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Regression of pelvic girdle pain after delivery: follow-up of a randomised singleblind controlled trial with different treatment modalitiesH. Elden a; H. Hagberg a; M. Fagevik Olsen b; L. Ladfors a; H. C. Ostgaard c

a Perinatal Center, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, GöteborgUniversity, Sweden b Department of Occupational Therapy and Physical Therapy, Sahlgrenska UniversityHospital, Göteborg University, Sweden c Department of Orthopedics, Sahlgrenska Academy, SahlgrenskaUniversity Hospital, Göteborg University, Sweden

First Published on: 10 December 2007

To cite this Article Elden, H., Hagberg, H., Olsen, M. Fagevik, Ladfors, L. and Ostgaard, H. C.(2007)'Regression of pelvic girdle painafter delivery: follow-up of a randomised single blind controlled trial with different treatment modalities',Acta Obstetricia etGynecologica Scandinavica,87:2,201 — 208

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ORIGINAL ARTICLE

Regression of pelvic girdle pain after delivery: follow-up of arandomised single blind controlled trial with different treatmentmodalities

H. ELDEN1, H. HAGBERG1, M. FAGEVIK OLSEN2, L. LADFORS1 & H.C. OSTGAARD3

1Perinatal Center, Department of Obstetrics and Gynecology, 2Department of Occupational Therapy and Physical Therapy,

and 3Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, Goteborg University, Sweden

AbstractObjective. An earlier publication showed that acupuncture and stabilising exercises as an adjunct to standard treatment waseffective for pelvic girdle pain during pregnancy, but the post-pregnancy effects of these treatment modalities are unknown.The aim of this follow-up study was to describe regression of pelvic girdle pain after delivery in these women. Design. Arandomised, single blind, controlled trial. Setting. East Hospital and 27 maternity care centres in Goteborg, Sweden.Population. Some 386 pregnant women with pelvic girdle pain. Methods. Participants were randomly assigned to standardtreatment plus acupuncture (n�125), standard treatment plus specific stabilising exercises (n�131) or to standardtreatment alone (n�130). Main outcome measures. Primary outcome measures: pain intensity (Visual Analogue Scale).Secondary outcome measure: assessment of the severity of pelvic girdle pain by an independent examiner 12 weeks afterdelivery. Results. Approximately three-quarters of all the women were free of pain 3 weeks after delivery. There were nodifferences in recovery between the 3 treatment groups. According to the detailed physical examination, pelvic girdle painhad resolved in 99% of the women 12 weeks after delivery. Conclusions. This study shows that irrespective of treatmentmodality, regression of pelvic girdle pain occurs in the great majority of women within 12 weeks after delivery.

Key words: Pelvic girdle pain, pregnancy, acupuncture, stabilising exercises, randomised controlled trial

Abbreviations: P4-test: posterior pelvic pain provocation test

Introduction

Pelvic girdle pain is a common complaint for women

during pregnancy causing considerable disability and

distress (1,2). Risk factors are a history of previous

low back pain, trauma, higher level of stress, and low

job satisfaction (3). In some women, it can be the

beginning of a chronic condition (4,5).

Pelvic girdle pain can be divided into subgroups

depending on the number of affected joints in the

pelvic girdle. Women with pelvic girdle syndrome,

i.e. bilateral sacroiliac pain plus symphysiolysial

pain, have been found to have the worst prognosis,

and those with isolated symphysiolysial pain, the

best prognosis (6). Postpartum follow-up studies

have shown that 10�75% of the women had persist-

ing pain 1�3 months after delivery (7,8).

The reason for the discrepancy between the results

from different studies could be that different criteria

for pelvic girdle pain have been used, and that

women with lumbar pain have also been included

(1,5,7�12).

However, in 2004, a new definition based on

existing systematic reviews and a national guideline

was published (13), which states that the diagnosis

can only be reached after exclusion of lumbar causes,

and that it should be based on both reports from the

women and a physical standardised examination

including specific clinical tests which reproduce

pain in the pelvic girdle. Standard treatment for

Correspondence: Helen Elden, Perinatal Center, Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Sahlgrenska University Hospital/

East, University of Goteborg, SE-416 85 Sweden. E-mail: helen.elden@vgregion.se

Acta Obstetricia et Gynecologica. 2008; 87: 201�208

(Received 12 March 2007; accepted 21 November 2007)

ISSN 0001-6349 print/ISSN 1600-0412 online # 2008 Taylor & Francis

DOI: 10.1080/00016340701823959

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pelvic girdle pain usually consists of a pelvic belt,

home training programme exercises, and patient

education, although the efficacy of these interven-

tions remains questionable (14).

Currently there are indications that acupuncture

(15�19) and stabilising exercises (19) are efficient

during pregnancy. To our knowledge, no study

has presented findings of the post-pregnancy effects

of acupuncture and stabilising exercises for pelvic

girdle pain. In the present study, we present 12-week

follow-up results of women who were randomised to

standard treatment, (12) standard treatment plus

acupuncture or standard treatment plus specific

stabilising exercises (19).

Material and methods

This study was carried out at East Hospital, Sahl-

grenska Academy and at 27 maternity care centres in

the hospitals reference area in Goteborg, Sweden,

from 2000 to 2002. The trial was approved by the

local ethics committee and the women gave their

informed consent before entering the study. The

study comprised 1 week baseline registration of pain,

treatment for 6 weeks, follow-up within 1 week after

end of treatment, and follow-up 12 weeks after

delivery. Inclusion criteria were healthy women at

12�31 completed gestational weeks, well integrated

in the Swedish language with singleton fetuses and

defined pelvic girdle pain, according to the criteria of

Ostgaard (Table I) (20). Patients with other pain

conditions, systemic disorders, or contraindications

to treatment were excluded. The pregnancy-related

part of this study has been reported previously (19).

Interventions

Patients were given standard treatment, standard

treatment plus acupuncture or standard treatment

plus specific stabilising exercises for 6 weeks.

Details of the interventions are given in a previous

paper (19).

Measurements before inclusion in the study

Each patient completed a previously used question-

naire (8) including a detailed history of back pain,

ascertained vocational factors, previous back pain,

level of physical exercise before pregnancy, and they

assessed their present pain on a 100-point visual

analogue scale (VAS) every morning and evening for

5�7 days before inclusion.

A detailed, standardised, physical examination was

performed by 1 of 3 independent specially trained

physiotherapists. The women were then randomised

individually. The full examination programme

and randomisation procedure have been extensively

described previously (19).

Measurements showing regression of pregnancy-related

pelvic girdle pain

The women’s reports of pain (VAS) and the results

from the physical examination 12 weeks after deliv-

ery were used as measures of regression of pelvic

girdle pain. Patients were instructed to estimate their

present pain related to motion every morning and

every evening. They were instructed not to continue

with their diaries if the pain disappeared and to

restart the registration if the pain returned. The

diaries were collected at follow-up.

Analysis/statistics

Calculating of sample size has been reported earlier

(19). The median VAS levels were defined in

the mornings and evenings for each patient by

calculating the median for the first 5�7 days after

delivery. The same calculations were carried out

for the following 11 weeks. We chose VAS B10 mm

as a definition of no pain according to the literature

(1,21). The main analyses were performed by

intention to treat. If values were missing or the

women had stopped registration due to disappear-

ance of pain, the last value was carried forward. An

analysis to investigate if the severity of pelvic girdle

pain during pregnancy affected the recovery after

delivery was carried out. The women were divided

into 5 subgroups (6).

Data were compared using the Mann�Whitney

U-test. Medians, 25�75th percentiles, means and

standard deviations were calculated when possible.

x2-tests were used as appropriate. Adjustments

(multiplication by three) of the p-values due to

multiple comparisons were performed by Bonferro-

ni’s method; an adjusted p-value B0.05 was con-

sidered significant. The SAS software package,

version V8 and SPSS, version 13.0, was used.

Table I. Pelvic girdle pain according to the criteria of Ostgaard.

All criteria have to be fulfilled for the diagnosis

. Time- and weight-bearing-related pain in the posterior pelvis,

deep in one or both gluteal areas

. Pain-drawing with markings in the gluteal area distal and

lateral to L5-S1 with or without radiating pain on the posterior

thigh but not down to the foot

. Pain-free intervals with sudden pain attacks

. Pain when turning in bed

. A free range of motion in the hips and spine

. No nerve root syndrome

. A positive posterior pelvic pain provocation test (the P4-test)

202 H. Elden et al.

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Results

Figure 1 shows the progress of patients through the

trial and withdrawals from the study. Of the 558

pregnant women assessed for eligibility, 172 women

were excluded because they did not fulfil the

inclusion criteria, 35 women were lost to follow-up

because they declined treatment, and 21 women

were lost to follow-up because they declined parti-

cipation after treatment.

Maternal age at inclusion was 30.8 (SD: 4.8) for

the standard group, 30.6 (SD: 4) for the acupunc-

ture group and 30.0 (SD: 4) for the stabilising

exercise group. Gestational week at inclusion was

24�3 (SD: 4.9) for the standard group, 24�3 (SD:

4.7) for the acupuncture group, and 24�3 (SD: 4.9)

for the stabilising exercise group, respectively. In

all, 33 women (25%) in the standard group, 34

(27%) in the acupuncture group, and 36 (28%) in

the stabilising group were primiparas (24). No

baseline differences between the women recruited

and the women who withdrew during the trial and

those who were followed up 12 weeks after delivery

were seen with respect to age, parity, and the results

of the physical examination, the questionnaire, and

the diaries (data not shown).

Regression of pregnancy-related pelvic girdle pain as

reported by the women

Figure 2 shows that about three-quarters of all the

women were free of pain 3 weeks after delivery, and

89% of the women reported no pain 12 weeks after

delivery. At 12 weeks follow-up, 33/99 women in the

standard group, 31/105 women in the acupuncture

group, and 25/107 women in the stabilising exercise

group stated that they experienced no pain after

delivery, and therefore they did not fill in a diary.

These women are included in Figure 2 from week 1.

Table II shows that no differences were found in pain

scores between the study groups among the women

that returned pain reports.

Regression of pelvic girdle pain according to the

assessments 12 weeks after delivery

Table III shows that 12 weeks after delivery, pelvic

girdle pain had resolved in 99% of the women. The

Women assessed for eligibility (n=558)1-wk baseline registration before inclusion visit

Excluded at inclusion visit (n=172 ( Not meeting inclusioncriteria)

Low back pain (n=18)Pelvic girdle pain plus low back pain (n=17)Isolated symphysiolysis ( n=36)No provocation tests positive (n=64)Other pain conditions (n=10)Systemic disorders (n=4)High risk pregnancy ( n=6)No complaints (n=8)Declined participation (n=7)Gestation week>32 (n=1)Twin pregnancy (n=1)

Randomised (n=386)

Standard treatment (n=130)Declined treatment (n=15)

Acupuncture (n=125)Declined treatment (n=10) Stabilizing Exercises (n=131)

Declined treatment (n=9)Moved from the area (n=1)

Allocation

Missing diaries (n=49)Declined participation aftertreatment (n=10)Lost by patient (n=5)Did not fill in diary (n=1)No diary because of no pelvicgirdle pain (n=33)

Lost to follow-up (n =10)Declined participation aftertreatment (n=10)

Missing diaries (n=38)Declined participation aftertreatment (n=4)Lost by patient (n=3)Did not fill in diary (n=1)No diary because of no pelvicgirdle pain (n=30)

Lost to follow-up (n =4)Declined participation aftertreatment (n=4)

Diaries and assessments excludedfrom analysis (n=2)Nerve root syndrome (n=1)Low back pain (n=1)

Missing diaries (n=39)Declined participation aftertreatment (n=7)Lost by patient (n=7)No diary because of no pelvic girdlepain (n=25)

Lost to follow-up (n=7)Declined participation aftertreatment (n=7)

Analysed12 weeksafterdelivery

Pain reports (n=33)Diaries (n=66)Follow-up visits (n=105)

Pain reports (n=30)Diaries (n=75)Follow-up visits (n=109)

Pain reports (n=25)Diaries (n=82)Follow-up visits (n=114)

Follow-up12 weeksafterdelivery

Figure 1. Participants’ progress through trial and withdrawals.

Regression of pelvic girdle pain after delivery 203

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women randomised to the stabilising exercise had

fewer positive pain provocation tests 12 weeks after

delivery than controls (pB0.001). The results of the

examination confirmed excellent recovery among all

women including those who did not fill in diaries

postpartum. A majority of these women ((24/33;

73%) in the standard group, (27/30; 90%) in the

acupuncture group, and (22/25; 88%) in the stabi-

lising exercise group) did not fulfil any of the criteria

for pelvic girdle pain at the examination 12 weeks’

postpartum. The other women fulfilled 1 or 2 of the

criteria, but none of them fulfilled all the criteria for

pelvic girdle pain (data not shown). No difference in

numbers of women in the subgroups of pelvic girdle

pain or in numbers of women that fulfilled all criteria

for pelvic girdle pain was found in the study groups.

When combining the results of the pain ratings and

the pain drawings, 12/105 (11%) of the women in

the standard group, 12/109 (11%) of the women in

the acupuncture group, and 7/114 (6%) of the

women in the stabilising exercise group filled in

markings in the gluteal area on the pain drawings

and reported daily pain (VAS ]0 mm) in their

diaries (data not shown).

Discussion

The main finding of this study was that complete

regression of pelvic girdle pain occurred in 99% of

the patients 12 weeks after delivery.

Pelvic girdle pain was diagnosed according to the

criteria of Ostgaard (20). This definition is compar-

able to the definition of pelvic girdle pain in the

European guidelines (13), except for women with

isolated symphyseal pain where the criteria used

in this study did not allow inclusion (36 women

excluded). However, symphyseal pain combined

with sacroiliac pain was common in the studied

population. Thus, 159 women (41%) had symphy-

seal pain combined with sacroiliac pain at inclusion,

i.e. pelvic girdle syndrome or one-sided sacroiliac

pain plus symphyseal pain. In addition, our results

showing that only 3 women had isolated symphyseal

pain 12 weeks after delivery are in line with results

from Albert et al. (6), who showed that almost all

women with isolated symphyseal pain had recovered

within 4 months after delivery.

It is recommended that 2 pain provocation tests

should be positive for the diagnosis of pelvic girdle

pain (1,22) The physical examination in our study

included 7 tests, but only 1 positive pain provocation

test (the P4-test) was required for inclusion, which

might have led to inclusion of 30 women with ‘mild’

symptoms. On the other hand, 264 women (68%)

had ]3 positive pain provocation test suggesting

that most women were severely affected.

The women in the group with stabilising exercises

had less frequent positive pain provocation tests, this

may be explained by the recommended continuous

daily exercises, including exercises in short sessions

on several occasions during the day even after

delivery. This may have strengthened their pelvic

muscles and made the women less sensitive to the

pain provocation tests.

In several studies, the incidence and intensity of

pelvic girdle pain and/or lumbar pain changing

rapidly at the time of delivery has been described.

This is the first study to demonstrate by daily

recordings of VAS that there is progressive resolution

of pain. However, a drawback of the study is that

0

01

02

03

04

05

06

07

08

09

001

211101987654321

)99=n(puorgdradnatS )501=n(puorgerutcnupucA )701=n(puorgesicrexegnisilibatS

skeeWretfa

yreviled

Per

cent

ages

of

wom

en

Figure 2. Percentages of women reporting pelvic girdle pain (VAS]10 mm) both in the mornings and in the evenings during 12 weeks after

delivery. VAS�Visual analogue scale.

204 H. Elden et al.

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about 29% of the women did not fill in a complete

diary because of the instruction that they were not

obliged to continue their recording after disappear-

ance of the pain. Nevertheless, a majority of the

women did fill in diaries, and the number of women

who did not return diaries was similar in the different

treatment groups. In addition, the results of the

examinations showed that a majority (82%) of these

women did not fulfil any of the criteria for pelvic

girdle pain 12 weeks’ postpartum, which confirms

the assumption that these women did not complete

their diaries because of resolution of pain rather than

because of neglect or other reasons. Even if we do

not know the exact time of disappearance of pain in

these women, the physical examination showed that

most were fully recovered 12 weeks after delivery.

The women appeared to recover faster in our

study compared with previous observational studies

of women with pelvic girdle pain (1,6,9). An

explanation for this could be that all women in our

study were offered some treatment, which may not

have been the case for women in other studies.

However, the women also recovered faster compared

to earlier intervention studies (7,8,10,23). The

treatments offered in our study may have been

more effective because all women received individual

information, which is superior to group information

(20). In addition, 2/3 of the women were given

additional acupuncture or specific stabilising exer-

cises during pregnancy (19).

An explanation for our findings could be the

chosen definition of no pain (VAS B10 mm). If we

had chosen the definition no pain VAS B0 mm,

fewer women would have been considered pain-free.

Another reason for the discrepancy in recovery

between ours and other follow-up studies with

interventions could be that the women were clini-

cally examined in our study, which is important

when differing between pelvic girdle pain and

lumbar pain (13). In fact, quite a few women with

‘unspecific back pain’ would have been categorised

as having persistent pelvic girdle pain in our study if

we had restricted data collection to a questionnaire

and a pain drawing, and not applied the definition

Table II. Primary outcome measure: pain on the Visual Analogue Scale related to motion during 12 weeks after delivery.

Standard group Acupuncture group Stabilising exercise group

Pain n

Median (25�75th

percentile) n

Median (25�75th

percentile) n

Median (25�75th

percentile)

Morning

1 week after delivery 64 9 (3�28) 73 14 (3�36) 77 9 (3�28)

2 weeks after delivery 66 4 (0�17) 72 6 (0�18) 77 4 (0�17)

3 weeks after delivery 66 3 (0�12) 73 3 (0�10) 81 3 (0�12)

4 weeks after delivery 66 2 (0�10) 73 1 (0�7) 81 2 (0�10)

5 weeks after delivery 66 1 (0�7) 74 0 (0�6) 81 1 (0�7)

6 weeks after delivery 66 0 (0�6) 74 0 (0�5) 81 0 (0�6)

7 weeks after delivery 66 0 (0�3) 74 0 (0�4) 81 0 (0�3)

8 weeks after delivery 66 0 (0�3) 74 0 (0�5) 81 0 (0�3)

9 weeks after delivery 66 0 (0�3) 75 0 (0�5) 81 0 (0�3)

10 weeks after delivery 66 0 (0�3) 75 0 (0�4) 81 0 (0�3)

11 weeks after delivery 66 0 (0�2) 75 0 (0�4) 82 0 (0�2)

12 weeks after delivery 66 0 (0�2) 75 0 (0�3) 80 0 (0�2)

Evening

1 week after delivery 64 25 (4�49) 73 17 (3�53) 77 12 (4�36)

2 weeks after delivery 66 11 (1�43) 72 9 (0�35) 77 5 (0�22)

3 weeks after delivery 66 4 (0�39) 73 3 (0�17) 81 3 (0�17)

4 weeks after delivery 66 3 (0�31) 73 0 (0�10) 81 2 (0�11)

5 weeks after delivery 66 0 (0�10) 74 0 (0�10) 81 2 (0�11)

6 weeks after delivery 66 0 (0�5) 74 0 (0�7) 81 0 (0�7)

7 weeks after delivery 66 0 (0�10) 74 0 (0�5) 81 0 (0�4)

8 weeks after delivery 66 0 (0�6) 74 0 (0�5) 81 0 (0�4)

9 weeks after delivery 66 0 (0�5) 75 0 (0�6) 81 0 (0�4)

10 weeks after delivery 66 0 (0�5) 75 0 (0�5) 81 0 (0�4)

11 weeks after delivery 66 0 (0�5) 75 0 (0�5) 82 0 (0�3)

12 weeks after delivery 66 0 (0�5) 75 0 (0�4) 80 0 (0�2)

*p Values: Mann�Whitney U-test. All original two-tailed p values were multiplied by three (Bonferroni’s correction), and there were no

statistically significant differences between the groups.

ACU, acupuncture; S, standard; SE, stabilising exercise.

Regression of pelvic girdle pain after delivery 205

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Table III. Secondary outcome measure: assessment of the severity of pelvic girdle pain by an independent examiner at inclusion during pregnancy and at follow-up 12 weeks after delivery.

Pooled data Standard group Acupuncture group Stabilising exercise group

Group comparisons

at follow-up

Inclusion

(n�386)

Follow-up

(n�328)

Inclusion

(n�130)

Follow-up

(n�109)

Inclusion

(n�125)

Follow-up

(n�105)

Inclusion

(n�131)

Follow-up

(n�114) Comparison p*

Tests for assessment of pelvic girdle pain

Positive pain drawing 386 [100] 55 [17] 130 [100] 22 [21] 125 [100] 19 [17] 131 [100] 14 [12] All groups NS

P4-test 386 [100] 73 [22] 130 [100] 28 [27] 125 [100] 27 [25] 131 [100] 18 [16] All groups NS

Pain when turning in bed 386 [100] 19 [6] 130 [100] 8 [8] 125 [100] 8 [8] 131 [100] 3 [3] All groups NS

Palpation of the pubic symphysis 160 [41] 21 [6] 47 [36] 8 [8] 51 [41] 7 [7] 62 [47] 5 [4] All groups NS

Patrick’s Fabere test 208 [54] 24 [7] 65 [50] 11 [10] 69 [55] 6 [6] 74 [56] 7 [6] All groups NS

Modified Trendelenburg test 148 [38] 15 [5] 51 [39] 8 [8] 52 [42] 3 [3] 45 [34] 4 [4] All groups NS

Number of positive pain provocation tests

0 positive pain provocation test 0 242 [74] 0 71 [65] 0 78 [74] 0 93 [82] S-ACU NS

S-SE 0.001

ACU-SE NS

1 positive pain provocation test 30 [8] 27 [8] 13 [10] 11 [10] 6 [5] 7 [6] 11 [8] 9 [8] All groups NS

2 positive pain provocation test 92 [24] 37 [11] 34 [26] 13 [12] 26 [21] 17 [16] 32 [24] 7 [6] All groups NS

]3 positive pain provocation test 264 [68] 22 [7] 83 [64] 10 [9] 93 [74] 7 [7] 88 [67] 5 [4] All groups NS

Fulfilling Ostgaards criteria for pelvic

girdle pain

386 [100] 4 [1] 130 [100] 2 [2] 125 [100] 1 [1] 131 [100] 1 [1] All groups NS

Subgroups of pelvic girdle pain

Pelvic girdle syndrome 124 [35] 2 34 [26] 1 42 [34] 0 48 [37] 1 All groups NS

Double sided sacroiliac pain 159 [41] 6 [2] 58 [45] 2 [2] 57 [46] 4 [4] 44 [34] 0 All groups NS

One-sided sacroiliac pain�symphyseal pain

35 [11] 0 13 [10] 0 8 [6] 0 14 [11] 0 All groups NS

One-sided sacroiliac pain 68 [18] 6 [2] 25 [19] 4 [4] 18 [14] 1 25 [19] 1 All groups NS

Barely pain in the symphysis pubis 0 3 0 1 0 2 [2] 0 0 All groups NS

P4 test, posterior pelvic pain provocation test; fulfilling Ostgaards criteria for pelvic girdle pain, women with positive pain drawing, a positive P4 test, pain when turning in bed and daily pain

(VAS ]10 mm); subgroups of pelvic girdle pain, pain in the pelvic joint after pain provocation test plus daily pain (VAS ]10 mm); pelvic girdle syndrome, double-sided sacroiliac pain plus

symphysis pubis pain. S, standard group; ACU, acupuncture group; SE, stabilising exercise group; NS, not significant.

*p-Values from x2-test. All original p-values were multiplied by 3 (Bonferroni’s correction).

Results are presented for each intervention group and for pooled data. Values are numbers [percentages].

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of ‘no pain’ to VAS ]10 mm at follow-up. About

13% of the women in the standard and acupuncture

groups filled in markings in the gluteal area on

the pain drawings and reported daily pain (VAS

]0 mm) in their diaries. A similar prevalence (15%)

of low back pain was found in non-pregnant women

aged 35 years (24).

An important difference between our study and

other follow-up studies is that stricter criteria had to

be fulfilled than in other published studies. The

criteria used by Albert et al. (6) were pain in one or

more of the pelvic joints confirmed with unspecified

objective findings. The criteria used by Larsen et al.

(12) were pain in the lower back when performing at

least 2 of 5 daily activities and a positive Patrick’s

fabere test, which is used primarily for provocation

of pain originating from the hip joints and not from

the gluteal area. Some of the criteria in the study of

Gutke et al. (1) were similar to our criteria. Women

with isolated symphyseal pain in that study were

not classified as having pelvic girdle pain, but other

criteria differed. They required ]2 positive pain

provocation tests and the women did not have to

experience pain when turning in bed. They reported

that 17% of the women had pelvic girdle pain

3 months postpartum, which is a higher estimate

than in our study. One explanation for the difference

in recovery could be that only 46/262 of the women

received some sort of treatment (1), whereas all

women in our study received treatment during their

pregnancies.

We do not know if women in our study received

any additional interventions during the postpartum

period. However, all women knew that those with

persistent pelvic girdle pain at follow-up would be

referred to specially trained physiotherapists. There-

fore, we believe that additional post-delivery therapy

is an unlikely confounder.

The finding that only 4 women had persistent

pelvic girdle pain is promising, but prospective

randomised studies with follow-up as well as epide-

miological studies are needed to confirm our find-

ings and to further investigate the natural regression

of pelvic girdle pain after pregnancy.

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1. Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and

lumbar pain in pregnancy: a cohort study of the consequences

in terms of health and functioning. Spine. 2006;/31:/149�55.

2. 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:/575�89.

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