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Jackson T, Bostock EL, Hassan A, Greeves JP, Sale C, Elliott-Sale KJ. The Legacy of Pregnancy: Elite Athletes and Women in Arduous Occupations. Exerc Sport Sci Rev 2021; 50:14-24. [PMID: 34669626 DOI: 10.1249/jes.0000000000000274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Best-practice guidance and management of pregnant and postpartum elite athletes and women in arduous occupations is limited by the lack of high-quality evidence available within these populations. We have summarised the adaptations and implications of pregnancy and childbirth; proposed a novel integrative concept to address these changes; and made recommendations to progress research in this area.
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Affiliation(s)
- Thea Jackson
- Sport Health and Performance Enhancement (SHAPE) Research Centre, Department of Sport Science, Nottingham Trent University, Nottingham, UK Army Health and Performance Research, Army Headquarters, Andover, UK Institute of Sport, Exercise & Health (ISEH), Division of Surgery & Interventional Science, University College London, London, UK Norwich Medical School, University of East Anglia, Norwich, UK
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Aldabe D, Lawrenson P, Sullivan J, Hyland G, Bussey M, Hammer N, Bryant K, Woodley S. Management of women with pregnancy-related pelvic girdle pain: an international Delphi study. Physiotherapy 2021; 115:66-84. [DOI: 10.1016/j.physio.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022]
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3
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Fruscalzo A, Cocco P, Londero AP, Gantert M. Low Back Pain during Pregnancy and Delivery Outcomes. Z Geburtshilfe Neonatol 2021; 226:104-111. [PMID: 34433210 DOI: 10.1055/a-1553-4856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate low back pain (LBP) incidence and impact throughout pregnancy in terms of women's well-being and delivery outcomes. MATERIAL AND METHODS Cross-sectional prospective study conducted on singleton pregnancies at ≥37th gestational age admitted for delivery. Localization of LBP, intensity and frequency as well as derived functional disability status were assessed with a self-reported questionnaire. Main delivery outcomes including mode of delivery, and maternal or neonatal complications were recorded. RESULTS A total of 229 women participated in the study. LBP prevalence amounted to 55.9%, with the pain already present before pregnancy in 14.0% of the cases. The pain was mostly localized in the lower back (40.6%), symphysis (23.3%), and coccyx (20.5%). Both the frequency and intensity of pain gradually increased significantly during pregnancy, reaching 20 days/month (IQR=10-30) and 6/10 points (IQR=5-8) on a visual analog scale in the 3rd trimester (p<0.05). The extent of functional impairment also progressively increased up to 39/100 points (IQR=25-55, p<0.05). Women affected by LBP during pregnancy had a higher cesarean section rate during labor than women without LBP (11.9% vs. 28.9%, p<0.05). The risk was also significant in the multivariate analysis (OR=4.0, 95%CI=1.1-15.0, p<0.05). There was no difference in the rate of operative vaginal births or in the other outcomes considered. CONCLUSIONS LBP is a common issue in pregnant women, accounting for increasing morbidity and invalidity, and leading to an increased cesarean section risk during labor.
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Affiliation(s)
- Arrigo Fruscalzo
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
| | - Paolo Cocco
- Pediatric Surgery, University of Naples Federico II School of Medicine and Surgery, Napoli, Italy and Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Ambrogio P Londero
- Clinic of Gynecology and Obstetrics, University Hospital of Udine, Udine, Italy
| | - Markus Gantert
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
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4
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Wiezer M, Hage-Fransen MAH, Otto A, Wieffer-Platvoet MS, Slotman MH, Nijhuis-van der Sanden MWG, Pool-Goudzwaard AL. Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum; a systematic review and meta-analysis. Musculoskelet Sci Pract 2020; 48:102154. [PMID: 32560862 DOI: 10.1016/j.msksp.2020.102154] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/04/2019] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although pelvic girdle pain postpartum and pregnancy related low back pain postpartum (combined and named PGPP in this study) have a natural favourable course, there is a subgroup of women who have persistent complaints. The objective of this study was to identify personal-, (pre)pregnancy-, obstetric-, and child related risk factors on PGPP by means of a systematic literature review and meta-analysis. METHODS Literature searches of PubMed, EMBASE, CINAHL and Cochrane up to October 2018 were conducted. Prospective cohort studies in English or Dutch describing three or more risk factors for PGPP were included. We assessed articles for inclusion and risk of bias. Studies with high risk of bias were excluded from data extraction. Data was extracted and checked for accuracy confirming to the CHARMS-checklist. Homogeneous variables were pooled. RESULTS Twelve full text studies were assessed. Seven studies were excluded due to high risk of bias. Data was extracted from five studies. Multivariate analysis was not possible due to heterogeneity in included risk factors as well as outcome measures on risk factor per study. Pooled univariate significant risk factors on PGPP were: a history of low back pain, pre-pregnancy body mass index >25, pelvic girdle pain in pregnancy, depression in pregnancy, and a heavy workload in pregnancy. No significant obstetric and child related risk factors were reported. CONCLUSIONS Risk factors on PGPP have been identified. Since multivariate analysis was not possible the outcome should be treated with care, because interaction between risk factors could not be analysed.
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Affiliation(s)
- M Wiezer
- Physical Therapy Practice Fysi-Unique, Amersfoort, the Netherlands.
| | | | - A Otto
- VU University of Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, the Netherlands
| | | | - M H Slotman
- B-fysic Pelvic Centre, Eindhoven, the Netherlands
| | - M W G Nijhuis-van der Sanden
- Radboud university medical center, Research Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
| | - A L Pool-Goudzwaard
- VU University of Amsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam, the Netherlands; SOMT University of Physiotherapy, Amersfoort, the Netherlands
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Szkwara JM, Milne N, Rathbone E. A prospective quasi-experimental controlled study evaluating the use of dynamic elastomeric fabric orthoses to manage common postpartum ailments during postnatal care. ACTA ACUST UNITED AC 2020; 16:1745506520927196. [PMID: 32525761 PMCID: PMC7290251 DOI: 10.1177/1745506520927196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Jaclyn Michele Szkwara
- Physiotherapy Program, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Nikki Milne
- Physiotherapy Program, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Evelyne Rathbone
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
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Sakamoto A, Gamada K. Altered musculoskeletal mechanics as risk factors for postpartum pelvic girdle pain: a literature review. J Phys Ther Sci 2019; 31:831-838. [PMID: 31645815 PMCID: PMC6801337 DOI: 10.1589/jpts.31.831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this literature review was to detect the factors associated with
pelvic girdle pain persisting for over 3 months in the postpartum period. [Methods] We
performed a broad literature search for eligible studies published before May 1, 2018
using electronic databases and processed the data using a review process. [Results] In the
initial online search, we identified 12,174 potential studies. Finally, 22 studies met the
specified criteria and were included for examination of risk factors for persistent pelvic
girdle pain after delivery. Pain intensity and disability during pregnancy were risk
factors for pelvic girdle pain persisting for over 6 months after delivery. The active
straight leg raising test predicted the risk of persistent pelvic girdle pain after
delivery. Dysfunction of the pelvic floor muscles was also a risk factor for persistent
pelvic girdle pain. [Conclusion] Pain intensity and disability during pregnancy, positive
provocation tests, active straight leg raising test, and musculoskeletal mechanics were
positively associated with pelvic girdle pain persisting for over 3 months after
delivery.
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Affiliation(s)
- Asuka Sakamoto
- Graduated School of Medical Technology and Health Welfare Sciences, Hiroshima International University: 555-36 Kurosegakuendai, Higashihirsoshima-shi, Hiroshima 739-2631, Japan.,Faculty of Rehabilitation Sciences, Nishikyushu University, Japan
| | - Kazuyoshi Gamada
- Graduated School of Medical Technology and Health Welfare Sciences, Hiroshima International University: 555-36 Kurosegakuendai, Higashihirsoshima-shi, Hiroshima 739-2631, Japan
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Szkwara JM, Milne N, Hing W, Pope R. Effectiveness, Feasibility, and Acceptability of Dynamic Elastomeric Fabric Orthoses (DEFO) for Managing Pain, Functional Capacity, and Quality of Life during Prenatal and Postnatal Care: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2408. [PMID: 31284612 PMCID: PMC6651323 DOI: 10.3390/ijerph16132408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Conservative interventions for addressing prenatal and postnatal ailments have been described in the research literature. Research results indicated that maternity support belts assist with reducing pain and other symptoms in these phases; however, compliance in wearing maternity support belts is poor. To combat poor compliance, commercial manufacturers designed dynamic elastomeric fabric orthoses (DEFO)/compression garments that target prenatal and postnatal ailments. This systematic review aimed to identify, critically appraise, and synthesize key findings on the effectiveness, the feasibility, and the acceptability of using DEFO to manage ailments during pre-natal and postnatal phases of care. Electronic databases were systematically searched to identify relevant studies, resulting in 17 studies that met the eligibility criteria. There were variations in DEFO descriptors, including hosiery, support belts, abdominal binders and more, making it difficult to compare findings from the research articles regarding value of DEFO during prenatal and/or postnatal phases. A meta-synthesis of empirical research findings suggests wearing DEFOs during pregnancy has a significant desirable effect for managing pain and improving functional capacity. Further research is required to investigate the use of DEFOs for managing pain in the postnatal period and improving quality life during prenatal and postnatal care.
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Affiliation(s)
- Jaclyn M Szkwara
- Department of Physiotherapy/Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4229, Australia.
| | - Nikki Milne
- Department of Physiotherapy/Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4229, Australia
| | - Wayne Hing
- Department of Physiotherapy/Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4229, Australia
| | - Rodney Pope
- Department of Physiotherapy/Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4229, Australia
- School of Community Health, Charles Sturt University, Thurgoona, NSW 2640, Australia
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Bø K, Artal R, Barakat R, Brown WJ, Davies GAL, Dooley M, Evenson KR, Haakstad LAH, Kayser B, Kinnunen TI, Larsén K, Mottola MF, Nygaard I, van Poppel M, Stuge B, Khan KM. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3-exercise in the postpartum period. Br J Sports Med 2017. [PMID: 28642221 DOI: 10.1136/bjsports-2017-097964] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Kari Bø
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Raul Artal
- Department of Obstetrics, Gynecology and Women's Health, Saint Louis University, St Louis, Missouri, USA
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte - INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Wendy J Brown
- Centre for Research on Exercise Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
| | - Gregory A L Davies
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Queen's University, Kingston, Canada
| | - Michael Dooley
- Department of Sport Gynaecology, Poundbury Clinic, Dorchester, UK.,Poundbury Clinic, King Edward VII Hospital, London, UK
| | - Kelly R Evenson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lene A H Haakstad
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Bengt Kayser
- Faculty of Biology and Medicine, Institute of Sport Science, University of Lausanne, Lausanne, Switzerland
| | - Tarja I Kinnunen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Karin Larsén
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Michelle F Mottola
- R Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, The University of Western Ontario, London, Canada
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | | | - Britt Stuge
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Karim M Khan
- Department of Family Practice and School of Kinesiology, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
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Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskelet Disord 2016; 17:276. [PMID: 27406174 PMCID: PMC4941027 DOI: 10.1186/s12891-016-1154-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/02/2016] [Indexed: 01/13/2023] Open
Abstract
Background Pelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term pregnancy-related PGP has been poorly investigated. This longitudinal follow-up study uniquely aimed to describe prevalence and predictors of PGP and its consequences on women’s health and function up to 11 years after pregnancy. Methods/Design A postal questionnaire was sent to 530 women who participated in 1 of 3 randomized controlled studies for PGP in pregnancy. Women who reported experiencing lumbopelvic pain were offered a clinical examination. Main outcome measure was the presence of long term PGP as assessed by an independent examiner. Secondary outcomes were: working hours/week, function (the Disability Rating Index, and Oswestry Disability Index), self-efficacy (the General Self-Efficacy Scale), HRQL (Euro-Qol 5D and EQ-Visual scale), anxiety and depression, (Hospital anxiety and depression scale,) and pain-catastrophizing (Pain Catastrophizing Scale), in women with PGP compared to women with no PGP. Results A total of 371/530 (70 %) women responded and 37/ 371 (10 %) were classified with long-term PGP. Pregnancy-related predictors for long-term PGP were number of positive pain provocation tests (OR = 1.79), history of low back pain (LBP) (OR = 2.28), positive symphysis pressure test (OR = 2.01), positive Faber (Patrick’s) test (OR = 2.22), and positive modified Trendelenburg test (OR = 2.20). Women with PGP had significantly decreased ability to perform daily activities (p < .001), lower self-efficacy (p = 0.046), decreased HRQL (p < .001), higher levels of anxiety and depression (p < .001), were more prone to pain catastrophizing, and worked significantly fewer hours/week (p = 0.032) compared to women with no PGP. Conclusions This unique long-term follow up of PGP highlights the importance of assessment of pain in the lumbopelvic area early in pregnancy and postpartum in order to identify women with risk of long term pain. One of 10 women with PGP in pregnancy has severe consequences up to 11 years later. They could be identified by number of positive pain provocation tests and experience of previous LBP. Access to evidence based treatments are important for individual and socioeconomic reasons.
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Affiliation(s)
- Helen Elden
- Gothenburg University, Institute of Health and Caring Sciences, Sahlgrenska Academy, S-405 30, Gothenburg, Sweden.
| | - Annelie Gutke
- Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, Gothenburg University, Institute of Neuroscience and Physiology, S-405 30, Gothenburg, Sweden
| | - Gunilla Kjellby-Wendt
- Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital/ Molndal, S-431 80, Molndal, Gothenburg, Sweden
| | - Monika Fagevik-Olsen
- Department of Health and Rehabilitation/Physiotherapy, Sahlgrenska Academy, Gothenburg University, Institute of Neuroscience and Physiology, S-405 30, Gothenburg, Sweden.,Department of Occupational Therapy and Physical Therapy, Sahlgrenska University Hospital, s-413 45, Gothenburg, Sweden
| | - Hans-Christian Ostgaard
- Department of Orthopaedics, Sahlgrenska Academy, Molndal Hospital, S-431 80, Molndal, Sweden
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10
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Capobianco R, Cher D. Safety and effectiveness of minimally invasive sacroiliac joint fusion in women with persistent post-partum posterior pelvic girdle pain: 12-month outcomes from a prospective, multi-center trial. SPRINGERPLUS 2015; 4:570. [PMID: 26543705 PMCID: PMC4627991 DOI: 10.1186/s40064-015-1359-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/21/2015] [Indexed: 01/13/2023]
Abstract
Postpartum posterior pelvic girdle pain (PPGP) affects nearly 20 % of women who experience back pain in the peripartum period. The sacroiliac joint is a source of this pain in 75 % of women with persistent PPGP. A subset of women will fail to obtain acceptable pain relief from the current array of non-surgical treatment options. The purpose of this study is to assess the safety and effectiveness of minimally invasive sacroiliac (SI) joint fusion in women with chronic SI joint dysfunction whose pain began in the peri-partum period whose symptoms were recalcitrant to non-surgical management. A sub-group analysis of subjects with sacroiliac joint disruption and/or degenerative sacroiliitis enrolled in a prospective, multi-center trial of SI joint fusion was performed. Subjects with PPGP were identified and compared with women without PPGP and with men. Of 172 enrolled subjects, 52 were male, 100 were females without
PPGP and 20 females had PPGP. PPGP subjects were significantly younger (43.3 years, vs. 52.8 for females without PPGP and 50.5 for men, p = 0.002). There were no differences in any other demographic or baseline clinical measure. Women with PPGP experienced a significant improvement in pain (−51 mm on VAS), function (−20.6 pts on ODI) and quality of life (SF-36 PCS +10.4, MCS +7.2, EQ-5D +0.31) at 12 months after surgery. These improvements were characteristic of the overall study results; no difference was detected between sub-groups. The sacroiliac joint can be a source of pain in women with persistent PPGP and should be investigated as a pain generator. In this study, women with carefully diagnosed chronic SI joint pain from PPGP recalcitrant to conservative therapies experienced clinically beneficially improvements in pain, disability and quality of life after minimally invasive SI joint fusion using a series of triangular porous plasma spray coated implants.
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Affiliation(s)
| | - Daniel Cher
- SI-BONE, Inc., 3055 Olin Ave Suite 2200, San Jose, CA 95128 USA
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11
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Schwerla F, Rother K, Rother D, Ruetz M, Resch KL. Osteopathic Manipulative Therapy in Women With Postpartum Low Back Pain and Disability: A Pragmatic Randomized Controlled Trial. J Osteopath Med 2015; 115:416-25. [DOI: 10.7556/jaoa.2015.087] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context: Persistent low back pain (LBP) is a common complaint among women during and after pregnancy, and its effects on quality of life can be disabling.
Objective: To evaluate the effectiveness of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) in women with persistent LBP and functional disability after childbirth.
Methods: A pragmatic randomized controlled trial was conducted among a sample of women with a history of pregnancy-related LBP for at least 3 months after delivery. Participants were identified from the general population in Germany. By means of external randomization, women were allocated to an OMTh group and a waitlist control group. Osteopathic manipulative therapy was provided 4 times at intervals of 2 weeks, with a follow-up after 12 weeks. The OMTh was tailored to each participant and based on osteopathic principles. The participants allocated to the control group did not receive OMTh during the 8-week study; rather, they were put on a waiting list to receive OMTh on completion of the study. Further, they were not allowed to receive any additional treatment (ie, medication, physical therapy, or other sources of pain relief) during the study period. The main outcome measures were pain intensity as measured by a visual analog scale and the effect of LBP on daily activities as assessed by the Oswestry Disability Index (ODI).
Results: A total of 80 women aged between 23 and 42 years (mean [SD], 33.6 [4.5] years) were included in the study, with 40 in the OMTh group and 40 in the control group. Pain intensity decreased in the OMTh group from 7.3 to 2.0 (95% CI, 4.8-5.9; P<.001) and in the control group from 7.0 to 6.5 (95% CI, -0.2 to -0.9; P=.005). The between-group comparison of changes revealed a statistically significant improvement in pain intensity in the OMTh group (between-group difference of means, 4.8; 95% CI, 4.1-5.4; P<.001) and level of disability (between-group difference of means, 10.6; 95% CI, 9.9-13.2; P<.005). The follow-up assessment in the OMTh group (n=38) showed further improvement.
Conclusion: During 8 weeks, OMTh applied 4 times led to clinically relevant positive changes in pain intensity and functional disability in women with postpartum LBP. Further studies that include prolonged follow-up periods are warranted. (German Clinical Trials Register: DRKS00006280.)
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12
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Bjelland EK, Owe KM, Stuge B, Vangen S, Eberhard-Gran M. Breastfeeding and pelvic girdle pain: a follow-up study of 10,603 women 18 months after delivery. BJOG 2014; 122:1765-71. [PMID: 25327939 DOI: 10.1111/1471-0528.13118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the associations of patterns and duration of breastfeeding with the persistence of pelvic girdle pain 18 months after delivery. DESIGN Longitudinal population study. SETTING Norway, for the period 1999-2011. POPULATION A follow-up of 10 603 women with singleton deliveries in the Norwegian Mother and Child Cohort Study who reported pelvic girdle pain at 0-3 months postpartum. METHODS Data were obtained by four self-administered questionnaires and linked to the Medical Birth Registry of Norway. MAIN OUTCOME MEASURE Pelvic girdle pain, defined as combined anterior and bilateral posterior pelvic pain, 18 months after delivery. RESULTS Eighteen months after delivery, 7.8% of respondents (829/10,603) reported pelvic girdle pain. Breastfeeding patterns at 5 months after delivery were not associated with persistence of pelvic girdle pain. The proportion of women with pelvic girdle pain 18 months after delivery increased as the duration of breastfeeding decreased (test for trend, P < 0.001). The estimated associations attenuated after adjustment for educational level, smoking status, and body mass index, but remained statistically significant for the association between 0 and 2 months of breastfeeding and persistent pelvic girdle pain (adjusted odds ratio 1.34; 95% confidence interval 1.03-1.75). The association of short breastfeeding duration with persistent pelvic girdle pain was only present in women with body mass index ≥25 kg/m(2) . CONCLUSIONS Breastfeeding was associated with a small beneficial effect on the recovery process of pelvic girdle pain in women with a body mass index ≥25 kg/m(2) . Among women with pelvic girdle pain, breastfeeding should be encouraged in accordance with the existing child-feeding recommendations.
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Affiliation(s)
- E K Bjelland
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - K M Owe
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Resource Centre for Women's Health, Division of Women and Children, Oslo University Hospital Rikshospitalet, Nydalen, Oslo, Norway
| | - B Stuge
- Department of Orthopaedics, Oslo University Hospital Ullevål, Nydalen, Oslo, Norway
| | - S Vangen
- Norwegian Resource Centre for Women's Health, Division of Women and Children, Oslo University Hospital Rikshospitalet, Nydalen, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Nydalen, Oslo, Norway
| | - M Eberhard-Gran
- Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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13
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Fernandes da Mota PG, Pascoal AGBA, Carita AIAD, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. ACTA ACUST UNITED AC 2014; 20:200-5. [PMID: 25282439 DOI: 10.1016/j.math.2014.09.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 09/03/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Abstract
Diastasis recti abdominis (DRA) is an impairment characterized by a midline separation of the rectus abdominis muscles along the linea alba. It has its onset during pregnancy and the first weeks following childbirth. There is scant knowledge on both prevalence and risk factors for development of the condition. The aim of this study was to investigate the prevalence of DRA at gestational week 35 and three timepoints postpartum, possible risk factors, and the relationship between DRA and lumbo-pelvic pain. Ultrasound images of inter rectus distance (IRD) were recorded in 84 healthy primiparous women, at three locations on the linea alba. The IRD was measured at: gestational week 35 and 6-8, 12-14, and 24-26 weeks postpartum. Diagnosis of DRA was defined as 16 mm at 2 cm below the umbilicus. Independent sample t-test and binary logistic regression was used to assess differences and risk factors in women with and without DRA and women with and without lumbo-pelvic pain. P < 0.05 was considered statistically significant. The prevalence of DRA decreased from 100% at gestational week 35-39% at 6 months postpartum. No statistically significant differences were found in prepregnancy body mass index (BMI), weight gain, baby's birth weight or abdominal circumference between women with and without DRA at 6 months postpartum. Women with DRA at 6 months postpartum were not more likely to report lumbo-pelvic pain than women without DRA. DRA is prevalent at 6 months postpartum, but is not linked with lumbo-pelvic pain.
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Affiliation(s)
| | | | | | - Kari Bø
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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Kwon YJ, Hyung EJ, Yang KH, Lee HO. How different modes of child delivery influence abdominal muscle activities in the active straight leg raise. J Phys Ther Sci 2014; 26:1271-4. [PMID: 25202194 PMCID: PMC4155233 DOI: 10.1589/jpts.26.1271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/20/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the activities of the abdominal muscles of women who had experienced vaginal delivery in comparison with those who had experienced Cesarean childbirth. [Subjects and Methods] A total of 14 subjects (7 vaginal delivery, 7 Cesarean section) performed an active straight leg raise to 20 cm above the ground, and we measured the activities of the internal oblique abdominal muscle, the external oblique abdominal muscle, and the rectus abdominal muscle on both sides using electromyography. The effort required to raise the leg was scored on a Likert scale. Then, the subjects conducted maximum isometric contraction for hip joint flexion with the leg raised at 20 cm, and maximum torque and abdominal muscle activities were measured using electromyography. [Results] During the active straight leg raise, abdominal muscle activities were higher in the Cesarean section subjects. The Likert scale did not show a significant difference. The activities of the abdominal muscles and the maximum torque of the hip joint flexion at maximum isometric contraction were higher in the vaginal delivery subjects. [Conclusion] The abdominal muscles of Cesarean section subjects showed greater recruitment for maintaining pelvic stability during the active straight leg raising, but were relatively weaker when powerful force was required. Therefore, we consider that more abdominal muscle training is necessary for maintaining pelvic stability of Cesarean section subjects.
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Affiliation(s)
- Yu-Jeong Kwon
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Eun-Ju Hyung
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
| | - Kyung-Hye Yang
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
| | - Hyun-Ok Lee
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Bhardwaj A, Nagandla K. Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management. Postgrad Med J 2014; 90:450-60. [DOI: 10.1136/postgradmedj-2013-132377] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Clinical course of pelvic girdle pain postpartum - impact of clinical findings in late pregnancy. ACTA ACUST UNITED AC 2014; 19:190-6. [PMID: 24508067 DOI: 10.1016/j.math.2014.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 11/23/2022]
Abstract
The aims were to study: prevalence of pelvic girdle pain (PGP) one year postpartum; clinical course of PGP, physical functioning (PF) and bodily pain (BP) (from SF-36, 0 (worst) to 100 (best)) from gestation week (GW) 30 to one year postpartum; and whether findings at GW30 were associated with development of PF and BP from GW30 to one year postpartum. 215 pregnant women were followed from GW30 to one year postpartum. Clinical examination and questionnaire were used at GW30, questionnaire only were used at 12 weeks and one year postpartum. The women were categorised by GW30 clinical variables: self-reported PGP, pain locations in the pelvis and response to two clinical tests. Linear mixed models for repeated measures were used to study PF and BP during follow-up, within the categories of clinical variables. PGP prevalence remained unchanged from 12 weeks to one year postpartum (31-30%). PF and BP scores improved markedly from GW30 to 12 weeks postpartum, and marginally thereafter. Median PF scores were 70, 95 and 100 at GW30, 12 weeks and one year postpartum, respectively. Corresponding median BP scores were 52, 84 and 84. We found significant interactions between each clinical variable and time (P ≤ 0.01) for PF and BP. The most afflicted women at GW30 experienced largest improvement. Despite high PGP prevalence one year postpartum, most women recovered in terms of PF and BP scores. Unfavourable clinical course postpartum did not appear to depend on self-reported PGP, pain locations in the pelvis, or response to clinical tests at GW30.
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Eberhard-Gran M, Bjelland EK. Vaginal fødsel er tryggest ved sterke bekkenleddsmerter. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014. [DOI: 10.4045/tidsskr.13.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Fitzgerald CM. Pregnancy-related lumbopelvic pain: what have we learned? Am J Obstet Gynecol 2013; 208:242. [PMID: 23465783 DOI: 10.1016/j.ajog.2013.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 02/18/2013] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
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