Effectiveness of the Physical Therapy treatment on pelvic floor muscles in pelvic girdle pain. A literature review.

BACKGROUD AND AIM Pelvic girdle pain (PGP) occurs mainly during pregnancy and in the first year after childbirth. Effectiveness of the physical therapy used for this condition is still widely discussed in the literature. The aim of this study is to investigate the effectiveness of the physical therapy for pelvic floor muscles in PGP.   MATERIAL AND METHODS PubMed, PeDro, The Cochrane Collaboration, CINHAL, and Scopus databases were searched using the terms pelvic floor, pelvic girdle, pubic symphysis, sacroiliac joint, pregnancy, and post pregnancy. No time limit or language was given. Additional records were searched through reference lists from guidelines and reviews.   RESULTS Only two randomized controlled trials (RCT) were found from the search. The first one involved 257 pregnant healthy women, before gestation week 20th. The experimental group received supervised group exercises, including pelvic floor muscles training, whereas the control group received standard care by midwife and gynaecologist. No significant difference in prevalence of low back pain or PGP was shown between groups. The second RCT involved 88 women with persistent PGP who were recruited 3 months after delivery. The treatment group was instructed to perform stabilizing exercises, including pelvic floor muscles training; the control group received information about PGP through a phone call. Pelvic floor muscles were evaluated before and after the treatment, by nerve conduction study (NCS). The program of stabilizing exercises was not more effective in improving consequences of persistent postpartum PGP than the clinically natural course. Pelvic floor muscles activity was not improved, unlike other muscles. DISCUSSION These articles raise important questions about the usefulness of pelvic floor exercises both for the prevention of PGP during pregnancy and the treatment of persistent PGP after childbirth. The lack of improvement of pelvic floor muscles after the performance of stabilization exercises makes questionable the effectiveness of this program, also when it is addressed to the pelvic floor. The very small number of high-quality clinical trials suggests that further research is needed.   CONCLUSIONS Pelvic floor physical therapy has not proved more effective than common obstetric care to prevent PGP during pregnancy, nor to treat persistent PGP after childbirth.