Physical Therapy for Pregnancy Related Pelvic Girdle Pain: A Community Education Endeavor

 

Physical Therapy for Pregnancy Related Pelvic Girdle Pain

A Community Education Endeavor

 

By: Lindsay Saunders, SPT

 

Background

Of all the memories I carry with me from this program, one of the most significant is the day that I learned of the pelvic health specialty. Like so many others, I was unaware of this specialty prior a rounds presentation that took place during our first semester of the program. At that time, I was not quite sure if I was drawn to the specialty itself or if the charisma and enthusiasm of the presenter had simply captured my admiration. Over the next several months, I dabbled with the thought of exploring the specialty further and decided to seek a pelvic health rotation.

My passion for pelvic health grew considerably during my rotation at Perfect Balance Physical Therapy. Working under the guidance of Kristen Murphy, PT, DPT, I was able to explore the specialty with a certain curiosity and eagerness that allowed me to expand both my clinical skill set and my knowledge base. Though I worked with both men and women who presented with a variety of symptoms, I found myself intrigued by the complexity of pelvic pain, its relationship to pregnancy, and its impact on patient function and quality of life.

This rotation was an eye-opening experience. In my mind, it seems obvious that healthcare providers would address pregnancy-related pelvic girdle pain with their pregnant and postpartum patients. In discussing this topic with my instructor, our patients, and members of the community, I quickly learned that this is not the case. Time and time again, I heard stories of women suffering in silence for years because no one had educated them on pregnancy’s impact on the pelvic floor or interventions to address their pain. I left Perfect Balance frustrated by this knowledge gap and determined to impart a change for the better.

This project and its products are a direct result of that determination. I pursued this project to not only improve patient knowledge and care, but to further my own understanding of pregnancy-related pelvic girdle pain to ensure that I provide optimal care in future clinical practice. Working with Planned Parenthood has allowed me to target a unique population that is often underrepresented and underserved in healthcare. By providing those that utilize Planned Parenthood with the language and the knowledge to ask questions and seek support, it is my hope to empower individuals to play an active role in their healthcare.

 

Overview/Purpose

Pregnancy-related pelvic girdle can be defined in a number of ways, making it difficult to diagnose ^1,2. Often, it is defined as pain in the pelvic region that begins during pregnancy or within three weeks of delivery that may or may not radiate to other areas of the body ¹. Research estimates that 48-56% of women experience pelvic girdle pain related to pregnancy; 25% of those women would classify their pain as severe and 10% go on to develop chronic pain ^1-4. Though the connection between pelvic girdle pain and pregnancy is not entirely understood, it is believed to arise from the interaction of a number of factors including hormonal changes and a changing center of mass ^1,2,5-7. The risk of developing pelvic girdle pain may also be influenced by factors such as mode and number of deliveries ⁸. Pregnancy-related pelvic girdle pain has been shown to negatively impact ones ability to perform daily activities and form intimate relationships; it is estimated that 68-82% of women report pain with sexual intercourse ^1,2,9-11. A number of physical therapy interventions can be used to address this condition, including manual therapy techniques, modalities such as biofeedback and ultrasound, and exercise for core strength and postural-reeducation ^1,2,9-12. Therefore, the purpose of this project was to create educational materials that could be utilized by Planned Parenthood for the purposes of educating individuals on pregnancy-related pelvic girdle pain and physical therapy intervention with the goal of promoting prompt recognition of symptoms and intervention.

 

Statement of Need

This project was initiated by conversations with individuals in the community and with my clinical instructor, conversations that highlighted the importance of discussing pelvic girdle pain with women who are pregnant or postpartum. The desire to work with Planned Parenthood takes root in several years of volunteer work with underserved populations. In talking with the Community Health Educator for the Planned Parenthood in Greensboro NC, I learned that the organization does not currently provide education related to pelvic girdle pain or physical therapy management. She expressed that she felt this was an important topic worthy of discussion. Because a primary focus of Planned Parenthood is to provide appropriate education and resources for those that need it, she and I both felt that this project would benefit current and future clients of Planned Parenthood.

 

Products

Though this project covered far more than physical therapy intervention alone, this served as my “starting block” for the project. I conducted a literature review of the best available evidence investigating core stabilization exercises for pregnancy-related pelvic girdle pain and used my findings to serve as a base for my educational materials. Those findings are summarized in an evidence table. While the studies included in this evidence table support the use of physical therapy intervention for pelvic girdle pain, they also highlight the need for continued research. Based on these findings and extensive additional research, I created a PowerPoint presentation geared toward college students. To ensure that the information included in the PowerPoint was conveyed effectively, only relevant content was included. Graphics were used to maximize participation and learning and language was kept simple with different levels of health literacy in mind. A brochure was created based on the content of the PowerPoint and included a list of useful resources and local clinics that offer pelvic health rehabilitation. On April 12^th, 2018, these materials were presented to a group of twenty college students at The University of North Carolina at Greensboro as part of Planned Parenthood’s Sex in the Dark event. Both the PowerPoint and brochure have been given to Planned Parenthood to use at their discretion.

 

Associated Products and Research

My exploration and study of pelvic pain began during the fall semester of third year. Though not a direct product of this project, these academic endeavors provided me with the foundation I needed to bring this project to fruition. As part of an Advanced Orthopedic Assessment course, I completed a research paper on chronic pelvic pain and physical therapy’s role in the evaluation and treatment of patients presenting with this complaint. The information included in this paper, including pelvic anatomy and treatment options, were included in the PowerPoint and brochure when appropriate. Additionally, completing a critically appraised topic on interventions for Interstitial Cystitis provided me with additional insight into the management of pelvic pain.

 

Evaluation

Throughout this process, I was able to maintain regular contact with the members of my capstone committee and incorporate their feedback into my educational products. As part of my presentation, I provided participants with a pre and post presentation knowledge assessment. This assessment helped me to gage whether or not the material I presented was provided in an effective manner. Additionally, participants filled out a feedback form. Their feedback was used to make any needed changes to the educational materials and will be incorporated into future presentations. A summary of assessment responses and feedback can be found here.

 

Self-Assessment

Overall, I am quite pleased with the end results of this project. As I have always had a passion for community involvement and education, this endeavor afforded me the opportunity to merge my passions into one project. While I found the process to be relatively smooth, I did encounter some issues along the way. Most notably, my target audience had to shift slightly after my initial contact ended up not working out. However, I appreciated the challenge as it forced me to expand my community contacts and critically evaluate my materials. Additionally, because research into pregnancy-related pelvic pain is rather limited, it was difficult to gather accurate information.

My classmates know that I do not enjoy public speaking in the slightest. No matter how many times I rehearse or how well I know material, I always find myself prone to blunders. I can speak to quickly and get off on tangents, and that makes me nervous. I chose to do a live presentation (as opposed to a recorded one) in an attempt to challenge myself in this regard. Based on the feedback I received, the presentation went quite well and participants seemed to enjoy the content. I found that it was helpful to incorporate some diaphragmatic breathing before beginning, which is comical given the fact that this was part of the presentation itself. Public speaking is something I will continue to work on in the coming years.

It’s not often that I get a chance to share my passion for pelvic health physical therapy with those in the community, and I am grateful that this project took the form that it did. While presenting complex health information in a manner that can be understood by college students was challenging, the feedback I received suggests that my attempt to create accurate and understandable materials was successful.

 

Acknowledgements

This project would not have been possible without such a supportive and knowledgeable capstone committee.

To Kristen Murphy, PT, DPT, thank you for all of your support and guidance over the last year. You took me under your wing, helped me to grow in my clinical skills, and encouraged me to seek answers where there weren’t any. Thank you for responding to my countless emails, for helping me to focus my efforts on an area of need, and for providing vital feedback on this project. I recognize that this project would not exist if you had been there to guide me, and I am forever grateful.

To Mary Connor-Hill, CHES, thank you for being as passionate about this topic as I am and for providing me with the opportunity to present to your group. Your willingness to work with me is very much appreciated, and I truly hope that use this project for the benefit of Planned Parenthood going forward.

To Abbie Marrale, PT, DPT, thank you for your constructive feedback throughout this process and for encouraging my continued study in this subject. This would not have been possible without your input!

I owe a debt of thanks to Dr. Prudence Plummer, my capstone advisor and instructor for Evidence Based Practice II. Researching a topic of interest can be quite the daunting task, and I am so grateful for your thorough instruction on how to construct and execute an effective search. Your knowledge and feedback over the previous year have left me confident in my abilities to search and appraise literature effectively and I believe this will make me a better clinician.

 

References

Image citation: Pelvic Pain Patterns. Brooklyn Gynecological Place. http://www.brooklyngynplace.com/pelvic-pain-obgyn-physicians-downtown-brooklyn-nyc/. Accessed 1 March 2018.

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