Pain pattern in pregnancy and "catching" of the leg in pregnant women with posterior pelvic pain

Evaluating Desk-Assisted Standing Techniques for Simulated Pregnant Conditions: An Experimental Study Using a Maternity-Simulation Jacket

Lower back pain, a common issue among pregnant women, often complicates daily activities like standing up from a chair. Therefore, research into the standing motion of pregnant women is important, and many research studies have already been conducted. However, many of these studies were conducted in highly controlled environments, overlooking everyday scenarios such as using a desk for support when standing up, and their effects have not been adequately tested. To address this gap, we measured multimodal signals for a sit-to-stand (STS) movement with hand assistance and verified the changes using a t-test. To avoid imposing strain on pregnant women, we used 10 non-diseased young adults who wore jackets designed to simulate pregnancy conditions, thus allowing for more comprehensive and rigorous experimentation. We attached surface electromyography (sEMG) sensors to the erector spinae muscles of participants and measured changes in muscle activity, skeletal positioning, and center of pressure both before and after wearing a Maternity-Simulation Jacket. Our analysis showed that the jacket successfully mimicked key aspects of the movement patterns typical in pregnant women. These results highlight the possibility of developing practical strategies that more accurately mirror the real-life scenarios met by pregnant women, enriching the current research on their STS movement.

Prevalence of lumbopelvic pain during pregnancy: A systematic review and meta-analysis of cross-sectional studies

INTRODUCTION

Lumbopelvic pain (LPP) is common in pregnant women and has a significant negative effect on physical and psychological health. In this study, for the first time, we conduct a meta-analysis to estimate the overall prevalence of LPP among pregnant women and clarify the reasons for the differences in the estimated results.

MATERIAL AND METHODS

A systematic search of four databases (PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials) was conducted from inception until October 2022. Two reviewers conducted a methodological quality assessment. Random-effects model analysis was used to estimate the pooled prevalence and the 95% confidence interval. Chi-square tests and I2 -values were used to assess the heterogeneity. Subgroup analysis (according to the participants' continent, age, body mass index [BMI], gestational age and study risk of bias), sensitivity analysis and random-effects meta-regression were used to explore the the sources of heterogeneity.

RESULTS

Of the 1661 unique citations, 38 studies (21 533 pregnant participants) were included in this systematic review and meta-analysis. The overall pooled prevalence of LPP during pregnancy was 63% (95% CI: 0.57 to 0.69), with significant heterogeneity (I2  = 99.1%, P < 0.001). The prevalence differed by participants' continents, 71% (North America), 74% (South America), 63% (Asia), 64% (Europe), 59% (Africa) and 45% (Oceania). The prevalence differed by BMI, 64% (BMI <25), 64% (25 ≤ BMI ≤ 28), and 71% (BMI >28). The prevalence differed by age, 72% (age <25 years), 58% (25 ≤ age ≤ 30 years), and 69% (age >30 years). The prevalence were the same differed by study risk of bias, 63% (both low and moderate risk of bias studies). The prevalence were similar by gestational age, 62% (second trimester) and 63% (third trimester).

CONCLUSIONS

Lumbopelvic pain during pregnancy is common; about three-fifths of pregnant women experience LPP. More prevention and intervention research for lumbopelvic should be conducted in pregnant women with different clinical characteristics.

Low back pain in a sample of Syrian pregnant women: A cross-sectional study

Introduction

Low back pain related to pregnancy occurs in 60%-70% of pregnancies, at any time during pregnancy. During pregnancy, many factors such as weight gain, and others are the causes of the back pain. In Syria, due to the circumstances of the war, many pregnant women may be exposed to increase the risk of lower back pain, so this study will determine the prevalence of lower back pain among pregnant women and its potential risk factors. We aimed to evaluate the prevalence of low back pain in pregnant women and to assess the risk factors related to it.

Methods

A cross-sectional, observational study was conducted between May 2020 and December 2022 at Obstetrics and Gynecology University Hospital in Damascus, Syria. Pregnant women aged over 18 years were selected from the outpatient clinic. Participants, after signing the informed consent, fill out the survey, which included the following parameters: age, weight, height, body mass index (BMI), education, parity, shoe type, weekly walking hours, occupation, low back pain, in which semester, radiation, onset, alleviating and aggravating factors, disability, and pain in previous pregnancies. We used Excel 2010, and the Statistical Package for the Social Sciences version 23.0. p < 0.05 was considered statistically significant, and we used the Chi-square test (χ 2 test), t student test to test the basal differences between groups.

Results

A number of 551 pregnant participants were included and low back pain prevalence was 62%. There was a statistically significant relation between low back pain and each of the following: Obesity, weekly walking hours, pain in previous pregnancies, and occupation.

Conclusion

Low back pain is prevalent during pregnancy and the most important risk factors include obesity and pain in previous pregnancies whereas walking and employment are protective measures to prevent low back pain.

The Swedish version of the pelvic girdle questionnaire, cross-cultural adaptation and validation

Purpose: The aims of this study were to translate and culturally adapt The Pelvic Girdle Questionnaire to Swedish, and to evaluate the construct and discriminative validity.Materials and methods: A translation and cultural adaptation process was performed according to international guidelines. Pilot tests were conducted among 16 women during pregnancy and post-partum. Analysis of the construct and discriminative validity of the Swedish version of the Pelvic Girdle Questionnaire was performed in a sample of 177 pregnant women suffering from pain in the lumbo-pelvic area. Participants completed the Pelvic Girdle Questionnaire along with Oswestry Disability Index, numeric rating scales for pain intensity and for pelvic girdle pain concerns.Results: The Swedish version of the Pelvic Girdle Questionnaire showed high internal consistency with Cronbach's alphas between 0.82 and 0.96, good convergent validity with high correlations with the Oswestry Disability Index and the pain intensity numeric rating scale, whereas moderate correlation was shown between the concerns numeric rating scale and the other instruments as hypothesized. Receiver operating characteristic curves showed good discriminatory capacity for women in need of treatment.Conclusions: The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability. It has good construct and discriminative validity for measurements of consequences of pregnancy-related pelvic girdle pain among Swedish speaking women.IMPLICATIONS FOR REHABILITATIONPregnancy-related pelvic girdle pain may be disabling and long-lasting, however treatable when identified.The Pelvic Girdle Questionnaire is the only condition-specific, reliability tested and validated questionnaire for pelvic girdle pain.The Swedish version of the Pelvic Girdle Questionnaire has patient acceptability, good construct validity for pelvic girdle pain among Swedish speaking women, and shows good discriminative capacity for women in need of treatment.

Low back pain and causative movements in pregnancy: a prospective cohort study

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.

Clinical outcome following anterior arthrodesis in patients with presumed sacroiliac joint pain

BACKGROUND

It has been reported that in 13-32% of patients with chronic low back pain, the pain may originate in the sacroiliac (SI) joints. When treatment of these patients with analgesics and physiotherapy has failed, a surgical solution may be discussed. Results of such surgery are often based on small series, retrospective analyses or studies using a minimal invasive technique, frequently sponsored by manufacturers.

PURPOSE

To report the clinical outcome concerning pain, function and quality of life following anterior arthrodesis in patients presumed to have SI joint pain using validated questionnaires pre- and post-operatively. An additional aim was to describe the symptoms of the patients included and the preoperative investigations performed.

MATERIAL AND METHODS

Over a 6 year period we treated 55 patients, all women, with a mean age of 45 years (range 28-65) and a mean pelvic pain duration of 9.1 years (range 2-30). The pain started in connection with minor trauma in seven patients, pregnancy in 20 and unspecified in 28. All patients had undergone long periods of treatment including physiotherapy, manipulation, needling, pelvic belt, massage and chiropractic without success, and 15 had been operated for various spinal diagnoses without improvement. The patients underwent thorough neurological investigation, plain X-ray and MRI of the spine and plain X-ray of the pelvis. They were investigated by seven clinical tests aimed at indicating pain from the SI joints. In addition, all patients underwent a percutaneous mechanical provocation test and extra-articular local anaesthetic blocks against the posterior part of the SI joints. Before surgery all patients answered the generic Short-Form-36 (SF-36) questionnaire, the disease specific Balanced Inventory for Spinal Disorders (BIS) questionnaire and rated their level of pelvic and leg pain (VAS, 0-100). At follow-up at a mean of 2 years 49 patients completed the same questionnaires (89%).

RESULTS

At follow-up 26 patients reported a lower level of pelvic pain than before surgery, 16 the same level and six a higher level. Applying Svensson's method RP_{pelvic pain}=0.3976, with 95% CI (0.2211, 0.5740) revealed a statistically significant systematic improvement in pelvic pain. At follow-up 28 patients reported a higher quality of life and 26 reported sleeping better than pre-operatively. In most patients the character of the pelvic pain was dull and aching, often accompanied by a stabbing component in connection with sudden movements. Referred pain down the leg/s even to the feet and toes was noted by half of the patients and 29 experienced frequency of micturition.

CONCLUSIONS

It is apparent that in some patients the SI joints may cause long-term pain that can be treated by arthrodesis. We speculate that continued pain despite a healed arthrodesis may be due to persistent pain from adjacent ligaments. The next step should be a prospective randomized study comparing posterior fusion and ligament resection with non-surgical treatment.

IMPLICATIONS

Anterior arthrodesis can apparently relieve pain in some patients with presumed SI joint pain. The problem is how to identify these patients within the low back pain group.

Transcultural adaptation and psychometric validation of a Spanish-language version of the "Pelvic Girdle Questionnaire"

Background

The Pelvic Girdle Questionnaire is the only instrument designed to assess pain and disability specifically in pregnant or postpartum women with pelvic girdle pain. The objective of this study was the adaptation to the Spanish language and analysis of the psychometric properties of the Pelvic Girdle Questionnaire.

Methods

This is a descriptive cross-sectional study divided into two phases. In the first phase, a translation and adaptation process was performed according to international guidelines. Secondly, the analysis of the properties of the Spanish version was conducted using a sample of 125 pregnant or postpartum women suffering from pelvic girdle pain. Participants completed the Spanish version along with five other measurement instruments through an online platform. Internal consistency, construct validity, test-retest reliability, the ceiling and floor effects, responsiveness and discriminatory ability of the Spanish version were analysed.

Results

The Spanish version of the Pelvic Girdle Questionnaire showed high internal consistency with Cronbach's alpha = 0.961, and an intraclass correlation coefficient of 0.962. The convergent validity showed high positive correlation with other questionnaires used. ROC curves showed no discriminatory capacity for number of sites of pain or pregnancy/post-partum state.

Conclusions

This article presents the translation, validation and psychometric properties of the Spanish version of the Pelvic Girdle Questionnaire, that has proved to be an appropriate and valid assessment tool of disability due to pelvic girdle pain in pregnant and postpartum women.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0605-0) contains supplementary material, which is available to authorized users.

Referred leg pain originating from the sacroiliac joint: 6-month outcomes from the prospective randomized controlled iMIA trial

BACKGROUND

The first results from the randomized, controlled iFuse Implant System Minimally Invasive Arthrodesis (iMIA) trial showed that minimally invasive surgical management (MISM) of low back pain originating from the sacroiliac joint (SIJ) by placing transarticular triangular titanium implants reduced pain more effectively than conservative management (CM). We now conducted a separate analysis of the iMIA data to assess whether the referred leg pain (RLP) component of SIJ-associated pain may also be affected by MISM or CM.

METHODS

Data from 101 patients, recruited between June 2013 and May 2015 at nine European spine care centers, were included. Forty-nine patients were randomized to CM and 51 patients to MISM. RLP was defined as pain below the gluteal fold and assessed using the visual analogue scale (VAS). Changes in RLP over 6 months were the primary endpoint.

RESULTS

The prevalence of clinically significant RLP was 76.2 %. Over 6 months of follow-up, CM produced no significant change in RLP, which was 51.0 VAS points (interquartile range (IQR) 17.0-75.0) at baseline. In contrast, in the MISM cohort, we found a significant decrease in RLP from VAS 58.0 (IQR 24.5-80.0) at baseline to VAS 13.5 (IQR 0.0-39.3) after 6 months (p < 0.01). Improvement of RLP was associated only with the type of treatment (OR 5.04, p < 0.01), but not with patient age, sex, or different patterns of pain referral.

CONCLUSIONS

Our analysis shows that RLP is a frequent phenomenon in patients with SIJ-associated pain. At 6 months of follow-up, MISM helped relieve RLP more effectively than CM. Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT01741025.

Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy - pain status, self-rated health and family situation

Background

Pelvic girdle pain (PGP) in pregnancy is distinct from pregnancy-related low back pain (PLBP). However, women with combined PLBP and PGP report more serious consequences in terms of health and function. PGP has been estimated to affect about half of pregnant women, where 25% experience serious pain and 8% experience severe disability. To date there are relatively few studies regarding persistent PLBP/PGP postpartum of more than 3 months, thus the main objective was to identify the prevalence of persistent PLBP and PGP as well as the differences over time in regard to pain status, self-rated health (SRH) and family situation at 12 months postpartum.

Methods

The study is a 12 month follow-up of a cohort of pregnant women developing PLBP and PGP during pregnancy, and who experienced persistent pain at 6 month follow-up after pregnancy. Women reporting PLBP/PGP (n = 639) during pregnancy were followed up with a second questionnaire at approximately six month after delivery. Women reporting recurrent or persistent LBP/PGP at the second questionnaire (n = 200) were sent a third questionnaire at 12 month postpartum.

Results

A total of 176 women responded to the questionnaire. Thirty-four women (19.3%) reported remission of LBP/PGP, whereas 65.3% (n = 115) and 15.3% (n = 27), reported recurrent LBP/PGP or continuous LBP/PGP, respectively. The time between base line and the 12 months follow-up was in actuality 14 months. Women with previous LBP before pregnancy had an increased odds ratio (OR) of reporting ‘recurrent pain’ (OR = 2.47) or ‘continuous pain’ (OR = 3.35) postpartum compared to women who reported ‘no pain’ at the follow-up. Women with ‘continuous pain’ reported statistically significant higher level of pain at all measure points (0, 6 and 12 months postpartum). Non-responders were found to report a statistically significant less positive scoring regarding relationship satisfaction compared to responders.

Conclusions

The results from this study demonstrate that persistent PLBP/PGP is a major individual and public health issue among women 14 months postpartum, negatively affecting their self-reported health. However, the perceived relationship satisfaction seems to be stable between the groups.

Pelvic girdle pain in Indian postpartum women: a cross-sectional study

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.

Trunk postural demands of occupational activities of some merchant pregnant women in Benin, West Africa

Strenuous physical work puts expectant mothers at risk of experiencing back pain during the gestational months. Pregnant women in Benin perform physically demanding occupational tasks that include the lifting and carriage of heavy loads on their heads for commercial activities. A large percentage of pregnant subjects (58%) reported having back pain episodes since the start of their pregnancy. However, the mean Oswestry score of the affected participants was relatively low with a mean score of 0.2 (SD: 0.12), on a scale form 0 to 1. An evaluation of the postural demands of the occupational activities of these women revealed that they performed on average 328 trunk flexions at angles exceeding 60°, with 66 of these flexions sustained for more than 4 s, during the average 7.9 h where trunk postures were recorded. They also spent on average 36% of the recording time at trunk flexion angles larger than 20°. These results show that the merchant pregnant women in the Porto-Novo area in Benin are at great risk for developing back disorders during pregnancy.

PRACTITIONER SUMMARY

Results will make a first contribution to the literature by identifying the stressful postures adopted during a typical day. The findings of this study can help in the development of preventative concepts and postural modification techniques to decrease the occurrence of back pain during pregnancy for women in Benin.

Pregnancy-related lumbopelvic pain: prevalence, risk factors, and profile in Kuwait

OBJECTIVE

To determine prevalence and risk factors of pregnancy-related lumbopelvic pain (PRLPP) in women in Kuwait.

DESIGN

The study was designed as a multisite, cross-sectional design in which self-administered surveys were distributed. Setting and Participants.  Public locations and health care facilities in Kuwait. Pregnant women (400) were invited to participate.

OUTCOME MEASURES

Demographics, history of PRLPP, risk factors for PRLPP, location of pain, absenteeism due to LPP, management of previous LPP, and functional disability due to PRLPP.

RESULTS

Two hundred eighty questionnaires were returned. Mean age was 29.5 years; mean body mass index (BMI) was 29.69 kg/m(2) . Of the participants, 91% reported LPP, 78.8% reported history of menstrual pain, and 58.7% reported previous LPP, and 59% reported PRLPP during previous pregnancies, 42.8% reported activities of daily living were limited. Risk factors included a history of back pain (P = 0.00), PRLPP in a previous pregnancy (P = 0.01), and being in the third trimester of pregnancy (P = 0.02). BMI was not associated with PRLPP.

CONCLUSIONS

Clinicians in Kuwait need to screen for risk factors and detect PRLPP early and intervene as needed. Although overweight and obesity may not contribute largely to PRLPP in women in Kuwait, weight control is a major concern for healthy pregnancy. Physical therapy has a role in preventing and addressing this condition.

Pregnancy-related pelvic girdle pain: an update

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.

Pelvic girdle pain and low back pain in pregnancy: a review

Pregnancy-related pelvic girdle pain (PGP) and pregnancy-related low back pain (PLBP) are common problems with significant physical, psychological, and socioeconomic implications. There are several management options that are underutilized because of lack of comprehensive knowledge by health-care professionals and fear of harmful effects of treatment on the developing fetus. Interventions such as patient education, the use of pelvic belts, acupuncture, and aquatic and tailored postpartum exercises can be of some benefit to these patients. This article will focus on the diagnosis and management of PGP and PLBP, with discussion of terminology, epidemiology, risk factors, pathophysiology, and prognosis.

Muscle activity during the active straight leg raise (ASLR), and the effects of a pelvic belt on the ASLR and on treadmill walking

Women with pregnancy-related pelvic girdle pain (PPP), or athletes with groin pain, may have trouble with the active straight leg raise (ASLR), for which a pelvic belt can be beneficial. How the problems emerge, or how the belt works, remains insufficiently understood. We assessed muscle activity during ASLR, and how it changes with a pelvic belt. Healthy nulligravidae (N=17) performed the ASLR, and walked on a treadmill at increasing speeds, without and with a belt. Fine-wire electromyography (EMG) was used to record activity of the mm. psoas, iliacus and transversus abdominis, while other hip and trunk muscles were recorded with surface EMG. In ASLR, all muscles were active. In both tasks, transverse and oblique abdominal muscles were less active with the belt. In ASLR, there was more activity of the contralateral m. biceps femoris, and in treadmill walking of the m. gluteus maximus in conditions with a belt. For our interpretation, we take our starting point in the fact that hip flexors exert a forward rotating torque on the ilium. Apparently, the abdominal wall was active to prevent such forward rotation. If transverse and oblique abdominal muscles press the ilia against the sacrum (Snijders' "force closure"), the pelvis may move as one unit in the sagittal plane, and also contralateral hip extensor activity will stabilize the ipsilateral ilium. The fact that transverse and oblique abdominal muscles were less active in conditions with a pelvic belt suggests that the belt provides such "force closure", thus confirming Snijders' theory.

The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain

Pregnancy-related lumbopelvic pain has varying clinical presentations and effects among subgroups. Different lumbopelvic pain subgroups require different specific management approaches which require the differentiation between lumbar and pelvic girdle pain (PGP). Thirty-one consecutive pregnant women with non-specific lumbopelvic pain were evaluated by two examiners and classified into lumbar pain, PGP, or combined pelvic girdle and lumbar pain. A standard history about different positions/activities of daily life such as bending, sitting, standing, walking, and lying, was followed by a standardised mechanical assessment of the lumbar spine (Mechanical Diagnosis and Therapy), including tests of repeated end-range movements to standing and lying, pelvic pain provocation tests (distraction test, posterior pelvic pain provocation test, Gaenslen's test, compression test, and sacral thrust) a hip-rotation range-of-motion test, the active straight-leg-raising test, and a neurological examination. Agreement for the three syndromes (lumbar pain, PGP, or combined pelvic girdle and lumbar pain) was 87% (27/31), with a kappa coefficient of 0.79 (95% CI 0.60-0.98). It was possible to perform the classification procedure throughout pregnancy. There was substantial agreement between the two examiners for the classification of non-specific lumbopelvic pain into lumbar pain and PGP in pregnant women.

Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs

The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.

Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain

The aim of this study was to investigate sensitivity and specificity of self-administrated tests aimed at pain provocation of posterior and/or anterior pelvis pain and to investigate pain intensity during and after palpation of the symphysis. A total of 175 women participated in the study, 100 pregnant women with and 25 pregnant women without lumbopelvic back pain and 50 non-pregnant women. Standard pain provocation tests were compared with self assessed tests. All women were asked to estimate pain during and after palpation of the symphysis. For posterior pelvic pain, the self-test of P4 and Bridging test had the highest sensitivity of 0.90 versus 0.97 and specificity of 0.92 and 0.87. Highest sensitivity for self-test for anterior pelvic pain was pulling a mat 0.85. Palpation of symphysis was painful and persistency of pain was the longest among women who fulfilled the criteria for symphyseal pain. There were overall significant differences between the groups concerning intensity and persistency of pain (P < 0.001). Our results indicate that pregnant women can perform a screening by provocation of posterior pelvic pain by self-tests with the new P4 self-test and the Bridging test. Palpation of the symphysis is painful and should only be used as a complement to history taking, pain drawing and pulling a MAT-test.

Detecting trunk motion changes due to pregnancy using pattern recognition techniques

There are anatomical changes during pregnancy due to the increased and altered mass distribution in the trunk that could lead to changes in gait. There is little research, however, regarding adaptations in trunk motion with pregnancy. In this paper, we investigated the application of two pattern recognition techniques: support vector machine (SVM) and linear discriminant analysis (LDA) to detect differences in trunk kinematics, when walking, between women in late pregnancy and nulliparous (control) women. Test results indicate that the SVM can identify the trunk motion of pregnant women from their counterparts with a better accuracy compared to the LDA (71.43% vs 28.57% respectively). Furthermore, with a feature selection technique applied, the accuracy improved to 95.24% % using only 2 features namely the pelvic sagittal plane displacement and thoracic lateral tilt displacement at heel contact. The results suggest that for better detection of trunk motion changes in pregnant women, non-linear analysis may be required. The SVM was able to effectively differentiate pregnancy related trunk motion changes during a walking task which may indicate altered musculoskeletal loads with potential for injury or pain.

Gait in Pregnancy-related Pelvic girdle Pain: amplitudes, timing, and coordination of horizontal trunk rotations

Walking is impaired in Pregnancy-related Pelvic girdle Pain (PPP). Walking velocity is reduced, and in postpartum PPP relative phase between horizontal pelvis and thorax rotations was found to be lower at higher velocities, and rotational amplitudes tended to be larger. While attempting to confirm these findings for PPP during pregnancy, we wanted to identify underlying mechanisms. We compared gait kinematics of 12 healthy pregnant women and 12 pregnant women with PPP, focusing on the amplitudes of transverse segmental rotations, the timing and relative phase of these rotations, and the amplitude of spinal rotations. In PPP during pregnancy walking velocity was lower than in controls, and negatively correlated with fear of movement. While patients’ rotational amplitudes were larger, with large inter-individual differences, spinal rotations did not differ between groups. In the patients, peak thorax rotation occurred earlier in the stride cycle at higher velocities, and relative phase was lower. The earlier results on postpartum PPP were confirmed for PPP during pregnancy. Spinal rotations remained unaffected, while at higher velocities the peak of thorax rotations occurred earlier in the stride cycle. The latter change may serve to avoid excessive spine rotations caused by the larger segmental rotations.

European guidelines for the diagnosis and treatment of pelvic girdle pain

A guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management", issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick's Faber, Gaenslen's test, and modified Trendelenburg's test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.

A longitudinal study of the effect of pregnancy on rising to stand from a chair

Rising to stand from a chair becomes more difficult to perform as pregnancy progresses, which may lead to altered biomechanics affecting the musculoskeletal demands on the body segments. The kinematic and kinetic adaptations in the lower limbs and trunk as pregnancy progresses are unknown. Nine maternal subjects were investigated using an eight-camera motion analysis system and two force plates, four times throughout pregnancy and once post-birth during rising to stand. Twelve nulliparous female subjects were used to establish natural variation with retesting over the time period. The maternal subjects used temporal-spatial, kinematic and kinetic strategies to widen the base of support, minimize propulsion, increase motion of the thoracic segment and minimize anterior trunk-thigh apposition. A fear of postural instability may have made the subjects more cautious, and as they were able to adequately flex the trunk forward, propulsion was minimized in favor of maintaining upright terminal balance.

Interrater reliability and diagnostic accuracy of pelvic girdle pain classification

OBJECTIVE

The purpose of this study was to measure the reliability of a classification system for pelvic girdle pain (PGP) and diagnostic accuracy of selected examination and clinical special findings for diagnosis of PGP.

METHODS

The design involved a prospective epidemiological study of pregnancy-related PGP. Consecutive subjects were recruited and classified using criteria defined by previous studies. Two clinicians examined the subjects and classified each patient into 1 of 5 classification groups. Clinical examination and clinical special tests were performed on the patients with PGP. Statistical analysis involved interobserver agreement using a kappa statistic and sensitivity and specificity values for the examination and clinical special testing.

RESULTS

Twenty-one subjects were included in the analyses. Aggregated percentage of agreement for the classification system was 84.6%. The Cohen kappa was 0.78 (CI, 0.64-0.92; P < .0001), which indicated substantial agreement during selection of the classification system. Most clinical examination and clinical special-test findings demonstrated low sensitivity and high specificity, whereas clusters of findings including the lunge, manual muscle testing of the hip (lower extremities), and passive range of motion of the hip demonstrated the strongest diagnostic value.

CONCLUSION

Selected tests and measures are moderately discriminatory in diagnosing PGP. A classification system for diagnosing PGP demonstrates strong agreement and may be useful for clinicians.

Pregnancy related pelvic girdle pain and low back pain in an Iranian population

STUDY DESIGN

A cross-sectional study in pregnancy.

OBJECTIVES

To differentiate between pregnancy related pelvic girdle pain (PGP) and low back pain (LBP) in Iranian women, and investigate the prevalence of each syndrome.

SUMMARY OF BACKGROUND DATA

Most of the information about PGP and LBP has been obtained in Western countries. There are few studies to investigate pregnancy related lumbopelvic pain, and, especially, differentiate between PGP and LBP in non-Western countries, particularly in the Middle East.

METHODS

This study included 325 pregnant women, ranging in age from 16 to 42 years. All pregnant women were interviewed using a questionnaire. Two trained physical therapists performed the posterior pelvic pain provocation test on all women with lumbopelvic pain.

RESULTS

A total of 161 pregnant women (49.5%) had reported lumbopelvic pain at the time of the examination. Based on the posterior pelvic pain provocation test, 91 women (28%) had PGP, 43 (13.2%) had LBP, and 27 (8.3%) had both PGP and LBP simultaneously. The intensity of pain in women with lumbopelvic pain using the visual analog scale was 5.6 (standard deviation 2.0; range 2-10).

CONCLUSIONS

About 1 in every 2 pregnant women studied experienced lumbopelvic pain at the time of the examination. In this study, PGP was almost 2 times more common than LBP. The high prevalence of PGP suggests that this symptom is a significant health problem in Iranian pregnant women, and needs more attention by Iranian health professionals and researchers.

Effects of a back-pain-reducing program during pregnancy for Korean women: A non-equivalent control-group pretest–posttest study

BACKGROUND

Although many pregnant women experience back pain, it has not considered an important health problem. No study has investigated the effects of a back-pain-reducing program (BPRP) during pregnancy for Korean women.

OBJECTIVE

The purpose of this study was to evaluate the effect of a program designed to reduce back pain in pregnant women.

METHODS

A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended an antenatal clinic and experienced back pain during their pregnancy were included in an intervention group (n=29), and their intensity of back pain, functional limitation and anxiety were compared with women in a control group from another antenatal clinic (n=27). The data were collected at three time points: prior to intervention, and 6 and 12 weeks after intervention.

RESULTS

At 12 weeks after intervention, the intensity of back pain experienced by the intervention group was significantly lower than that of the control group. However, there were no statistically significant differences between the groups with respect to functional limitations and anxiety.

CONCLUSIONS

The findings show that the pain-reducing program developed for this study was effective in reducing the intensity of back pain experienced by pregnant women. Promoting good posture and regular exercise can be recommended as a method to relieve back pain in pregnancy women. Further studies are needed to confirm the effect of the BPRP during pregnancy.

Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain

Approximately 5-20% of postpartum women suffer from long-lasting pelvic girdle pain (PGP). The etiology and pathogenesis of PGP are still unclear. The aim of this study was to examine whether subjects with and without persisting PGP and disability differed with respect to their ability to voluntarily contract the deep abdominals (TrA and IO) and to the strength of the pelvic floor muscles (PFM). Twenty subjects (12 with persisting PGP, 8 recovered from PGP) were examined. Contractions of the deep abdominal muscles (TrA and IO) were imaged by real-time ultrasound. Vaginal palpation and observation were used to assess the women's ability to perform correct a PFM contraction. PFM strength was measured by a vaginal balloon catheter connected to a pressure transducer. The active straight leg raise test was used to assess the ability of load transfer. The results showed no statistical significant difference between the groups in increase of muscle thickness of the deep abdominal muscles (TrA; P = 0.87 and IO; P = 0.51) or regarding PFM strength (P = 0.94). The ability to voluntarily contract the deep abdominal muscles and the strength of the PFMs are apparently not associated to PGP. However, the results are based on a small sample and additional studies are needed.

Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning

STUDY DESIGN

A cohort study in pregnancy.

OBJECTIVES

To differentiate between pregnancy-related pelvic girdle pain (PPGP) and lumbar pain, and to study the prevalence of each syndrome and its consequences in terms of pain, functioning, and health.

SUMMARY OF BACKGROUND DATA

When studying prevalence, etiology, and consequences, differentiation between PPGP and lumbar pain is important, and, to our knowledge, its consequences for functioning and health during pregnancy have not previously been studied.

METHODS

All women answered questionnaires (demographic data, EuroQol). Women with lumbopelvic pain completed the Oswestry Disability Index, pain intensity measures, in addition to undergoing a mechanical assessment of the lumbar spine, pain provocation tests, and active straight leg raising test.

RESULTS

Of 313 women, 194 had lumbopelvic pain. The PPGP subgroup comprised 54% of those women with lumbopelvic pain, lumbar pain 17%, and combined PPGP and lumbar pain 29%. Women having both PPGP and lumbar pain reported the highest consequences in terms of health and functioning.

CONCLUSIONS

Pain intensity, disability, and health measurements differentiate subgroups of lumbopelvic pain in pregnancy.

Sacroiliac joint dysfunction: evaluation and management

Sacroiliac joint dysfunction is believed to be a significant source of low back and posterior pelvic pain.

METHODS

To assess the clinical presentation, diagnostic testing, and treatment options for sacroiliac joint dysfunction, a systematic literature review was performed using MEDLINE.

RESULTS

Presently, there are no widely accepted guidelines in the literature for the diagnosis and treatment of sacroiliac instability. Establishing management guidelines for this disorder has been complicated by the large spectrum of different etiologic factors, the variability of patient history and clinical symptoms, limited availability of objective testing, and incomplete understanding of the biomechanics of the sacroiliac joint.

CONCLUSIONS

A reliable examination technique to identify the sacroiliac joint as a source of low back pain seems to be pain relief following a radiologically guided injection of a local anaesthetic into the sacroiliac joint. Most patients respond to non-operative treatment. Patients who do not respond to non-operative treatment should be considered for operative sacroiliac joint stabilization.

Back pain in pregnancy: 1-year follow-up of untreated cases

Back Pain (BP) is one of the most frequent symptoms during the last period of pregnancy, and high incidence has been described in several studies. Until now no wide, multicenter and prospective clinical studies on the natural course of BP after pregnancy have been available. We performed a multicenter follow-up study in a sample of pregnant women using the Italian validated version of the Roland questionnaire to assess the evolution of BP after pregnancy and identify prognostic factors. Each center had to re-evaluate at least 75% of the initially enrolled women, with latency of 1 year after delivery. At the follow-up, we acquired substantial clinical data concerning the post-delivery period. The evaluation of symptom evolution was based on the Roland questionnaire. At follow-up, 53% of re-evaluated women had no BP symptoms. Moreover, there was a significant improvement of patient-oriented assessment in women who suffered BP after delivery. With regard to the predictive factors, the presence of BP before pregnancy implied a 3.1-fold higher probability of improvement after delivery. In conclusion, women without history of BP before pregnancy and who complain of these symptoms during pregnancy require greater attention, because they have a lower possibility for improvement. Conversely, in women with a history of BP, pregnancy represents a transient period of worsening symptoms, probably due to the temporary para-physiological mechanical condition.

Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence

Pregnancy-related lumbopelvic pain has puzzled medicine for a long time. The present systematic review focuses on terminology, clinical presentation, and prevalence. Numerous terms are used, as if they indicated one and the same entity. We propose "pregnancy-related pelvic girdle pain (PPP)", and "pregnancy-related low back pain (PLBP)", present evidence that the two add up to "lumbopelvic pain", and show that they are distinct entities (although underlying mechanisms may be similar). Average pain intensity during pregnancy is 50 mm on a visual analogue scale; postpartum, pain is less. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. The mechanisms behind disabilities remain unclear, and constitute an important research priority. Changes in muscle activity, unusual perceptions of the leg when moving it, and altered motor coordination were observed but remain poorly understood. Published prevalence for PPP and/or PLBP varies widely. Quantitative analysis was used to explain the differences. Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PPP and/or PLBP. These values decrease by about 20% if one excludes mild complaints. Strenuous work, previous low back pain, and previous PPP and/or PLBP are risk factors, and the inclusion/exclusion of high-risk subgroups influences prevalence. Of all patients, about one-half have PPP, one-third PLBP, and one-sixth both conditions combined. Overall, the literature reveals that PPP deserves serious attention from the clinical and research communities, at all times and in all countries.

Gait in patients with pregnancy-related pain in the pelvis: an emphasis on the coordination of transverse pelvic and thoracic rotations

OBJECTIVE

To quantify gait impairments in women with pregnancy-related pain in the pelvis which persisted post-partum.Design. Nine patients and nine healthy subjects were studied during treadmill walking at different velocities.

BACKGROUND

Walking problems in patients with pregnancy-related pain in the pelvis have been known to exist for a long time. To date, no quantitative gait studies have been conducted in this population.

METHODS

Maximum attainable walking velocity was determined, amplitudes of pelvic and thoracic rotations were calculated, and spectral analysis was used to assess the harmonicity of these rotations. Coordination between pelvic and thoracic rotations was characterized as mean relative Fourier phase and weighted coherence.

RESULTS

Maximum attainable walking velocity was highly variable between patients, but on average significantly lower than in healthy controls. Moreover, patients had a significantly lower mean relative Fourier phase (again, highly variable) and higher weighted coherence. The other parameters did not differ significantly between groups.

CONCLUSIONS

Coordination between pelvic and thoracic rotations in the transverse plane was affected in patients with pregnancy-related pain in the pelvis. Individual patients may apply different strategies during walking to cope with the underlying problems.

RELEVANCE

Pregnancy-related pain in the pelvis is poorly understood. Patients with this condition are known to have problems with locomotion. The present study reveals that gait coordination is altered. Theoretically, this underlines the importance of analysing coordination in pathological movement. Clinically, better understanding the gait problems of women with pregnancy-related pain in the pelvis may contribute to more appropriate treatments.

Reliability and validity of hip adduction strength to measure disease severity in posterior pelvic pain since pregnancy

STUDY DESIGN

A cross-sectional analysis was performed in patients with posterior pelvic pain since pregnancy (PPPP). The strength of adduction of the hips was measured and compared with the scores of commonly used disease severity measures of lumbopelvic pain.

OBJECTIVES

To assess the reliability and validity of using hip adduction strength as measure of disease severity in patients with PPPP.

SUMMARY OF BACKGROUND DATA

Various tools are used to measure disease severity in PPPP; there is still a need for simple tests with high reliability and validity.

METHODS

Intra- and intertester reliability of hip adduction strength measurement was assessed in two small groups of women with PPPP. Validity of hip adduction strength to measure disease severity was investigated in a group of 200 patients with PPPP by comparing the test scores with the medical history, scores on self-reported scales on disability, pain, and tiredness, pain provocation tests, and the active straight leg raise test. Responsiveness of hip adduction strength was assessed in a group of 75 patients with PPPP. Global impression of improvement, scored by the patient, was used as criterion standard. The responsiveness of the hip adduction strength was expressed as the standardized response mean and was compared with the responsiveness of the Quebec Back Pain Disability Scale.

RESULTS

The intratester reliability for measuring hip adduction strength and the intraclass correlation coefficient were both 0.79. The intertester reliability for measurement of adduction strength and the intraclass correlation coefficient were also both 0.79. Hip adduction strength correlated as expected with all disease severity measures. Responsiveness of the hip adduction strength was large (standardized response mean = 0.93) and slightly less than that of the Quebec Back Pain Disability Scale (standardized response mean = 1.20).

CONCLUSION

Hip adduction strength can be recommended to measure disease severity in PPPP, especially to describe groups of patients and to evaluate the course of the disease in groups as well as in individual patients. Decreased hip adduction strength appears to be caused by the inability to use the hip muscles rather than by weakness of the muscles.

The use of a modified classification system in the treatment of low back pain during pregnancy: a case report

STUDY DESIGN

Case study.

OBJECTIVE

To describe the use of a classification approach in the evaluation and treatment of a pregnant patient with low back pain (LBP).

BACKGROUND

The patient was a 28-year-old primigravida in her 20th week of pregnancy. She presented with a chief complaint of LBP without precipitating trauma. Her pain limited her sitting to 20 minutes or less and restricted her ability to bend forward.

METHODS AND MEASURES

This patient was treated 4 times during a period of 2 weeks. The patient was classified as stage 1 extension syndrome. Because of the patient's pregnancy, treatment with active extension exercises commonly prescribed for this syndrome was deemed inadequate. Therefore, manual joint mobilization was applied to the symptomatic vertebral segment. Additional intervention included moist heat, soft tissue mobilization to the thoracolumbar paraspinals, manual stretching of the hip flexors, abdominal bracing, and wall squat exercises.

RESULTS

After 4 treatments, the patient was able to bend forward without pain, sit longer than 1 hour without discomfort, and work with minimal discomfort. She improved from a stage 1 classification to a stage 3 classification.

CONCLUSION

This case illustrates the use of a classification system to guide physical therapy intervention. It also demonstrates an effective and safe use of manual techniques in the treatment of a pregnant patient.

Responsiveness of outcome measurements in rehabilitation of patients with posterior pelvic pain since pregnancy

STUDY DESIGN

A cohort study was conducted.

OBJECTIVE

To develop a test battery for evaluating the course of posterior pelvic pain since pregnancy.

SUMMARY OF BACKGROUND DATA

Properly validated scales to evaluate the course of posterior pelvic pain since pregnancy are scarce. Moreover, the use of many tests would be too strenuous for the patient and has an unfavorable cost-benefit ratio.

METHODS

The ability of 48 effect measures to detect clinically relevant changes over time (responsiveness) was tested in patients with posterior pelvic pain since pregnancy. In this test, 35 measures were evaluated in a group of 44 patients, and 16 measures in a group of 56 patients (three measures were evaluated in both groups). All the tests were performed at baseline and after 8 weeks treatment. A global impression of improvement (improved or not improved) scored by the patient was used as the standard for assessing the course of the disease. Responsiveness was examined by calculating the standardized response mean of the improved patients and by using a two-tailed Mann-Whitney nonparametric test to compare the patients who had improved and those who had not improved.

RESULTS

Of the 48 effect measures, 26 measures of five categories (activities of daily living, pain, hip muscle strength, spine mobility, and spine muscle strength) showed good correlation with the patient's global impression of improvement. The measures in the "mobility of the pelvic joints" category were insufficient for assessing clinical change in posterior pelvic pain since pregnancy. The measures in the "fatigue" and "pain provocation tests" categories correlated only moderately with clinical change.

CONCLUSIONS

It seems possible to gain appropriate information about the course of posterior pelvic pain since pregnancy with a small test battery. The usefulness of the Québec Back Pain Disability Scale, the hip adduction strength assessment, and the active straight-leg-raise test was proved by the current study. The value of 23 other instruments was substantiated, but further studies are needed to confirm their usefulness. The correlation of 22 evaluated measures with the patient's global improvement was too weak for them to be recommended as measures of clinical changes over time in posterior pelvic pain since pregnancy. It is recommended that clinicians and investigators compile a small test battery by selecting the best representatives of the five measurement categories that have good correlation with the patient's global impression of improvement.

Validity of the active straight leg raise test for measuring disease severity in patients with posterior pelvic pain after pregnancy

STUDY DESIGN

A cross-sectional analysis was performed with a group of women meeting strict criteria for posterior pelvic pain after pregnancy. The active straight leg raise test and common severity measurement scales of lumbopelvic pain were scored.

OBJECTIVE

To assess the validity of the active straight leg raise test as a disease severity scale for patients with posterior pelvic pain after pregnancy.

SUMMARY OF BACKGROUND DATA

Various diagnostic tools are used to measure disease severity in patients with posterior pelvic pain after pregnancy, but simple tests with high reliability and validity still are needed.

METHODS

The investigation was performed with 200 women who had posterior pelvic pain after pregnancy. The validity of the active straight leg raise test as a severity scale was investigated by comparing the test score with the medical history, scores on self-reported disability scales, pain and tiredness, and pain provocation tests. The usefulness of the active straight leg raise test as a severity scale was compared with that of the Québec Back Pain Disability Scale. The influence of several demographic and anthropometric variables on the active straight leg raise score was investigated.

RESULTS

The active straight leg raise score ranged from 0 to 10 and correlated as expected with all severity scales. The correlation between the scores on the active straight leg raise test and the Québec Back Pain Disability Scale was 0.70. No association was found between the active straight leg raise score and age, parity, duration of the postpartum period, height, or weight.

CONCLUSION

The active straight leg raise test can be recommended as a disease severity scale for patients with posterior pelvic pain after pregnancy.

Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints

OBJECTIVE

The aim of this study was to investigate the association between pregnancy-related pelvic pain (PRPP) and sacroiliac joint (SIJ) laxity.

METHODS

A cross-sectional analysis was performed in a group of 163 women, 73 with moderate or severe (PRPP+) and 90 with no or mild (PRPP-) PRPP at 36 weeks of pregnancy. SIJ laxity was measured by means of Doppler imaging of vibrations in threshold units (TU). Pain, clinical signs and disability were assessed with visual analog scale (VAS), posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR) test, and Quebec back pain disability scale (QBPDS), respectively.

RESULTS

Mean SIJ laxity in the PRPP+ group was not significantly different from the PRPP- group (3.0 versus 3.4 TU). The mean left-right difference, however, was significantly higher in the PRPP+ group (2.2 TU) than in the PRPP- group (0.9 TU). In the PRPP- group, only 4% had asymmetric laxity of the SIJs in contrast to 37% of the PRPP+ group. Between the PRPP+ subjects with asymmetric and symmetric laxity of the SIJs significant differences were found with respect to mean VAS for pain (7.9 versus 7.0), positive PPPP test (59% versus 35%), positive ASLR test (85 versus 41%) and mean QBPDS score (61 versus 50).

CONCLUSIONS

Increased SIJ laxity is not associated with PRPP. In fact, pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. However, a clear relation between asymmetric laxity of the SIJs and PRPP is found.

Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy

STUDY DESIGN

A cross-sectional analysis was performed in a group of women meeting strict criteria for posterior pelvic pain since pregnancy (PPPP). The scores on the Active Straight Leg Raise Test (ASLR test) were compared with the scores of healthy controls.

OBJECTIVES

To develop a new diagnostic instrument for use in patients with PPPP. The objectives of the present study were to assess the validity and reliability of the ASLR test.

SUMMARY OF BACKGROUND DATA

Various diagnostic tools are used to diagnose PPPP, but there is still a need for simple tests with high reliability, sensitivity, and specificity.

METHODS

Reliability of the ASLR test was assessed in a group of 50 women with lumbopelvic pain of various etiologies and various degrees of severity. Sensitivity was assessed in 200 patients with PPPP and specificity in 50 healthy women. Sensitivity and specificity of the ASLR test were compared with the posterior pelvic pain provocation test (PPPP test).

RESULTS

The test-retest reliability measured with Pearson's correlation coefficient between the two ASLR scores 1 week apart was 0.87. The intraclass correlation coefficient (ICC) was 0.83. Pearson's correlation coefficient between the scores of the patient and the scores of a blinded assessor was 0.78; the ICC was 0.77. In the patient group, the ASLR score ranged from 0-10; in the control group it ranged from 0-2. The best balance between specificity and sensitivity was found when scores 1-10 are designated as positive and zero as negative. With this cut-off point sensitivity of the test was 0.87 and specificity was 0.94. The sensitivity of the ASLR test is higher than the sensitivity of the PPPP test; an advantage of the ASLR test is the simplicity of measuring the score.

CONCLUSION

The ASLR test is a suitable diagnostic instrument to discriminate between patients who are disabled by PPPP and healthy subjects. The test is easy to perform; reliability, sensitivity, and specificity are high. It seems that the integrity of the function to transfer loads between the lumbosacral spine and legs is tested by the ASLR test.

Functional changes in back muscle activity correlate with pain intensity and prediction of low back pain during pregnancy

OBJECTIVE

To assess low back pain (LBP) intensity and subjective disability during pregnancy and compare the pain scores with lumbar motion patterns.

DESIGN

A prospective study of pregnant back pain sufferers and healthy controls.

SETTING

Kuopio University Hospital, Kuopio, Finland.

PARTICIPANTS

Study group consisted of 32 pregnant women with LBP; control group consisted of 21 healthy pregnant women.

MAIN OUTCOME MEASURES

Back pain intensity was assessed by visual analog scale (VAS), and subjective disability index was measured by Oswestry Low Back Disability Questionnaire, at 20 and 36 weeks of pregnancy. Back muscle activities were recorded by surface electromyography, and movement sensors were used to detect lumbar motion.

RESULTS

In the study group current pain scores (VAS) at first and last trimester correlated strongly (r = .82, p < .00). Pain scores correlated with body weight at the first trimester (r = .54, p = .003) and at the last trimester (r = .67, p < .00). Significant correlation was noted between current pain intensity and back muscle activity level during forward body flexion at first trimester (r = .704, p < .00). Back muscle activity during bending measured at first trimester significantly correlated with pain intensity at last trimester (r = .703, p < .00). Back muscle activity during the first trimester of pregnancy had a negative correlation with current (r = -.57, p = .002) and later subjective disability index (r = -.42, p = .02). It correlated inversely (r = -.54, p = .003) with pain score at last trimester of pregnancy, ie, the lower the back muscle activity at the beginning of pregnancy, the more pain and disability throughout pregnancy. In the control group, three women developed LBP and disability feelings during pregnancy. They had increased muscle activity during flexion at delivery, ie, disturbed flexion relaxation.

CONCLUSIONS

Prepregnancy LBP predicts renewed pain during pregnancy, and dysfunction of back muscles has been established in LBP. In this study, disturbance in the relaxation of the back muscles was linearly related to current, and also to later, pain scores. In addition, back muscle activity level was inversely related to the disability index. For the first time, it has been shown prospectively that the function pattern of back extensors seems to predict, and is related to, future back pain. Simple function testing is promising and might be valuable in identifying mothers with a high risk of pregnancy-related back pain and in directing preventive intervention to high risk women by making them aware of self-treatment methods.