The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial

Transabdominal ultrasonography-guided biofeedback training for pelvic floor muscles integrated with stabilization exercise improved pregnancy-related pelvic girdle pain and disability: a randomized controlled trial

OBJECTIVES

Investigate effects of integrated training for pelvic floor muscles (PFM) with and without transabdominal ultrasonography (TAUS) imaging-guided biofeedback in postpartum women with pregnancy-related pelvic girdle pain (PPGP).

DESIGN

Three-arm, single-blinded randomized controlled trial SETTING: University laboratory PARTICIPANTS: Fifty-three postpartum women with PPGP randomized into stabilization exercise with TAUS-guided biofeedback (BIO+EXE), exercise (EXE), and control (CON) groups.

INTERVENTIONS

The BIO+EXE and EXE groups underwent an 8-week exercise program, with the BIO+EXE group receiving additional TAUS-guided biofeedback for PFM training during the first 4 weeks. The CON group only received a pelvic educational session.

MAIN OUTCOME MEASURES

Primary outcomes included self-reported pain (numeric rating scale) and disability (pelvic girdle questionnaire). Secondary outcomes included functional tests (active straight leg raising [ASLR] fatigue, timed up-and-go, and 6-meter walking tests) and muscle contractibility indicated by muscle thickness changes for abdominal muscles and bladder base displacement for PFM (ultrasonographic measures).

RESULTS

The BIO+EXE group had lower pain [1.8 (1.5) vs. 4.4 (1.5), mean difference -2.6, 95% confidence interval (CI) -3.9 to -1.2] and disability [14% (10) vs. 28% (21), mean difference -14, 95% CI -25 to -2] and faster walking speed [3.1 seconds (1) vs. 3.3 seconds (1), mean difference -0.2, 95% CI -1.0 to -0.2] than the CON group. The EXE group only had lower pain intensity compared to the CON group [2.7 (2.0) vs. 4.4 (1.5), mean difference -1.7, 95% CI -3.1 to -0.4]. No significant differences were observed among groups in timed up-and-go, ASLR fatigue, or muscle contractibility.

CONCLUSIONS

Integrated training for PFM and stabilization with TAUS-guided biofeedback seems to be beneficial for reducing pain and disability in postpartum women with PPGP. CONTRIBUTION OF THE PAPER.

Suitable Heel Height, a Potential Method for Musculoskeletal Problems during the Third Trimester: A Pilot Study

BACKGROUND

The treatment options for third-trimester musculoskeletal issues are limited. This study aims to examine how heel height affects gait biomechanics and provides heel height recommendations for various musculoskeletal problems.

METHODS

Five third-trimester gravidas were recruited wearing uniform footwear with four heel heights (0 mm, 15 mm, 30 mm, and 45 mm). Lower-limb muscle forces, joint angles, joint torques, joint contact forces, and ground reaction forces (GRF) at specific moments (the first peak, valley, and second peak of GRF) were collected for one-way analysis of variance with repeated measures.

RESULTS

The soleus, gastrocnemius, tibialis posterior, plantaris, obturator externus, gluteus maximus, gemellus superior, and obturator internus were the smallest at heel heights of 45 mm and 15 mm at the valley of GRF. Hip extension and knee flexion displayed the smallest joint angle and joint torques at a height of 15 mm. Ankle joint contact force decreased with increased heel height.

CONCLUSIONS

The height of the heel significantly impacts muscle force, joint angles, joint torques, and joint contact force. A heel of 15 mm might be the most suitable heel height to potentially avoid or alleviate musculoskeletal problems during the third trimester.

Return to Running for Postpartum Elite and Subelite Athletes

CONTEXT

There is little evidence to guide elite athletes who desire returning to competition after giving birth to a child. Ultimately, this can result in decreased performance and increased risk of injury. This paper addresses aspects that must be considered when building and monitoring a return to running program for a postpartum elite or subelite athlete, including pelvic floor and core stability, progressive reloading of the musculoskeletal system, monitoring of nutritional parameters, and considerations for lactation.

EVIDENCE ACQUISITION

PubMed and CINAHL (Cumulative Index for Nursing and Allied Health Literature) were searched with the following search strategy: (extreme sports OR elite athletes OR running OR exercise) AND (breastfeeding OR lactation OR bone density OR fetal weight OR gestational weight gain OR postpartum or post-partum OR postnatal OR post-natal OR pregnancy OR childbirth). The following information is based on best available evidence and clinical experience.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Due to the interplay between cardiovascular fitness, postpartum nutrition, lactation, and progressive reloading of the muscular and skeletal system, we propose a multimodal, multidisciplinary approach to safely and successfully allow an athlete to return to an elite level of competition.

CONCLUSION

Return to running in the postpartum period is a highly individualized process that benefits from multidisciplinary, individualized care. This includes monitoring of nutrition, core and pelvic floor function, bone reloading, muscle and tendon reloading, and breastfeeding care when applicable.

STRENGH OF RECOMMENDATION TAXONOMY (SORT)

C.

[Medical recommendations from primary care on physical exercise in the postpartum]

There is evidence that demonstrates the benefits of practicing physical activity/exercise for the mother after childbirth. However, this postpartum period (PP) is often a missed opportunity in a lifetime for women to start or resume physical exercise and get the great benefits that it can bring them. The objective of this article was to analyze the benefits of physical exercise during PP; the prescription of physical exercise; recommendations on when to resume your practice; barriers and facilitators; physical exercise during breastfeeding; as well as its role in the most frequent illnesses and discomforts in this period, always keeping in mind that the work of the primary care doctor is essential to motivate and encourage women to perform physical exercise in the PP.

Knowledge Mapping Analysis of Research on Pregnancy-Related Pelvic Girdle Pain (PPGP) from 2002 to 2022 Using Bibliometrics

Background

Pregnancy-related Pelvic Girdle Pain (PPGP) is a prevalent condition characterized by various physiological and pathological processes in the female body. The objective of this study is to offer a comprehensive understanding of the current research landscape, key areas of interest, and potential future directions in the field of PPGP.

Methods

Using Web of Science, we explored PPGP literature from 2002 to 2022. VOSviewer and CiteSpace facilitated a quantitative analysis, revealing co-authorship patterns, co-occurring themes, citations, and co-citations.

Results

We identified, peaking at 99 publications in 2021. The United States led with 138 publications and the highest citation count (3160). The Karolinska Institute boasted the highest tally of publications (n = 21). Regarding the volume of publications, the esteemed journal of BMC Pregnancy and Childbirth attained the foremost position. Notably, Gutke, Annelie emerged as the most prolific and highly cited author. The analysis of keyword co-occurrence and co-citation clustering unveiled an intricate tapestry of PPGP studies, spanning various domains including risk factors, mechanistic intricacies, diagnostic benchmark, treatment modalities, and far-reaching ramifications on one's quality of life.

Conclusion

Research endeavors exploring PPGP have unveiled an enduring trajectory of growth in contemporary times. The existing body of research primarily focuses on delving into the intricate interplay of epidemiological factors and the profound implications of interventions encompassing physical therapy, exercise protocols, and diverse modes of pain management within the domain of PPGP. Multidisciplinary integration encapsulates a prevailing trajectory of progress within this domain, while the focal point of future inquiries into PPGP may revolve around subjects pertaining to standardized outcome reporting.

Effects of Movement Retraining and Lumbar Stabilization Exercises in Mechanical Low Back Pain: A Pilot Study

Objective To determine and compare the effects of movement retraining (MR), lumbar stabilization exercises (LSE), and a combination of both these exercises on pain, flexibility, strength, and functional disability in chronic mechanical low back pain (CMLBP) patients. Materials and methods Fifteen CMLBP participants, aged 20-40 years, were randomly allocated into three groups. Group A (n=5) received MR, group B (n=5), LSE, and group C (n=5), a combination of MR and CSE, along with hot packs for eight weeks, thrice a week on alternate days. Outcomes used were the Numerical Pain Rating Scale (NPRS), Modified Modified Schober's Test (MMST), Pressure Biofeedback (PBU), Roland Morris Disability Questionnaire (RMDQ), and Movement Control (MC) dissociation tests to identify MC impairments and were assessed at pre-intervention, post-four weeks, and post-eight weeks. The data were analyzed using repeated measures ANOVA. The level of significance was considered at p-value<0.05. Results Participants with CMLBP significantly improved in all variables in all three groups (p-value≤0.05). On inter-group comparison, group A showed better improvement in lumbar extension range of motion than the other two groups, with a mean difference of MMST in group A of 0.62±0.30, group B of 0.52±0.22, and group C of 0.36±0.02, with a p-value ≤0.002. Group C showed more improvement in core strength, with a mean difference of 5.0±0.25 in group A, 3.2±0.56 in group B, and 5.2±0.57 in group C, with a p-value ≤0.03. A significant improvement was observed in NPRS, MMST flexion, RMDQ, and uncontrolled movements (UCMs). Conclusion All three methods of treatment are effective in the management of CMLBP. Clinically, kinetic control showed better improvement in reducing pain and improving lumbar flexion and extension range of motion. Functional disability was better improved with lumbar stabilization exercises, and core strength was improved with a combination of KC and LSE. However, a combination of MR and LSE helps improve core strength, and movement retraining improves lumbar extension.

The Influence of Physical Activity during Pregnancy on Maternal Pain and Discomfort: A Meta-Analysis

Pregnant women may experience pain and discomfort during pregnancy, especially in areas such as the lower back and pelvic girdle. Pain in pregnancy is associated with poor quality of life, and because it is a common occurrence, pregnant women may be offered several resources to prevent discomforts throughout pregnancy, such as engaging in physical activity. This study was a meta-analysis of randomised controlled trials (prospectively registered in Prospero, registration number: CRD42023451320) aimed to assess the effects of physical activity during pregnancy on maternal pain and discomfort. We analysed 16 randomised clinical trials. The results of these analyses indicate that women who performed physical activity had significantly less intensity of pain (z = <2.69, p = <0.007; SMD = -0.66, 95% CI = -1.13, -0.18, I2 = <91%, Pheterogeneity = <0.001) and a reduction observed in the disability questionnaire (z = <2.37, p = <0.02; SMD = -0.80, 95% CI = -1.47, -0.14, I2 = <91%, Pheterogeneity = <0.001), and overall reduced general pain (z = <3.87, p = <0.001; SMD = -0.56, 95% CI = -0.84, -0.27, I2 = <86%, Pheterogeneity = <0.001) than women who did not practice physical activity during pregnancy. In conclusion, physical activity during pregnancy could effectively help to diminish pain intensity, reduce disability due to pain, and generally reduce pain.

Gap between the prevalence of and consultation rate for lumbopelvic pain in postnatal Japanese women

BACKGROUND

We aimed to assess the prevalence of lumbopelvic pain (LPP), including low back pain (LBP) and/or pelvic girdle pain (PGP), consultation rate, and desire for treatment of postnatal Japanese women.

METHODS

We performed a cross-sectional study of 98 postnatal Japanese women within 1 year of childbirth. We retrospectively evaluated the prevalence of LBP before and during pregnancy and the prevalence of LPP after childbirth using a self-administered questionnaire. We used the distribution of pain to differentiate LBP and/or PGP after childbirth and its intensity was assessed using a visual analogue scale. The effects of LPP on daily life were assessed using the Oswestry disability index (ODI). In addition, we assessed the consultation rate for LPP and the desire to consult a healthcare professional, using self-administered questionnaires.

RESULTS

The prevalence of LPP after childbirth was 66%. Women with a history of LBP before and during pregnancy were more likely to have LPP following childbirth (both P < 0.001). The consultation rate among the postnatal women with LPP was 9%, but 56% of the women wished to consult a healthcare professional. The ODI score was significantly higher in postnatal women who wanted to consult a healthcare professional than in those who did not (P < 0.01).

CONCLUSIONS

Two thirds of the postnatal Japanese women who participated in this study had LPP, but the consultation rate was low. However, more than half of these women had the desire to consult a healthcare professional.

Is Pregnancy-Related Lumbopelvic Pain Reported to Health Care Providers?

Background: Pregnancy-related lumbopelvic pain (PLPP) is a common ailment during pregnancy with physical, psychosocial, and economic consequences. Despite being common, prior literature has found that this symptom is widely underreported and therefore undertreated, especially in the United States. The objectives of this study were to determine the proportion of pregnant women who report PLPP during pregnancy to their health care providers (HCPs) and to determine what contributing factors for reporting exist. Materials and Methods: This is a cross-sectional survey design and was conducted at an academic medical center. All pregnant women attending a prenatal visit in obstetrical offices from July 2018 through March 2020 were asked to complete a questionnaire compiling demographic and socioeconomic information, answer validated survey instruments measuring physical and urinary function, and describe any pain, including intensity, frequency, and whether they told their HCPs about these symptoms and received any treatments. Results: Of the 538 respondents who had PLPP, only 43% (n = 233) reported PLPP to their provider. Of those who reported PLPP, 22% (n = 51) received treatment, of which 80% (n = 41) noted that treatment was effective. Factors that increased the likelihood of informing HCPs about PLPP were difficulty with daily mobility and a greater week of gestation. Conclusions: HCPs should inquire about PLPP throughout pregnancy. Any level of PLPP should be reported and monitored by a patient's HCP, and if it is interfering with activities of daily living, sleeping, or quality of life, it should be treated.

The Impact of Functional Stability Exercises on Alleviating Pelvic Girdle Pain in Pregnancy: A Review

Pelvic girdle pain (PGP) during pregnancy is a major source of stress for mothers. This review summarizes studies on the effectiveness of functional stability exercises (FSEs) in preventing PGP during pregnancy. FSE is a rising area of study in maternal health, focusing on core muscle groups and addressing the biomechanical changes during pregnancy. Although data shows that FSE may relieve PGP and improve the quality of life in pregnant women, the research landscape is defined by limitations and differences in intervention parameters among studies, resulting in contradictory conclusions. As a result, the efficacy of FSE in pregnant women with PGP remains inconclusive. This review can help comprise the existing research on FSE alleviating PGP in pregnancy to provide full knowledge on the topic, analyze long-term effects, and develop practice guidelines. While FSE shows promise, treating the multidimensional nature of PGP in pregnancy requires a comprehensive approach to therapy that incorporates several therapeutic modalities.

Potential role of thoracolumbar fascia in younger middle-aged patients with chronic low back pain

AIM

This study aimed to quantitatively assess the thickness of the thoracolumbar fascia (TLF) and lumbar multifidus muscle through ultrasound imaging in younger-middle aged individuals, both those experiencing chronic low back pain (LBP) and those without LBP. Additionally, the study sought to explore the potential significance of these anatomical structures in relation to clinical and sonographic findings.

METHOD

A cross-sectional study was conducted involving a cohort of 50 participants, divided into two groups: chronic LBP group (Group LBP, n = 30) and a group without LBP (Group control, n = 20). Participants from both groups underwent assessments pertaining to pain characteristics (intensity and quality), functional impairment, and kinesiophobia. The thicknesses of the thoracolumbar fascia and lumbar multifidus muscle were measured using ultrasonography.

RESULTS

Among participants with chronic LBP, the thoracolumbar fascia displayed a statistically significant increase in thickness on the left side, whereas the lumbar multifidus muscle exhibited reduced thickness on the left side. Notably, positive correlations were observed between the thickness of the thoracolumbar fascia and scores from the Numerical Rating Scale (NRS) for pain intensity (r = 0.472, p = 0.008) as well as the McGill Pain Questionnaire (MPQ) (r = 0.547, p = 0.002). Moreover, a positive correlation was established between the thickness of the lumbar multifidus muscle and the modified Schober test (r = 0.174, p = 0.040). However, the thickness of the lumbar multifidus muscle demonstrated a negative correlation with age (r = -0.304, p = 0.032). Multiple logistic regression analysis did not identify any significant predictors for the presence of LBP based on demographic or clinical variables.

CONCLUSIONS

Individuals afflicted with chronic LBP exhibited pronounced thickening of the thoracolumbar fascia and attenuation of the lumbar multifidus muscle in comparison to asymptomatic counterparts. Notably, increased thickness of the thoracolumbar fascia corresponded to heightened pain intensity, while reduction in lumbar multifidus muscle thickness was associated with decreased lumbar flexion ability. These findings underscore the importance of incorporating tailored regimens targeting both fascial and muscular components in the rehabilitation of individuals with LBP.

Effect of Core Stabilization Exercises on Pain, Functional Disability, and Quality of Life in Pregnant Women With Lumbar and Pelvic Girdle Pain: A Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to assess the effect of adding core stability to usual care for pregnant women with lumbar and pelvic girdle (LPG) pain.

METHODS

This was a repeated-measures design randomized controlled trial with blinded outcome assessors. Thirty-five pregnant women with LPG pain were recruited from prenatal health care providers. They were allocated to 2 study groups to receive either usual prenatal care (control group, n = 17) or usual care with core stability exercises focusing on the pelvic floor muscles and deep abdominal muscles (exercise group, n = 18) for 10 weeks. The visual analog scale, score on the Oswestry Disability Index, and the World Health Organization's Quality of Life Brief Version (WHOQOL-BREF) were evaluated with analysis of variance at pre-intervention, post-intervention, at the end of pregnancy, and 6 weeks after childbirth.

RESULTS

There was a statistically significant interaction of group and time for all outcome measures except for the Social category (P = .18) in the WHOQOL-BREF questionnaire. The analysis of the group within time showed that mean scores in the exercise group were substantially improved at the post-intervention, end of pregnancy, and 6-week follow-up evaluation, except in the Environment category (end of pregnancy: P = .36; 6-week follow-up: P = .75) in the WHOQOL-BREF questionnaire.

CONCLUSION

The results of this study indicate that the addition of core stability exercises was more effective than the usual care alone in pain relief, improving disability, and quality of life of pregnant women with LPG pain.

Pelvic Girdle Pain in Pregnancy: A Review

Importance

Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies.

Objective

The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain.

Evidence Acquisition

Electronic databases (PubMed and Embase) were searched from 1980 to 2021 with the only limitation being that the articles were in English. Studies were selected that examined associations between pelvic pain/pelvic girdle pain and pregnancy.

Results

There were 343 articles identified. After reviewing the abstracts, 88 were used in this review. Pelvic girdle pain is a common condition of pregnancy, affecting a reported 20% of pregnant women. The pathophysiology is poorly understood and likely multifactorial, involving both hormonal and biomechanical changes that occur during pregnancy. Several risk factors have been identified. This diagnosis is most commonly made based on symptoms related to pelvic pain during pregnancy. Treatment should be multimodal, including pelvic girdle support, stabilizing exercises, analgesia, and potentially complementary therapies. The effects on future pregnancies are uncertain, although some limited information suggests an increased risk of recurrent PGP in subsequent pregnancies.

Conclusions

Pelvic girdle pain in pregnancy is a common condition that is often overlooked as a normal part of pregnancy but has a significant impact on quality of life during, after, and in subsequent pregnancies. Multimodal therapies are available and are largely low cost and noninvasive.

Relevance

Our aim is to increase the awareness of pelvic girdle pain in pregnancy as a common but often underdiagnosed and undertreated condition.

The effect of pelvic floor muscle-strengthening exercises on low back pain: a systematic review and meta-analysis on randomized clinical trials

BACKGROUND

Low back pain is a musculoskeletal disorder (MSD), and Kegel exercise is considered as one of the non-surgical management methods. Therefore, the present systematic review and meta-analysis aimed to estimate the results of randomized clinical trials (RCT) about the effect of pelvic floor muscle-strengthening exercises on reducing low back pain‏.‏ METHODS: The present study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline (2020) to January 2022. The relevant studies were searched in the MagIran, SID, PubMed, Embase, Web of Science (WoS), Scopus, ClinicalTrials.gov databases and Google Scholar motor engine using related MeSH/Emtree terms, which were combined with free text word. The heterogeneity of the studies was checked using I² statistic.

RESULTS

Finally, 19 RCTs with a sample size of 456 subjects in the intervention group and 470 in the control group were included in the meta-analysis. The low back pain intensity in the intervention group decreased up to 1.261 ± 0.213 (SMD ± 95% CI) with I² = 87.60 more than that in the control group (P <0.001). The low back pain intensity in postpartum women decreased up to 1.614 ± 0.312 (95% CI) followed by pregnant women as 1.282 ± 0.479 (SMD ± 95% CI) more than that in other populations. But due to high the heterogeneity in all sub-groups (I² > 80%) this result should be considered with caution. Meta-regression analysis showed the effect of pelvic floor muscle-strengthening exercises increased by increasing the year of publication, quality assessment score of the article, and the number of weeks of intervention (P<0.05).

CONCLUSION

Based on the results of the present meta-analysis, pelvic floor muscle-strengthening exercises significantly reduce the low back pain intensity. Therefore, these exercises can be regarded as a part of a low back pain management plan.

EFFECTS OF SLING EXERCISE ON THE CORE ENDURANCE AND PERFORMANCE OF BASKETBALL PLAYERS

ABSTRACT Introduction Strong core stability and strength enable the trunk to transfer the maximum amount of torque to the terminal segments, which is conducive to improving athletic performance. Because sling training is a new core exercise method, its effect on trunk endurance relative to basketball performance has rarely been studied. Objective To investigate whether a core exercise program in a specific sports group can improve core and sports-specific performance. Methods A total of 40 college students majoring in basketball were randomly assigned to training and control groups. A standardized set of core endurance and basketball-specific performance tests were used to determine and assess the effects of sling training on trunk strength, endurance, and control. Results Flexor, extensor, and right and left lateral trunk flexor muscles endurance were significantly greater in the training group than in the control group, and the time to complete the layup obstacle course was shorter than in the control group at the end of the training program, p<0.01. No differences between the two groups were found in the penalty shot, the fixed position shot, or the vertical jump and reach at the end of the training program. Conclusions Sling exercises can improve the core endurance and strength of basketball players and increase the speed of lay-ups over obstructions. Level of evidence I; Randomized clinical trial.

Motor control of the spine in pregnancy-related lumbopelvic pain: A systematic review

BACKGROUND

Some studies observed differences in motor control of the spine between women with pregnancy-related lumbopelvic pain and matched controls. Understanding alterations in spine motor control may help optimizing treatment in this population. The objective is to determine if there are differences in motor control of the spine in pregnant and post-partum women with and without pregnancy-related lumbopelvic pain.

METHODS

Five databases were searched: MEDLINE, Embase, CINAHL, Web of Science and Evidence-Based Medicine Reviews (last search: February 4th 2021). Observational studies that compared motor control of the lumbopelvic spine (in terms of muscle activation [e.g. using EMG or ultrasound imaging] or kinematics) between women with pregnancy-related lumbopelvic pain and matched controls were included. Risk of bias was assessed with a modified version of STROBE statement for cross-sectional studies. No meta-analysis was performed.

FINDING

Fifteen studies were included. Compared to matched controls, pregnant women with pregnancy-related lumbopelvic pain showed differences in lumbar spine kinematic during walking and lifting, although not consistent between studies. The only consistent results were higher transversus abdominis muscle activation during leg movements in post-partum pregnancy-related lumbopelvic pain. Differences in pelvic floor muscle function was inconsistent.

INTERPRETATION

This systematic review identified multiple differences in motor control in pregnancy-related lumbopelvic pain population, predominantly in dynamic tasks. However, consistent differences in lumbopelvic spine motor control were rare. More studies are necessary to determine if motor control is different in pregnancy-related lumbopelvic pain to better understand alteration in motor control and to optimize the efficacy of rehabilitation treatments.

Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials

BACKGROUND

Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain.

OBJECTIVE

This review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin.

METHODS

This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review.

RESULTS

Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1 week to 2 years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [-0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD =-0.07 [-0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD =-1.78 [-2.49, -1.07]; 95%CI) and lessened disability (SMD =-1.80 [-3.03, -0.56]; 95%CI) at short-term.

CONCLUSION

Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.

The Effect of Core Exercise Using Online Videoconferencing Platform and Offline-Based Intervention in Postpartum Woman with Diastasis Recti Abdominis

To investigate the efficacy of exercise intervention using a real-time video conferencing platform (ZOOM) on inter-recti distance, abdominal muscle thickness, static trunk endurance, and maternal quality of life, 37 women with diastasis recti between six months and one year postpartum were randomly divided into the online (n = 19) and offline (n = 18) groups. The online group underwent 40-min trunk stabilization exercise sessions twice a week for six weeks, through a real-time video conference platform, while the offline group attended the same program in person. The inter-recti distance and muscle thickness between the abdominal muscles were measured by rehabilitation ultrasound imaging, the Torso endurance test was used to compare the static trunk endurance, and the maternal quality of life questionnaire (MAPP-QOL, score) was applied. Significant improvements were observed in the inter-recti distance between the rectus abdominis, abdominal muscle thickness, static trunk endurance, and maternal quality of life in both groups (p < 0.001); a more significant improvement was observed in the offline group. No significant differences were observed between groups except for the left rectus abdominis thickness and Psychological/Baby and Relational/Spouse-Partner subscale in the maternal quality of life index (p > 0.05). Exercise interventions delivered in a real-time videoconferencing platform are effective at improving the inter-recti distance, trunk stability, and quality of life in postpartum women and may be an alternate to face-to-face intervention.

Effects of a motor control exercise program on lumbopelvic pain recurrences and intensity in pregnant women with a history of lumbopelvic pain: a study protocol for a randomized controlled feasibility trial

Background

About 50% of women experience lumbopelvic pain (LBPP) during their pregnancy. LBPP has negative repercussions on sleep, social and sexual life, physical and work capacity, and psychological health and contributes to physical inactivity. The benefits of LBPP prevention or treatment in pregnant women through specific exercises should therefore be further investigated. This study protocol has been designed to establish the feasibility of implementing motor control exercise program with pregnant women presenting with a history of LBPP.

Methods/design

Forty pregnant women with a history of LBPP will be recruited and randomly allocated to a control (20 participants) or intervention (20 participants) group. The control group will receive standard prenatal care, including basic information on what to do when suffering from LBPP. The intervention group will participate in three 40-min exercise sessions per week from < 20 weeks until 34–36 weeks of gestation: one supervised group session via the Zoom platform (once a month, this session will take place at the Université du Québec à Trois-Rivières) and two unsupervised sessions at home. A motor control exercise program will be developed to target strengthening of the lumbo-pelvic-hip core muscles and improve spinal and pelvic stabilization. Participants of this group will also receive standard prenatal care. Women of the control group will receive after 6 weeks postpartum an exercise program designed to reduce LBPP they may have developed during pregnancy and that may persist after delivery. Primary outcomes will be participants’ recruitment, retention and adherence rates, safety, and acceptability of the intervention. Secondary outcomes will include LBPP incidence, frequency, and intensity, as well as self-reported functional disability, physical activity levels, fear avoidance behavior, anxiety, and depression.

Discussion

This study will inform the feasibility of conducting a full-scale randomized controlled study to test the effectiveness of a motor control exercise program on the prevention and treatment of LBPP in women with a history of LBPP. Adequate prevention and treatment of pregnant women with a history of LBPP should help limit the recurrences of LBPP or the aggravation of its intensity during pregnancy.

Trial registration

US National Institutes of Health Clinical Trials registry NCT04253717 April 27, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01024-0.

Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy

There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.

Spine Injury Prevention

Spinal injury and back pain are a common problem facing patients seeking medical care including athletes, which can lead to significant disability, medical costs, and impaired performance for these patients. Rehabilitation including core muscle stabilization, Kinesio taping, and flexibility have been shown to help with treatment and prevention. Critical factors such as equipment, technique, and rule changes can also be an important part of spine injury prevention.

Telerehabilitation for pelvic girdle dysfunction in pregnancy during COVID-19 pandemic crisis: A case report

Background: Pelvic girdle dysfunction is a common musculoskeletal disorder among pregnant women. It is a disabling condition affecting the ability of a pregnant woman to perform her daily functional activities. The scope of digital health in delivering rehabilitation services is growing exponentially, especially in the present COVID -19 pandemic crisis.Case description: A 29-year-old primigravida, at 32 weeks of gestation with severe pelvic girdle pain during bed transitions, sought physiotherapy consultation via video call, as she expressed difficulty in accessing Physiotherapy services due to the present pandemic crisis. Physiotherapy consultation was provided in 4 weekly sessions using a real-time video-based telerehabilitation program and the patient performed unsupervised exercise sessions for 30 minutes for 5 days per week for 4 weeks. The plan of care included muscle energy techniques, pelvic cloth belt, strengthening, stabilization exercises and stretching.Outcomes: The patient completed four sessions including evaluation and treatment and there was a reduction of pain scores for bed transitions from NPRS 8/10 during session one to NPRS 0/10 during session four. The Pelvic girdle dysfunction questionnaire showed a decrease in percentage scores from 54.6 to 4 at the end of physiotherapy sessions.Conclusion: Telerehabilitation was successfully used to manage a pregnant woman with pelvic girdle dysfunction.

International Society for the Advancement of Spine Surgery Policy 2020 Update-Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity

The index 2014 International Society for the Advancement of Spine Surgery Policy Statement-Minimally Invasive Surgical Sacroiliac Joint Fusion-was generated out of necessity to provide an International Classification of Diseases, Ninth Revision (ICD-9)-based background and emphasize tools to ensure correct diagnosis. A timely ICD-10-based 2016 update provided a granular threshold selection with improved level of evidence and a more robust and relevant database (Appendix Table A1). As procedures and treatment options have evolved, this 2020 update reviews and analyzes the expanding evidence base and provides guidance relating to differences between the lateral and dorsal surgical procedures for minimally invasive surgical sacroiliac joint fusion.

A painful unknown: sacroiliac joint diagnosis and treatment

The sacroiliac joint (SIJ) is a complex anatomical structure located near the centre of gravity of the body.

Micro-traumatic SIJ disorders are very difficult to diagnose and require a complete clinical and radiological examination.

To diagnose micro-trauma SIJ pain it is recommended to have at least three positive provocative specific manoeuvres and then a radiologically controlled infiltration test.

Conservative treatment combining physiotherapy and steroid injections is the most common therapy but has a low level of efficiency. SIJ thermolysis is the most efficient non-invasive therapy.

SIJ fusion using a percutaneous technique is a solution that has yet to be confirmed on a large cohort of patients resistant to other therapies.

Cite this article: EFORT Open Rev 2020;5:691-698. DOI: 10.1302/2058-5241.5.190081

Common musculoskeletal impairments in postpartum runners: an international Delphi study

Background

Postpartum runners report musculoskeletal pain with running. Because of inadequate research, little is known about the origin and pain-related classification. Through expert consensus, this study is the first attempt to understand the musculoskeletal impairments that these runners present with. The objective of this survey was to gather expert consensus on characteristics of reported impairments in postpartum runners that have musculoskeletal pain.

Methods

A web-based Delphi survey was conducted and was composed of five categories: strength, range of motion, alignment and flexibility impairments, as well as risk factors for pain in postpartum runners.

Results

A total of 117 experts were invited. Forty-five experts completed round I and forty-one completed rounds II and III. The strength impairments that reached consensus were abdominal, hip and pelvic floor muscle weakness. The range of motion impairments that reached consensus were hip extension restriction, anterior pelvic tilt and general hypermobility. The alignment impairments that reached consensus were a Trendelenburg sign, dynamic knee valgus, lumbar lordosis, over-pronation and thoracic kyphosis. The flexibility impairments that reached consensus were abdominal wall laxity, and tightness in hip flexors, lumbar extensors, iliotibial band and hamstrings. The risk factors for pain in postpartum runners were muscular imbalance, poor lumbopelvic control, too much too soon, life stressors, pain during pregnancy and pelvic floor trauma.

Conclusion

This study presents a framework for clinicians to understand pain in postpartum runners and that can be investigated in future cohort studies.

Level of evidence

5.

The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review

Longstanding (chronic) adductor-related groin pain syndrome is a widely common problem for athletes in many sports activities which often drastically reduces player activity and performance. The first choice in therapeutic treatment is conservative therapy. The objective of this study is to provide a systematic review regarding conservative treatment for longstanding adductor-related groin pain syndrome present in literature today. Furthermore, this study aims to give a critical vision of the current state of the art of the considered topic. After screening 234 articles, 19 studies following the inclusion criteria were included and summarized in this current systematic review and seven different types of therapeutic interventions were described. Compression clothing therapy, manual therapy together with strengthening exercise and prolotherapy were the therapeutic interventions which showed both the greatest level of strength of evidence (Moderate) and grade of recommendation (D). The remaining four types of therapeutic interventions i.e.: corticoid injection, platelet rich plasma therapy, intra-tissue percutaneous electrolysis and pulse-dose radiofrequency, showed both lower levels of strength of evidence (Conflicting) and grade of recommendation (C). In conclusion the literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence. Therefore, our recommendation is to refer only to the few studies with higher level of evidence and at the same time to encourage further research in this area. The intervention showing the greater level of strength of evidence, and the greater grade of recommendation are compression clothing therapy, manual therapy and strengthening exercise, and prolotherapy. Other therapeutic interventions such as intra-tissue percutaneous electrolysis and pulse-dose radiofrequency seem promising but require further studies to confirm their efficacy.

The association between sacral morphology and sacroiliac joint conformity demonstrated on CT-based bone models

INTRODUCTION

Knowledge of the stress distribution on structures around the sacroiliac joint (SIJ) is required to treat or prevent SIJ disorders. The purpose of this study was to reveal the association between sacral morphology and SIJ conformity.

MATERIALS AND METHODS

This cross-sectional study included 11 adult patients with unilateral SIJ pain who underwent computed tomography (CT) imaging of the pelvis. Bony coordinate systems for the sacrum and innominates were embedded using anatomical landmarks. Local coordinate systems for the auricular surfaces of the sacrum and innominate were also defined. Conformity of the SIJ was quantified by the offset of the coordinate systems between the auricular surfaces of the sacrum and innominate. Repeated measure ANOVA and multiple regression analysis were used for statistical analyses.

RESULTS

There were large variations across subjects in sacral morphology and SIJ conformity. There were no differences in any of the six degrees-of-freedom positions or orientations of the bilateral sacral and innominate auricular surfaces between the symptomatic and asymptomatic sides. The SIJ downward rotation on the asymptomatic and symptomatic sides were 0.0 [-1.0, 1.1]° and 2.1 [1.2, 3.0]°, respectively. Smaller downward rotation of the sacral auricular surface based on the sacral bony coordinate system had significant association with the greater SIJ downward rotation (standard partial regression coefficient: -.44, p = .043).

CONCLUSIONS

The results indicate that the morphology of the sacrum is associated with poor SIJ conformity and that separation of the superior portion of the SIJ can be a risk factor for SIJ pain.

Effect of different exercise programs on non-specific chronic low back pain and disability in people who perform sedentary work

BACKGROUND

This study compared the short- and long-term effects of different exercise programs on lumbar muscle function, cross-sectional area of the multifidus muscle, functional disability and low back pain in people who perform sedentary work.

METHODS

A total of 70 volunteer women with sedentary occupations suffering from low back pain were randomized to either the lumbar stabilization exercise program group or the lumbar muscle strengthening exercise program group. All subjects entered the 20-week exercise programs. The measurement of the cross-sectional area of the multifidus muscle was executed by using an ultrasound system, isokinetic peak torque was measured applying an isokinetic dynamometer.

FINDINGS

The results indicated that the 20-week exercise programs reduced low back pain and functional disability. Positive effects for the cross-sectional area of the multifidus muscle, functional disability and low back pain lasted for 4 weeks after the application of lumbar muscle strengthening exercise program and for 12 weeks after the application of lumbar stabilization exercise program. The lumbar muscle strength increased and lasted for 8 weeks after both exercise programs.

INTERPRETATION

The 20-week lumbar stabilization exercise and muscle strengthening exercise programs were efficacious in decreasing LBP and functional disability in people performing sedentary work, however the lumbar stabilization exercise program was more effective, and this effect lasted for 12 weeks after completion of the program.

Effects of lumbar stabilization and muscular stretching on pain, disabilities, postural control and muscle activation in pregnant woman with low back pain

BACKGROUND

Low back pain is common during pregnancy. Lumbar stabilization and stretching exercises are recommended to treat low back pain in the general population. However, few studies have applied the effects of these two interventions in pregnant women with low back pain.

AIM

To compare the effects of lumbar stabilization and stretching exercises for the treatment of gestational low back pain.

DESIGN

A pilot randomized clinical trial.

SETTING

Laboratory of Functional Evaluation and Human Motor Performance and physical therapy clinics.

POPULATION

Initially, 30 pregnant women with low back pain were recruited, of which 24 met the following inclusion criteria: being between 19-29 weeks of gestation; being in prenatal clinical follow-up; having nonspecific mechanical low back pain started in pregnancy; not participating in specific low back pain treatment in the last 3 months. A total of 20 women completed the study (10 each group).

METHODS

The main outcome measures were clinical (pain by Visual Analogue Scale (VAS) and McGill Pain Questionnaire and disability by Roland Morris Questionnaire), and secondary outcome measures were: postural balance (force platform); muscle activation level of multifidus, iliocostalis lumborum, rectus abdominis and external abdominal oblique (electromyography). The women were randomized into two groups for 6 weeks of intervention twice a week for a 50-minute treatment: 1) lumbar stabilization exercise protocol and 2) stretching exercise protocol.

RESULTS

There was a significant reduction (P=0.03) in pain (1.68 in VAS and 4.81 for McGill questionnaire) for both interventions, but no change in disability score. In addition, both interventions were comparable for a significant improvement in postural stability (in mean d=0.77) for the velocity sway parameter, and significantly increased activation (P>0.05) of the external abdominal oblique muscle after intervention.

CONCLUSIONS

Both modalities (lumbar stabilization and stretching) were efficient for pain reduction, improving balance and increasing one trunk activity muscle after 6 weeks of intervention in pregnant women with low back pain.

CLINICAL REHABILITATION IMPACT

The present study has implications, especially for clinical decision-making with regard to therapy choice in pregnant women with LBP to reduce pain and improve trunk function as measured through balance performance.

Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial

BACKGROUND

Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women.

OBJECTIVE

This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP.

METHODS

Forty postpartum women participated in the study. Their age ranged from 25-35 years and their body mass index (BMI) was 25-29.9 kg/m2. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively.

RESULTS

Both groups (A and B) revealed a significant decrease (p= 0.001) in pain and functional disability and a significant increase (p= 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p= 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A).

CONCLUSIONS

PFM training should be an essential part in rehabilitation programs of PGP postpartum.

Effects of exercise therapy for pregnancy-related low back pain and pelvic pain: A protocol for systematic review and meta-analysis

BACKGROUND

Pregnancy-related low back pain (PLPB) and pelvic pain (PP) are common in pregnancy. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Women commonly utilize complementary exercise therapies such as yoga, motor control exercises, breathing exercises, core stability exercise, pelvic stability exercise, and so on to manage their symptoms. However, it is currently unknown whether exercise produces more beneficial effects than other treatment in patients with PLPB and PP. The aim of this study is to explore the therapeutic effect of exercise for pregnancy-related low back pain and PP.

METHODS

This review will only include randomized controlled trials. Published articles from July 1999 to July 2019 will be identified using electronic searches. Search strategy will be performed in 3 English databases, 1 Chinese database, and the World Health Organization International Clinical Trials Registry Platform. Two reviewers will screen, select studies, extract data, and assess quality independently. The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool and Physiotherapy Evidence Database scale. Review Manager Software (Revman5.3) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence.

RESULTS

We will provide some more practical and targeted results investigating the effect of exercise therapy (ET) for PLPB and PP in the current meta-analysis. Meanwhile, we will ascertain study progress of ET for PLPB and PP and find out defects or inadequacies of previous studies, so that future researchers could get beneficial guidance for more rigorous study.

CONCLUSION

The stronger evidence about PLPB and PPs rehabilitative effect and safety will be provided for clinicians and policymakers.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD 42017075099.

A prospective quasi-experimental controlled study evaluating the use of dynamic elastomeric fabric orthoses to manage common postpartum ailments during postnatal care

OBJECTIVE

To evaluate the effectiveness of a postnatal dynamic elastomeric fabric orthoses to manage postpartum pain, improve functional capacity and enhance the quality of life arising from postnatal ailments immediately to an 8-week postpartum, compared with patients who did not wear dynamic elastomeric fabric orthoses.

METHOD

A total of 51 postpartum women were recruited (day 0 to 10 days post-delivery) from hospitals and community-based health clinics to participate in a prospective quasi-experimental controlled study using parallel groups without random allocation. The subgroup of the compression shorts group wore SRC recovery shorts and received standard postnatal care. The comparison group received standard postnatal care alone. Wear compliance was monitored throughout the study. Primary outcome measure, Numeric Pain Rating Scale, and secondary outcome measures, Roland Morris Disability Questionnaire, Pelvic Floor Impact Questionnaire-7, and Short Form (SF-36) were assessed fortnightly over 8 weeks for both groups.

RESULTS

The compression shorts group reported a larger reduction in mean (SD) Numeric Pain Rating Scale score (-3.09 (2.20)) from baseline to 8 weeks, compared to the comparison group (-2.00 (1.41)). However, there was insufficient evidence of a statistical difference in Numeric Pain Rating Scale score at 8 weeks when comparing the compression shorts group and comparison group (-1.17; 95%CI: (-2.35, -0.01), R2 = .19, p = .050). The compression shorts group met the wear compliance of the dynamic elastomeric fabric orthoses and reported an average wear of the dynamic elastomeric fabric orthoses as 9 out of 14 days for 11 h per day (SD 4.8 h) between the fortnightly timepoints.

CONCLUSION

The use of dynamic elastomeric fabric orthoses may be considered during postnatal care as a non-pharmacological therapeutic intervention to manage pain resulting from common postpartum ailments. While the dynamic elastomeric fabric orthoses was clinically well accepted by participants with high wearing compliance, future research with larger population samples are needed to enable statistical conclusions on the effectiveness of a dynamic elastomeric fabric orthoses in postnatal care to be made.

REGISTRATION

Trial registration was not required as per the Australian Government Department of Health, Therapeutic Goods Administration.

The Effects of Stabilization Exercise on the Thickness of Lateral Abdominal Muscles During Standing Tasks in Women With Chronic Low Back Pain: A Randomized Triple-Blinded Clinical Trial Study

CONTEXT

Chronic low back pain (CLBP) often presents with a dysfunction in deep abdominal muscles activity during standing tasks. Although some studies indicated that deep abdominal muscle activity improved during some functional tasks following stabilization exercise (SE), there is no study to evaluate the effect of SE on lateral abdominal muscles thickness during standing postural tasks.

OBJECTIVE

The purpose of this study was (1) to evaluate the lateral abdominal muscles thickness in the participants with CLBP while standing on a balance board and (2) to compare the effects of SE and a general exercise (GE) program on the lateral muscles thickness changes.

METHODS

This was a between-groups, triple-blinded randomized controlled trial design. In total, 40 females with CLBP were randomly assigned into 2 groups:  GE (control group) and supervised progressive SE (experimental group). Diagnostic ultrasound imaging was used before and after the intervention to measure lateral abdominal muscles thickness during standing on 2 different levels of platform in the Biodex Balance System. Visual analog scale and Roland-Morris Disability Questionnaire were used to evaluate changes in pain intensity and disability.

RESULTS

The results indicated significant increases in transverse abdominis muscle thickness during all standing tasks (P = .02) and significant decreases in pain intensity and disability following SE intervention (P < .001). However, the lateral abdominal muscle thicknesses were not changed after GE intervention while standing postural tasks (P > .05). The GE group revealed only significant decreases in pain intensity after intervention (P = .03).

CONCLUSION

Supervised progressive SE improved the activity of deep abdominal muscles in standing postural tasks in the patients with CLBP.

Outcomes and outcomes measurements used in intervention studies of pelvic girdle pain and lumbopelvic pain: a systematic review

Background

Pelvic girdle pain is a common problem during pregnancy and postpartum with significant personal and societal impact and costs. Studies examining the effectiveness of interventions for pelvic girdle pain measure different outcomes, making it difficult to pool data in meta-analysis in a meaningful and interpretable way to increase the certainty of effect measures. A consensus-based core outcome set for pelvic girdle pain can address this issue. As a first step in developing a core outcome set, it is essential to systematically examine the outcomes measured in existing studies.

Objective

The objective of this systematic review was to identify, examine and compare what outcomes are measured and reported, and how outcomes are measured, in intervention studies and systematic reviews of interventions for pelvic girdle pain and for lumbopelvic pain (which includes pelvic girdle pain).

Methods

We searched PubMed, Cochrane Library, PEDro and Embase from inception to the 11th May 2018. Two reviewers independently selected studies by title/abstract and by full text screening. Disagreement was resolved through discussion. Outcomes reported and their outcome measurement instruments were extracted and recorded by two reviewers independently. We assessed the quality of reporting with two independent reviewers. The outcomes were grouped into core domains using the OMERACT filter 2.0 framework.

Results

A total of 107 studies were included, including 33 studies on pelvic girdle pain and 74 studies on lumbopelvic pain. Forty-six outcomes were reported across all studies, with the highest amount (26/46) in the 'life impact' domain. 'Pain' was the most commonly reported outcome in both pelvic girdle pain and lumbopelvic pain studies. Studies used different instruments to measure the same outcomes, particularly for the outcomes pain, function, disability and quality of life.

Conclusions

A wide variety of outcomes and outcome measurements are used in studies on pelvic girdle pain and lumbopelvic pain. The findings of this review will be included in a Delphi survey to reach consensus on a pelvic girdle pain - core outcome set. This core outcome set will allow for more effective comparison between future studies on pelvic girdle pain, allowing for more effective translation of findings to clinical practice.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12998-019-0279-2.

The Effect of Stabilization Exercises on Pain, Disability, and Pelvic Floor Muscle Function in Postpartum Lumbopelvic Pain: A Randomized Controlled Trial

OBJECTIVE

The effect of stabilization exercises on pain, disability, and pelvic floor muscle function in postpartum lumbopelvic pain.

DESIGN

This is a single-blind, randomized controlled trial.

SETTING

This study was performed at the physiotherapy clinic, Zahedan University of Medical Science, from January to November 2017.

PARTICIPANTS

Thirty-six multiparous women with persistent postpartum lumbopelvic pain were recruited at least 3 mos after delivery.

INTERVENTIONS

Subjects in the training group (n = 18) received electrotherapy modalities and specific stabilizing exercises. The control group (n = 18) received only electrotherapy modalities.

MAIN OUTCOME MEASURES

Pain, disability, and bladder base displacement (at rest and pelvic floor muscles contraction) were measured through visual analog scale, Oswestry Disability Index questionnaires, and transabdominal ultrasound imaging respectively at baseline and after 6 wks of intervention.

RESULTS

Between-groups comparison showed significant improvement in pain, disability, and bladder base displacement in the training group (P < 0.05). In within-group comparison, training group had significant difference for all variables (P < 0.05). In the control group, pain and disability had significant difference (P < 0.05), whereas bladder base displacement had no significant change (P < 0.05).

CONCLUSIONS

The stabilizing exercises can remarkably improve pain, disability, and pelvic floor muscles function in postpartum lumbopelvic pain (Clinical Trial Registry: NCT03030846).

Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts

BACKGROUND

Pelvic girdle pain (PGP) and sacroiliac joint (SIJ) dysfunction/pain are considered frequent contributors to low back pain (LBP). Like other persistent pain conditions, PGP is increasingly recognized as a multifactorial problem involving biological, psychological, and social factors. Perspectives differ between experts and a diversity of treatments (with variable degrees of evidence) have been utilized.

OBJECTIVE

To develop a collaborative model of PGP that represents the collective view of a group of experts. Specific goals were to analyze structure and composition of conceptual models contributed by participants, to aggregate them into a metamodel, to analyze the metamodel's composition, and to consider predicted efficacy of treatments.

DESIGN

To develop a collaborative model of PGP, models were generated by invited individuals to represent their understanding of PGP using fuzzy cognitive mapping (FCM). FCMs involved proposal of components related to causes, outcomes, and treatments for pain, disability, and quality of life, and their connections. Components were classified into thematic categories. Weighting of connections was summed for components to judge their relative importance. FCMs were aggregated into a metamodel for analysis of the collective opinion it represented and to evaluate expected efficacy of treatments.

RESULTS

From 21 potential contributors, 14 (67%) agreed to participate (representing six disciplines and seven countries). Participants' models included a mean (SD) of 22 (5) components each. FCMs were refined to combine similar terms, leaving 89 components in 10 categories. Biomechanical factors were the most important in individual FCMs. The collective opinion from the metamodel predicted greatest efficacy for injection, exercise therapy, and surgery for pain relief.

CONCLUSIONS

The collaborative model of PGP showed a bias toward biomechanical factors. Most efficacious treatments predicted by the model have modest to no evidence from clinical trials, suggesting a mismatch between opinion and evidence. The model enables integration and communication of the collection of opinions on PGP.

Time to Reflect on the Role of Motor Control in Low Back Pain

The articles in this special issue on low back pain are the outcome of work undertaken by a series of working parties established during the meeting, "State-of-the-Art in Motor Control and Low Back Pain: International Clinical and Research Expert Forum," held in Chicago in October 2015. This multidisciplinary meeting provided an opportunity for discussion of key issues that interconnect motor control, pain, and the spine. What started as a relatively straightforward objective to summarize the field subsequently developed into an extensive process of literature review and discussion that culminated in the commentaries and articles presented in this special issue. We hope that the up-to-date information and in-depth insights into pain, motor control, and rehabilitation provide novel insights and a clear trajectory for future work and form the foundation for ongoing lively discussion. J Orthop Sports Phys Ther 2019;49(6):367-369. doi:10.2519/jospt.2019.0104.

Evidence of stabilizing exercises for low back- and pelvic girdle pain - a critical review

BACKGROUND

Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) have been associated with an alteration in the strategy for lumbopelvic stabilization. Different core stabilization approaches exist, the evidence is however controversial.

METHODS

This paper discusses how to improve the evidence of exercises for women suffering from LBP and PGP during and after pregnancy. Exercises should be understood in a context, where the bio-psycho-social perspective directs the prescription of exercises, targeting both psychological and physical factors. The type of exercise probably should be individually tailored to the needs and capability of the individual and it is not only about the most appropriate exercise, it is about dosage and delivery of the exercises, and it is about performance. To promote adherence the use of patient preferences, with self-defined movement goals, may be a motivational basis for behavior change. Communication skills may facilitate positive beliefs and provide a motivational foundation for empowerment, self-efficacy and for self-management. To learn by discovery where the patient learns through their own experiences, might motivate the patients to active engagement and to behavioral change. Adherence probably will increase when the patients understand the aim and the rationale behind the exercises they are prescribed. However, with high adherence to exercises that maintains an inappropriate motor pattern, LBP and PGP possibly could proceed into chronicity.

CONCLUSION

Exercises need to be meaningful to the patient, relevant for daily activities, individualized according to patient preferences, guided and supervised to secure performance and quality.

Cross-cultural adaptation of the Pelvic Girdle Questionnaire (PGQ) into Brazilian Portuguese and clinimetric testing of the PGQ and Roland Morris questionnaire in pregnancy pelvic pain

OBJECTIVE

To translate and cross-culturally adapt the Pelvic Girdle Questionnaire (PGQ) into Brazilian Portuguese and test the measurement properties of the PGQ and the Roland Morris Disability Questionnaire (RMDQ) in women with pelvic pain during pregnancy.

METHODS

Thirty pregnant women were included in the assessment of the pre-test of the final version of the PGQ and 100 were included in the assessment of the measurement properties. In the initial assessment, the PGQ, RMDQ, pain numerical rating scale, and WHOQOL-BREF were applied to test the internal consistency and construct validity. In the 48-hour assessment, only the PGQ and RMDQ were applied to test reliability and measurement error; in the reassessment after one month, the PGQ, RMDQ, and global perceived effect scale were applied to evaluate responsiveness.

RESULTS

The PGQ showed adequate internal consistency (Cronbach's alpha=0.83), substantial reliability (ICC2,1=0.85), very good measurement error (5%), and good responsiveness (r=-0.62). We also observed good correlation with disability and quality of life in the physical health domain, moderate correlation with pain and quality of life in the psychological domain, and poor correlation with quality of life in the domains social relationships and environment. The RMDQ showed adequate internal consistency (Cronbach's alpha=0.80), substantial reliability (ICC2,1=0.76), good measurement error (9%), moderate responsiveness (r=-0.51), moderate correlation with quality of life in the physical health and psychological domains, and weak correlation with pain and quality of life in the social relationships and environment domains.

CONCLUSION

The Brazilian Portuguese version of the PGQ showed superior measurement properties compared to the RMDQ, being a valid, reliable, and responsive instrument for assessing patients with pelvic pain during pregnancy.

The effects of Gyrotonic expansion system exercise and trunk stability exercise on muscle activity and lumbar stability for the subjects with chronic low back pain

The Gyrotonic expansion system comprises three-dimensional (3D) spinal motion that not only improves functional spinal motion but also increases muscular strength and flexibility around the spine. This study aimed to demonstrate the clinical effect of Gyrotonic exercise on patients with chronic low back pain by comparing between Gyrotonic and trunk stability exercises. This study included 26 subjects with chronic low back pain patients and who were randomly assigned to the Gyrotonic exercise group or trunk stability exercise group. Each group performed their exercises 3 times a week for 4 weeks. All subjects were measured before and after the exercise for muscles activity of the erector spinae (ES), rectus abdominis (RA), external oblique (EO), and internal oblique (IO) using surface electromyography. Lumbar stability was measured using a 3D spine tester, and functional disability was measured using the Korean Oswestry disability index. In the Gyrotonic exercise group, ES and EO muscle activity significantly increased (P<0.05). In the trunk stability exercise group, ES, EO, and RA muscle activity significantly increased (P<0.05). No differences in muscle activity were found between the groups. Both groups showed significant improvements in lumbar stability and functional disability but no significant differences were noted between the groups. Gyrotonic exercise and trunk stability exercise are encouraged owing to their positive effects on muscle activity, lumbar stability, and functional ability in patients with chronic low back pain. We suggest that Gyrotonic exercise is one of the effective exercise for mitigating chronic low back pain caused by spinal instability.

Effect of core stability exercises on postpartum lumbopelvic pain: A randomized controlled trial

BACKGROUND

Core stability exercises have been widely advocated for management of patients with different musculoskeletal conditions, even though its effect on postpartum Lumbopelvic Pain (LPP) has not been fully investigated.

OBJECTIVE

This study was conducted to investigate the effect of core stability exercises on postpartum LPP.

METHODS

Thirty four women suffering from postpartum LPP were randomly assigned to the study or control group. The control group (n= 17) received traditional treatment (infrared radiation and continuous ultrasound) on lumbosacral region (L1-S5), whereas the study group (n= 17) received core stability exercises in addition to traditional treatment three sessions a week for six weeks. Pain Pressure Threshold (PPT), Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were assessed for all participants in both groups before and after the treatment program.

RESULTS

There was a significant improvement in PPT, VAS and ODI post-treatment compared with the pre-treatment in both groups (p= 0.001). There was a significant improvement in participants who received core stability exercises in addition to traditional treatment as compared to participants treated with the traditional treatment only in PPT (P= 0.001), VAS (P= 0.001) and ODI (P= 0.009).

CONCLUSIONS

Core stability exercises in addition to traditional treatment significantly decreased pain and improved function for women with postpartum LPP.

Factors associated with pain in the pelvic girdle in pregnant adolescents: A case-control study

BACKGROUND

Due to biological immaturity and unfavorable psychosocial conditions, it is conjectured that teenage pregnancy may be associated with disorders such as pelvic girdle pain. The evidence for risk factors for pelvic girdle pain in pregnant adolescents remains unclear.

OBJECTIVES

To evaluate the factors associated with pelvic girdle pain related to pregnancy in adolescents.

DESIGN

Case-control study.

METHOD

Seventy three pregnant women with presence of pelvic girdle pain (case group) and 331 pregnant women without pelvic girdle pain (control group) aged between 10 and 19 years, with gestational age between 28 and 40 weeks were included.

RESULTS/FINDINGS

A logistic regression model was used to identify factors associated with the occurrence of pelvic girdle pain. The following aspects were considered for the model: sociodemographic, anthropometric, gynecological and obstetrical, related to lifestyle, musculoskeletal and psychosocial factors. The results showed that suspected common mental disorder (OR: 2.27; 95% CI: 1.23 to 4.18), low back pain during menstruation (OR: 2.10; 95% CI: 1.16 to 3.80) and strenuous work (OR: 1.95; 95% CI: 1.13 to 3.35) were associated with pelvic girdle pain among pregnant adolescents.

CONCLUSIONS

Attention must be given to pregnant adolescents with suspected common mental disorder, low back pain during menstruation and strenuous work in order to ensure referral to the appropriate healthcare professional for early prevention of pelvic girdle pain.

Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study

OBJECTIVE

To explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.

DESIGN

A prospective longitudinal cohort study.

PARTICIPANTS

Pregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination.

SETTING

Obstetric outpatient clinic at Stavanger University Hospital, Norway.

METHODS

Women reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.

RESULTS

503 women participated. 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests.

CONCLUSION

If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic pain of more than 5 days per week throughout the remainder of pregnancy could be predicted. Increased individual control over work situation and an active lifestyle, including regular exercise before and during pregnancy, may serve as a PGP prophylactic.

The impact of progressive pelvic floor muscle exercise and manual therapy in a patient postpartum who met the criteria for sacroiliac joint pain based on Laslett's cluster of provocation signs

Sacroiliac joint (SIJ) pain has been identified as a primary or contributing source of pain in patients with low back pain. The Laslett cluster of SIJ pain provocation tests has the strongest evidence for noninvasive clinical testing. The purpose of this report was to describe the impact of physical therapy treatments for a patient postpartum with SIJ pain who satisfied the Laslett cluster. Specifically, the goal was to assess the impact of progressive pelvic floor muscle exercise and manual therapy. The Modified Oswestry Low Back Pain Disability Questionnaire (MODI) was the primary outcome measure used in this case. In addition, the Numeric Pain Rating Scale (NRPS) and Global Rating of Change (GROC) were used as secondary outcome measures. In this case report, the patient responded to the combined interventions with decreases in MODI, NRPS and GROC. Further research is warranted to develop stronger evidence to identify specific interventions for the treatment of SIJ pain.