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Pregnancy-related pelvic girdle pain (PGP) describes the pain occurring in lumbosacral, sacroiliac, and symphysis pubis joints (1). It represents significant discomfort to pregnant women and requires timely identification, assessment, and appropriate treatment (2). The pain can be safely treated at any stage both during pregnancy and after birth as soon as a patient reports reoccurring symptoms. Scholars have reported that the problem is often underestimated because many women experience them, with the condition not considered dangerous (3). In addition, there is an issue of inconsistency associated with the lack of consensus associated with the incidence, treatment, clinical manifestations, and the final outcomes of PGP (4). The lack of consistency is also supported by the fact that PGP does not have known exact causes, with some patients experiencing mild symptoms and others being in serious pain (5). Therefore, it is essential not to overlook the adverse impact of PGP and implement cohesive treatment and management strategies to relieve patients’ pain and discomfort.
Mrs. J, a 32-year old female at 34 weeks of gestation, presented to the healthcare provider with complaints of low back pain and anterior pubic pain (6). The woman reported having difficulties lifting her leg, the inability to stand on either leg, pain in the hips, and the restriction of the hip movement, as well as frequent nerve pain down the leg. The current pregnancy is the patient’s first; thus, there is no history of having similar symptoms in the past. Upon interviewing the patient, it was revealed that the pain enhances when she is walking and going both up and down the stairs and turning over in bed (7). When questioned regarding rating the level of pain from 1 to 10, the patient reported her pain at the level of 7. The patient wanted to take some over-the-counter pain medication but was unsure whether they would be safe during pregnancy.
The treatment plan for the 32-year old patient is recommended to combine education and physical therapy methods (8). Patient education is necessary to provide the necessary information on the condition, develop self-care interventions for addressing pain, and identify high-risk symptoms to refer to a healthcare specialist immediately (9). Offering adequate information and reassurance of the patient is an essential step since the plan involves a pregnant woman who requires the support and understanding on the part of her healthcare provider (10). The pain and discomfort associated with PGP contribute to declining mental well-being, which decreases the quality of life and puts the patient in a negative headspace in regards to pregnancy (11). Therefore, prior to implementing an intervention that will include exercises and attempts to relieve the pain with the help of physical methods, patients’ stress levels should be addressed.
From the physical therapy perspective, it is suggested to introduce such practices as manual therapy, exercise therapy, joint mobilization and manipulation, and physical conditioning (12). The patient will be presented with a physical therapy plan that will include stabilizing exercises (13). The physical aspect of the treatment plan is targeted at developing management strategies that the patient will find possible to implement and easy to follow. For example, during physical (or work) conditioning, existent or simulated work tasks can be performed (14). Manual therapy, which implies joint mobilization and manipulation, is an intervention that is recommended for implementation to restore the normal motion of the joints through administering low-velocity movements within the limit range of the joint’s motion (15).
Exercises therapy is seen as the most promising aspect of the intervention because of the possibility to include a range of exercises and movements with various types of targets – from flexibility to mild strength training (16). Exercises that target the improvement of muscle function and motor control must take place without provoking any pain. Individualizing such exercising to the extent of the patient’s PGP is an essential step to ensure that she is not experiencing any severe pain when completing the plan (17). Thus, the treatment plan for the patient is two-fold and implies education as well as distinct physical activities that the patient can do at home.
The improvement of the general well-being and the enhancement of the physical state of the patient are expected. The intervention may work through the attention to physical conditioning, which is expected to increase the emotional, psychological, and physical tolerance of the patient (18). From the perspective of manipulative theory, it is thought that manipulations administered to the patient, such as massages or manual therapy (19), will reduce internal mechanical stresses and reduce the adverse influence of the symptoms on the quality of the patient’s life (20). The massage of the soft tissue administered to the patient has the potential to block the pain nociception through the stimulation of nerve fibers and activation of the parasympathetic nervous system. In addition, the massage can have a positive influence on stimulating endorphin and serotonin release, which are beneficial for improving the overall well-being of the patient experiencing PGP.
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