MasterclassDiagnosis and classification of pelvic girdle pain disorders—Part 1: A mechanism based approach within a biopsychosocial framework
Section snippets
Pelvic girdle pain disorders
Pelvic girdle pain (PGP) disorders represent a small but significant group of musculoskeletal pain disorders. Pain associated with the sacroiliac joints (SIJs) and/or the surrounding musculoskeletal and ligamentous structures represent a sub-group of these disorders. Specific inflammatory pain disorders of the SIJs, such as sacroiliitis, are the most readily identified PGP disorders (Maksymowych et al., 2005). However, PGP disorders more commonly present as ‘non-specific’ (no identified
Challenging the beliefs regarding the sacroiliac joints and the pelvis
The SIJ perhaps more than any other joint complex in the body has been shrouded by an enormous amount of mystique within the field of Manual Therapy—with complex, poorly validated and often confusing theories and treatment approaches associated with it. Beliefs of the clinician (that the pelvis is ‘displaced’ or ‘unstable’) commonly become the beliefs of the patients. For many patients these clinical labels can be detrimental with the potential to render the patient passively dependent on
Classification of pelvic girdle pain disorders
Chronic pain disorders are complex, multifactorial and need to be considered within a biopsychosocial framework. A different cluster of potential physical, pathoanatomical, psychosocial, hormonal and neuro-physiological factors is associated with each disorder (Fig. 1). Needless to say the interactions between these factors are very complex. This highlights the need for a flexible classification and management approach for each disorder.
Although the SIJs and the surrounding ligamentous and
Specific pelvic girdle pain disorders
Pelvic girdle pain disorders associated with specific pathological processes include inflammatory arthritis, sacroiliitis, infections and fractures. These disorders are amenable to specific diagnosis with appropriate blood screening and radiological investigation. They can be associated with altered patterns of motor control behaviour that are ‘adaptive’ and/or protective of the underlying disorder. Treating the signs and symptoms of these disorders by manual therapy and/or specific exercise
Non-specific inflammatory pelvic girdle pain disorders
There appears to be a group of PGP disorders that present as being inflammatory in nature, rather than mechanical. They are characterised by constant, disabling and non-remitting pain, located in the SIJs, that is provoked with weight bearing, pelvic compression (such as a SIJ belt) and with SIJ pain provocation tests. These disorders may show areas of increased uptake on bone scan but are not linked to a specific inflammatory disorder diagnosis based on blood screening. They may be relieved
Summary
This paper provides a broad clinical classification model for the management of chronic PGP disorders. It is a flexible, mechanism-based approach within a multifactorial biopsychosocial framework. The classification model directs appropriate management based on the underlying mechanism/s that drives the pain. Although there is growing support for the validity of this approach, further research is required into this area.
Acknowledgements
Many thanks to Dr Britt Stuge and Dr Wim Dankaerts for their clinical insights and advice in the final stages of writing this manuscript.
Note
Part 2 of this Masterclass can be viewed online only at doi:10.1016/jmath.2007.03.003.
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2019, Best Practice and Research: Clinical RheumatologyCitation Excerpt :Two contemporary views of SIJ dysfunctions that may lead to SIJ pain include impairments in SIJ force closure and maladaptation resulting from lumbar and lumbosacral joint fusion. The primary causes of impairment to the force closure mechanism of the SIJs are considered to be trauma, laxity of the pelvic ligaments, biomechanical asymmetry and suboptimal motor control of associated muscles [3,4,20,22]. Altered joint stiffness and impaired motor control of deep muscles have been associated with lumbopelvic pain [20,23].
Analysis of Test-Retest Reliability, Construct Validity, and Internal Consistency of the Brazilian Version of the Pelvic Girdle Questionnaire
2018, Journal of Manipulative and Physiological Therapeutics