Gait in Pregnant Women: Spinal and Lower Extremity Changes From Pre- to Postpartum

Effect of pregnancy on female gait characteristics: a pilot study based on portable gait analyzer and induced acceleration analysis

Introduction: The changes in physical shape and center of mass during pregnancy may increase the risk of falls. However, there were few studies on the effects of maternal muscles on gait characteristics and no studies have attempted to investigate changes in induced acceleration during pregnancy. Further research in this area may help to reveal the causes of gait changes in women during pregnancy and provide ideas for the design of footwear and clothing for pregnant women. The purpose of this study is to compare gait characteristics and induced accelerations between non-pregnant and pregnant women using OpenSim musculoskeletal modeling techniques, and to analyze their impact on pregnancy gait. Methods: Forty healthy participants participated in this study, including 20 healthy non-pregnant and 20 pregnant women (32.25 ± 5.36 weeks). The portable gait analyzer was used to collect participants' conventional gait parameters. The adjusted OpenSim personalized musculoskeletal model analyzed the participants' kinematics, kinetics, and induced acceleration. Independent sample T-test and one-dimensional parameter statistical mapping analysis were used to compare the differences in gait characteristics between pregnant and non-pregnant women. Results: Compared to the control group, pregnancy had a 0.34 m reduction in mean walking speed (p < 0.01), a decrease in mean stride length of 0.19 m (p < 0.01), a decrease in mean stride frequency of 19.06 step/min (p < 0.01), a decrease in mean thigh acceleration of 0.14 m/s² (p < 0.01), a decrease in mean swing work of 0.23 g (p < 0.01), and a decrease in mean leg falling strength of 0.84 g (p < 0.01). Induced acceleration analysis showed that pregnancy muscle-induced acceleration decreased in late pregnancy (p < 0.01), and the contribution of the gastrocnemius muscle to the hip and joint increased (p < 0.01). Discussion: Compared with non-pregnant women, the gait characteristics, movement amplitude, and joint moment of pregnant women changed significantly. This study observed for the first time that the pregnant women relied more on gluteus than quadriceps to extend their knee joints during walking compared with the control group. This change may be due to an adaptive change in body shape and mass during pregnancy.

The Legacy of Pregnancy: Elite Athletes and Women in Arduous Occupations

ABSTRACT

Best-practice guidance and management of pregnant and postpartum elite athletes and women in arduous occupations is limited by the lack of high-quality evidence available within these populations. We have summarised the adaptations and implications of pregnancy and childbirth; proposed a novel integrative concept to address these changes; and made recommendations to progress research in this area.

Common musculoskeletal impairments in postpartum runners: an international Delphi study

Background

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

Methods

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

Results

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

Conclusion

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

Level of evidence

5.

Mechanisms of Gait Adaptation in Overweight Pregnant Women

BACKGROUND

Pregnancy is a period when a woman's body undergoes changes. The purpose of this study was to analyze the mechanisms of gait adaptation in overweight pregnant women regarding spatiotemporal gait parameters, ground reaction forces, and plantar pressure distribution.

METHODS

The tests were performed in 29 normal-weight pregnant women and 26 pregnant women who were overweight before pregnancy. The measurements included spatiotemporal gait parameters, in-shoe plantar pressure distribution, and ground reaction forces during gestation.

RESULTS

The results indicate that both normal-weight and overweight pregnant women make use of the same spatiotemporal gait parameters to increase body stability and safety of movement during pregnancy. The double-step duration in the third trimester of pregnancy was higher in normal-weight and overweight pregnant women compared with in the first trimester (P < .05). A significant change in pressure amplitude was found under all anatomical parts of the foot in the third trimester (P < .05). The results also suggest a higher increase in the maximum amplitude of force in overweight pregnant women in the third trimester compared with the normal-weight group.

CONCLUSIONS

This study suggests that both normal-weight and overweight pregnant women use different mechanisms of gait adaptation during pregnancy. In practice, understanding the biomechanical changes in women's gait can protect the musculoskeletal system during gestation.

Special footwear designed for pregnant women and its effect on kinematic gait parameters during pregnancy and postpartum period

During pregnancy, an array of changes occurs in women body to enable the growth and development of the future baby and the consequent delivery. These changes are reflected in the range of motion of trunk, pelvis, lower limbs and other body segments, affect the locomotion and some of these changes may persist to the postpartum period. The aim of this study was to describe the changes affecting the gait during pregnancy and to determine the effect of tested footwear on kinematic gait characteristics during pregnancy as previous studies indicate that special orthopaedic insoles and footwear might be useful in prevention of the common musculoskeletal pain and discomfort related to pregnancy. Participants from the control group (n = 18), without any intervention, and the experimental group (n = 23), which was wearing the tested shoes, were measured at their 14, 28 and 37 gestational weeks and 28 weeks postpartum to capture the complete pregnancy-related changes in gait. The gait 3D kinematic data were obtained using Simi Motion System. The differences between the control and experimental group at the first data collection session in most of the analysed variables, as well as relatively high standard deviations of analysed variables indicate large individual differences in the gait pattern. The effect of tested footwear on kinematic gait pattern changes may be explained by its preventive effect against the foot arches falling. In the control group, changes associated previously with the foot arches falling and hindfoot hyperpronation were observed during advanced phases of pregnancy and postpartum, e.g. increase in knee flexion or increase in spinal curvature. For the comprehensive evaluation of the tested footwear on pregnancy gait pattern, future studies combining the kinematic and dynamic plantographic methods are needed.

Spinal Curvature and Lower Extremities Kinematics of Simulated Pregnancy during Stair Ascending and Descending

The purpose of this work is to investigate the effect of anteriorly-added mass to simulate pregnancy on lower extremities kinematic and lumbar and thoracic angles during stair ascending and descending. 18 healthy females ascended and descended, with and without a pseudo-pregnancy sac of 12 kg (experimental and control groups, respectively), a costume-made wooden staircase while instrumented with 20 reflective markers placed on the lower extremities and the spine. The movements were captured by 12 infrared cameras surrounding the staircase. Tracked position data were exported to MATLAB to calculate the required joints angles. SPSS was used to compare the ascent and descent phases of control group, and to find if there are any significant differences between control and experimental groups in the ascent phase as well as in the descent phase. When comparing the ascent and descent phases of control group, data revealed a higher hip flexion during ascending and greater ankle planter-flexion and dorsiflexion, lumbar, and thoracic angles during descending; however, no significant difference was shown in the knee flexion angle between ascending and descending. Non-pregnant data showed greater maximum hip flexion and ankle dorsiflexion during stair ascending compared to simulated-pregnant group; while ankle planter-flexion, knee flexion, and lumbar angle were greater for simulated-pregnant status. During stair descending, non-pregnant group had greater minimum hip flexion and ankle dorsiflexion compared to simulated pregnant group; while ankle planter-flexion, knee flexion, and maximum hip flexion were greater for simulated-pregnant group. However, the lumbar and thoracic angles were found to be similar for simulated-pregnant and non-pregnant groups during stair descending. In conclusion, the current study revealed important kinematic modifications pregnant women adopt while ascending and descending stairs at their final stage of pregnancy to increase their stability.

Does the first trimester of pregnancy induce alterations in the walking pattern?

Introduction

From among many studies observing the walking pattern throughout pregnancy, only two items monitor the influence of pregnancy on the movement system during gait considering the period before gestation.

Research question

Does the women’s gait pattern at the end of the first trimester undergo changes in comparison to body movement pattern before pregnancy?

Methods

All subjects who met the inclusion criteria gave signed and informed consent before the study. Two experimental sessions were arranged according to the same protocol: (P0) before pregnancy and (P1) at the end of the first trimester of pregnancy (12^th week of gestation). At first the anthropometric measures were taken. Then, walking trials at a self-selected speed along a walkway were registered with Vicon 250 (Oxford Metrics Ltd.; Oxford, UK) and FreeMED force platform (Sensor Medica, Italy).

Results

An analysis of anthropometric parameters in 12^th pregnancy week demonstrated significant changes in mean values of waist circumference and waist to hip ratio as well as waist to height ratio indexes compared to the results before pregnancy. No significant differences were found in the basic kinematic gait parameters between experimental conditions. Significant increase of mean inter—ankle distance during double support phase occurred during the first trimester of pregnancy. Also, the ratio of the ankle separation width to the pelvic width was noticeably higher in gestation. Then, angular changes of the pelvis in coronal and transverse planes throughout gait cycle during pregnancy demonstrated significant differences compared to those measured before pregnancy. At the same time in the first trimester of pregnancy no adaptive changes in the pattern of feet loading take place.

Significance

Since our study is of longitudinal character, in the course of pregnancy we expect compensatory mechanisms more clearly demonstrated. Therefore, we hope to identify a strategy of the gravid body progression in space.

Gait assessment of the expectant mothers - Systematic review

INTRODUCTION

Since pregnant women may have potentially greater difficulty maintaining balance, their stability has been investigated by some researchers. However, there is no consensus considering the results. The purpose of our investigation was to compare all the experimental studies focusing on the analysis of gait that have been conducted over the last years to assess their methodological issues and changes induced by pregnancy.

METHODS

The PRISMA Guidelines incorporating a risk of bias and strength of recommendations were used as a methodological template for this review. Literature searches were conducted using the following databases: PubMed, Embase, SPORTDiscus, Scopus. After limiting the search to meet the inclusion criteria, 25 articles remained in the final analysis.

RESULTS

Some authors emphasised that adaptations due to pregnancy are recognised to provide safety and stability. Thus, they consistently reported reduced walking velocity as a result of lower frequency and smaller length of the steps. Longer contact times were reflected by the shortened peak forces. Plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. Another adjustment was an increase of base of support to improve lateral gait stability which allows to compensate increased medio-lateral ground reaction force. During the course of pregnancy the increase of anterior body mass and hormonal changes enhance some realignments of the pelvis and lumbar spine. Methodological approaches varied across the included studies. The critical appraisal identified some areas of weaknesses that should be considered for designing the future investigations.

CONCLUSIONS

Since many gait parameters are interrelated, in order to understand the cause-and-effect relationships an integrative and complete analysis of multiple factors is required.

Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2-the effect of exercise on the fetus, labour and birth

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes.

Effects of additional anterior body mass on gait

BACKGROUND

Gradual increases in mass such as during pregnancy are associated with changes in gait at natural velocities. The purpose of this study was to examine how added mass at natural and imposed slow walking velocities would affect gait parameters.

METHODS

Eighteen adult females walked at two velocities (natural and 25 % slower than their natural pace) under four mass conditions (initial harness only (1 kg), 4.535 kg added anteriorly, 9.07 kg added anteriorly, and final harness only (1 kg)). We collected gait kinematics (100 Hz) using a motion capture system.

RESULTS

Added anterior mass decreased cycle time and stride length. Stride width decreased once the mass was removed (p < .01). Added mass resulted in smaller peak hip extension angles (p < .01). The imposed slow walking velocity increased cycle time, double limb support time and decreased stride length, peak hip extension angles, and peak plantarflexion angles (p < .01). With added anterior mass and an imposed slow walking velocity, participants decreased cycle time when mass was added and increased cycle time once the mass was removed (p < .01).

CONCLUSIONS

Gait adaptations may be commensurate with the magnitude of additional mass when walking at imposed slow versus natural velocities. This study presents a method for understanding how increased mass and imposed speed might affect gait independent of other effects related to pregnancy. Examining how added body mass and speed influence gait is one step in better understanding how women adapt to walking under different conditions.

Comparison between overweight due to pregnancy and due to added weight to simulate body mass distribution in pregnancy

The assessment of biomechanical loading in the musculoskeletal system of the pregnant women is particularly interesting since they are subject to morphological, physiological and hormonal changes, which may lead to adaptations in gait. The purpose of this study was to analyze the effect of the increased mass in the trunk associated to pregnancy on the lower limb and pelvis, during walking, on temporal-distance parameters, joint range of motion and moments of force, by comparing a pregnant women group to a non-pregnant group, and to this group while carrying a 5 kg additional load located in the abdomen and breasts during walking, to understand which gait adaptations may be more related with the increased trunk mass, or if may be more associated with other factors such as the girth of the thigh. The subjects performed a previous 12 min training adaption to the added load. To calculate ankle, knee and hip joint angles and moments of force, a three-dimensional biomechanical model was developed. The inverse dynamics method was used to estimate net joint moments of force. The increased mass of the anterior trunk associated with second trimester of pregnancy may influence some gait variables such as the left step time, left and right stance times, double limb support time, maximum hip extension, maximum pelvic right obliquity, pelvic obliquity range of motion, maximum transversal left rotation and peak hip flexion moments of force.

Intrinsic Factors Associated with Pregnancy Falls

Approximately 25% to 27% of women sustain a fall during pregnancy, and falls are associated with serious injuries and can affect pregnancy outcomes. The objective of the current study was to identify intrinsic factors associated with pregnancy that may contribute to women's increased risk of falls. A literature search (Medline and Pubmed) identified articles published between January 1980 and June 2013 that measured associations between pregnancy and fall risks, using an existing fall accident investigation framework. The results indicated that physiological, biomechanical, and psychological changes associated with pregnancy may influence the initiation, detection, and recovery phases of falls and increase the risk of falls in this population. Considering the logistic difficulties and ethnic concerns in recruiting pregnant women to participate in this investigation of fall risk factors, identification of these factors could establish effective fall prevention and intervention programs for pregnant women and improve birth outcomes.

Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy

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.