Craniosacral Therapy for Pregnancy-related Pelvic Girdle Pain

Lumbopelvic and pelvic girdle pain (PGP) in pregnancy is estimated to occur in 20-30% of women, with prevalence as high as 50%. (Elden et al., 2013; Gutke et al., 2006; Mens & Pool-Goudzwaard, 2012; Ostgaard, 1991; Vleeming et al., 2008) One in four women who develop PGP in pregnancy develop chronic postpartum pain. (Ostgaard, 1991) According to Albert et al., 2006, risk factors for developing pelvic girdle pain in pregnancy include history of prior low back pain, back or pelvic trauma, high levels of stress, multiparity, and low job satisfaction. Non-risk factors include contraceptive medications, time since past pregnancy, height, weight, and smoking. (Vleeming et al., 2008) Fortunately, there is a trend for PGP to decrease within the first 3 months of delivery. (Elden et al., 2008) For pain that does persist, guidelines for treating pelvic girdle pain include providing individualized exercise prescription. (Vleeming et al., 2008) What type of individualized exercise or other intervention is appropriate?

A recent study by Elden and colleagues (2013) assessed the effect of including craniosacral therapy to standard treatment for pregnant women with pelvic girdle pain. In the multicenter, randomized, single blind, controlled trial, 123 patients were treated, with 60 in the control group and 63 in the intervention group. Standard treatment included education about the condition and anatomy of the back and pelvis, instruction in concepts of load demand and rest, activities of daily living advice, instruction in use of pelvic support belt, and exercises to stretch and strengthen the trunk, hip and shoulder muscles. Women in the intervention group received, in addition to the above, craniosacral manual releases to the pelvis. To see the program utilized, access the full article here.

Outcome measures included frequency of sick leave, morning and evening pain on visual analog scale, the Oswestry Disability Index scale, Disability Rating Index, European Quality of Life measure, intensity of discomfort of PGP, and blinded examiner assessment of recovery. The authors conclude the following: "Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group…treatment effects were small and clinically questionable…"

While craniosacral therapy is not strongly suggested based on the outcomes of this study, the authors acknowledge that craniosacral therapy is demonstrated in this and in previous research to have pain-relieving effects and a potential to halt deterioration of function. This type of clinical research model may prove to be very helpful in development of additional studies that assess the effects of specific interventions.

In my clinical and teaching experiences, and in the experiences of my colleagues, many therapists have questions about how to treat pregnant and postpartum conditions. It is common to encounter fears about working with patients who are pregnant due to the importance of avoiding potentially harmful examination and intervention techniques. We have also found that many therapists who are interested in women's health seek more information about orthopedic skills and practical clinical considerations. For these reasons, the Peripartum course series was developed over the past couple of years. Many of you may have taken the "Highlights of Pregnancy and Postpartum" taught by Institute founder Holly Herman, and will enjoy expanding your knowledge with the added days of coursework that includes both lecture and lab activities. The Institute offers a course based on pregnancy, one on postpartum, and a course on special topics during the peripartum period. The next opportunity to take the Pregnancy course is in January in Oklahoma City- there are still a few openings for this site.Join us to discuss issues such as pelvic girdle pain, what the evidence tells us, and what we can do for our patients.

References

Albert, H. B., Godskesen, M., Korsholm, L., & Westergaard, J. G. (2006). Risk factors in developing pregnancy-related pelvic girdle pain. [Article]. Acta Obstetricia et Gynecologica Scandinavica, 85(5), 539-544. doi: 10.1080/00016340600578415

Elden, H., Hagberg, H., Fagevik Olsén, M., Ladfors, L., & Ostgaard, H. (2008). Regression of pelvic girdle pain after delivery: follow?up of a randomised single blind controlled trial with different treatment modalities. Acta Obstetricia et Gynecologica Scandinavica, 87(2), 201-208

Elden, H., Östgaard, H. C., Glantz, A., Marciniak, P., Linnér, A. C., & Olsén, M. F. (2013). Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women: a multicenter, single blind, randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica.

Gutke, A., Lundberg, M., Östgaard, H. C., & Öberg, B. (2011). Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. European Spine Journal, 20(3), 440-448

Gutke, A., Östgaard, H. C., & Öberg, B. (2006). Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine, 31(5), E149-E155.

Ostgaard, H. C., Anderson, G. B. J., & Karlson, K. (1991). Prevalence of back pain in pregnancy: A review (Vol. 16, pp. 95-101)

Mens, J., & Pool-Goudzwaard, A. (2012). Severity of signs and symptoms in lumbopelvic pain during pregnancy. Manual Therapy

Vleeming, A., Albert, H. B., Östgaard, H. C., Sturesson, B., & Stuge, B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal, 17(6), 794-819