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Hrvatin I, Rugelj D, Šćepanović D. Pregnancy-related pelvic girdle pain affects balance in the second and third trimesters of pregnancy. PLoS One 2024; 19:e0287221. [PMID: 38457422 PMCID: PMC10923470 DOI: 10.1371/journal.pone.0287221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/01/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION During pregnancy, many changes in the musculoskeletal system and pregnancy-related disorders affect posture and postural stability. Pregnancy-related pelvic girdle pain (PPGP) is a common disorder in pregnancy; the cause remains unknown. The purpose of the present study was to determine if PPGP affects static postural stability and its relation to the stage of pregnancy. METHODS Sixty-three pregnant women between the ages of 18 and 45 and between the 12th and 38th weeks of gestation were included in the study. They were divided into four groups according on the trimester and the presence of PPGP. Static balance was assessed using a force plate on firm and compliant surfaces with eyes open and closed. RESULTS Pregnant women with PPGP had significantly (p < 0.05) greater centre-of-pressure velocity and sway area compared to pregnant women without PPGP, especially in the third trimester of pregnancy. In the second trimester, only two significant differences in COP parameters were observed between pregnant women with and without PPGP. Pregnant women in the third trimester of pregnancy had significantly (p < 0.05) greater centre-of-pressure velocity and larger postural sway area compared to pregnant women in the second trimester of pregnancy, regardless of PPGP. DISCUSSION AND CONCLUSION Pregnant women with PPGP had poorer static stability when compared to pregnant women without pain, especially in the third trimester of pregnancy. The cause could be found in the poorer ability to stabilise the trunk and pelvis, poorer proprioception, and issues with automatic movement patterns.
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Affiliation(s)
- Ivana Hrvatin
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Rugelj
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Darija Šćepanović
- Gynaecological Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Shanshan H, Liying C, Huihong Z, Yanting W, Tiantian L, Tong J, Jiawei Q. Prevalence of lumbopelvic pain during pregnancy: A systematic review and meta-analysis of cross-sectional studies. Acta Obstet Gynecol Scand 2024; 103:225-240. [PMID: 37997035 PMCID: PMC10823407 DOI: 10.1111/aogs.14714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/11/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023]
Abstract
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.
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Affiliation(s)
- Hong Shanshan
- Department of Obstetrics and GynecologyQuan Zhou Women's and Children's HospitalQuanzhouChina
| | - Chen Liying
- Department of Obstetrics and GynecologyQuan Zhou Women's and Children's HospitalQuanzhouChina
| | - Zhuang Huihong
- Department of Rehabilitation MedicineQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Wang Yanting
- Department of Obstetrics and GynecologyQuan Zhou Women's and Children's HospitalQuanzhouChina
| | - Lin Tiantian
- Department of Rehabilitation MedicineQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
| | - Jin Tong
- Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijingChina
| | - Qin Jiawei
- Department of Rehabilitation MedicineQuanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhouChina
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Galanis A, Dimopoulou S, Karampinas P, Vavourakis M, Papagrigorakis E, Sakellariou E, Karampitianis S, Zachariou D, Theodora M, Antsaklis P, Daskalakis G, Vlamis J. The correlation between transient osteoporosis of the hip and pregnancy: A review. Medicine (Baltimore) 2023; 102:e35475. [PMID: 37832084 PMCID: PMC10578699 DOI: 10.1097/md.0000000000035475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
Transient osteoporosis of the hip is indubitably a comparatively infrequent entity affecting both men and women worldwide. Its occurrence in the course of pregnancy, specifically in the third trimester, and lactation are of paramount concernment. The exact association between transient hip osteoporosis and pregnancy is precarious. Etiology and potential pathophysiological mechanisms behind this correlation are still to be utterly defined. Magnetic resonance imaging is highly regarded as the gold standard imaging method for assiduous assessment of this disorder. Physicians of copious medical specialties should practice scrupulous techniques for early and pertinent diagnosis when pregnant women are presented with persistent hip pain, as differential diagnosis with femoral head avascular necrosis can be exceedingly arduous. Treatment is predominantly conservative with protected weight-bearing and analgesic medication in the first line of management. In terms of prognosis, the disease ordinarily resolves spontaneously after a few months. Further research is required in order to elucidate the ambiguity surrounding the establishment of globally approved diagnosis and treatment guidelines for pregnancy-associated transient hip osteoporosis. This paper aims to accentuate the significance of this particular disorder by providing a succinct review of the existing literature, augmenting clinicians' knowledge about the features of pregnancy-related transient proximal femur osteoporosis.
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Affiliation(s)
- Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Stefania Dimopoulou
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Panagiotis Karampinas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Eftychios Papagrigorakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Evangelos Sakellariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Spyridon Karampitianis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Dimitrios Zachariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Panagiotis Antsaklis
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - George Daskalakis
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - John Vlamis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
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Motor control of the spine in pregnancy-related lumbopelvic pain: A systematic review. Clin Biomech (Bristol, Avon) 2022; 98:105716. [PMID: 35843136 DOI: 10.1016/j.clinbiomech.2022.105716] [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: 05/10/2021] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Some studies observed differences in motor control of the spine between women with pregnancy-related lumbopelvic pain and matched controls. Understanding alterations in spine motor control may help optimizing treatment in this population. The objective is to determine if there are differences in motor control of the spine in pregnant and post-partum women with and without pregnancy-related lumbopelvic pain. METHODS Five databases were searched: MEDLINE, Embase, CINAHL, Web of Science and Evidence-Based Medicine Reviews (last search: February 4th 2021). Observational studies that compared motor control of the lumbopelvic spine (in terms of muscle activation [e.g. using EMG or ultrasound imaging] or kinematics) between women with pregnancy-related lumbopelvic pain and matched controls were included. Risk of bias was assessed with a modified version of STROBE statement for cross-sectional studies. No meta-analysis was performed. FINDING Fifteen studies were included. Compared to matched controls, pregnant women with pregnancy-related lumbopelvic pain showed differences in lumbar spine kinematic during walking and lifting, although not consistent between studies. The only consistent results were higher transversus abdominis muscle activation during leg movements in post-partum pregnancy-related lumbopelvic pain. Differences in pelvic floor muscle function was inconsistent. INTERPRETATION This systematic review identified multiple differences in motor control in pregnancy-related lumbopelvic pain population, predominantly in dynamic tasks. However, consistent differences in lumbopelvic spine motor control were rare. More studies are necessary to determine if motor control is different in pregnancy-related lumbopelvic pain to better understand alteration in motor control and to optimize the efficacy of rehabilitation treatments.
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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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Mouchantaf ME, Freiha KF, Moussa MK, Asfour AH, Yahchouchi C, Moussallem CD. Hip avascular necrosis in a healthy pregnant woman: A case report and review of literature. Int J Surg Case Rep 2021; 85:106197. [PMID: 34280879 PMCID: PMC8319442 DOI: 10.1016/j.ijscr.2021.106197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background Hip pain during pregnancy is very common, but hip avascular necrosis represents a very rare entity. Case report We report a rare case of a healthy30-year-old female patient pregnant with twins, that suffered right hip avascular necrosis in the peripartum period, her symptoms were initially neglected as a benign cause of hip pain, this led to aggressive treatment at a young age. Discussion With less than 100 cases reported in the literature, pregnancy is not a well-known risk factor for femoral head avascular necrosis and it should be differentiated from one of the more common hip pathologies in pregnancy which is the so-called “Pelvic pain syndrome” and transient osteoporosis of the hip. Conclusion Having a high index of suspicion and low threshold for MRI imaging in a pregnant woman with hip pain is a must to prevent such complications. Corticosteroids and alcohol intake are the most common atraumatic cause of hip osteonecrosis Hip and pelvic pain during pregnancy are very frequent and may hide a serious event such as hip avascular necrosis Hip avascular necrosis can have disastrous complications if not diagnosed in young pregnant women. Having a high index of suspicion in a pregnant woman with hip pain is a must to prevent such complications
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Affiliation(s)
- Mark E Mouchantaf
- Orthopedic surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon.
| | - Kinan F Freiha
- Orthopedic surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Mohamad K Moussa
- Orthopedic surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Ali H Asfour
- Orthopedic surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Christine Yahchouchi
- Orthopedic surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon; Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Charbel D Moussallem
- Orthopedic surgery, Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon; Chief of Orthopedic Surgery Department, Ain W Zein Hospital, Beirut, Lebanon; Orthopedic Surgery, Lebanese Hospital Geitaoui, University Medical Center, Beirut, Lebanon
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Chiropractic Care for the Pregnant Body. Clin Obstet Gynecol 2021; 64:602-610. [PMID: 33882524 DOI: 10.1097/grf.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chiropractic care is a commonly used treatment modality for musculoskeletal pain in pregnancy. Low back pain, pelvic pain, and other neuromuscular complaints are prevalent in pregnancy and contribute to significant maternal discomfort in many women. Nonpharmacologic therapies to relieve pain are increasingly important during pregnancy because of the opioid epidemic. Chiropractic treatment is one of the potential therapies that offers intervention without medications. This article provides an evidence-based review of the epidemiology of chiropractic use in obstetrics, commonly treated conditions, related physiology of pregnancy, and safety of spinal manipulation.
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8
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Clarkson CE, Adams N. A qualitative exploration of the views and experiences of women with Pregnancy related Pelvic Girdle Pain. Physiotherapy 2018; 104:338-346. [DOI: 10.1016/j.physio.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/15/2018] [Indexed: 11/26/2022]
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Almousa S, Lamprianidou E, Kitsoulis G. The effectiveness of stabilising exercises in pelvic girdle pain during pregnancy and after delivery: A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 23. [DOI: 10.1002/pri.1699] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 10/01/2017] [Accepted: 10/10/2017] [Indexed: 01/12/2023]
Affiliation(s)
- S. Almousa
- Faculty of life Sciences and Education; University of South Wales; Pontypridd Wales UK
| | | | - G. Kitsoulis
- Physiotherapy Department; University Hospital of Ioannina; Ioannina Greece
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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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Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women's Health and the Orthopaedic Section of the American Physical Therapy Association. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/jwh.0000000000000081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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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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Flack NAMS, Hay-Smith EJC, Stringer MD, Gray AR, Woodley SJ. Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial. BMC Pregnancy Childbirth 2015; 15:36. [PMID: 25885585 PMCID: PMC4339641 DOI: 10.1186/s12884-015-0468-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/03/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pregnancy-related pubic symphysis pain is relatively common and can significantly interfere with daily activities. Physiotherapist-prescribed pelvic support belts are a treatment option, but little evidence exists to support their use. This pilot compared two pelvic belts to determine effectiveness (symptomatic relief), tolerance (comfort) and adherence (frequency, duration of use). METHODS Unblinded, 2-arm, single-center, randomized (1:1) parallel-group trial. Twenty pregnant women recruited from the community (Dunedin, New Zealand), with physiotherapist-diagnosed symphyseal pain, were randomly allocated to wear either a flexible or rigid belt for three weeks. One author, not involved in data collection, randomized the allocation to trial group. The unblinded primary outcome was the Patient Specific Functional Scale (PSFS). Secondary outcomes were pain intensity during the preceding 24 hours and preceding week (visual analogue scale [VAS]), and disability (Modified Oswestry Disability Questionnaire [MODQ]). Duration of use (hours) was recorded daily by text messaging. Participants were assessed at baseline, by weekly phone interviews and at intervention completion (three weeks). To assess comfort, women wore the alternate belt in the fourth week. RESULTS Twenty pregnant women (mean ± SD age, 29.4 ± 6.5 years; mean gestation at baseline, 30.8 ± 5.2 weeks) were randomized to treatment groups (flexible = 10, rigid =10) and all were included in analysis. When adjusted for baseline, PSFS scores were not significantly different between groups at follow up (mean difference -0.1; 95% CI: -2.5 to 2.3; p =0.94). Pain in the preceding 24 hours reached statistical significance in favor of the flexible belt (VAS, p = 0.049). Combining both groups' data, function and pain were significantly improved at three weeks (mean difference -2.3; 95% CI: 1.2 to 3.5; p< 0.001). Belts were worn for an average of 4.9 ± 2.9 hours per day; women preferred the flexible belt. No adverse events were reported. CONCLUSION These preliminary results suggest the flexible pelvic support belt may be more effective in reducing pain and is potentially better tolerated than a rigid belt. Based on these data, a larger trial is both feasible and clinically useful. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000898651 , 25th August, 2014.
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Affiliation(s)
| | - E Jean C Hay-Smith
- Department of Medicine, University of Otago, Wellington, New Zealand. .,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
| | - Mark D Stringer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.
| | - Andrew R Gray
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
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Evaluation of self-administered tests for pelvic girdle pain in pregnancy. BMC Musculoskelet Disord 2014; 15:138. [PMID: 24767628 PMCID: PMC4005904 DOI: 10.1186/1471-2474-15-138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/23/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Different tests are used in order to classify women with pelvic girdle pain (PGP). One limitation of the tests is that they need to be performed by an examiner. Self-administered tests have previously been described and evaluated by women who performed the tests directly before the examiner performed the original tests. Thus, an evaluation of the self-administered tests performed in a more natural setting, such as the women's home is needed.The purpose of this study was to investigate the agreement between self-administered tests performed at home and tests performed by an examiner on women with suspected PGP. Additionally to compare the classification made by an examiner and classification based on results of the self-administered tests and questionnaire. METHODS One hundred and twenty three pregnant women with suspected PGP participated. Before the appointment at the clinic the women performed the self-administered tests and filled in a questionnaire. During the appointment one specialized physiotherapist performed the tests. Result of the two different sets of tests and the classifications made by the examiner and the self-administered tests including questionnaires were compared concerning percentage of agreement (POA), sensitivity and positive predicted value (PPV). RESULTS The P4 and the bridging test had the highest POA (≥ 74.8%), sensitivity (≥ 75.5%) and PPV (≥ 91.2%) for posterior PGP. For anterior PGP the MAT test had highest POA (76.4%), and PPV (69.5%), and the modified Trendelenburg test the highest sensitivity (93.0%). Agreement between the two classifications was 87%.A significantly higher number of positive P4 and bridging tests (p<0.01) and a significantly lower number of positive Trendelenburg tests, Active Straight Leg raise and Straight Leg Raise (p<0.05) were recorded by the examiner compared to the self-administered ones. CONCLUSIONS Our results indicate that self-administered test and questionnaires are possible to use for testing and classification of women with suspected PGP.
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Peterson CK, Mühlemann D, Humphreys BK. Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropr Man Therap 2014; 22:15. [PMID: 24690125 PMCID: PMC3994225 DOI: 10.1186/2045-709x-22-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 02/25/2014] [Indexed: 12/13/2022] Open
Abstract
Background Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome. Methods Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited. Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded. The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better’ or ‘much better’ were categorized as ‘improved’. The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed. Results 52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to ,improvement’ when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013). Conclusions Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of, improvement’ in the logistic regression model.
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Affiliation(s)
- Cynthia K Peterson
- Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, Zürich, Switzerland.
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Ribeiro AP, João SMA, Sacco ICN. Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy. ACTA ACUST UNITED AC 2013; 9:99-108. [PMID: 23241158 DOI: 10.2217/whe.12.59] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this literature review is to evaluate the studies that have investigated static and dynamic biomechanical changes of the lower limbs and gait patterns during pregnancy. Original articles on this subject, published between 1934 and 2012, were considered. In general, pregnant women demonstrated greater hip flexion, more extended knees and less plantar flexion ankles. These changes could explain the gait patterns of pregnant women characterized by increased hip angles, decreased propulsion forces associated with increased durations of stance phase and changes in distributions of the plantar loads with increased loads in the forefoot and decreased ones in the rearfoot. This can lead to arthrokinematic deviations that, with time, contribute to the development of musculoskeletal discomfort. In summary, these findings showed the importance of further longitudinal studies to investigate the relationships between musculoskeletal discomfort in pregnant women in the lower limbs and gait changes observed throughout this period.
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Affiliation(s)
- Ana Paula Ribeiro
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, Rua Cipotânia, 51 Cidade Universitária, 05360-160 São Paulo, Brazil.
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Bakker EC, van Nimwegen-Matzinger CW, Ekkel-van der Voorden W, Nijkamp MD, Völlink T. Psychological determinants of pregnancy-related lumbopelvic pain: a prospective cohort study. Acta Obstet Gynecol Scand 2013; 92:797-803. [PMID: 23465064 DOI: 10.1111/aogs.12131] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To study whether pregnancy-related lumbopelvic pain outcomes at 36 weeks of gestation can be predicted by psychological determinants earlier in pregnancy. DESIGN Prospective cohort study. SETTING Nine midwifery practices in different regions of the Netherlands. POPULATION A cohort of 223 low-risk pregnant women in the Netherlands was followed from week 12 of gestation until 36 weeks of gestation. METHODS Both psychological determinants and lumbopelvic pain symptoms were investigated with a set of questionnaires at 12, 24 and 36 weeks of gestation. Psychological determinants were measured with the Perceived Stress Scale (PSS), the Symptom Checklist-90-Revised (SCL-90), the Pregnancy-related Anxiety Questionnaire (PRAQ), and the Utrecht Coping List (UCL). Lumbopelvic pain outcomes were measured with the Pregnancy Mobility Index (PMI) and the Overall Complaints Index (OCI). MAIN OUTCOME MEASURES Lumbopelvic pain symptoms and their impact at 36 weeks of gestation. RESULTS There was a significant increase in scores on both the PMI and OCI across the three sampling occasions in pregnancy. Lumbopelvic pain outcomes showed significant associations with the psychological determinants perceived stress and recently perceived psychological and physical distress at all three times during pregnancy. Pregnancy-related anxiety was not a significant predictor of lumbopelvic pain outcomes, neither was coping. CONCLUSIONS Lumbopelvic pain symptoms and their impact on daily activities at 36 weeks of gestation can be predicted by psychological determinants earlier in pregnancy; the combination of perceived stress and physical disability at 24 weeks of pregnancy seems to be the best predictor of disability in later pregnancy.
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Affiliation(s)
- Esther C Bakker
- Department of Health Psychology, School of Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
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Eisenach JC, Pan P, Smiley RM, Lavand'homme P, Landau R, Houle TT. Resolution of pain after childbirth. Anesthesiology 2013; 118:143-51. [PMID: 23249931 PMCID: PMC3876485 DOI: 10.1097/aln.0b013e318278ccfd] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic pain after surgery occurs in 10-40% of individuals, including 5-20% of women after cesarean delivery in previous reports. Pain and depression 2 months after childbirth are independently associated with more severe acute post-delivery pain. Here we examine other predictors of pain at 2 months and determine the incidence of pain at 6 and 12 months after childbirth. METHODS Following Institutional Review Board approval, 1228 women were interviewed within 36 h of delivery. Of these, 937 (76%) were successfully contacted by telephone at 2 months, and, if they had pain, at 6 and 12 months after delivery. The primary outcome measure was presence of pain which began at the time of delivery. We also generated a model of severity of acute post-delivery pain and 2 month pain and depression. RESULTS Pain which began at the time of delivery was remarkably rare 6 and 12 months later (1.8% and 0.3% [upper 95% confidence limit, 1.2%], respectively). Past history of pain and degree of tissue damage at delivery accounted for 7.0% and 16.7%, respectively, of one aspect in the variability in acute post-delivery pain. Neither of these factors was associated with incidence of pain 2 months later. CONCLUSIONS Using a definition of new onset pain from delivery, we show a remarkably low incidence of pain 1 yr after childbirth, including those with surgical delivery. Additionally, degree of tissue trauma and history of chronic pain, risk factors for pain 2 months after other surgery, were unimportant to pain 2 months after cesarean or vaginal delivery.
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Affiliation(s)
- James C Eisenach
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC 27157, USA.
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Okanishi N, Kito N, Akiyama M, Yamamoto M. Spinal curvature and characteristics of postural change in pregnant women. Acta Obstet Gynecol Scand 2012; 91:856-61. [PMID: 22429046 DOI: 10.1111/j.1600-0412.2012.01400.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Pregnant women often report complaints due to physiological and postural changes. Postural changes during pregnancy may cause low back pain and pelvic girdle pain. This study aimed to compare the characteristics of postural changes in pregnant compared with non-pregnant women. DESIGN Prospective case-control study. SETTING Pregnancy care center. POPULATION Fifteen women at 17-34 weeks pregnancy comprised the study group, while 10 non-pregnant female volunteers comprised the control group. METHODS Standing posture was evaluated in the sagittal plane with static digital pictures. Two angles were measured by image analysis software: (1) between the trunk and pelvis; and (2) between the trunk and lower extremity. Spinal curvature was measured with Spinal Mouse® to calculate the means of sacral inclination, thoracic and lumbar curvature and inclination. MAIN OUTCOME MEASURES The principal components were calculated until eigenvalues surpassed 1. RESULTS Three distinct factors with eigenvalues of 1.00-2.49 were identified, consistent with lumbosacral spinal curvature and inclination, thoracic spine curvature, and inclination of the body. These factors accounted for 77.2% of the total variance in posture variables. Eleven pregnant women showed postural characteristics of lumbar kyphosis and sacral posterior inclination. Body inclination showed a variety of patterns compared with those in healthy women. CONCLUSIONS Spinal curvature demonstrated a tendency for lumbar kyphosis in pregnant women. Pregnancy may cause changes in spinal curvature and posture, which may in turn lead to relevant symptoms. Our data provide a basis for investigating the effects of spinal curvature and postural changes on symptoms during pregnancy.
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Affiliation(s)
- Natsuko Okanishi
- Hiroshima International University, Faculty of Health Sciences, Higashihiroshima, Hiroshima, Japan.
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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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Abstract
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.
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Affiliation(s)
- Era Vermani
- Department of Anesthesiology, University Hospital Aintree, Liverpool, UK.
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Sipko T, Grygier D, Barczyk K, Eliasz G. The Occurrence of Strain Symptoms in the Lumbosacral Region and Pelvis During Pregnancy and After Childbirth. J Manipulative Physiol Ther 2010; 33:370-7. [DOI: 10.1016/j.jmpt.2010.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 03/01/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
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Pelvic girdle pain, clinical tests and disability in late pregnancy. ACTA ACUST UNITED AC 2010; 15:280-5. [PMID: 20117040 DOI: 10.1016/j.math.2010.01.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 01/04/2010] [Accepted: 01/11/2010] [Indexed: 11/18/2022]
Abstract
The objective of this cross-sectional study was to explore the associations between pain locations, responses to the posterior pelvic pain provocation (P4) test, responses to the active straight leg raise (ASLR) test and disability in late pregnancy. 283 women in gestation week 30 (mean age 31.3 years; 59% nullipara) completed a questionnaire (including pain drawing and Disability Rating Index, DRI). A physiotherapist blinded for the questionnaire data assessed responses to the P4 and ASLR tests. The pain drawing was used to: 1) distinguish between Pelvic girdle pain (PGP) and low back pain (LBP); 2) discriminate between pain locations within the pelvic area. A large variation was found in DRI within each pain location group. Women with PGP were more afflicted than the women with LBP and those without PGP. Highest DRI score was reported by women having combined symphysis pain and bilateral posterior pain. The multivariate analyses showed that results from P4 and ASLR contributed independently to DRI. Taken together, pain location combined with responses to P4 and ASLR tests are relevant when evaluating affliction in pregnant women with possible PGP.
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Murphy DR, Hurwitz EL, McGovern EE. Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule: A Prospective Observational Cohort Study. J Manipulative Physiol Ther 2009; 32:616-24. [DOI: 10.1016/j.jmpt.2009.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 02/20/2009] [Accepted: 04/06/2009] [Indexed: 11/25/2022]
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Elden H, Fagevik-Olsen M, Ostgaard HC, Stener-Victorin E, Hagberg H. Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG 2008; 115:1655-68. [PMID: 18947338 DOI: 10.1111/j.1471-0528.2008.01904.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether acupuncture has a greater treatment effect than non-penetrating sham acupuncture in women with pelvic girdle pain (PGP) during pregnancy. DESIGN Randomised double-blinded controlled trial. SETTING East Hospital, Gothenburg, and 25 antenatal primary care units in the region of Västra Götaland, Sweden. POPULATION A total of 115 pregnant women with a clinical diagnosis of PGP who scored > or =50 on a 100-mm visual analogue scale (VAS). METHOD Women were randomly allocated to standard treatment plus acupuncture or to standard treatment plus non-penetrating sham acupuncture for 8 weeks. MAIN OUTCOME MEASURES Main outcome measure was pain. Secondary outcomes were frequency of sick leave, functional status, discomfort of PGP, health-related quality of life and recovery of severity of PGP as assessed by the independent examiner. RESULTS After treatment, median pain decreased from 66 to 36 in the acupuncture group and from 69 to 41 in the non-penetrating sham group (P = 0.493) as assessed on a VAS. Women in the acupuncture group were in regular work to a higher extent than women in the sham group (n = 28/57 versus 16/57, P = 0.041). The acupuncture group had superior ability to perform daily activities measured with the disability rating index (DRI) (44 versus 55, P = 0.001). There were no significant differences in quality of life, discomfort of PGP and recovery from severity of PGP between the groups. CONCLUSIONS Acupuncture had no significant effect on pain or on the degree of sick leave compared with non-penetrating sham acupuncture. There was some improvement in performing daily activities according to DRI. The data imply that needle penetration contributes to a limited extent to the previously reported beneficial effects of acupuncture.
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Affiliation(s)
- H Elden
- Perinatal Center, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, East Hospital, Göteborg, Sweden.
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Gait in Pregnancy-related Pelvic girdle Pain: amplitudes, timing, and coordination of horizontal trunk rotations. 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 2008; 17:1160-9. [PMID: 18661160 PMCID: PMC2527418 DOI: 10.1007/s00586-008-0703-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/29/2008] [Accepted: 06/09/2008] [Indexed: 11/22/2022]
Abstract
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.
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Elden H, Ostgaard HC, Fagevik-Olsen M, Ladfors L, Hagberg H. Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. Altern Ther Health Med 2008; 8:34. [PMID: 18582370 PMCID: PMC2467402 DOI: 10.1186/1472-6882-8-34] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 06/26/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain, PGP, in pregnant women. However, the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition. The aim of the present work was to assess adverse effects of acupuncture on the pregnancy, mother, delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to standard treatment or standard treatment alone. METHODS In all, 386 women with PGP entered this controlled, single-blind trial. They were randomly assigned to standard treatment plus acupuncture (n = 125), standard treatment plus specific stabilising exercises (n = 131) or to standard treatment alone (n = 130) for 6 weeks. Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy. Adverse effects were recorded during treatment and throughout the pregnancy. Influence on the fetus was measured with cardiotocography (CTG) before-during and after 43 acupuncture sessions in 43 women. A standardised computerized method to analyze the CTG reading numerically (Oxford 8000, Oxford, England) was used. After treatment, the women rated their overall experience of the treatment and listed adverse events if any in a questionnaire. Data of analgesia and oxytocin augmentation during labour, duration of labour, frequency of preterm birth, operative delivery, Apgar score, cord-blood gas/acid base balance and birth weight were also recorded. RESULTS There were no serious adverse events after any of the treatments. Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this. The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal. CONCLUSION This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/neonate.
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Bernstein P, Kirschner S, Kittner T, Witzleb WC. [Necrosis of the femoral head in late pregnancy. Necessity of early diagnosis]. DER ORTHOPADE 2007; 35:1261-4. [PMID: 17109121 DOI: 10.1007/s00132-006-1020-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Limping and groin pain can issue diagnostic problems during late pregnancy. Differential diagnosis of two idiopathic syndromes, transient osteoporosis and osteonecrosis of the femoral head, is made possible by MRI in the early stages. This case is reported to demonstrate the need to distinguish between those syndromes early so as to prevent further joint damage.
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Affiliation(s)
- P Bernstein
- Klinik und Poliklinik für Orthopädie, Universitätsklinikums Dresden, Fetscherstrasse 74, 01307 Dresden, Deutschland.
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Interrater reliability and diagnostic accuracy of pelvic girdle pain classification. J Manipulative Physiol Ther 2007; 30:252-8. [PMID: 17509433 DOI: 10.1016/j.jmpt.2007.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 01/01/2007] [Accepted: 01/09/2007] [Indexed: 01/13/2023]
Abstract
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.
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Steib-Furno S, Luc M, Mathieu L, Pham T, Armingeat T, Porcu G, Gamerre M, Chagnaud C, Lafforgue P. Pregnancy-related hip diseases: incidence and diagnoses. Joint Bone Spine 2007; 74:373-8. [PMID: 17560159 DOI: 10.1016/j.jbspin.2006.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 12/07/2006] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pregnancy-related hip diseases epidemiology has been poorly evaluated. We report our experience of gestational and postpartum hip diseases and evaluate their incidence. METHODS (1) Prospective survey: all pregnant or early postpartum women suspected to have hip involvement during their follow-up in an Obstetric unit were referred to a rheumatologist. If clinically confirmed, magnetic resonance imaging (MRI) and additional investigations as needed were performed. This survey had 2 years duration. (2) Retrospective study: all cases of definite (with MRI confirmation) pregnancy-related hip disease referred to our Rheumatology unit during the past 15 years were analyzed. RESULTS During the 2-year prospective survey, 3 patients (4 hips) of pregnancy-related hip disease were observed over 4900 pregnancies (1 case of transient osteoporosis of the hip (TOH) and 2 cases of occult fracture of the femoral head). During the 15-year retrospective study, 12 patients (17 hips) with hip diseases during pregnancy or early postpartum were identified. There were 6 patients (9 hips) with TOH, 4 patients (6 hips) with occult fracture of the femoral head, 1 patient with osteonecrosis of the femoral head, and 1 coxitis in a patient with ankylosing spondylitis. Differentiating diagnosis between TOH and occult fractures could only be made by MRI. Five of the 6 women with TOH had osteopenia at the lumbar spine at dual energy X-ray absorptiometry (DEXA). The 4 women with occult fractures had either osteopenia or osteoporosis at the lumbar spine. CONCLUSION Hip diseases are infrequent during pregnancy and early postpartum. Transient osteoporosis of the hip and occult stress fractures of the femoral head appear the main causes and those diagnoses justify evaluation for an underlying bone fragility. Osteonecrosis is very rare in this setting.
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Affiliation(s)
- Sarah Steib-Furno
- Department of Rheumatology, CHU la Conception, Hôpital la Conception, 147 Boulevard Baille, F-13385 Marseille Cedex 5, France
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Alalade AO, Odejinmi FO. A rare and potentially fatal cause of pelvic pain in pregnancy: anaplastic large cell lymphoma. J OBSTET GYNAECOL 2007; 26:691-2. [PMID: 17071444 DOI: 10.1080/01443610600930621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A O Alalade
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London, UK
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de Groot M, Pool-Goudzwaard AL, Spoor CW, Snijders CJ. The active straight leg raising test (ASLR) in pregnant women: differences in muscle activity and force between patients and healthy subjects. ACTA ACUST UNITED AC 2006; 13:68-74. [PMID: 17188924 DOI: 10.1016/j.math.2006.08.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2005] [Revised: 07/10/2006] [Accepted: 08/30/2006] [Indexed: 01/13/2023]
Abstract
Pregnancy-related low back and pelvic pain (PLBP) is a frequent complication of pregnancy. Although pathological mechanisms underlying PLBP are obscure, dysfunction of the sacroiliac joints (SI-joints) seems to play an important role. A cross-sectional study was performed on 24 pregnant women with and without PLBP. The objective was to determine muscle activation patterns of trunk and leg muscles during the active straight leg raising test (ASLR) and static hip flexion, and to determine maximal hip flexion force at 0 and 20 cm leg raise height. Moreover, the effort to raise the leg was scored. The measurements resulted in several significant differences between the patients and healthy controls; among others (a) patients scored subjectively more effort during ASLR, (b) at both 0 and 20 cm leg raise height patients had less hip flexion force, and (c) patients developed more muscle activity during ASLR. Since pregnant women with PLBP developed a higher muscle activity during ASLR with a significantly lower output at 0 and 20 cm than healthy pregnant women, it could be proposed that the ASLR demonstrates a disturbed load transfer across the SI-joints in this population.
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Affiliation(s)
- M de Groot
- Department of Biomedical Physics and Technology, University Medical Center Rotterdam, Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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