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

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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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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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  1. Department of Orthopaedics, Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands

    W. H. Wu, K. Uegaki & P. I. J. M. Wuisman

  2. Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT , Amsterdam, The Netherlands

    W. H. Wu, O. G. Meijer, K. Uegaki & J. H. van Dieën

  3. Department of Rehabilitation Medicine, Erasmus Medical Centre, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    J. M. A. Mens

  4. Department of Orthopaedics, Sahlgren University Hospital, 43180, Mölndal, Sweden

    H. C. Östgaard

  5. Department of Orthopaedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People’s Republic of China

    W. H. Wu

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  1. W. H. Wu
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Correspondence to O. G. Meijer.

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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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