How Does Pelvic Girdle Pain Alter Peripartum Gait?

Do women who have pelvic girdle pain in pregnancy have altered gait patterns? The answer to this question was the aim of a study published in the European Spine Journal in 2008 by Wu and colleagues. Pelvic girdle pain, defined by Vleeming and colleagues as "…a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP…" has been estimated to occur as often as 50% in pregnancy. (Gutke et al., 2006) Unfortunately, of the women who develop pelvic girdle pain in pregnancy, research has demonstrated that 1 in 4 women will develop chronic postpartum pain. (Ostgaard et al., 1991) Pelvic girdle pain can appear as mild, moderate, or severely debilitating, and can be confirmed using provocation tests such as the posterior pelvic provocation test and the active straight leg raise (ASLR). Our role as pelvic rehabilitation providers is critical in minimizing the functional impact of pelvic girdle pain during and following pregnancy.

In regards to gait changes in women who present with PGP in pregnancy, in general, walking velocity is reduced, is negatively correlated with fear of movement, and there are changes in thorax and pelvic rotations. In the study by Wu and colleagues, kinematics were examined in 11 women with PGP and 12 pelvic-healthy controls. Findings within the patients with PGP include that transverse segmental rotation amplitudes were larger, and peak thorax rotation occurred earlier in the stride cycle at higher velocities. The authors suggest that this change in thorax rotation may aid in avoiding excessive spinal rotations caused by larger segmental rotations, or in limiting the motion in the lumbopelvic region.. They further describe that in healthy subjects, pelvic rotations are relatively out-of-phase with the lower extremities at lower velocities, and more in-phase during higher velocities, and that this pattern may be altered in the presence of PGP.

What is the clinical relevance of this information? The primary author in the study also reported on postpartum pelvic girdle pain and gait, and found that changes in trunk and pelvic coordination persist in the postpartum period, and that an individual may employ a variety of adaptive strategies to deal with pain and possibly weakness during gait. What changes in movement strategies does a patient present with in early postpartum versus late postpartum? Does a woman, if she has never been offered rehabilitation, spontaneously recover from these gait adaptations? How does fear of movement and pain-avoiding strategies affect her movement even decades later? In the absence of having gait laboratories, clinical observation of walking at varied speeds can identify patterns of movement that may be aggravating a spinal or pelvic condition. Does she rotate her trunk with a reciprocal limb pattern? Does she limit rotation at the pelvis and overcompensate in the thoracic spine? Observation of patterns that fit clinical symptoms may assist in avoiding persisting gait alterations. Early recognition of pelvic girdle dysfunction in pregnancy and throughout the postpartum period may allow her to avoid compensations in gait that contribute to musculoskeletal dysfunction. To learn about more exciting concepts in postpartum recovery, come to the Care of the Postpartum Patient in Houston in June or in Chicago area in September!

References

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. Spine, 16(5 549-552.

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.