Does therapist-assisted exercise improve pregnancy related pelvic girdle pain? : a randomised, cross-over, blinded, sham-controlled trial

Background: Pregnancy related pelvic girdle pain (PPGP) is a common musculoskeletal disorder affecting up to 70% of pregnant women. Although PPGP resolves in most women following childbirth there is marked pain and restriction of activities of daily living. Standard treatment has consisted of education, pelvic belt application, manual therapy and independent/assisted exercises aimed at providing immediate pain relief, all of which are safe and cost effective while posing minimal risk to the mother and baby. Exercise improving muscle coordination in the pelvic region may provide pain relief in patients with lumbosacral pain. Therefore, performance of low load exercise has the potential to alleviate pain in pregnant women who are often unable to safely use analgesia. Purpose: The purpose of this study was to determine whether therapist-assisted exercise would provide immediate pain relief and improvement in function in women with PPGP. Methods: This was a repeated measure, randomised, cross-over, blinded, sham-controlled trial. Consenting volunteers had PPGP and no other significant or serious pathology or obstetric related complication. Twenty-two pregnant women (mean (SD)) 30 (5) years of age, 162 (6) cm in height, 70 (5) kg in body mass and 27 (6) weeks gestation provided written and informed consent (Ethical approved by the Westmead Hospital Human Research Ethics Committee, WMEAD13/HREC/288). Pain (visual analogue scale (VAS)) at rest and Timed Up and Go (TUG) test results were recorded prior to and following each treatment. Each participant was treated using therapist-assisted exercises (EX) and sham Transcutaneous Electrical Nerve Stimulation (sTENS) (non-conductive electrodes) in a random order. Participants were then provided standardised physiotherapy (SP) which included patient education, manual therapy, exercise prescription, pelvic belt application or referral for follow-up with a medical officer. A repeated measures ANOVA was performed to determine differences in the outcome measures with statistical significance accepted at p 0.05) or vice versa (p > 0.093). Box’s test demonstrates that there was no equality of the covariance matrices across groups and is likely due to unequal participants in the group which received EX prior to sTENS (n = 9) compared to sTENS prior to EX (n = 16). Furthermore, post hoc independent t-tests determined that each group was significantly different in the VAS score prior to treatment (p < 0.01) and that scores were similar at each subsequent measure. Conclusion(s): This preliminary pilot study does not support the use of therapist-assisted exercise in improving PPGP. However, there may be a decrease in pain over the course of a single consult regardless of the type of treatment which was administered. Implications: Changes in pain intensity reported following physiotherapy treatment may be the natural short-term progression of pain regardless of the type of treatment administered