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Introduction
Lumbo-pelvic pain (LPP) affects a significant number of
pregnant women, and has a negative impact on their pro-
fessional life, everyday activity, and sleep [1]. Different au-
thors estimate the prevalence of LPP at 44% to 91% [2-8]
depending on classification, on methodology applied, and
on the advancement of pregnancy. According to European
guidelines and international literature, LPP has to be dif-
ferentiated into the lumbar pain (LP), pelvic girdle pain
(PGP) and mixed pain, i.e. simultaneous pain of both lum-
bar spine and pelvic girdle [1, 6, 9-11]. LP is defined as
pain located above the lumbosacral junction radiating or
not to one or both lower extremities [6]. PGP, as defined
by European guidelines, can be felt between posterior iliac
crest and gluteal folds, in the region of one or both sacroil-
iac joints and/or the pubic symphysis, possibly radiating to
the posterior part of the thigh [9]. Individual constituent el-
ements of LPP have to be analyzed separately, as they are
related to distinct clinical symptoms and to different risk
factors [4], and therefore they require different treatment
[9, 12]. PGP results in greater pain and greater limitations
to everyday activity than LP [6, 13, 14]. It also shows a
greater tendency to continue after childbirth, thus signifi-
cantly affecting everyday life [15]. Women who suffer from
PGP are less active during pregnancy and therefore they
suffer from accompanying issues, among others from de-
pression [11]. The Polish literature uses various terms when
discussing health issues related to pregnancy. Some of the
terms that are used include “low back pain” [16], “lum-
bosacral region pain” [17], “lower spinal segment pain syn-
drome” [18], “lumbosacral region, and pelvic pain” [19].
The aim of the study was to determine the prevalence of
individual kind of LPP in pregnant Poles in accordance
with European guidelines and the latest trends in the liter-
ature.
Materials and Methods
The study population consisted of 234 pregnant Poles. The con-
trol group consisted of 47 non-pregnant Poles. The criteria for
subject inclusion in the study were: a single uncomplicated preg-
nancy, informed consent to participate in the study, age between
18 and 40 years, week of pregnancy between 12 and 36. The cri-
teria for subject exclusion from the study were: additional dis-
eases or disorders that can result in LP/PGP (inter alia scoliosis,
discogenic disease, hip dysplasia, constitutional hypermobility, or
Scheuremann’s disease).
The control group consisted of randomly chosen women, aged
18 to 40 years, who did not suffer from diseases that would result
in LP or PGP. Pregnant women were surveyed in childbirth
classes, fitness classes, and in obstetric clinics.
On the basis of the questionnaires received, and having rejected
those incorrectly filled out, 189 pregnant women qualified for the
Revised manuscript accepted for publication February 13, 2017
CEOG Clinical and Experimental
Obstetrics & Gynecology
7847050 Canada Inc.
www.irog.net
Clin. Exp. Obstet. Gynecol. - ISSN: 0390-6663
XLV, n. 2, 2018
doi: 10.12891/ceog4090.2018
Pregnancy-related lumbar and pelvic girdle pain
in Polish women
M. Starzec1, A. Truszyńska-Baszak2, A. Tarnowski3
1Rehabilitation Division, Department of Physiotherapy, Second Faculty of Medicine,Medical University of Warsaw, Warsaw
2Jozef Pilsudski University of Physical Education, Physiotherapy Department, Warsaw
3Psychology Department, University of Warsaw, Warsaw (Poland)
Summary
Purpose of investigation: To examine lumbo-pelvic pain (LPP) characteristics in pregnant Polish women. Materials and Methods:
The study population consisted of 189 Poles aged 21 to 40 (mean age 29.86 sd. 3.84) years, between 12 and 36 gestation weeks. The
control group consisted of 36 non-pregnant Poles. On the basis of body diagrams the authors found three distinctive kinds of pain: lum-
bar, pelvic girdle, and mixed pain. For further pain characteristics visual analogue scale (VAS) scale, Oswestry Disability Index (ODI),
and Pelvic Girdle Questionnaire (PGQ) were used. Results: Sixty-five percent of pregnant women reported suffering from LPP. Mean
pain intensity was 4.84 for lumbar pain (LP) and 4.87 for pelvic girdle pain (PGP) on the VAS scale. Mean activity limitation caused
by PGP was 32.67% and mean disability caused by LP was 17.92%. The control group reported PGP significantly less often. Conclu-
sions: LPP can cause significant problems in pregnant women and they also experience PGP more often than non-pregnant women.
Key words: Pelvic girdle; Lumbar pain; Pregnancy.
author's personal copy
Pregnancy-related lumbar and pelvic girdle pain in Polish women
study population and 36 women for the control group. Table 1
presents biometric data for both subject groups.
The questionnaires were anonymous. The questions concerned
the type and character of occupation, pregnancy course, physical
activity in the year prior to pregnancy, pain from the lumbar spine
and/or pelvic girdle in the year prior to pregnancy, current pain
from the lumbar spine and pelvic girdle, pain from the lumbar
spine and/or pelvic girdle in previous pregnancies, chronic disor-
ders, and urinary incontinence. Additional research instruments
included: body diagrams with LP and PGP marked, body diagram
for marking the actual pain - “pain map” - to verify the reliability
of declarations and to identify PGP location, the visual analogue
(VAS) scale (0-10), the Oswestry Disability Index (ODI) [20],
used to assess LP, and the Pelvic Girdle Questionnaire (PGP) [21],
translated into Polish, to assess pelvic girdle pain.
To process and analyze the data the authors used the following
statistical tools: arithmetic mean with standard deviation and me-
dian, the Mann-Whitney U-test, Chi-squared test, Fisher’s exact
test, and Kendall’s tau coefficient. Statistical significance was set
at p < 0.05.
Results
LPP was reported by 65% (n=122) of pregnant women,
23% (n=43) subjects reported isolated LP, 17% (n=32) re-
ported isolated PGP, and 25% (n=47) reported mixed pain.
The incidence of LP and of PGP pain was 47% and 42%,
respectively. In the control group, 44% of subjects reported
LP and 22% reported PGP. This was significantly less (p <
0.05) when compared to pregnant women. Tables 2 and 3
present the discussed results. The compared mean values
of the VAS, ODI, and PGQ did not result in significant dif-
ferences between the study population and the control
group. Table 4 presents the discussed parameters.
The authors decided to ascertain what percentage of pain
syndromes reported by pregnant women may result in
limitations to everyday activity and decreased quality of
life. Such changes were indicated by the following refer-
ence values: values higher than 5 on the VAS scale, values
higher than 30% on the PGQ, and higher than 20% on the
ODI. They found higher VAS and ODI values of 33% and
32%, respectively, in pregnant women with LP. 35% and
52% of pregnant women with PGP had higher VAS and
PGQ values, respectively. The authors also found that LPP
in non-pregnant women was significantly more prevalent in
those subjects who had been pregnant before and who had
then been suffering from similar pain.
Discussion
The present study of a group of pregnant Poles presented
results that are in line with previous studies on LPP preva-
lence in pregnant women in other countries. These studies
were based either on self-reported LPP or involved func-
tional tests on patients. A survey by Kovacs et al. [4] in-
volved 1,158 Spanish women 31 to 38 (mean 35) weeks of
pregnancy. Prior to the test 71.3% patients reported LPP.
Pierce et al. [5] studied 96 Australian women 28 to 41
weeks (mean 34.8) weeks pregnant and had similar results:
71% of patients reported LPP during pregnancy. Robinson
et al. [22] analyzed declarations of 283 Norwegians who
Table 1. — Participants’ biometric data.
Mean SD Min Max Median p
pregnant controls pregnant controls pregnant controls pregnant controls pregnant controls
Age (years) 29.85 29.58 3.84 4.93 21 21 40 39 30 29 1
Height (m) 1.67 1.66 0.06 0.06 1.52 1.53 1.80 1.78 1.68 1.65 1
BMI before 21.66 22.89 3.00 3.13 15.67 17.58 36.57 31.61 21.30 22.08 0.06
pregnancy (kg/m2)
Gestation week 26.89 - 5.67 - 12 - 36 - 28 - -
Table 4. — LP and PGP characteristics.
VAS PGP 5 pPGQ pVAS LP p ODI p
Pregnant (n=189) 4.87±1.73 0.55 32.67±17 0.28 4.83±1.73 117.92±12.15 0.22
Controls (n=36) 5.75±2.43 22.63±15.81 5.19±2.04 11.5±5.19
Table 3. — LP and PGP prevalence.
Pregnant group (n=189) Controls (n=36) p
n % n %
LP overall 90 47 16 44 0,98
PGP overall 79 42 8 22 <0,01
Table 2. — LPP among pregnant women.
Type of pain Pregnant group (n=189)
n % % of LPP women
LPP (any type) 122 65 -
LP (isolated) 43 23 35
PGP (isolated) 32 17 26
Mixed (LP+PGP) 47 25 39
Without pain 67 36 -
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M. Starzec, A. Truszyńska-Basak, A. Tarnowski
were 30 weeks pregnant. They found LPP in 82% of them.
The methodology the abovementioned authors used was
similar to the present one: they differentiated pain on the
basis of body diagrams. The scope of individual types of
pain was the same used in the present study. The fact that
the abovementioned authors found higher incidence of LPP
than the present can most likely be attributed to the fact that
they studied women at later weeks of pregnancy. Gutke et
al. [8] in their study on LPP analyzed its prevalence in two
groups of patients: first between ten and 24 (mean of 17)
weeks of pregnancy and second between 28 and 38 (mean
33) weeks of pregnancy. In the first group of patients (10-
24 weeks pregnant) 58% (n=177) of Swedes and 44%
(n=136) of Norwegians reported LPP. In the second group
of patients (28 to 38 weeks pregnant) 63% (n=173) of
Swedes and 81% (n=215) of Norwegians reported LPP.
Al-Sayegh et al. [7] surveyed 280 Kuwaiti women aged
17 to 42 (mean 29.6) years and had significantly different
results: 91% of their patients declared LPP. The results were
explained in relation to the Middle Eastern culture that re-
sulted in low physical activity and in following overweight
or obesity in a large number of subjects.
In the studies that diagnosed LPP using additional subject
examination and functional tests, the prevalence of pain
was slightly lower. However, these studies focused on
women whose pregnancies were less advanced. In the study
by Gutke et al. [23] on 313 Swedes between 12 and 18
weeks pregnant, LPP was found in 61.9% of them. Mens at
al. [3] studied 182 Dutch women between 20 and 30 weeks
pregnant. They used pain maps accompanied by a series of
functional tests and diagnosed LPP in 60.4% of their sub-
jects. Gupta et al. [2] found LPP in 60.3% of pregnant In-
dians. Their study population (n=227) was similar to the
present in terms of pregnancy advancement (12-36 weeks),
while their age was younger (20-35 years, mean age 23.83).
In addition, the pain analysis did not entail pain from the
pubic symphysis. Musavi et al. [24] found a lower inci-
dence of LPP in Iranian women. Their study population
consisted of 325 women, aged 16 to 42 years, 12 to 36
weeks pregnant and 49.5% of subjects were diagnosed with
LPP. Alike Gupta et al. and Musavi et al. did not take pubic
symphysis pain into account, which may explain the lower
pain prevalence.
While LPP incidence seems to be consistent in studies by
different authors, significant differences appear in differ-
entiating the pain according to the pain location - LP, PGP
or the mixed pain. In the studies based on self-reported
pain, the results were as follows: among subjects studied
by Pierce et al. [5] 22% reported isolated PGP, 11% re-
ported isolated LP, and 33% reported mixed pain. Among
subjects studied by Al-Sayegh et al. [7], 14.3% reported
isolated PGP, 38.3% reported isolated LP, and 26.4% re-
ported mixed pain. Among subjects studied by Robinson et
al. [22] 5% reported isolated LP, 52% reported isolated
PGP, and 25% reported mixed pain. Gutke et al. [22] used
additional tests and they found isolated PGP in 33.2% of
their subjects, isolated LP in 10.5% of subjects and mixed
pain in 18.2% of subjects. Mousavi et al. [24] used addi-
tional patient examination too and they found isolated (pos-
terior) PGP in 28% of their subjects, isolated LP in 13.2%
of subjects, and mixed pain in 8.3% of subjects. Gupta et al.
[2] found isolated (posterior) PGP in 29.5% of subjects, and
mixed and isolated LP in 30% of their subjects.
The reasons for the differences in results in the discussed
studies may be related to the way the authors differentiated
between symptoms, differences in subjects’ age, type of the
study (prospective vs. retrospective), point prevalence, pe-
riod prevalence, or how advanced the pregnancies were.
Notably, incidence of LP was high among the Polish sub-
jects, and even higher among the Kuwaiti subjects [7]. It
had been hypothesised that in the Middle Eastern women,
sedentary lifestyle and overweight may lead to the symp-
toms. It can also be assumed that these factors led to the in-
creased incidence of LP in Poles. Though cultures of these
two region are very different, the issue of sedentary lifestyle
and overweight are present in both. According to the Pol-
ish Central Statistical Office 2011 report [25], Poland
ranked seventh among 18 European countries in over-
weight incidence in adults. This hypothesis seems to be
confirmed by a similar incidence of LP in the clinical con-
trol group. However, the obtained BMI results do not sup-
port the hypothesis. The composition of the body is not
reflected in the BMI. This may have been the factor that
was different in the two groups. Another hypothesis may
relate to the fact that the subjects had low body awareness
and they had difficulties in locating the pelvic area. When
conducting the present study, the authors were confronted
with the inability of the Polish subjects to locate the pain
they suffered from. In the Polish literature, the term “pelvic
girdle pain” seems to be relatively rare. When referring to
pregnancy-related symptoms, the term “lumbo-sacral re-
gion pain” or “sacral pain” are much more common. The
new terminology that subjects had previously been unaware
of may have distorted pain location reports, although body
maps were used for illustration.
According to Rost et al. [15] 10% of women who expe-
rienced PGP when pregnant still experienced moderate to
strong pain as long as 18 months after labour. Engeset et
al. [26] confirm these and conclude that PGP may affect
quality of life as long as months and years after labour. The
present authors were not able to find reports on persistent
PGP in pregnant Polish women. However, in the present
study the declared PGP in the clinical control group was
significantly related to the symptoms experienced when
being pregnant, and this may indicate to a kind of pro-
longed PGP. Some alarming reports of a number of authors
and observed correlations indicate a need of further studies
of PGP in Poles.
In the report by Pierce et al. [5], only 25% of pregnant
women who complained of PGP received some form of
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Pregnancy-related lumbar and pelvic girdle pain in Polish women
treatment. The complexity of chronic pain syndromes sig-
nifies that they require to be identified as early as possible
and that they also require early, effective, and appropriate
treatment.
The main limitation of this study was the fact that it was
conducted in the form of a survey. Using body diagrams and
pain maps instead of an examination limits the value of the
observations presented. Still, the collected results on LPP
prevalence were largely in accordance with reports by other
authors, and also with the reports where functional tests
were used. Another factor limiting the interpretation of the
collected data is the significant difference in study group
numbers. In subsequent studies, it would be advisable to
compose groups of comparable numbers, so that the results
collected are more reliable. The PGQ version used was the
present authors’ translation and it had not undergone the Pol-
ish language validation process. This may result in certain
limitations in comparison to results by other authors. The
present authors decided that using an international ques-
tionnaire, even in its non-standardized version, would have
a higher study value than creating a survey of their own.
According to the best of the present authors’ knowledge,
this is the first study in Poland to attempt to classify preg-
nancy-related LPP according to European guidelines and the
latest trends in the literature. Contemporary medical world
attempts to introduce unified classification and treatment. In-
troducing international termin- ology on pregnancy-related
symptoms will allow for facilitated exchange of knowledge
among professionals and improved patient treatment.
Conclusions
LPP can cause significant problems in pregnant women.
PGP is more prevalent in pregnant than in non-pregnant
women.
References
[1] Pennick V., Liddle S.: “Interventions for preventing and treating
pelvic and back pain in pregnancy (review)”. Cochrane Database
Syst Rev., 2013, 8, CD001139.
[2] Gupta M., Srivastava S., Khan S.: “Prevalence of pregnancy related
pelvic girdle pain in Indian primigravida: a tertiary care hospital based
study”. IJOG, 2014, 1, 16.
[3] Mens J., Huis in’t Veld Y., Pool-Goudzwaard A.: “Severity of signs
and symptoms in lumbopelvic pain during pregnancy”. Man Ther.,
2012, 17, 175.
[4] Kovacs F., Garcia E., Royuela A., Gonzalez L., Abraira V., Spanish
Back Pain Research Network: “Prevalence and factors associated
with low back pain and pelvic girdle pain during pregnancy: a mul-
ticentered study conducted in the Spanish National Health Service”.
Spine (Phila. Pa 1976), 2012, 37, 1516.
[5] Pierce H., Homer C., Dahlen H., King J.: “Pregnancy-related lum-
bopelvic pain: listening to Australian women”. Nurs. Res. Pract.,
2012, 2012, 387428
[6] Robinson H.: “Pelvic girdle pain and disability during and after preg-
nancy”. Doctoral Thesis, University of Oslo, 2010 [cited 2015 May 15].
Available at: https://www.duo.uio.no/bitstream/handle/10852/ 27906/2/
dravh-publ-Robinson.pdf
[7] Al-Sayegh N., Selem M., Daashti F., Al-Sarrah S., Kalakh S., Al-
Rashidi R.: “Pregnancy-related lumbopelvic pain: prevalence, risk
factors, and profile in Kuwait”. Pain Med., 2012, 13, 1081.
[8] Gutke A., Olsson C., Vollestad N., Uberg B., Wikmar L., Robinson
H.: “Association between lumbopelvic pain, disability and sick leave
during pregnancy – a comparison of three Scandinavian cohorts”. J.
Rehabil. Med., 2014, 46, 468.
[9] Vleeming A., Albert H., Ostgaard H., Stuge B., Sturesson B.: “Eu-
ropean guidelines on the diagnosis and treatment of pelvic girdle
pain”. Eur. Spine J., 2008, 17, 794.
[10] Casagrande D., Gugala Z., Clark S., Lindsey R.: “Low back and
pelvic girdle pain in pregnancy”. J. Am. Acad. Orthop. Surg., 2015,
9, 539.
[11] Vermani E., Mittal R., Weeks A.: “Pelvic girdle pain and low back
pain in pregnancy: a review”. Pain Pract., 2010, 10, 60.
[12] Sabino J., Grauer J.: “Pregnancy and low back pain”. Curr. Rev. Mus-
culoskelet. Med., 2008, 1, 137.
[13] Gutke A., Kjellby-Wendt G., Oberg B.: “The inter-rater reliability of
a standardised classification system for pregnancy-related lum-
bopelvic pain”. Man. Ther., 2010, 15, 13.
[14] Malmkvist S., Kjaermann I., Andersen K.: “Prevalence of low back
and pelvic pain during pregnancy in a Norwegian population”. J.
Manipulative Physiol. Ther., 2012, 35, 272.
[15] Rost C., Jacqueline J., Kaiser A., Verhagen A., Koes B.: “Prognosis
of women with pelvic girdle pain during pregnancy: a long term fol-
low-up study”. Acta Obstet. Gynecol. Scand., 2006, 85, 771.
[16] Opala-Berdzik A., Bacik B., Kurkowska M.: “Zmiany biomechan-
iczne u kobiet w ciąży”. Fizjoterapia,2009, 17, 51.
[17] Boguszewski D., Sałata D., Adamczyk J., Białoszewski D.: “Ocena
skuteczności ćwiczeń relaksacyjnych i stabilizacyjnych w minimal-
izacji bólu lędźwiowo-krzyżowego odcinka kręgosłupa u kobiet
ciężarnych”. Prz. Med. Uniw. Rzesz. i Inst. Leków, 2014, 2, 152.
[18] Boguszewski D., Sałata D., Adamczyk J., Korabiewska I., Cabak A.,
Białoszewski D.: “Ocena skuteczności klasycznego masażu wykony-
wanego przez partnera w łagodzeniu zespołów bólowych dolnego
odcinka kręgosłupa u kobiet ciężarnych”. Fizjoter. Pol., 2012, 4, 379.
[19] Majchrzycki M., Mrozikiewicz P., Kocur P., Bartkowiak-Wieczorek
J., Hoffman M., Stryła W., et al.: “Dolegliwości bólowe dolnego od-
cinka kręgosłupa u kobiet w ciąży”. Ginekol. Pol., 2010, 81, 851.
[20] Fairbank J., Pynsent P.: “The Oswestry Disability Index”. Spine,
2000, 25, 2940.
[21] Stuge B., Garratt A., Krogstad Jenssen H., Grotle M.: “The Pelvic
Gridle Questionnaire: a condition-specific instrument for assessing
activity limitations and symptoms in people with pelvic girdle pain”.
Phys. Ther., 2011, 7, 1.
[22] Robinson H.S., Mengshoel A.M., Bjelland E.K., Vollestad N.K.:
“Pelvic girdle pain, clinical tests and disability in late pregnancy”.
Man. Ther., 2010, 15, 280.
[23] Gutke A.: “Pelvic girdle pain and lumbar pain in relation to pregnancy”. Linkop-
ing University Medical Dissertations, 2007, 998 [cited 2015 Dec 13]. Available
at: http://liu.diva-portal.org/smash/get/diva2:17602/FULLTEXT01.pdf
[24] Mousavi S., Parnianpour M., Vleeming A.: “Pregnancy related pelvic
girdle pain and low back pain in an Iranian population”. Spine, 2007,
32, E100.
[25] Główny Urząd Statystyczny 2012: “Zdrowie i ochrona zdrowia w
2011r. Informacje i opracowania statystyczne. Departament Badań
Społecznych i Warunków Życia”. Warszawa. Available at:
http://stat.gov.pl/cps/rde/xbcr/gus/zo_zdrowie_i_ochrona_zdrowia_
w_2011.pdf
[26] Engeset J., Stuge B., Fegran L.: “Pelvic girdle pain affects the whole
life – a qualitative interview study in Norway on women’s experi-
ences with pelvic girdle pain after delivery”. BMC Res. Notes, 2014,
7, 686.
Corresponding Author:
M. STARZEC
ul. Piastowska 13,
39-300 Mielec (Poland)
email: m.starzec@outlook.com
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