Underreported Pregnancy Related Lumbopelvic Pain (PLPP)

Details: Written by: Kasia Gondek, PT, DPT, CSCS; Published: 26 September 2023; Last Updated: 19 October 2023; 1816 Views

Underreported Pregnancy Related Lumbopelvic Pain:

A common condition that most healthcare providers are missing and how physical therapy can help

Being pregnant comes with lots of changes to an expecting mother’s body. Hormonal and physical changes to the body, as well as vascular and neural factors can cause pregnancy-related lumbopelvic pain (PLPP). About 63% of pregnant women in the U.S. experience it at some point during gestation. A recent survey study involving 538 pregnant women with pregnancy-related lumbar and pelvic pain (henceforth termed lumbopelvic pain) found that only 43% reported it, and of those, only 22% received any treatment!¹ Physical therapy through the use of manual treatments, therapeutic exercises, muscle re-education, and functional activity training (lifting mechanics, proper sitting and standing posture) have been proven effective at reducing pregnancy-related lumbopelvic pain and improving quality of life.^2,3,4 Pregnancy-related lumbopelvic pain can interfere with quality of life, physical function, inability to perform daily activities, sleep disturbances, and can contribute to mood disorders such as anxiety and depression.^1,2

This article explores the reasons why healthcare providers (HCPs) are missing the mark with identifying and recommending treatment for pregnancy-related lumbopelvic pain and what we can do to change that.

In a recent study, Hameed, et al. found that HCPs may inaccurately minimize patient’s symptoms and pain (classifying them as expected and normal with pregnancy), and fail to evaluate potential limitations (including ability to work, drive, perform daily activities and physical activity) stemming from pregnancy-related lumbopelvic pain. Recent survey studies found that participants felt their condition was normalized and overlooked by their HCPs. The study also found that because pregnancy is a self-limited condition, it may also influence the likelihood of reporting pain to their provider. In the United States, a lack of universal health care resources may also influence a person's choice to seek treatment for this.¹

It is important that any healthcare provider ask about any low back pain, pelvic girdle pain, or issues with bowel and bladder functioning (leakage, difficulty emptying, or having any pelvic pressure), as these are all things that are very treatable with orthopedic and pelvic physical therapy! All of our Physical Therapists have specialized training to identify and treat pregnancy-related lumbopelvic pain and other pelvic floor-related symptoms including pain.

Physical therapy is an effective first line treatment for pregnancy-related lumbopelvic pain.^2,3,4 Physical therapy can help decrease and relieve pain, improve your posture, core and hip strength as well as treat any muscle trigger points. Your physical therapist will also identify ways you can modify your daily activities to decrease the strain on your body and improve pain long-term.

Do you have pregnancy related lumbopelvic pain? Read more of our articles on this topic and contact our office for the help you deserve!

References:

1. Farah Hameed, Ariana Cesare, Nura Mariscal del Moral, Travis Barton, and Cynthia Chiarello. Is Pregnancy-Related Lumbopelvic Pain Reported to Health Care Providers?. Journal of Women's Health. August 3, 2023 ahead of print https://doi.org/10.1089/jwh.2022.0459

2. van Benten E, Pool J, Mens J, Pool-Goudzwaard A. Recommendations for physical therapists on the treatment of lumbopelvic pain during pregnancy: a systematic review. J Orthop Sports Phys Ther. 2014;44(7):464-A15. doi:10.2519/jospt.2014.5098

3. Fontana Carvalho AP, Dufresne SS, Rogerio de Oliveira M, et al. Effects of lumbar stabilization and muscular stretching on pain, disabilities, postural control and muscle activation in pregnant woman with low back pain. Eur J Phys Rehabil Med. 2020;56(3):297-306. doi:10.23736/S1973-9087.20.06086-4

4. Sonmezer E, Özköslü MA, Yosmaoğlu HB. The effects of clinical pilates exercises on functional disability, pain, quality of life and lumbopelvic stabilization in pregnant women with low back pain: A randomized controlled study. J Back Musculoskelet Rehabil. 2021;34(1):69-76. doi:10.3233/BMR-191810

What Our Patients Have to Say

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.
Read more: Testimonial by M.N., age 28

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.
Read more: Testimonial by R.M., Age 40

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.
What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.
It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

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Underreported Pregnancy Related Lumbopelvic Pain (aka PLPP)