Pelvic Girdle Pain (PGP) and Lower Back Pain

One in three women suffer potentially severe and disabling pelvic girdle pain during pregnancy.

  • Acupuncture is superior to physiotherapy in the treatment of lower back pain and symphysis pubis pain386 pregnant women were studied with the objective to compare the efficacy of: – standard treatment for pelvic pain (e.g. a pelvic belt, patient education, and home exercises for the abdominal and gluteal muscles) with – standard treatment plus acupuncture or – standard treatment plus physiotherapy stabilising exercises (for the deep lumbar-pelvic muscles).

    The study time frame consisted of one week, which was used to establish a baseline, followed by six weeks of treatment. The acupuncture treatment was given twice a week and the stabilising exercise sessions one hour per week (with patients then doing these exercises several times a day on a daily basis).

    Follow up was carried out one week after treatment finished. Three physiotherapists gave standard treatment, two medical acupuncturists delivered the acupuncture treatment and two physiotherapists gave the stabilising exercises.
    Pain was measured by a visual analogue scale and by an independent examiner before and after treatment.

    Conclusion: acupuncture was superior to stabilising exercises in the management of pelvic girdle pain in pregnancy, with acupuncture the treatment of choice for patients with one-sided sacroiliac pain, one-sided sacroiliac pain combined with symphysis pubis pain and bilateral sacroiliac pain.

    Elden, Ladfors, Fagevik-Olsen, Ostaard, Hagberg (2005) Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single-blind controlled trail. BMJ 330 (7494):761.

  • Acupuncture decreases pain and improves women’s ability to perform daily activitiesAcupuncture was compared with non-penetrating sham acupuncture in women with pelvic girdle pain (PGP) during pregnancy. In a randomised double-blinded controlled trial 115 pregnant women with PGP were randomly allocated to: standard treatment plus acupuncture or to standard treatment plus non-penetrating sham acupuncture for eight weeks.

    After treatment, median pain decreased in both groups (from 66 to 36 in the acupuncture group and from 69 to 41 in the non-penetrating sham group), but there was no significant difference between groups.

    Women in the acupuncture group were in regular work to a higher extent than women in the sham group and the acupuncture group had superior ability to perform daily activities measured by the disability-rating index.

    The authors conclude that acupuncture has no superior effect on pain relief, compared with sham, but that it improved women’s functional ability to perform daily activities.

    Elden, Fagevik-Olsen, Ostgaard, Stener-Victorin, Hagberg (2008) Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG. Dec; 115(13):1655-68.

  • Acupuncture is effective in treating pelvic or back pain in pregnancyA systematic review of the effectiveness of acupuncture in treating pelvic and back pain in pregnancy has found evidence, although limited, which supports the use of acupuncture in treating these conditions. Two small trials on mixed pelvic and back pain and one large high-quality trial on pelvic pain met the inclusion criteria.

    Ee, Manheimer, Pirotta, White (2008) Acupuncture for pelvic and back pain in pregnancy: a systematic review. Am J Obstet Gynecol. Mar; 198(3):254-9.

  • Acupuncture relieves pelvic pain better than usual prenatal careA systematic review using the Cochrane database has assessed the effects of interventions for preventing and treating back and pelvic pain in pregnancy.

    Authors searched the Cochrane database for randomised controlled trials of any treatment used to prevent or reduce the incidence or severity of back or pelvic pain in pregnancy. Eight studies (1305 participants from five countries) were included in the analysis.

    Strengthening exercises, sitting pelvic tilt exercises and water gymnastics reduced pain intensity and back pain-related sick leave better than usual prenatal care alone. Both acupuncture and stabilising exercises relieved pelvic pain better than usual prenatal care and acupuncture gave more relief from evening pain than exercises. One study found that acupuncture was more effective than physiotherapy in reducing the pain intensity scores of women with combined pelvic and back pain.

    60% of those who received acupuncture reported reduced pain, compared with 14% of those receiving usual care. No complications were associated with the use of acupuncture in pregnant women. Women who received usual prenatal care alone reported more use of analgesics, physical modalities and sacroiliac belts.

    The authors advise caution in interpretation of the results as all studies but one were judged to have considerable potential for bias.

    Pennick (2007) Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. Apr 18;(2): CD001139.

  • Acupuncture is more effective than either standard or specialised exercises in relieving the pelvic pain.In a Swedish study 386 pregnant women were assigned to a six-week treatment programme involving either standard home exercise, standard exercise plus acupuncture or specialised exercises designed to improve mobility and strength.

    Pain levels were assessed morning and evening. The women receiving the acupuncture showed the greatest relief in pain, which, achieved without the use of medication, is of particular benefit to pregnant women.

    Acupuncture treatment focused on the following points: Baihui DU-20, Hegu L.I.-4, Guanyuanshu BL-26, Ciliao BL-32 Zhongliao BL-33, Zhibian BL-54 Henggu KID-11,Kunlun BL-60, Huantiao GB-30, Chongmen SP-12 and Zusanli ST-36.
    Deqi was obtained and the needles were retained for 30 minutes, with manipulation every 10 minutes. Treatment was given twice weekly for the six-week study period.

    The authors conclude, that acupuncture as well as stabilising exercises, constitute effective complements to standard treatment for pregnant women with pelvic girdle pain. Acupuncture was superior to stabilising exercises in this study.

    Elden, Ladfors, Fagevik-Olsen, Ostgaard, Hagberg (2005) Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ; 330:761 (2 April), doi:10.1136/bmj.38397.507014.E0.

  • Decrease of pregnant women’s pelvic pain after acupuncture: a randomized controlled single-blind study.Acupuncture has previously been shown to be more effective than either standard or specialised exercises in relieving pelvic pain in pregnancy (BMJ 2005; 330:761). Now a new study has compared subcutaneous needling without further stimulation and deep needling with deqi for the same problem.

    Both groups experienced significant improvements in levels of pain intensity at rest and in daily activities as well as in rated emotional reaction and loss of energy, but there was no difference between the two different methods of acupuncture.

    Acta Obstet Gynecol Scand. 2006;85:12-9.

  • In the Swedish study, 72 pregnant women (24-37 weeks) suffering pelvic or low back pain were randomly assigned to an acupuncture group or a control group.Traditional acupuncture points and ah-shi points were needled (with deqi elicited) in individualised treatments, once or twice a week until disappearance of symptoms or delivery in the acupuncture group. Treatment was given for at least three weeks, twice weekly for the first two weeks, then once a week. The control group received no treatment.

    During the study period the pain decreased in 60% of patients in the acupuncture group compared to 14% of the controls, dropping to 43% and 9% respectively at the end of the study.

    Acta Obstet Gynecol Scand 2004; 83(3): 246-50

  • Acupuncture may be more effective than physiotherapy for pregnancy-related low-back and pelvic pain, according to a recent prospective study. 60 pregnant women with low-back and pelvic pain were randomised to receive 10 treatments of either acupuncture (30-minute sessions, given within 1 month) or physiotherapy (50-minute sessions of counseling and physical therapies, given within 6 to 8 weeks).Significant improvements were noted in pain and in the ability to perform daily activities in the acupuncture group. The physiotherapy group had less pain relief but symptoms did not become worse (as they often do in pregnancy).

    While the physiotherapy group had a high dropout rate, which weakened the analysis, the researchers conclude that acupuncture is “promising enough to warrant further studies.”

    Acta Obstet Gynecol Scand. 2000; 79:331-335.

  • A Brazilian study which compared the levels of low back and pelvic pain in women treated by acupuncture to non-treated controls, found that the acupuncture group showed a greater reduction in overall pain, maximum pain, and pain at the time of interview, reduced use of analgesics, and greater capacity to perform general activities, to walk, and to work.Guerreiro da Silva JB, Uchiyama Nakamura M, Cordeiro JA, Kulay L (2004) Acupuncture for low back pain in pregnancy – a prospective, quasi- randomised, controlled study – quoted in Acupuncture in Medicine, vol. 22(2), 60-67.
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