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Ekdahl AS, Gutke A, Olsén MF, Mannerkorpi K. Expertise and individually tailored interventions are expected by pregnant women with pelvic girdle pain who seek physical therapy: a qualitative study. Braz J Phys Ther 2023; 27:100494. [PMID: 36965211 PMCID: PMC10064431 DOI: 10.1016/j.bjpt.2023.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/12/2022] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Pelvic girdle pain (PGP) in pregnancy may result in activity limitations and thus a negative impact on the individual woman's everyday life. Women's expectations when they seek physical therapy because of PGP are not yet known. OBJECTIVE To explore pregnant women's lived experience of PGP and what needs and expectations they express prior to a physical therapy consultation. METHODS A qualitative study using a descriptive phenomenological method. Interviews conducted with 15 pregnant women seeking physical therapy because of PGP, recruited through purposive sampling at one primary care rehabilitation clinic. RESULTS PGP was described by four themes; An experience with larger impact on life than expected, A time for adjustments and acceptance, A feeling of insecurity and concern, A desire to move forward. PGP had a large impact on the pregnant women´s life. Thoughts of PGP as something to be endured was expressed, the women therefore accepted the situation. Finding strategies to manage everyday life was hard and when it failed, the women described despair and a need for help. They expected the physical therapist to be an expert who would see them as individuals and provide advice that could make their everyday life easier. CONCLUSION Our results reveal that pregnant women with PGP delay seeking physical therapy until their situation becomes unmanageable and they run out of strategies for self-care. The women express, in light of their individual experiences, needs and expectations for professional management and advice tailored to their individually unique situation.
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Affiliation(s)
- Annika Svahn Ekdahl
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Annelie Gutke
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Närhälsan Eriksberg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Romero-Gallardo L, Roldan Reoyo O, Castro-Piñero J, May LE, Ocón-Hernández O, Mottola MF, Aparicio VA, Soriano-Maldonado A. Assessment of physical fitness during pregnancy: validity and reliability of fitness tests, and relationship with maternal and neonatal health - a systematic review. BMJ Open Sport Exerc Med 2022; 8:e001318. [PMID: 36172399 PMCID: PMC9511659 DOI: 10.1136/bmjsem-2022-001318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives To systematically review studies evaluating one or more components of physical fitness (PF) in pregnant women, to answer two research questions: (1) What tests have been employed to assess PF in pregnant women? and (2) What is the validity and reliability of these tests and their relationship with maternal and neonatal health? Design A systematic review. Data sources PubMed and Web of Science. Eligibility criteria Original English or Spanish full-text articles in a group of healthy pregnant women which at least one component of PF was assessed (field based or laboratory tests). Results A total of 149 articles containing a sum of 191 fitness tests were included. Among the 191 fitness tests, 99 (ie, 52%) assessed cardiorespiratory fitness through 75 different protocols, 28 (15%) assessed muscular fitness through 16 different protocols, 14 (7%) assessed flexibility through 13 different protocols, 45 (24%) assessed balance through 40 different protocols, 2 assessed speed with the same protocol and 3 were multidimensional tests using one protocol. A total of 19 articles with 23 tests (13%) assessed either validity (n=4), reliability (n=6) or the relationship of PF with maternal and neonatal health (n=16). Conclusion Physical fitness has been assessed through a wide variety of protocols, mostly lacking validity and reliability data, and no consensus exists on the most suitable fitness tests to be performed during pregnancy. PROSPERO registration number CRD42018117554.
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Affiliation(s)
- Lidia Romero-Gallardo
- Department of Physical Education and Sport, Universidad de Granada, Granada, Spain.,Sport and Health University Research Centre, Universidad de Granada, Granada, Spain
| | - Olga Roldan Reoyo
- Applied Sports Technology Exercise and Medicine Research Centre, Swansea University, Swansea, UK.,Sport Science Department, Swansea University, Swansea, UK
| | - Jose Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, Universidad de Cadiz, Cadiz, Spain.,The Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, España
| | - Linda E May
- Kinesiology, East Carolina University College of Health and Human Performance, Greenville, North Carolina, USA.,Department of Obstetrics & Gynecology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Olga Ocón-Hernández
- Gynaecology and Obstetrics Unit, 'San Cecilio' University Hospital, Universidad de Granada, Granada, Spain.,The Biosanitary Research Institute of Granada.ibs, Granada, Spain
| | - Michelle F Mottola
- R. Samuel McLaughlin Foundation- Exercise and Pregnancy Lab, School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Virginia A Aparicio
- Sport and Health University Research Centre, Universidad de Granada, Granada, Spain.,Department of Physiology, Institute of Nutrition and Food Technology and Biomedical Research Centre, Universidad de Granada, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
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Weis CA, Pohlman K, Barrett J, Clinton S, da Silva-Oolup S, Draper C, Lee J, Kumar R, O'Beirne M, Stuber K, Hawk C. Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process. J Manipulative Physiol Ther 2022; 45:469-489. [PMID: 34836673 DOI: 10.1016/j.jmpt.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination. METHODS A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale. RESULTS Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included. CONCLUSION An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.
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Affiliation(s)
- Carol Ann Weis
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | | | | | - Susan Clinton
- Embody Physiotherapy & Wellness (Private Practice), Andrews University, Sewickley, Pennsylvania
| | - Sophia da Silva-Oolup
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Crystal Draper
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Joyce Lee
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Rupali Kumar
- Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas Texas
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Calgary, AB, Canada
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Gutke A, Sundfeldt K, De Baets L. Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions. J Clin Med 2021; 10:jcm10225397. [PMID: 34830680 PMCID: PMC8622577 DOI: 10.3390/jcm10225397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.
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Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden
- Correspondence:
| | - Karin Sundfeldt
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40350 Gothenburg, Sweden;
- Department of Gynecology, Sahlgrenska University Hospital, 41346 Gothenburg, Sweden
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium;
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Long G, Fang ZY, Xiang-Sheng T, Feng Y, Hao-Ning M, Qing-Ying H, Ping Y, Ming-Sheng T. Symmetry in Paraspinal Muscles as a Predictor of the Development of Pregnancy-Related Low Back and Pelvic Pain: A Prospective Study. Orthop Surg 2021; 13:2255-2262. [PMID: 34668324 PMCID: PMC8654660 DOI: 10.1111/os.13126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/12/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To determine the asymmetry in the paraspinal muscle before pregnancy and evaluate its association with pregnancy‐associated lumbopelvic pain (LPP). Methods This was a prospective case–control study conducted from January 2017 and December 2018. A total of 171 subjects (mean age ± SD, 27.4 ± 5.8 years) were finally divided into the LBP group, PGP group, and no LPP group. Each subject was asked to follow a standardized clinical imaging protocol before the pregnancy. The area of muscles (multifidus, erector spinae, and psoas muscles) on the axial slice at mid‐disc of L4–L5 and L5–S1 were segmented and then the cross‐sectional area (CSA) of a particular muscle was measured by outlining the innermost fascial border surrounding each muscle. The mean value of F‐CSA's ratio to T‐CSA (F/T CSA) was used to determine whether the bilateral paraspinal muscle was asymmetrical. Total muscle CSA (T‐CSA) represents the sum of CSA of interested three muscles. The signal intensity can distinguish fat and muscle tissue in a different range. Based on this, functional CSA (F‐CSA), represented by fat‐free area, was evaluated quantitively by excluding the signal of the deposits of intramuscular fat. Total muscle CSA (T‐CSA), functional CSA (F‐CSA), and the ratio of F‐CSA to T‐CSA (F/T CSA) were measured unilaterally and compared between groups. Logistic regression was performed to determine the risk factors for pregnancy‐associated LPP. The Pearson correlation coefficient was performed to test the relationship between asymmetry in F/T‐CSA and pain rating. Results A total of 124 subjects (72.5%) (28.5 ± 5.2 years) had LPP during pregnancy. Forty‐eight (38.7%) individuals had low back pain (LBP) and 76 (61.3%) had pelvic girdle pain (PGP). Seventy‐six women (44.4%) were determined to have asymmetry in paraspinal muscle according to the definition in this methods section. The duration of follow‐up was 24 months postpartum. A total of 39 (31.5%) women unrecovered from LPP. F/T‐CSA was significantly decreased for LBP in the PGP group than in the and control group (0.03 ± 0.02 vs 0.05 ± 0.03 vs 0.12 ± 0.05, P < 0.001). Meanwhile, significant differences were detected in both groups (all P < 0.001). In patients with LBP, the level of paraspinal asymmetry, represented by the difference in F/T‐CSA, was positively correlated with pain scores (r = 0.52, P < 0.01). However, no statistically significant correlation between pain scores and paraspinal asymmetry was found in PGP (r = 0.42, P > 0.05). Asymmetry in the paraspinal muscle (adjusted OR = 1.5), LBP (adjusted OR = 1.6), LPP in a previous pregnancy (adjusted OR = 1.4), sick leave ≥90 days (adjusted OR = 1.2), and heavy labor (adjusted OR = 1.2) were risk factors for the unrecovered LPP during pregnancy. Conclusions Asymmetrical muscular compositions could lead to abnormal biomechanics for the segmental motions. Lateral‐directed physical training and stretching may help decrease the occurrence and severity of this condition.
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Affiliation(s)
- Gong Long
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Zhi-Yuan Fang
- Department of Orthopaedic, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tang Xiang-Sheng
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Yang Feng
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Ma Hao-Ning
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Hao Qing-Ying
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Yi Ping
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Tan Ming-Sheng
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
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Svahn Ekdahl A, Fagevik Olsén M, Jendman T, Gutke A. Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial. BMJ Open 2021; 11:e046314. [PMID: 34598980 PMCID: PMC8488730 DOI: 10.1136/bmjopen-2020-046314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate if there are differences between acupuncture and transcutaneous electrical nerve stimulation (TENS) as treatment for pelvic girdle pain (PGP) in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and physical activity (PA). DESIGN Randomised controlled trial. SETTING AND PARTICIPANTS Pregnant women (n=113) with clinically verified PGP in gestational weeks 12-28, recruited from maternity healthcare centres, randomised (1:1) into two groups. EXCLUSION CRITERIA any obstetrical complication, systemic disease or previous disorder that could contradict tests or treatment. INTERVENTIONS The intervention consisted of either 10 acupuncture sessions (two sessions per week) provided by a physiotherapist or daily home-based TENS during 5 weeks. PRIMARY OUTCOME VARIABLES Disability (Oswestry Disability Index), functioning (Patient Specific Functional Scale), work ability (Work Ability Index) and PA-level according to general recommendations. SECONDARY OUTCOME VARIABLES Functioning related to PGP (Pelvic Girdle Questionnaire), evening pain intensity (Numeric Rating Scale, NRS), concern about pain (NRS), health (EuroQoL 5-dimension), symptoms of depression/catastrophising (Edinburgh Postnatal Depression Scale/Coping Strategies Questionnaire). RESULTS No mean differences were detected between the groups. Both groups managed to preserve their functioning and PA level at follow-up. This may be due to significantly (p<0.05) reduced within groups evening pain intensity; acupuncture -0.96 (95% CI -1.91 to -0.01; p=0.049), TENS -1.29 (95% CI -2.13 to -0.44; p=0.003) and concern about pain; acupuncture -1.44 (95% CI -2.31 to -0.57; p=0.0012), TENS -1.99 (95% CI -2.81 to -1.17; p<0.0001). The acupuncture group showed an improvement in functioning at follow-up; 0.82 (95% CI 0.01 to 1.63; p=0.048) CONCLUSION: Treating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity and also less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active. TRIAL REGISTRATION NUMBER 12726. https://www.researchweb.org/is/sverige/project/127261.
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Affiliation(s)
- Annika Svahn Ekdahl
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tove Jendman
- Physiotherapy Clinic 'I Rorelse', Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation; Physiotherapy, Sahlgrenska Academy, Gothenburg, Sweden
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Xiangsheng T, Long G, Yingying S, Xiao A, Ping Y, Mingsheng T. Personality traits predict regression of pelvic girdle pain after pregnancy: a longitudinal follow-up study. BMC Pregnancy Childbirth 2021; 21:353. [PMID: 33947356 PMCID: PMC8094604 DOI: 10.1186/s12884-021-03759-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background Pelvic girdle pain (PGP) is a multifactorial condition with a partly unknown etiology. This condition can be mentally and physically compromising both during and after pregnancy. To provide all-around preventive measures to improve the recovery from PGP, it is a necessity for obstetricians and orthopaedists to develop predictive studies about the worse prognosis for this condition. Therefore, this study aims to determine whether personality traits can predict the consequences of long-term pregnancy-related PGP. Methods This was a prospective study conducted from January 2015 to August 2018. A total of 387 pregnant women were enrolled in this study. According to whether they had experienced PGP during the past 4 weeks, the subjects were classified into no PGP and PGP groups. Persistent PGP after the pregnancy was defined as a recurrent or continuous visual analog score (VAS) pain rating of ≥3 for more than 1 week. The Quick Big Five Personality Test (QBFPT) was used to assess personality traits. Data were obtained by mail or in the clinic. The authors collected data including age, BMI, educational level, annual household income, cesarean delivery, breastfeeding, unexpected sex of the baby, parity, sick leave, no or rare ability to take rest breaks at work, and PGP in the previous pregnancy. Results Of 387 included women, 264 subjects experienced PGP during the pregnancy with a mean age of 26.3 ± 4.5 years. A total of 80 of 264 (30.3%) women experienced persistent PGP after the pregnancy. Persistent PGP after the pregnancy was associated with higher levels of neuroticism (OR = 2.12, P = 0.001). Comparing women with persistent PGP, those who reported higher levels of extraversion and conscientiousness were more likely to recover from this condition (OR = 0.65, P = 0.001; OR = 0.78, P = 0.010, respectively). Besides, neuroticism was positively associated with higher pain scores (r = 0.52, P = 0.005). However, extraversion and conscientiousness domains showed negative correlations with pain score (r = − 0.48, P = 0.003; r = − 0.36, P = 0.001). Conclusions Personality traits were significantly associated with the outcomes of PGP.
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Affiliation(s)
- Tang Xiangsheng
- Department of Orthopaedic, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, 100853, China
| | - Gong Long
- Department of Orthopaedic, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, 100853, China
| | - Shi Yingying
- Department of Psychology, Hai Nan branch of Chinese PLA General Hospital, Sanya, 572000, Hainan, China
| | - An Xiao
- Department of Orthopaedic, Hai Nan branch of Chinese PLA General Hospital, Sanya, 572000, Hainan, China
| | - Yi Ping
- Department of Orthopaedic, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, 100853, China. .,Department of Orthopedic, China-Japan Friendship Hospital, No. 2 Yinhuayuan East Street, Chaoyang, Beijing, 100029, China.
| | - Tan Mingsheng
- Department of Orthopaedic, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, 100853, China. .,Department of Orthopedic, China-Japan Friendship Hospital, No. 2 Yinhuayuan East Street, Chaoyang, Beijing, 100029, China.
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Fagevik Olsén M, Körnung P, Kallin S, Elden H, Kjellby Wendt G, Gutke A. Validation of self-administered tests for screening for chronic pregnancy-related pelvic girdle pain. BMC Musculoskelet Disord 2021; 22:237. [PMID: 33648489 PMCID: PMC7923664 DOI: 10.1186/s12891-021-04103-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/18/2021] [Indexed: 01/13/2023] Open
Abstract
Background Many women develop pelvic girdle pain (PGP) during pregnancy and about 10% have chronic pain several years after delivery. Self-administered pain provocation tests are one way to diagnose and evaluate this pain. Their validity in post-partum women is not yet studied. The purpose of this study was to evaluate the validity of self-administered test for assessment of chronic pregnancy-related PGP several years after delivery. Methods Women who previously have had PGP during pregnancy and who participated in one of three RCT studies were invited to a postal follow up of symptoms including performance of self-administered tests after two, 6 or 11 years later, respectively. In total, 289 women returned the questionnaire and the test-results. Of these, a sub-group of 44 women with current PGP underwent an in-person clinical examination. Comparisons were made between test results in women with versus without PGP but also, in the sub-group, between the self-administered tests and those performed during the clinical examination. Results Fifty-one women reported PGP affecting daily life during the last 4 weeks, and 181 reported pain when performing at least one of the tests at home. Those with chronic PGP reported more positive tests (p < 0.001). There was no significant difference between diagnosis from the self-administered tests compared to tests performed during the in-person clinical examination (p = 0.305), either for anterior or posterior PGP. There were no significant differences of the results between the tests performed self-administered vs. during the clinical examination. Conclusion A battery of self-administered tests combined with for example additional specific questions or a pain-drawing can be used as a screening tool to diagnose chronic PGP years after delivery. However, the modified SLR test has limitations which makes its use questionable.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, S-405 30, Gothenburg, Sweden. .,Department of Physical Therapy, Sahlgrenska University Hospital, S-413 45, Gothenburg, Sweden.
| | - Paulina Körnung
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, S-405 30, Gothenburg, Sweden
| | - Sophie Kallin
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, S-405 30, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Caring Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska Academy, S-405 30, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Kjellby Wendt
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, S-405 30, Gothenburg, Sweden.,Department of Physical Therapy, Sahlgrenska University Hospital, S-413 45, Gothenburg, Sweden
| | - Annelie Gutke
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, S-405 30, Gothenburg, Sweden
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Flack NAMS, Depledge J, Hay-Smith EJC, Stringer MD, Gray AR, Woodley SJ. A self-report questionnaire for pregnancy-related symphyseal pain. Musculoskelet Sci Pract 2020; 48:102151. [PMID: 32560859 DOI: 10.1016/j.msksp.2020.102151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/24/2019] [Accepted: 03/10/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Symphyseal pain (SP) experienced during pregnancy is a common condition that can negatively influence function and wellbeing. Despite its adverse impact on quality of life, standardised diagnostic criteria for SP as a distinct type of pelvic girdle pain (PGP) are lacking. OBJECTIVES To develop a reliable self-administered instrument that could differentiate SP from posterior PGP in pregnant women, and ultimately be used for epidemiological or clinical purposes. METHOD Qualitative data from 17 women (four focus groups) were used to develop a questionnaire. The questionnaire was tested against physical therapy diagnoses based on clinical assessment in 122 pregnant women with SP (n = 41), posterior PGP (n = 41) or no PGP (n = 40); 30 women repeated the questionnaire a day later to assess reliability. Multinomial logistic regression models were used to assess the performance of candidate items in distinguishing between the groups. RESULTS/FINDINGS The single questionnaire item relating to location of worst pain (diagrammatic form) is useful for differentiating SP from posterior PGP and individuals with no PGP. The worst pain location question with the addition of the Pelvic Girdle Questionnaire provides a measure of "SP with impact", and is the best combination for distinguishing SP and posterior PGP. Test-retest reliability scores were excellent. CONCLUSION These findings provide new opportunities for diagnosing pregnancy-related SP, and highlight questionnaire items which best differentiate SP from posterior PGP. These items could be used in future epidemiological research, and in clinical settings as a quick, effective screening tool.
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Affiliation(s)
- Natasha A M S Flack
- Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand
| | - Jill Depledge
- Auckland District Health Board, Auckland, New Zealand
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Mark D Stringer
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Andrew R Gray
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Stephanie J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, New Zealand.
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11
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The Effect of Stabilization Exercises on Pain, Disability, and Pelvic Floor Muscle Function in Postpartum Lumbopelvic Pain: A Randomized Controlled Trial. Am J Phys Med Rehabil 2019; 97:885-891. [PMID: 29979205 DOI: 10.1097/phm.0000000000000993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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).
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12
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Abdelnaeem AO, Vining R, Rehan Youssef A. Classification of pregnancy related non-specific low back pain and pelvic girdle pain: a systematic review. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1637600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ahmed Omar Abdelnaeem
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, United States
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13
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Back Pain in Pregnant Women: Its Origins, Peculiarities of Pathogenesis and Biomechanics. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The problem of the back pain in pregnant women is one of the most important in modern medicine. 65–90 % of pregnant women complain of the back pain. The women may have the back pain from the early stages of pregnancy, or it may occur with the growth of the fetus.The causes of the pain during pregnancy are late reproductive age, high body mass index, physical strain, pain during previous pregnancies. Vertebrogenic and pelvic pain in pregnant women can first appear at the beginning of the gestational period. According to various authors, the frequency of such pain is 30–35 %. As a rule, painful neurologic manifestations begin in the third trimester, on average at the 18 th –22 nd week of pregnancy. About a half of women with early manifestation of lumbosacral pain during the pregnancy keep suffering from pain for a year after giving birth. In 20 % of cases, symptomatic pain is felt for 3 years after the delivery. The primary factors causing the pain syndrome is the shift in the centre of gravity due to enlargement of the pregnant uterus of the postural balance. The localization of the pain depending on the peculiarities of the posture can be different. In most of cases the lower back, thoracolumbar passage, sacrum, with the occasional radiation to buttock or pelvic joint, are affected. One of the most common pain syndromes in gynecology is the myofascial syndrome characterized by hyper tonus of the muscles and fasciae and ligaments of the pelvic minor.
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14
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Saleh MSM, Botla AMM, Elbehary NAM. Effect of core stability exercises on postpartum lumbopelvic pain: A randomized controlled trial. J Back Musculoskelet Rehabil 2019; 32:205-213. [PMID: 30282349 DOI: 10.3233/bmr-181259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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15
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Malmqvist S, Kjaermann I, Andersen K, Gausel AM, Økland I, Larsen JP, Bronnick KS. Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study. BMJ Open 2018; 8:e021378. [PMID: 30049694 PMCID: PMC6067360 DOI: 10.1136/bmjopen-2017-021378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Stefan Malmqvist
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Chiropractic unit, Sundbybergskliniken, Sundbyberg, Sweden
| | - Inger Kjaermann
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Knut Andersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Anne Marie Gausel
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Kolbjorn S Bronnick
- Regional Centre for Psychosis Research, Helse Stavanger HF, Stavanger, Norway
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16
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Dufour S, Vandyken B, Forget MJ, Vandyken C. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskelet Sci Pract 2018; 34:47-53. [PMID: 29268147 DOI: 10.1016/j.msksp.2017.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence, cost and disability associated with lumbopelvic pain continues to rise despite the range of available therapeutic interventions, indicating a deficiency in current approaches. A literature base highlighting a correlation between lumbopelvic pain and pelvic floor function is developing; however, the features that characterize this correlation have yet to be fully established. PURPOSE The purpose of this study was to determine the prevalence and characteristics of pelvic floor muscle function among women with lumbopelvic pain. METHODS A cross-sectional study was conducted on non-pregnant women presenting with lumbopelvic pain to one of seven outpatient orthopaedic clinics in Canada. Potential participants underwent a screening process to assess for pelvic floor muscle dysfunction. RESULTS A total of 182 women were recruited and 97 were excluded, leaving 85 participants (n = 85). Of these, 95.3% were determined to have some form of pelvic floor dysfunction. Specifically, 71% of the participants had pelvic floor muscle tenderness, 66% had pelvic floor weakness and 41% were found to have a pelvic organ prolapse. Participants with combined low back pain and pelvic girdle pain presented with higher levels of disability and increased characteristics of pelvic floor dysfunction. CONCLUSIONS Our findings corroborate and extend recent research supporting the hypothesis that a high proportion of pelvic floor muscle dysfunction is present among women with lumbopelvic pain. Specifically, increased pelvic floor muscle pressure-pain sensitivity represented the most frequent characteristic, the clinical implications of which require further study.
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Affiliation(s)
- Sinéad Dufour
- McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada.
| | - Brittany Vandyken
- McMaster University, School of Rehabilitation Science, Hamilton, Ontario, Canada
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17
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Low back pain and causative movements in pregnancy: a prospective cohort study. BMC Musculoskelet Disord 2017; 18:416. [PMID: 29037184 PMCID: PMC5644197 DOI: 10.1186/s12891-017-1776-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Low back pain (LBP) during pregnancy might be strongly related to posture and movements of the body, and its management is a clinically important issue. The purpose of this study was to investigate the activities related to LBP during pregnancy. Methods Participants included 275 women before 12 weeks of pregnancy. The women were evaluated at 12, 24, 30, and 36 weeks of pregnancy. The intensity of LBP was assessed using the Numerical Rating Scale (NRS). Movements related to LBP were investigated by free descriptive answers. Descriptive statistics were used to compile the movements that pregnant women thought induced LBP at each evaluation. Subsequently, a linear regression analysis was performed to evaluate the degree of association of certain movements with LBP using the data of participants who had LBP. The intensity of LBP (NRS score) was specified as the dependent variable, the movements that were related to pain were specified as the independent variables at the analysis. A significance threshold was set at 0.05. Results The final sample used in the analyses was 254, 249, 258, and 245 women at 12, 24, 30, and 36 weeks of pregnancy, respectively. There were 16 kinds of movements that induced LBP and all of them were daily activities rather than special movements that require extra task or effort. As pregnancy progressed, less number of participants attributed pain to a specific movement. At all evaluations, movements, especially sitting up, standing up from a chair, and tossing and turning were thought to be related to LBP. Furthermore, standing up from a chair and tossing and turning were significantly related to LBP throughout the pregnancy. In contrast, lying down and sitting up were significantly related to LBP but the relationship did not continue till late pregnancy. Conclusions Daily routine activity is related to LBP during pregnancy. These results suggest that recommendations for pregnant women about basic physical movements, such as ways of standing up that reduce the load on the body might be useful in the management of LBP.
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18
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Starzec M, Truszczyńska-Baszak A. Pregnancy-related lumbopelvic pain: classification and diagnostics according to European guidelines and a review of literature. REHABILITACJA MEDYCZNA 2017. [DOI: 10.5604/01.3001.0010.5005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lumbopelvic pain associated with pregnancy may originate from the lumbar spine, the pelvic girdle or may be mixed. According to European guidelines, individual subtypes of pain require different procedures, for which a detailed differential diagnosis is necessary. These ailments arouse a lot of controversy.
The aim of the work was to present the current state of knowledge on the aforementioned ailments, including European guidelines and the latest trends in foreign literature.
The diagnosis of lumbopelvic pain, with particular emphasis on the pathophysiology and methods of differentiation of both pain syndromes, was discussed. Lumbar spine pain is mainly related to the mechanical load caused by a pregnant uterus. In the case of pelvic girdle pain, the main cause is the disorder of optimal stability, which depends on the correct mechanisms of force and form closure. Pelvic girdle pain is characterized by other clinical symptoms and risk factors, it also often remains after pregnancy, having negative impact on the daily functioning of a woman even years after giving birth. Depending on the location (one or both sacroiliac joints, pubic symphysis), several types of this pain syndrome are distinguished. The worst prognosis is pelvic pain associated with the involvement of all three joints at the same time. Until now, this term has not been more widely used in the Polish-language literature.
The complexity of chronic pain syndromes, in which the discomforts of the pregnancy period may develop, entails the necessity of early identifi cation and deliberate action. Knowledge of the etiopathogenesis of these ailments is a prerequisite for therapeutic success. Introduction of terminology popular in foreign literature will improve treatment of these diseases, adapting it to current standards and will also enable better exchange of experience between professionals.
pelvic girdle pain, lumbar pain, pregnancy
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Affiliation(s)
- Małgorzata Starzec
- Zakład Rehabilitacji, Oddział Fizjoterapii, II Wydział Lekarski, Warszawski Uniwersytet Medyczny / Department of Rehabilitation, Physiotherapy Division, Medical University of Warsaw, Poland
| | - Aleksandra Truszczyńska-Baszak
- Wydział Rehabilitacji, Akademia Wychowania Fizycznego Józefa Piłsudskiego w Warszawie / Jozef Pilsudski University of Physical Education, Faculty of Rehabilitation, Poland
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19
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Gutke A, Bullington J, Lund M, Lundberg M. Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth. Disabil Rehabil 2017; 40:3054-3060. [DOI: 10.1080/09638288.2017.1368724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Jennifer Bullington
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
| | - Madeleine Lund
- Home Care and Rehabilitation, The City of Gothenburg, Gothenburg, Sweden
| | - Mari Lundberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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20
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Hilde G, Gutke A, Slade SC, Stuge B. Physical therapy interventions for pelvic girdle pain (PGP) after pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Gunvor Hilde
- Akershus University Hospital; Department of Obstetrics and Gynecology; Sykehusveien 25 Lørenskog Akershus Norway 1478
| | - Annelie Gutke
- Sahlgrenska Academy, University of Gothenburg; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation/Physiotherapy; Gothenburg Sweden 405 30
| | - Susan C Slade
- Monash University; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Malvern Victoria Australia
- Monash University; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Malvern Victoria Australia
| | - Britt Stuge
- Oslo University Hospital; Department of Orthopaedics; Kirkeveien 166 Oslo Norway N-0407
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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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Sunaga Y, Kanemura N, Anan M, Takahashi M, Shinkoda K. Estimation of inertial parameters of the lower trunk in pregnant Japanese women: A longitudinal comparative study and application to motion analysis. APPLIED ERGONOMICS 2016; 55:173-182. [PMID: 26995047 DOI: 10.1016/j.apergo.2016.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 06/05/2023]
Abstract
We aimed to quantify the inertial parameters of the lower trunk segment in pregnant Japanese women and compare kinetic data during tasks calculated with parameters estimated in this study to data calculated with standard parameters. Eight pregnant women and seven nulliparous women participated. Twenty-four infrared reflective markers were attached to the lower trunk, and the standing position was captured by eight infrared cameras. The lower trunk was divided into parts, and inertial parameters were calculated. Pregnant women performed a movement task that involved standing from a chair, picking up plates, and walking forward after turning to the right. Kinetic analysis was performed using standard inertial parameters and the newly calculated parameters. There were more significant differences between methods in the kinetic data at the latter stages of pregnancy. The inertial parameters calculated in this study should be used to ensure the validity of biomechanical studies of pregnant Japanese women.
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Affiliation(s)
- Yasuyo Sunaga
- Department of Physical Therapy, Faculty of Health and Social Services, Saitama Prefectural University, 380 San-nomiya, Koshigaya-shi, Saitama, 343-8540, Japan; Health Sciences Major, Division of Physical Therapy and Occupational Therapy Sciences, Graduate School of Health Sciences, Hiroshima University, 2-3, Kasumi-1 Chome, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Naohiko Kanemura
- Department of Physical Therapy, Faculty of Health and Social Services, Saitama Prefectural University, 380 San-nomiya, Koshigaya-shi, Saitama, 343-8540, Japan.
| | - Masaya Anan
- Department of Biomechanics, Institute of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi-1 Chome, Minami-ku, Hiroshima, 734-8553, Japan; Hiroshima University Center for Advanced Practice and Research of Rehabilitation, 2-3, Kasumi-1 Chome, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Makoto Takahashi
- Department of Biomechanics, Institute of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi-1 Chome, Minami-ku, Hiroshima, 734-8553, Japan; Hiroshima University Center for Advanced Practice and Research of Rehabilitation, 2-3, Kasumi-1 Chome, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Koichi Shinkoda
- Department of Biomechanics, Institute of Biomedical and Health Sciences, Hiroshima University, 2-3, Kasumi-1 Chome, Minami-ku, Hiroshima, 734-8553, Japan; Hiroshima University Center for Advanced Practice and Research of Rehabilitation, 2-3, Kasumi-1 Chome, Minami-ku, Hiroshima, 734-8553, Japan.
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23
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Sjödahl J, Gutke A, Ghaffari G, Strömberg T, Öberg B. Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study. Clin Biomech (Bristol, Avon) 2016; 35:49-55. [PMID: 27128765 DOI: 10.1016/j.clinbiomech.2016.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/09/2016] [Accepted: 04/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. METHODS Sixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. FINDINGS No significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P=0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P=0.01) and the muscles of the lower lateral abdominal wall (P<0.01). INTERPRETATION We suggest that disturbed motor activation patterns influence women's ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements.
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Affiliation(s)
- Jenny Sjödahl
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.
| | - Annelie Gutke
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Division of Physiotherapy, University of Gothenburg, Sweden.
| | - Ghazaleh Ghaffari
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
| | - Tomas Strömberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
| | - Birgitta Öberg
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.
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Bernard M, Tuchin P. Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study. J Chiropr Med 2016; 15:129-33. [PMID: 27330515 DOI: 10.1016/j.jcm.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe chiropractic management of a patient with pregnancy-related lumbopelvic pain. CLINICAL FEATURES A pregnant 35-year-old woman experienced insidious moderate to severe pregnancy-related lumbopelvic pain and leg pain at 32 weeks' gestation. Pain limited her endurance capacity for walking and sitting. Clinical testing revealed a left sacroiliac joint functional disturbance and myofascial trigger points reproducing back and leg pain. INTERVENTION AND OUTCOME A diagnosis of pregnancy-related low back pain and pregnancy-related pelvic girdle pain was made. The patient was treated with chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice in 13 visits over 6 weeks. She consulted her obstetrician for her weekly obstetric visits. At the end of treatment, her low back pain reduced from 7 to 2 on a 0-10 numeric pain scale rating. Functional activities reported such as walking, sitting, and traveling comfortably in a car had improved. CONCLUSION This patient with pregnancy-related lumbopelvic pain improved in pain and function after chiropractic treatment and usual obstetric management.
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Affiliation(s)
| | - Peter Tuchin
- Associate Professor, Department of Chiropractic Faculty Science, Macquarie University, Sydney, NSW, Australia
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Tseng PC, Puthussery S, Pappas Y, Gau ML. A systematic review of randomised controlled trials on the effectiveness of exercise programs on Lumbo Pelvic Pain among postnatal women. BMC Pregnancy Childbirth 2015; 15:316. [PMID: 26612732 PMCID: PMC4661954 DOI: 10.1186/s12884-015-0736-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/10/2015] [Indexed: 01/13/2023] Open
Abstract
Background A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment.
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Affiliation(s)
- Pei-Ching Tseng
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Shuby Puthussery
- Department of Clinical Education and Leadership & Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton LU2 8LE, Bedfordshire, UK.
| | - Meei-Ling Gau
- Graduate Institute of Nurse-Midwifery, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Road, Peitou, Taipei, Taiwan.
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Gutke A, Betten C, Degerskär K, Pousette S, Olsén MF. Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand 2015; 94:1156-67. [PMID: 26018758 DOI: 10.1111/aogs.12681] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/21/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain. MATERIAL AND METHODS Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain. RESULTS For lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity. CONCLUSIONS The levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain.
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Affiliation(s)
- Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | | | - Sara Pousette
- Private Clinic 'Friskispraktiken', Stockholm, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ozdemir S, Bebis H, Ortabag T, Acikel C. Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain: a prospective randomized controlled trial. J Adv Nurs 2015; 71:1926-39. [DOI: 10.1111/jan.12659] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Serpil Ozdemir
- Public Health Nursing Department; School of Nursing; Gulhane Military Medical Academy; Ankara Turkey
| | - Hatice Bebis
- Public Health Nursing Department; School of Nursing; Gulhane Military Medical Academy; Ankara Turkey
| | - Tulay Ortabag
- Public Health Nursing Department; School of Nursing; Hasan Kalyoncu University; Sahinbey Gaziantep Turkey
| | - Cengizhan Acikel
- Public Health and Epidemiology Department; Gulhane Military Medical Academy; Ankara Turkey
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Sunaga Y, Anan M, Shinkoda K. Biomechanics of rising from a chair and walking in pregnant women. APPLIED ERGONOMICS 2013; 44:792-798. [PMID: 23452381 DOI: 10.1016/j.apergo.2013.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 01/08/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
The present study aimed to assess the changes in the pattern of rising from a chair and walking forward as pregnancy progressed. Twelve pregnant women and 10 nulliparous women were included in this study. Participants were videotaped with a digital video camera in the sagittal plane, and the coordinates of the markers attached to the subjects were identified using image analysis software. The peak trunk-flexion angle in pregnant women during rising was smaller, but the hip-extension angle during the stance phase was larger than in controls. Also, the peak horizontal and vertical velocities of the center of mass were lower, and appeared earlier, in pregnant women than in controls. During rising, pregnant women dampened the propulsion attributable to increased uterus volume, and they enhanced the forward propulsion at gait initiation. To ensure safe motion, pregnant women should not initiate gait until reaching a stable standing position after rising.
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Affiliation(s)
- Yasuyo Sunaga
- Department of Physical Therapy, Faculty of Health and Social Services, Saitama Prefectural University, 380 San-nomiya, Koshigaya-shi, Saitama 343-8540, Japan.
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Mukkannavar P, Desai BR, Mohanty U, Kulkarni S, Parvatikar V, Daiwajna S. Pelvic girdle pain in Indian postpartum women: a cross-sectional study. Physiother Theory Pract 2013; 30:123-30. [PMID: 23899351 DOI: 10.3109/09593985.2013.816399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
UNLABELLED During pregnancy or postpartum period many women will experience some degree of pelvic girdle pain (PGP). In India, there is no information about the PGP prevalence and its associated factors evaluated during postpartum period. PURPOSE To reveal the prevalence of PGP postpartum in Indian women and identify associated factors with PGP postpartum. METHODS In this cross-sectional study, 284 postpartum women completed a questionnaire and underwent clinical examinations. The clinical examination included pain provocation tests for the pelvic as well as the active straight leg raise (ASLR) test. Possible associating factors were studied by using nonparametric tests and logistic regression analysis. RESULTS A total of 116 postpartum women (41%) had reported PGP at the time of the examination. A stepwise logistic regression analysis was performed to reveal associated factors. In the final model, factors such as (1) Caesarean delivery (adjusted OR, 2.0; 95% CI, 1.3-4.9); (2) ASLR test score ≥4 (adjusted OR, 2.3; 95% CI, 1.2-3.3); (3) Unilateral P4 test (adjusted OR, 1.8; 95% CI, 1.1-3.0); and (4) Sitting position during feeding (adjusted OR, 1.5; 95% CI, 0.9-2.8) were associated with the PGP. CONCLUSION We found a high prevalence of PGP in Indian women during the first three months of postpartum period. Our finding suggests that unilateral posterior pelvic pain provocation test (P4), ASLR test score ≥4, caesarean section delivery and sitting in breast-feeding posture were associated with increased risk of PGP during postpartum.
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Sjödahl J, Gutke A, Öberg B. Predictors for long-term disability in women with persistent postpartum pelvic girdle pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1665-73. [PMID: 23430102 DOI: 10.1007/s00586-013-2716-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 11/19/2012] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE The majority of prognostic studies on postpartum lumbopelvic pain have investigated factors during pregnancy. Since the majority of women recover within the first few months of delivery, it is unknown if the same predictors are valid for long-term consequences. It is also important to investigate predictors within subgroups of patients with pregnancy-related lumbopelvic pain due to their different clinical courses. The aim of this study was to identify predictors for disability 15 months postpartum in women with persistent postpartum pelvic girdle pain (PGP). METHODS Data were obtained by clinical tests and questionnaires 3 months postpartum. The outcome 15 months postpartum was disability measured with the Oswestry Disability Index. RESULTS A multiple linear regression analysis identified two significant two-way interaction effects that were predictive of disability 15 months postpartum: (a) age + trunk flexor endurance, and (b) disability + hip extensor strength. CONCLUSIONS Age, muscle function and disability seem to influence the long-term outcome on disability in women with persistent postpartum PGP. It may be important to consider the possibility of different variables impact on each other when predicting long-term disability. In addition, further studies are needed to investigate the impact of interaction effects on long-term consequences in women with persistent postpartum PGP.
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Affiliation(s)
- Jenny Sjödahl
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden.
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Hu H, Meijer OG, Hodges PW, Bruijn SM, Strijers RL, Nanayakkara PW, van Royen BJ, Wu W, Xia C, van Dieën JH. Understanding the Active Straight Leg Raise (ASLR): An electromyographic study in healthy subjects. ACTA ACUST UNITED AC 2012; 17:531-7. [DOI: 10.1016/j.math.2012.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 05/21/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Abstract
Since its founding in Montreal, Canada in 1974, the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has been providing orthopaedic and manual therapists from around the world with the highest-quality learning opportunities through a conference held every 4 years. In 2012, IFOMPT is partnering with The International Private Practitioners Association (IPPA) to host this prestigious event in Quebec City, Canada. As more than 51% of the Canadian Physiotherapy Association membership is working in private practice, this adds even greater value to this quadrennial event. This conference emulates best-evidence practice in the marriage of research and clinical excellence by pulling together some of the best and brightest hands and minds in orthopaedic physiotherapy. Through a call for proposals that equally emphasized research, clinical excellence, and the knowledge translation link between the two, the IFOMPT mandate of clinical and academic excellence has been kept at the forefront of this year's conference. Included in this supplement are the IFOMPT 2012 keynote addresses, schedule, and abstracts.
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Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial. Phys Ther 2012; 92:781-90. [PMID: 22282770 DOI: 10.2522/ptj.20110119] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Many women have low back pain (LBP) or pelvic girdle pain (PGP) during pregnancy, but there is limited evidence of effective primary and secondary preventive strategies. OBJECTIVE The purpose of this study was to investigate whether a group-based exercise program can reduce the prevalence and severity of LBP and PGP in pregnant women. DESIGN An observer-blinded randomized controlled trial with equal assignments to a training group and a control group was conducted. SETTING The study was conducted in primary care maternity units in 2 suburban municipalities in the southeastern part of Norway. PATIENTS The participants were 257 pregnant women who were healthy and between 18 and 40 years of age before gestation week 20. INTERVENTION The training group received supervised exercises in groups once a week, and the control group received standard care. MEASUREMENTS The main outcome measures were self-reported LBP and self-reported PGP. Secondary outcome measures were pain intensity in the morning and evening, disability, and 8-Item Short-Form Health Survey (SF-8) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Follow-up measurements were performed at gestation weeks 24, 28, 32, and 36. RESULTS Overall, there was no effect of the program on the prevalence of PGP (odds ratio = 1.03, 95% confidence interval [CI] = 0.66 to 1.59) or LBP (odds ratio = 0.77, 95% CI = 0.50 to 1.19). For the secondary outcomes, the estimated mean differences between the groups were -0.4 (95% CI = -0.8 to 0.1) for pain intensity in the morning, -0.4 (95% CI = -1.0 to 0.2) for pain intensity in the evening, -1.0 (95% CI = -2.2 to 0.0) for disability, 1.8 (95% CI = 0.0 to 3.7) for the SF-8 PCS, and -0.6 (95% CI = -2.2 to 1.4) for the SF-8 MCS. LIMITATIONS Due to low statistical power, the estimates for the primary outcomes are imprecise. CONCLUSIONS Supervised group exercise did not reduce the prevalence of LBP or PGP in pregnancy.
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Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1769-76. [PMID: 22310881 DOI: 10.1007/s00586-012-2162-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 01/11/2012] [Accepted: 01/18/2012] [Indexed: 01/13/2023]
Abstract
PURPOSE The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy. METHODS PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using six different databases. Observational cohorts, cross-sectional or case-control studies focused on the association between relaxin levels and PPGP during pregnancy were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Newcastle-Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group. RESULTS 731 references were identified. Six articles met the inclusion criteria and were considered for this systematic review. The main reason for the studies exclusion was PPGP related to gynaecological reasons. Five studies were case-control and one study was a prospective cohort. Four studies were ranked as high while two were ranked as low quality. Among the high quality studies, three found no association between PPGP and relaxin levels. CONCLUSIONS Based on these findings, the level of evidence for the association between PPGP and relaxin levels was found to be low. PPGP assessment and controlling for risk factors were found to increase bias leaving uncertainty in interpretation of these findings and a need for further research.
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Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med 2011; 9:15. [PMID: 21324134 PMCID: PMC3050758 DOI: 10.1186/1741-7015-9-15] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 02/15/2011] [Indexed: 01/13/2023] Open
Abstract
A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women.
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Affiliation(s)
- Nikolaos K Kanakaris
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Craig S Roberts
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:440-8. [PMID: 20593205 DOI: 10.1007/s00586-010-1487-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 04/15/2010] [Accepted: 06/11/2010] [Indexed: 01/08/2023]
Abstract
The majority of women recover from pregnancy-related lumbopelvic pain within 3 months of delivery. Since biomechanical and hormonal changes from pregnancy are largely reversed by 3 months postpartum, consequently, it is assumed that other factors might interfere with recovery. Relative to the fear-avoidance model and with reference to previous studies, we chose to investigate some pre-decided factors to understand persistent lumbopelvic pain. The evaluation of lumbopelvic pain postpartum is mostly based on self-administered questionnaires or interviews. Clinical classification of the lumbopelvic pain may increase our knowledge about postpartum subgroups. Two hundred and seventy-two consecutively registered pregnant women evaluated at 3 months postpartum, answered questionnaires concerning disability (Oswestry disability index), pain intensity on visual analog scale, health-related quality of life (HRQL, EQ5D), activity level, depressive symptoms (Edinburgh postnatal Depression Scale) and kinesiophobia (Tampa Scale for Kinesiophobia). Women were classified into lumbopelvic pain subgroups according to mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Multiple linear regression analysis was performed to explain the variance of disability. Thirty-three percent of postpartum women were classified with lumbopelvic pain; 40% reported moderate to severe disability. The impacts were similar among subgroups. Pain intensity, HRQL and kinesiophobia explained 53% of postpartum disability due to lumbopelvic pain. In conclusion, one of three postpartum women still had some lumbopelvic pain and the impacts were equivalent irrespective of symptoms in lumbar or pelvic areas. The additional explanations of variance in disability by HRQL and kinesiophobia were minor, suggesting that pain intensity was the major contributing factor.
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