Hypopressive-Core Stabilization With and Without Whole-Body Vibration in Postpartum Pelvic Girdle Pain

Pregnancy-related pelvic girdle pain is one of the most frequent musculoskeletal complications of pregnancy and the postpartum period. Its prevalence during pregnancy ranges between 20% and 70%, and about 10% of women still have symptoms beyond three months after delivery (persistent postpartum pelvic girdle pain). It limits walking, stair-climbing, prolonged standing, lifting and turning in bed, just when the demands of caring for a newborn are highest. Hypopressive exercise combines diaphragmatic apnea with a costal expansion manoeuvre to co-activate the transversus abdominis and pelvic floor muscles, core stabilization restores lumbopelvic neuromuscular control, and whole-body vibration (WBV) enhances recruitment of trunk and pelvic stabilizers. However, the combination of these approaches has not yet been investigated in postpartum pelvic girdle pain. This randomized clinical trial will compare hypopressive-core stabilization with WBV (Group A) against hypopressive-core stabilization alone (Group B) on pain, mobility and disability. Thirty postpartum women (15 per group) will be recruited by convenient sampling from physiotherapy centers in Lahore and randomly allocated using sealed opaque envelopes. Both groups will attend 3 supervised sessions per week for a total of 8 weeks (24 sessions), each preceded by a moist hot pack for 15 minutes. Each session combines progressive hypopressive postures with core stabilization exercises (squats, bridge and push-up positions); in Group A the core exercises are performed on a vibrating platform at 25 Hz and 2 mm amplitude. Pain (NPRS), pelvic girdle disability (PGQ) and functional mobility (Timed Up and Go) will be measured by a blinded assessor at baseline, end of week 4 and end of week 8. The whole study will be completed within 8 months after synopsis approval. The findings can assist physiotherapists in implementing evidence-based treatment strategies and contribute to better maternal health outcomes for postpartum women.

Inclusion Criteria: Postpartum women aged 22 to 40 years. Pain located between the posterior iliac crest and the gluteal fold, with or without spread to the back of the thigh and/or the pubic symphysis. Between 6 weeks and 12 months after delivery (puerperium recovery phase). Pain that gets worse with weight bearing, climbing stairs, turning in bed, walking, or parting the legs. Delivered vaginally. Pain score of 3 to 6 on the Numeric Pain Rating Scale (NPRS). At least 3 of 5 standard clinical tests positive (Posterior Pelvic Pain Provocation, Active Straight Leg Raise, FABER, Gaenslen's, and pelvic compression/distraction), confirming clinically significant pelvic girdle dysfunction. Pelvic Girdle Questionnaire (PGQ) score of 28/75 or higher, indicating at least moderate disability. Body mass index between 18 and 35.4 kg/m². Exclusion Criteria: Nerve-related pain that can mimic pelvic girdle pain (for example, lumbar disc herniation or radiculopathy). History of pelvic fracture or severe pelvic trauma, or sciatica due to osteoporosis or other bone disease. Low back pain or pelvic pain that was already present before the index pregnancy. Current pregnancy. Any systemic, metabolic, neurological, or psychiatric condition that would interfere with participation, or active malignancy. Acute deep vein thrombosis, recent pelvic or abdominal surgery, uncontrolled cardiovascular disease, or implanted electronic devices. Inflammatory joint disease such as ankylosing spondylitis or rheumatoid arthritis. Lumbar spine pathology such as disc herniation, nerve root compression, or spondylolisthesis