study of 91,721 pregnancies in the Norwegian Mother and Child Cohort. Hum Reprod. 2013;28(11):3134–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Albert H, Godskesen M, Westergaard J. Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Eur Spine J. 2000;9(2):161–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hansen A, Jensen DV, Wormslev M, Minck H, Johansen S, Larsen EC, et al. Symptom-giving pelvic girdle relaxation in pregnancy. II: symptoms and clinical signs. Acta Obstet Gynecol Scand. 1999;78(2):111–5.

    CAS  PubMed  Google Scholar 

  26. Ostgaard HC, Zetherstrom G, Roos-Hansson E. The posterior pelvic pain provocation test in pregnant women. Eur Spine J. 1994;3(5):258–60.

    Article  CAS  PubMed  Google Scholar 

  27. Robinson HS, Mengshoel AM, Bjelland EK, Vollestad NK. Pelvic girdle pain, clinical tests and disability in late pregnancy. Man Ther. 2010;15(3):280–5.

    Article  PubMed  Google Scholar 

  28. Kristiansson P, Svardsudd K. Discriminatory power of tests applied in back pain during pregnancy. Spine. 1996;21(20):2337–43; discussion 43–4.

    Article  CAS  PubMed  Google Scholar 

  29. Mens JM, Vleeming A, Snijders CJ, Koes BW, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine. 2001;26(10):1167–71.

    Article  CAS  PubMed  Google Scholar 

  30. Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ. The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain. Spine. 2002;27(24):2820–4.

    Article  PubMed  Google Scholar 

  31. Mens JM, Huis In’t Veld YH, Pool-Goudzwaard A. The Active Straight Leg Raise test in lumbopelvic pain during pregnancy. Man Ther. 2012;17(4):364–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jaclyn H. Bonder MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Bonder, J.H., Fitzpatrick, L. (2015). Diagnosis of Pelvic Girdle Pain. In: Fitzgerald, C., Segal, N. (eds) Musculoskeletal Health in Pregnancy and Postpartum. Springer, Cham. https://doi.org/10.1007/978-3-319-14319-4_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-14319-4_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14318-7

  • Online ISBN: 978-3-319-14319-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics