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Aulds M. Prevalence of sacroiliac joint fusion in females and males depending on parity status. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 184:e24951. [PMID: 38783687 DOI: 10.1002/ajpa.24951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 04/14/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Previous research shows that sacroiliac (SI) joint fusion is age and sex dependent. Older individuals-specifically starting in the fifth or sixth decade of life-are more likely to develop SI fusion. Females have a lower frequency of SI joint fusion than males, perhaps due to pregnancy or parturition. This study examines the relationship between SI joint fusion with both sex and parity status in females. The issue is whether the prevalence of SI fusion in nulliparous females is more similar to that of males or parous females. MATERIALS AND METHODS The sample consists of 46 nulliparous females, 119 parous females, and 158 males from the William M. Bass Donated Skeletal Collection. Ages of the individuals ranged from 50 to 89 years. Sex, age, and parity status were self-reported. RESULTS The frequency of SI joint fusion is significantly different among males (13.29%), nulliparous females (6.52%), and parous females (0.84%). Pairwise comparison of the three groups for SI joint fusion shows that parous females and males are significantly different, but nulliparous females are nonsignificantly different from parous females and males. DISCUSSION Parity status does not appear to be a factor in the sexually dimorphic nature of SI joint fusion in this sample. Rather, biomechanical and hormonal factors may have a greater contribution to higher rates of SI joint fusion in males than females.
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Affiliation(s)
- Meredith Aulds
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, Louisiana, USA
- Department of Anthropology, Purdue University, West Lafayette, Indiana, USA
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Dumke BR, Theilen LH, Shaw JM, Foreman KB, Dibble LE, Fino PC. Sensory integration and segmental control of posture during pregnancy. Clin Biomech (Bristol, Avon) 2024; 115:106264. [PMID: 38744223 DOI: 10.1016/j.clinbiomech.2024.106264] [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: 03/08/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Approximately 25% of pregnant people fall, yet the underlying mechanisms of this increased fall-risk remain unclear. Prior studies examining pregnancy and balance have utilized center of pressure analyses and reported mixed results. The purpose of this study was to examine sensory and segmental contributions to postural control throughout pregnancy using accelerometer-based measures of sway. METHODS Thirty pregnant people (first trimester: n = 10, second trimester: n = 10, third trimester: n = 10) and 10 healthy, nonpregnant control people stood quietly for one minute in four conditions: eyes open on a firm surface, eyes closed on a firm surface, eyes open on a foam pad, and eyes closed on foam. Postural sway was quantified using the root mean square accelerations in the anterior-posterior and medial-lateral directions from an inertial sensor at the lumbar region. Sensory sway ratios, segmental coherence and co-phase, were calculated to assess sensory contributions and segmental control, respectively. FINDINGS Pregnant people did not display greater sway compared to healthy, nonpregnant controls. There were no group differences in vestibular, visual, or somatosensory sway ratios, and no significant differences in balance control strategies between pregnant and nonpregnant participants across sensory conditions. INTERPRETATION The small effects observed here contrast prior studies and suggest larger, definitive studies are needed to assess the effect of pregnancy on postural control. This study serves as a preliminary exploration of pregnant sensory and segmental postural control and highlights the need for future to hone the role of balance in fall risk during pregnancy.
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Affiliation(s)
- Breanna R Dumke
- University of Utah, Department of Health & Kinesiology, Salt Lake City, UT, USA.
| | - Lauren H Theilen
- University of Utah, Department of Obstetrics and Gynecology, Salt Lake City, UT, USA
| | - Janet M Shaw
- University of Utah, Department of Health & Kinesiology, Salt Lake City, UT, USA
| | - K Bo Foreman
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Leland E Dibble
- University of Utah, Department of Physical Therapy and Athletic Training, Salt Lake City, UT, USA
| | - Peter C Fino
- University of Utah, Department of Health & Kinesiology, Salt Lake City, UT, USA
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Filtes P, Beckerman MA, Austin K, Buckley PS, Swan KG. Surgical Management of a Torn ACL and Bucket-Handle Meniscal Tear in the Pregnant Patient: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00005. [PMID: 38579103 DOI: 10.2106/jbjs.cc.23.00423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
CASE A 36-year-old, 7-month pregnant woman presented to the office with a locked knee and a displaced bucket-handle medial meniscus tear, in the setting of chronic anterior cruciate ligament (ACL) insufficiency. After thorough discussion with the patient and her husband, the obstetrician, and the anesthesiologist, the patient was treated with left knee ACL reconstruction and medial meniscus repair. CONCLUSION With sufficient preoperative planning and coordinated multidisciplinary care among orthopaedic, anesthesiologist, and obstetric specialists, elective knee surgery can be performed safely in time-sensitive situations during pregnancy.
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Affiliation(s)
- Peter Filtes
- Department of Orthopaedics, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Marc A Beckerman
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kimberlee Austin
- Department of Obstetrics and Gynecology, Atlantic Health, Morristown Memorial Hospital, Morristown, New Jersey
| | - Patrick S Buckley
- Department of Orthopaedics, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kenneth G Swan
- Department of Orthopaedics, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Minervini G, Marrapodi MM, La Verde M, Meto A, Siurkel Y, Cicciù M, Russo D. The relationship between pregnancy and temporomandibular disorder (TMD) through diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: a case-control cross-sectional study. BMC Oral Health 2024; 24:342. [PMID: 38493079 PMCID: PMC10944601 DOI: 10.1186/s12903-024-04009-y] [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: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION This study focuses on temporomandibular disorders (TMDs), which affect the temporomandibular joint and related muscles and have multiple causes. Recent studies have examined the connection between menstrual cycles, estrogen levels, and TMDs, but results are inconsistent, highlighting the need for more research. The aim is to explore the prevalence of TMDs in pregnant women and consider how hormonal changes during pregnancy might influence these disorders. METHODS In this cross-sectional case-control study, we compared 32 pregnant women with 35 non-pregnant women. We evaluated several TMD-related factors such as pain levels, chronic pain classification, scores on the Jaw Functional Limitation Scale-20 and Oral Behaviors Checklist, and psychological health. We used various statistical methods including descriptive statistics, chi-square tests, linear regression, and adjustments for multiple comparisons to analyze the data. RESULTS Pregnant women showed different pain perceptions, generally reporting less pain and lower severity. Nonetheless, these differences were not uniform across all TMD-related measures. Linear regression did not find a consistent link between pregnancy and TMD scores, except for chronic pain grade, which was not significant after adjusting for multiple comparisons. There was a significant relationship between depression and TMD severity, emphasizing the need to consider mental health in TMD evaluations. DISCUSSION The findings suggest that pregnancy is neither a risk nor a protective factor for TMD. Differences in pain perception, functional status, and psychological health were observed in pregnant women but were not consistent for all TMD-related aspects. The role of estrogen in TMJ health and TMD risk is complex and requires further study. The research highlights the necessity of including mental health, especially depression, in TMD assessments. More comprehensive research with larger sample sizes is essential to better understand the connections between pregnancy, TMD, and hormones, aiming to improve TMD management in pregnant women and others.
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Affiliation(s)
- Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy.
| | - Aida Meto
- Department of Dental Therapy, Faculty of Dental Medicine, University of Medicine, Tirana, Albania
| | - Yuliia Siurkel
- International European University School of Medicine, Akademika Hlushkova Ave, 42B, Kyiv, 03187, Ukraine.
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123, Catania, Italy
| | - Diana Russo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy.
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Casto EM, Mancinelli C, Meszaros P, McCrory JL. Asymmetric changes in foot anthropometry with pregnancy may be related to onset of lower limb and low back pain. PLoS One 2024; 19:e0292115. [PMID: 38394292 PMCID: PMC10890715 DOI: 10.1371/journal.pone.0292115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 09/10/2023] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Fifty percent of pregnant females experience pain with 20% reporting long-term pain post-partum. Pregnant females undergo changes in foot anthropometry, lower extremity alignment, and joint laxity. It is unknown if asymmetric alterations may be related to development of pain. The purpose of this study was twofold: 1) to compare asymmetric alignment in pregnant females with and without pain during pregnancy and in nulliparous controls and 2) to assess the relationship between asymmetric alignment and pain severity in all participants. METHODS Ten pregnant females in their third trimester and nine nulliparous controls participated. Bilateral asymmetry of foot length, width, arch index, arch height index, arch rigidity index, arch drop, rearfoot angle, and pelvic obliquity were determined. Joint laxity and musculoskeletal pain were also assessed. ANOVAs were utilized to compare asymmetries between pregnant females reporting pain (n = 5), those not reporting pain (n = 5), and controls. Spearman's Rho correlations were used to relate asymmetry to pain magnitude (α = 0.05). RESULTS No statistical differences (p>0.05) were found between pregnant females with or without pain and controls for any of the metrics. Negative correlations were found between arch index asymmetry and low back pain (p = 0.005), foot length asymmetry and lower leg pain (p = 0.008), and pelvic obliquity and lower leg pain (p = 0.020). Positive correlations were found between foot width asymmetry and knee pain (p = 0.028), as well as arch drop asymmetry and upper leg (p = 0.024), knee (p = 0.005), and lower leg pain (p = 0.019). CONCLUSIONS This study was successful in identifying potential targets for prevention and treatment of pain in pregnancy. Furthermore, because pain during pregnancy may be predictive of pain post-partum, it is important to conduct future research to determine both if interventions such as footwear or exercise can prevent or treat these asymmetries and prevent post-partum pain.
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Affiliation(s)
- Erica M. Casto
- Division of Exercise Physiology, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Corrie Mancinelli
- Division of Physical Therapy, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Petronela Meszaros
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Jean L. McCrory
- Division of Exercise Physiology, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
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Martin LC, Routzong MR, Moalli PA, Rostaminia G, Abramowitch SD. Sacrum and Coccyx Shape Changes During Pregnancy and After Delivery. Ann Biomed Eng 2024; 52:292-301. [PMID: 37828266 DOI: 10.1007/s10439-023-03375-y] [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: 06/12/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023]
Abstract
Remodeling of the sacrum and coccyx to accommodate pregnancy and delivery has been hypothesized but not directly quantified. This study aimed to quantify the remodeling of the sacrum and coccyx by comparing midsagittal lengths, angles, curvature, and shape between nulliparous, pregnant, and parous women using both 2 and 3 dimensional measures. Ninety pelvic magnetic resonance images of the pelvis were retrospectively collected and segmented. Twelve length, angle, and curvature measurements were made using definitions from previous literature on the midsagittal plane to define the sacrum, coccyx, and combined sacrum-coccyx shape. These measures were followed by a statistical shape analysis, which returned modes of variation and principal component scores. A separate MANCOVA analysis was conducted for both the 2D and 3D measures. The 2D and 3D analyses agreed that pregnant women had a significantly straighter coccyx and combined sacrum/coccyx than nulliparous (9.1% and 5.6%, respectively) and parous (7.5% and 2.7%, respectively) subjects. All comparisons showed that, on average, a pregnant woman's sacrum and coccyx were significantly straighter than their nulliparous counterparts. Then after delivery, the sacrum/coccyx returned, but not completely back to a more curved configuration.
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Affiliation(s)
- Liam C Martin
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Benedum Hall, Office 406, 3700 O'Hara Street, Pittsburgh, PA, 15260, USA
| | - Megan R Routzong
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Benedum Hall, Office 406, 3700 O'Hara Street, Pittsburgh, PA, 15260, USA
| | - Pamela A Moalli
- Department of Obstetrics, Gynecology & Reproductive Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Ghazaleh Rostaminia
- Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Division of Urogynecology, University of Chicago, Northshore University HealthSystem, Skokie, IL, USA
| | - Steven D Abramowitch
- Translational Biomechanics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Benedum Hall, Office 406, 3700 O'Hara Street, Pittsburgh, PA, 15260, USA.
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Cordell RF, Wickes CK, Casey A, Greeves JP. Female UK Army Service personnel are at greater risk of work-related morbidity on return to duty postpartum. BMJ Mil Health 2023; 169:46-51. [PMID: 32123003 DOI: 10.1136/jramc-2019-001282] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The 2016 Interim Report on the Health Risks to Women in Ground Close Combat Roles highlighted an increased risk of skeletal injury and significant physiological changes, including increased ligament laxity and decreased bone mineral content, during the postpartum period. The report called for further research and a re-evaluation of postpartum policy to optimise the return of female Service personnel to arduous employment. The purpose of this study was to determine whether returning to duty is at greater risk of injury and illness in the first year postpartum than they were prepregnancy. METHODS Fifty-five female UK Army Service personnel aged 18-41 years, who had given birth in the previous 4 years, completed a lifestyle questionnaire and gave written consent for a review of their medical records. The number of working days lost (WDL) due to illness, injury and combined illness and injury was obtained from medical records, for 1 year prepregnancy and 1 year postpartum. Female Service personnel returned to duty at different time-points postpartum, so data were expressed as WDL/week. RESULTS WDL/week due to illness and combined illness and injury were higher postpartum compared with prepregnancy (p<0.05). WDL/week due to combined illness and injury was significantly lower prepregnancy (p<0.05) and at 0-26 weeks postpartum (p<0.05), compared with 26-52 weeks postpartum. CONCLUSIONS Postpartum female UK Army Service personnel are at greater risk of illness and a combination of illness and injury in the year after giving birth, compared with prepregnancy. The study suggests female Service personnel are unprepared for the demands of full active duty in the first year postpartum.
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Affiliation(s)
| | | | - A Casey
- Women in Ground Close Combat Research Programme (WGCC), United Kingdom Ministry of Defence, Andover, UK
| | - J P Greeves
- Women in Ground Close Combat Research Programme (WGCC), United Kingdom Ministry of Defence, Andover, UK
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Bagwell JJ, Reynolds N, Smith JA, Walaszek M, Runez H, Lam K, Peterson J, Katsavelis D. An exploratory analysis of gait biomechanics and muscle activation in pregnant females with high and low scores for low back or pelvic girdle pain during and after pregnancy. Clin Biomech (Bristol, Avon) 2022; 97:105705. [PMID: 35763890 DOI: 10.1016/j.clinbiomech.2022.105705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/16/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to compare gait kinematics, kinetics, and muscle activation between pregnant females with high and low scores for low back and/or pelvic girdle pain during and after pregnancy. METHODS Twenty participants tested during second trimester, third trimester, and again post-partum. At each session, motion capture, force plates, and surface electromyography data were captured during self-selected velocity over-ground walking. Participants completed the Quebec Back Pain Disability Scale (QBPDS) and were assigned to high (QBPDS ≥15) or low pain groups (QBPDS <15) based on third trimester scores. Two-way mixed model ANOVAs were used to compare high and low pain groups over time. FINDINGS Nine participants met the high pain group criteria and 11 were low pain. During second trimester the high pain group compared to the low pain group demonstrated smaller peak hip flexor moments, total hip work, percent hip contribution to work, and larger percent ankle contribution to work. Pregnant females demonstrated greater hip, knee, and ankle moments, ankle work, and gluteus maximus muscle activation third trimester than second trimester. INTERPRETATION Reduced hip and greater ankle contribution to work in the high pain group during second trimester could indicate decreased hip utilization early in pregnancy and may contribute to disability as pregnancy progresses. It is also possible kinetic differences during second trimester reflect an early strategy to reduce pain by avoiding hip joint loading. Increased moments and work during third trimester indicate a clinical imperative to better prepare pregnant females to accommodate increased joint loading and muscular demand.
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Affiliation(s)
- Jennifer J Bagwell
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA.
| | - Nicholas Reynolds
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Jo Armour Smith
- Department of Physical Therapy, Chapman University, 9401 Jeronimo Road, Irvine, CA 92618, USA
| | - Michelle Walaszek
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Hannah Runez
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Kristina Lam
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Julie Peterson
- Department of Physical Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
| | - Dimitrios Katsavelis
- Department of Exercise Science, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
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How Does the Lumbopelvic Complex Cope with the Obstetrical Load during Standing? Ergonomic Aspects of Body Posture in Pregnant Women. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pregnancy induces numerous modifications in the musculoskeletal system of the female body. Since one of the essential roles of the lumbopelvic structure is to support mechanical loads in the upright position, this study was designed to simulate the response of this complex to the growing foetus in pregnant women. The authors hypothesized that posture (i.e., lordosis and muscle involvement) under pregnancy conditions might be adjusted to minimize the demands of the obstetrical load. The analysis of the load on the musculoskeletal system during gestation was made based on numerical simulations carried out in the AnyBody Modeling System. The pregnancy-related adjustments such as increased pelvic anteversion and increased lumbar lordosis enhance the reduction of muscle activation (e.g., erector spinae, transversus abdominis or iliopsoas), muscle fatigue and spinal load (reaction force). The results may help develop antenatal exercise programs targeting core strength and pelvic stability.
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Long G, Fang ZY, Xiang-Sheng T, Feng Y, Hao-Ning M, Qing-Ying H, Ping Y, Ming-Sheng T. Symmetry in Paraspinal Muscles as a Predictor of the Development of Pregnancy-Related Low Back and Pelvic Pain: A Prospective Study. Orthop Surg 2021; 13:2255-2262. [PMID: 34668324 PMCID: PMC8654660 DOI: 10.1111/os.13126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/12/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To determine the asymmetry in the paraspinal muscle before pregnancy and evaluate its association with pregnancy‐associated lumbopelvic pain (LPP). Methods This was a prospective case–control study conducted from January 2017 and December 2018. A total of 171 subjects (mean age ± SD, 27.4 ± 5.8 years) were finally divided into the LBP group, PGP group, and no LPP group. Each subject was asked to follow a standardized clinical imaging protocol before the pregnancy. The area of muscles (multifidus, erector spinae, and psoas muscles) on the axial slice at mid‐disc of L4–L5 and L5–S1 were segmented and then the cross‐sectional area (CSA) of a particular muscle was measured by outlining the innermost fascial border surrounding each muscle. The mean value of F‐CSA's ratio to T‐CSA (F/T CSA) was used to determine whether the bilateral paraspinal muscle was asymmetrical. Total muscle CSA (T‐CSA) represents the sum of CSA of interested three muscles. The signal intensity can distinguish fat and muscle tissue in a different range. Based on this, functional CSA (F‐CSA), represented by fat‐free area, was evaluated quantitively by excluding the signal of the deposits of intramuscular fat. Total muscle CSA (T‐CSA), functional CSA (F‐CSA), and the ratio of F‐CSA to T‐CSA (F/T CSA) were measured unilaterally and compared between groups. Logistic regression was performed to determine the risk factors for pregnancy‐associated LPP. The Pearson correlation coefficient was performed to test the relationship between asymmetry in F/T‐CSA and pain rating. Results A total of 124 subjects (72.5%) (28.5 ± 5.2 years) had LPP during pregnancy. Forty‐eight (38.7%) individuals had low back pain (LBP) and 76 (61.3%) had pelvic girdle pain (PGP). Seventy‐six women (44.4%) were determined to have asymmetry in paraspinal muscle according to the definition in this methods section. The duration of follow‐up was 24 months postpartum. A total of 39 (31.5%) women unrecovered from LPP. F/T‐CSA was significantly decreased for LBP in the PGP group than in the and control group (0.03 ± 0.02 vs 0.05 ± 0.03 vs 0.12 ± 0.05, P < 0.001). Meanwhile, significant differences were detected in both groups (all P < 0.001). In patients with LBP, the level of paraspinal asymmetry, represented by the difference in F/T‐CSA, was positively correlated with pain scores (r = 0.52, P < 0.01). However, no statistically significant correlation between pain scores and paraspinal asymmetry was found in PGP (r = 0.42, P > 0.05). Asymmetry in the paraspinal muscle (adjusted OR = 1.5), LBP (adjusted OR = 1.6), LPP in a previous pregnancy (adjusted OR = 1.4), sick leave ≥90 days (adjusted OR = 1.2), and heavy labor (adjusted OR = 1.2) were risk factors for the unrecovered LPP during pregnancy. Conclusions Asymmetrical muscular compositions could lead to abnormal biomechanics for the segmental motions. Lateral‐directed physical training and stretching may help decrease the occurrence and severity of this condition.
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Affiliation(s)
- Gong Long
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Zhi-Yuan Fang
- Department of Orthopaedic, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tang Xiang-Sheng
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Yang Feng
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Ma Hao-Ning
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Hao Qing-Ying
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China
| | - Yi Ping
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Tan Ming-Sheng
- Department of Orthopaedic, China-Japan Friendship Hospital, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
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Hand grip strength as a predictor of recovery from low back pain in the pregnant women-a prospective study. J Orthop Sci 2021; 26:566-571. [PMID: 32807585 DOI: 10.1016/j.jos.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Low back pain (LBP) is a common musculoskeletal problem during pregnancy with an estimated prevalence ranging from 30% to 78%. The symptoms usually disappear gradually after delivery, but some women may have persistent problems even later in their lives. The definite mechanism behind LBP during pregnancy remains unknown. Therefore, the purpose of this study was to investigate whether hand grip strength (HGS), which is a straightforward and reliable indicator of overall muscle strength, is associated with unrecovered LBP after delivery. METHODS 257 pregnant women who registered at obstetrics units in two tertiary hospitals from January 2016 to June 2017 and meanwhile suffered the LBP during pregnancy were included. They were grouped based on whether they recovered from LBP after delivery (recovery was defined as a pain rating of ≤3). The variables such as age, HGS, and education level were recorded and examined for the risk analysis of unrecovered LBP. Also, the Pearson correlation between HGS levels and pain intensities was investigated. RESULTS LBP without recovery at two years after delivery was reported among 22.7% of the subjects. Women with increasing age, low HGS (<25 kg), LBP in a previous pregnancy, back pain, sick leave, and a large amount of physical demand (all p < 0.05), were more likely to report LBP without recovery. Besides, there was a significant correlation between HGS values and the intensities of LBP (r = -0.525; p = 0.003). CONCLUSIONS Low HGS has the highest OR value (adjusted OR = 9.12, P < 0.001) among these factors. The present findings may be used to design and encourage a specific stabilization exercise regime to build well stability of the lumbar spinal column and thus alleviating the LBP.
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Stendal Robinson H, Lindgren A, Bjelland EK. Generalized joint hypermobility and risk of pelvic girdle pain in pregnancy: does body mass index matter? Physiother Theory Pract 2021; 38:2222-2229. [PMID: 33849378 DOI: 10.1080/09593985.2021.1913774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Women with generalized joint hypermobility may be at increased risk of pregnancy-related pelvic girdle pain, but evidence is inconclusive. Objectives: In this prospective cohort study of 283 pregnant women in Norway, we aimed to study the association of generalized joint mobility with pelvic girdle pain, and to evaluate if pre-pregnancy body mass index was a modifier of the association. Methods: Generalized joint hypermobility was defined as a score of ≥5/9 positive tests on the Beighton score measured in early pregnancy. Primary outcome was evening pain intensity in gestation week 30, measured by a 100 mm visual analogue scale. We applied linear regression analyses to estimate age-adjusted unstandardized beta coefficients. Results: Evening pain intensity was similar among women with Beighton score ≥ 5/9 and women with Beighton score < 5/9 (age-adjusted mean difference 2.8 mm; 95% CI: -9.2 to 14.9 mm). Women with Beighton score ≥ 5/9 and pre-pregnancy body mass index ≥ 25 kg/m2, reported higher evening pain than women with Beighton score < 5/9 and pre-pregnancy body mass index <25 kg/m2 (age-adjusted mean difference 28.7 mm; 95% CI: 14.3-43.1 mm). Conclusions: Overall, evening pain intensity was similar among pregnant women with and without generalized joint hypermobility. However, women with a combination of generalized joint hypermobility and body mass index ≥25 kg/m2 reported higher evening pain compared to women with normal joint mobility and body mass index <25 kg/m2, suggesting that body mass index may modify the association. The estimates could be imprecise due to the small study sample, and our findings should be interpreted with caution.
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Affiliation(s)
- Hilde Stendal Robinson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Lindgren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Physiotherapy, Sundsvall Hospital, Sundsvall, Sweden
| | - Elisabeth Krefting Bjelland
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.,, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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13
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Weis CA, Stuber K, Murnaghan K, Wynd S. Adverse events from spinal manipulations in the pregnant and postpartum periods: a systematic review and update. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2021; 65:32-49. [PMID: 34035539 PMCID: PMC8128327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purpose of this study is to update a previous critical review of adverse events in pregnant and postpartum populations. METHODS The following databases were searched: PubMed, CINAHL, Index to Chiropractic Literature, Cochrane Database of Systematic Reviews/Cochrane Central Register of Controlled Trials and MEDLINE. We included all study design types as it was determined a priori that there would not be enough high-quality research on spinal manipulative therapy (SMT) in these populations to make any determinations. The Scottish Intercollegiate Guidelines Network (SIGN) and CARE (CAse REport) checklists were used for quality rating. RESULTS This update found one case study that demonstrated a serious adverse event in the cervical spine following SMT and a handful of minor and transient adverse events in the low back following SMT. CONCLUSIONS There was limited evidence of adverse events following SMT in these populations. Although we are calling for improved reporting of such events in future studies, it may be that such injuries are rare.
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Aota E, Kitagaki K, Tanaka K, Tsuboi Y, Matsuda N, Horibe K, Perrein E, Ono R. The Impact of Sedentary Behavior After Childbirth on Postpartum Lumbopelvic Pain Prolongation: A Follow-Up Cohort Study. J Womens Health (Larchmt) 2021; 30:1804-1811. [PMID: 33534633 DOI: 10.1089/jwh.2020.8695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A substantial number of women have postpartum lumbopelvic pain (LBPP). Additionally, many postpartum women stay for long inactivity. Therefore, we examined the impact of sedentary behavior on persistent postpartum LBPP and the difference in this impact due to parity. Materials and Methods: This cohort study followed up women who had reported LBPP at 4 months postpartum and divided them into the presence or absence of LBPP at 10 months postpartum. Sedentary time and physical activity were assessed at 4 months postpartum using the International Physical Activity Questionnaire short form. Univariate and multivariate logistic regression analysis was used to calculate persistent LBPP odds ratios (ORs) according to sedentary times, followed by stratification analysis by parity. The institutional review board approval was obtained. Results: A total of 182 women (32.1 ± 5.1 years old) were included for analysis and 112 (61.5%) participants had persistent LBPP at 10 months postpartum. Those with persistent LBPP at 10 months postpartum had increased sedentary time (5.0 [3.0-7.0] hours vs. 3.5 [2.0-6.0] hours, p = 0.05) at 4 months compared with those without LBPP. Even after adjusting for confounding factors, longer sedentary time at 4 months postpartum affected persistent LBPP at 10 months postpartum in primiparas (adjusted OR [95% confidence interval, CI] = 1.28 [1.05-1.55]), but longer sedentary time at 4 months postpartum did not affect persistent LBPP at 10 months postpartum in multiparas (adjusted OR [95% CI] = 0.96 [0.86-1.07]). Conclusion: Sedentary behavior after childbirth is associated with persistent postpartum LBPP in primiparas, but not multiparas. Reducing sedentary time might be beneficial to prevent persistent postpartum LBPP for primiparas.
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Affiliation(s)
- Eri Aota
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kazufumi Kitagaki
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan.,Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Yamato Tsuboi
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan.,BackTech, Inc., Tokyo, Japan
| | - Naoka Matsuda
- Department of Rehabilitation, Kobe Mariners Hospital, Kobe, Japan
| | - Kana Horibe
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Emeline Perrein
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Rei Ono
- Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
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15
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Lower extremity kinetics and muscle activation during gait are significantly different during and after pregnancy compared to nulliparous females. Gait Posture 2020; 81:33-40. [PMID: 32659459 DOI: 10.1016/j.gaitpost.2020.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/05/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Low back, pelvic, and lower extremity pain are common during and after pregnancy. Understanding differences in mechanics between pregnant and non-pregnant females is a first step toward identifying potential pathological mechanisms. The primary purpose of this study was to compare joint kinetics and muscle activation during gait between females during and after pregnancy to nulliparous females. METHODS Twenty pregnant females completed testing on three occasions (second trimester, third trimester, and post-partum), while 20 matched, nulliparous controls were tested once. Motion capture, force data, and surface electromyography were averaged across seven trials during gait. Lower extremity kinematics, lower extremity moments and work normalized to pre-pregnancy body mass, work distribution, and peak and average muscle activation amplitude were calculated. Independent t-tests were conducted between pregnant and nulliparous females at each time point. RESULTS Compared to controls, peak hip abductor moments were greater throughout and after pregnancy. Females in second trimester also demonstrated greater sagittal negative ankle work and greater percent contribution of the ankle and smaller percent contribution of the hip to negative work. Compared to controls, during third trimester there were greater knee abductor, ankle plantarflexor, and ankle dorsiflexor moments and greater work at the ankle and total work. Several moment and work variables continued to be elevated post-partum compared to controls. Gluteus maximus muscle activation amplitude was smaller in second trimester and post-partum compared to controls. SIGNIFICANCE While overall joint demands were greater during and after pregnancy, there was a smaller relative sagittal utilization of the hip early in pregnancy and smaller gluteus maximus muscle amplitude during second trimester and post-partum. Because the gluteus maximus muscle contributes to force closure and dynamic stability of the low back and pelvis, relative gluteus maximus disuse, concurrent with increased joint loads, could potentially contribute to pain during and after pregnancy.
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16
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Aldabe D, Milosavljevic S, Bussey MD. A multivariate model for predicting PPGP considering postural adjustment parameters. Musculoskelet Sci Pract 2020; 48:102153. [PMID: 32560861 DOI: 10.1016/j.msksp.2020.102153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/25/2019] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prospective studies have described evidence about the risk of developing pregnancy-related pelvic girdle pain (PPGP) such as, parity, previous history of low back and pelvic girdle pain. No previous studies have prospectively associated PPGP with postural control. AIM This study aimed to identify postural control predictors of PPGP during pregnancy. METHODS Forty-six pregnant women were surveyed throughout their pregnancy for the presence of PPGP. At baseline, participants were evaluated for muscle latencies, mediolateral centre-of-pressure (COP) displacement and velocity during single-leg lift performed with eyes open and closed. PPGP was considered if they presented with one positive clinical assessment as well as pain within the pelvic area. RESULTS Eighteen (45%) of the participants developed PPGP. This group presented with PPGP around a mean 29th week (SD = 5.7), with mean pelvic pain intensity of 4 mm VAS (SD = 2) on a (0-10 cm VAS) and mean PPGP questionnaire score of 21.5 points (SD = 10.6) out of a possible 100 points with 0 indicating no functional disability. The two factors that were significantly associated with PPGP were the right and left biceps femoris (BF) muscle. For every 50 ms of difference of BF muscles latency between eyes open and closed, the risk of PPGP increases by 20% (right BF) and 30% (left BF) to develop PPGP. CONCLUSION(S) This study shows that BF muscle delay during single-leg lift presented at baseline was a significant predictor for the development of PPGP in late pregnancy.
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Affiliation(s)
- Daniela Aldabe
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Stephan Milosavljevic
- School of Physiotherapy, University of Saskatchewan, Health Sciences Building, E-Wing Suite 3400, 3rd Floor, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada.
| | - Melanie D Bussey
- School of Physical Education, Sports and Exercise Science, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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17
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Gilliam E, Hoffman JD, Yeh G. Urogenital and pelvic complications in the Ehlers-Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clin Genet 2020; 97:168-178. [PMID: 31420870 PMCID: PMC6917879 DOI: 10.1111/cge.13624] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 12/19/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a heterogenous group of connective tissue disorders associated with significant morbidity. The urogenital aspects of these disorders are understudied and there is little guidance on the prevalence, types, or outcomes of urogenital complications in EDS/HSD. Our objective was to perform a scoping review to characterize and synthesize the literature reporting urogenital and pelvic complications in EDS/HSD patients. We performed a systematic search of three databases (Medline, CINAHL, Embase) to January 2019. English language, full-text articles reporting on urogenital or pelvic complications in EDS/HSD were included. A total of 105 studies were included (62 case reports/series, 43 observational) involving patients with hypermobile (23%), vascular (20%), classical (12%) EDS, and HSD (24%). Some studies looked at multiple subtypes (11%) or did not report subtype (33%). Reported complications included urinary (41%), gynecological (36%), obstetrical (25%), renal (9%), and men's health problems (7%), with some studies reporting on multiple areas. Urinary and gynecological complications were most prevalent in patients with HSD, while a broad range of complications were reported in EDS. While further research is required, results suggest a higher index of suspicion for urogenital problems is probably warranted in this population.
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Affiliation(s)
- Elizabeth Gilliam
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jodi D. Hoffman
- Division of Genetics, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Gloria Yeh
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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18
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Desseauve D, Pierre F, Fernandez A, Panjo H, Decatoire A, Lacouture P, Fradet L. Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An "In Vivo" Innovative Biomechanical Study. Sci Rep 2019; 9:15968. [PMID: 31685875 PMCID: PMC6828717 DOI: 10.1038/s41598-019-52338-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 01/20/2023] Open
Abstract
The study aimed to assess the associations between the pelvis orientation, lumbar curve and thigh postures throughout pregnancy in a population of healthy women. Additionally, optimal mechanical birth conditions in terms of the pelvic inlet and lumbar curve were researched. The individuals' posture was assessed with three-dimensional motion analysis and the lumbar curve with the Epionics SPINE system. The association between the hip joint angles (flexion and abduction), the pelvis external conjugate, and lumbar curve position was assessed with a generalized linear mixed model (GLMM) adjusted to individuals' characteristics. Joint laxity was assessed with a modified Jobbin's extensometer. For all of the subjects, hip flexion and hip abduction were significantly associated with the angle between the external conjugate and spine, with higher correlation in the multivariate regression model. The association between hip flexion and the lumbar curve was less significant in multivariate than univariate regression analysis. Optimal birth conditions were never reached. The findings contribute to the understanding of the association between the hip position (flexion and abduction), pelvic orientation, and lumbar curve adjusted for joint laxity in healthy pregnant women. They lay the groundwork for future research in the field of obstetrical biomechanics.
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Affiliation(s)
- David Desseauve
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, Poitiers, France. .,Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France.
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, Poitiers, France
| | - Anna Fernandez
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland
| | - Henri Panjo
- Gender, Sexual and Reproductive Health, Centre for Research in Epidemiology and Population Health, (CESP), F-94807, Villejuif, France.,INED, F-75020, Paris, France
| | - Arnaud Decatoire
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Patrick Lacouture
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Laetitia Fradet
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
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19
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Poilliot A, Doyle T, Tomlinson J, Zhang M, Zwirner J, Hammer N. Quantification of fat in the posterior sacroiliac joint region: fat volume is sex and age dependant. Sci Rep 2019; 9:14935. [PMID: 31624283 PMCID: PMC6797796 DOI: 10.1038/s41598-019-51300-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/26/2019] [Indexed: 11/09/2022] Open
Abstract
Fat is appreciated as a structural component of synovial joints. It may serve a shock-absorbing function for the incongruent surfaces, vessels and ligaments, but has not been investigated in the posterior sacroiliac joint (PSIJ). Sixty-six cadaveric hemipelves were serially-sectioned and photographed. The amount of visible fat in the PSIJ was quantified using a modified version of Cavalieri’s method. Total volume, fat volume and fat percentage of the PSIJ were calculated in predefined sub-regions. Fat is consistently present in the PSIJ (1.9 ± 1.3 cm3). Fat volume correlates with the PSIJ total volume (p < 0.0001; r = 0.73) and age (p = 0.024; r = 0.24), and is smaller in males (1.4 ± 0.8 cm3) than females (2.4 ± 1.5 cm3). Fat volumes in the middle and inferior sub-regions of the PSIJ show side- (p < 0.0001) and sex-differences (p = 0.013 females, middle sub-region). Age and PSIJ total volume correlate between sexes in various sub-regions (p = 0.05 females superior sub-region; males inferior sub-region). Fat percentage differs between sexes and sub-regions (p = 0.018 females, superior sub-region) but is independent of age and sides. The presence of fat within the PSIJ is a normal finding and shows sex-dependant and age-related differences. It is unclear whether fat is linked to age-related degeneration or has a shock-absorbing role in stress- and load-dissipation in the PSIJ.
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Affiliation(s)
- Amélie Poilliot
- Department of Anatomy, University of Otago, Dunedin, New Zealand.
| | - Terence Doyle
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joanna Tomlinson
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Ming Zhang
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria.,Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
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The Effect of Maternity Support Garments on Alleviation of Pains and Discomforts during Pregnancy: A Systematic Review. J Pregnancy 2019; 2019:2163790. [PMID: 31467715 PMCID: PMC6699320 DOI: 10.1155/2019/2163790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
Maternity support garments (MSGs) are widely available and commonly recommended and used for alleviation of lower back pain (LBP) and pelvic girdle pain (PGP) during pregnancy; however, most studies available use the garments as a conjunct intervention with other therapies, with scarce research demonstrating the effects of the garments as a sole intervention. This study aims to review the available literature on the effects of using MSGs as sole intervention for comfort improvement of women during pregnancy, as well as to discuss the attributes of the garments which may influence their performance. A systematic review was undertaken, which adheres to PRISMA guideline for systematic reviews. Multiple databases, such as ScienceDirect, CINAHL, EBSCO, Elsevier, SCOPUS, Wiley Online Library, ProQuest, ProQuest Health and Medical Complete, PubMed, and Cochrane Central Register of Controlled Trials, were electronically searched. Six studies met the inclusion criteria and covered three trial studies, two pilot studies and one observational study. Three outcome measurements were identified from the included studies: alleviation of pain, improvement of balance, and improvement of functionality and mobility. The study concluded that wearing MSGs during pregnancy could have beneficial effects in women such as LBP and PGP alleviation, improvement of functionality and mobility, and reduction of risk of fall during pregnancy; however, the mechanisms of the garments' actions as well as the duration of the garments' effectiveness are not elucidated through the studies. This study contributes to the understanding of the effects and effectiveness of the use of MSGs as a sole intervention for improvement of comfort during pregnancy as well as information about the different types of garments commercially available and the attributes that may influence the garment performance.
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21
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Awoleke JO, Olofinbiyi BA, Awoleke AO, Omoyajowo AC. Obstetric Correlates of Maternal Falls in Southern Nigeria. ScientificWorldJournal 2019; 2019:9716919. [PMID: 31427904 PMCID: PMC6683779 DOI: 10.1155/2019/9716919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/05/2019] [Accepted: 07/14/2019] [Indexed: 11/20/2022] Open
Abstract
Falls during pregnancy can be associated with serious obstetric complications. Apart from sparse data highlighting traumatic outcomes, there are no studies identifying the obstetric correlates of maternal falls in Nigeria. A cross-sectional cohort survey of 1,175 women in five public health facilities in Ado-Ekiti was conducted to address this need. Fall rate was 25%; mothers who fell during pregnancy were significantly older, of higher parity, and with unintended/unwanted pregnancies than those who did not fall. Most of the reported falls occurred in the third trimester, with about 10% of the women falling at least thrice during the course of the pregnancy. More than half of the reported falls occurred while engaging in household chores and carrying child/object with compromised visibility of the feet and floor. Uterine contractions/abdominal pain was the commonest; 29 (76.3%), obstetric event attributed to the falls. Antepartum haemorrhage, 4 (10.5%), and ruptured membranes, 2 (5.3%), also occurred after falls, although it was rare and occurred with the same frequency as in the general population. Maternal age ≥ 30 years (odds ratio: 1.36; 95% C.I. 1.03 - 1.80, p = 0.031), multiparity (odds ratio: 1.54; 95% C.I. 1.15 - 2.07, p = 0.004), unintended pregnancy (odds ratio: 1.48; 95% C.I. 1.02 - 2.15, p = 0.037), and delivery age ≤ 40 weeks (odds ratio: 1.71; 95% C.I. 1.07 - 2.75, p = 0.026) were found to be independent risk factors for falls during pregnancy. Fall awareness campaigns and fall-preventing safety tips are advocated in women's clinics. Improving contraceptive uptake will reduce unintended pregnancies and the risk of pregnancy-related fall/injuries.
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22
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Anthropometric Changes During Pregnancy Provide Little Explanation of Dynamic Balance Changes. J Appl Biomech 2019; 35:232-239. [DOI: 10.1123/jab.2018-0345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Bey ME, Marzilger R, Hinkson L, Arampatzis A, Legerlotz K. Patellar Tendon Stiffness Is Not Reduced During Pregnancy. Front Physiol 2019; 10:334. [PMID: 30984023 PMCID: PMC6449680 DOI: 10.3389/fphys.2019.00334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/13/2019] [Indexed: 01/03/2023] Open
Abstract
It is believed that hormonal changes during pregnancy lead to an increased compliance in ligaments and tendons, increasing the risk to suffer from connective tissue injuries particularly during exercise. While the laxity of the pelvic ligaments may increase to facilitate childbirth, to our knowledge no study has ever investigated the mechanical properties of human tendons in different stages of pregnancy. Thus, the purpose of our longitudinal study was to investigate the mechanical properties of the patellar tendon in different stages of pregnancy and postpartum. Nineteen pregnant women (30 ± 4 years) and 11 non-pregnant controls (28 ± 3 years) performed maximum isometric knee extension contractions on a dynamometer. Muscle strength and mechanical properties of the patellar tendon were determined integrating ultrasound, kinematic, and electromyographic measurements. In pregnant women, measurements were performed in the 16 ± 4th week of pregnancy (EP), the 29 ± 4th week of pregnancy (LP) and 32 ± 9th weeks postpartum (PP). On average, muscle strength as well as patellar tendon stiffness, force, and relative strain did not change during pregnancy and did not differ from non-pregnant controls. Tendon length measured at 90° knee flexion continuously increased during and after pregnancy (tendon length PP>EP; PP>controls). Our results indicate that patellar tendon stiffness is not universally affected by pregnancy. We found no evidence to support the often stated assumption that tendons would become more compliant during pregnancy. However, variability between individuals as well as the progressive increase in tendon rest length during and after pregnancy and its implications on injury risk need to be further examined.
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Affiliation(s)
- Marie Elena Bey
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Robert Marzilger
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Kirsten Legerlotz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
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24
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Cherni Y, Desseauve D, Decatoire A, Veit-Rubinc N, Begon M, Pierre F, Fradet L. Evaluation of ligament laxity during pregnancy. J Gynecol Obstet Hum Reprod 2019; 48:351-357. [PMID: 30794956 DOI: 10.1016/j.jogoh.2019.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 01/28/2019] [Accepted: 02/19/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pregnancy-related changes in ligament laxity have been shown to be associated with various disorders such as back pain or pelvic floor disorders. The purpose of this study was to assess laxity changes during pregnancy by confronting different methods in order to suggest a simple clinical tool helping to prevent the aforementioned problems. DESIGN Seventeen pregnant women were evaluated at the first, second and third trimesters as cases and 16 non-pregnant women participated as controls. Ligamentous laxity was measured using an extensometer for the metacarpophalangeal joint of the index, a fingertip to floor test and a sit and reach test to assess hip and lumbar flexibility and the Beighton score. Statistical analysis included independent samples t-tests, analysis of variance and Pearson correlation coefficients. RESULTS Laxity of the metacarpophalangeal joint increased by 11% from the first to the second trimester of pregnancy and stabilized until delivery. The Beighton score was significantly higher in the second trimester of pregnancy (p < 0.05). The flexibility of the hip and lumbar vertebra showed a significant increase of the distance measured between the foot soles and the middle fingers at third trimester (p < 0.05). A moderate correlation was observed between the results given by the extensometer and the Beighton score in both the cases and the control group at first trimester (r = 0.60, p < 0.05) but none was found for the two hip and lumbar flexibility tests. CONCLUSION Laxity reached its maximum at the second trimester. The combination of an objective measurement by the extensometer and a global evaluation of the laxity by the Beighton' score for example may be useful for a daily assessment of laxity. However, the chosen clinical tests don't seem appropriate to be used alone in pregnant women.
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Affiliation(s)
- Yosra Cherni
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France; Département de Kinésiologie, Université de Montréal, 1700 rue Jacques-Tétreault, H7N 0B6, Laval, Québec, Canada
| | - David Desseauve
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France; Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Arnaud Decatoire
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France
| | | | - Mickaël Begon
- Département de Kinésiologie, Université de Montréal, 1700 rue Jacques-Tétreault, H7N 0B6, Laval, Québec, Canada; Centre de recherche du centre de réadaptation Marie-Enfant, CHU Sainte-Justine, 5200 Rue Bélanger, H1T 1C9, Montréal, Québec, Canada
| | - Fabrice Pierre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Laetitia Fradet
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France.
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Pregnancy Results in Lasting Changes in Knee Joint Laxity. PM R 2019; 11:117-124. [PMID: 29964215 DOI: 10.1016/j.pmrj.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/19/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Altered joint laxity can contribute to joint dysfunction. Knee joint laxity has been shown to increase during pregnancy, but its long-term persistence is unknown. OBJECTIVE To determine whether pregnancy leads to lasting increases in knee joint compliance and laxity that persist longer than 4 months postpartum. DESIGN Prospective cohort study. SETTING A motion analysis laboratory at an academic medical center. PARTICIPANTS Fifty healthy women in their first trimester of pregnancy (mean ± SD 29.2 ± 4.3 years old and baseline body mass index 26.0 ± 5.4 kg/m2 ) were recruited. INTERVENTION End-range knee laxity and midrange joint compliance were measured during the first trimester and 19 ± 4 weeks postpartum. Anterior-posterior and varus-valgus laxity were measured using 3-dimensional motion tracking while applying forces and moments in each respective plane using the Vermont Knee Laxity Device. Nonlinear models were constructed to assess relations between applied forces and joint translation, comparing early pregnancy with postpartum. OUTCOMES Multiplanar knee laxity and compliance. RESULTS Peak varus-valgus (20-22%; P = .001) and posterior translation (51%; P < .001) of the tibia relative to the femur decreased from baseline, with a concomitant decrease in laxity (P < .001) and compliance (P = .039) in the coronal plane and in the posterior direction in primiparous (P = .009) and multiparous (P = .014) women. For primiparous women, laxity (P < .001) and compliance (P = .009) increased in the anterior direction. CONCLUSIONS Pregnancy resulted in a lasting decrease in multiplanar knee laxity and compliance in the varus and posterior directions with an increase in anterior compliance. The effects of these changes in laxity and compliance of the passive stabilizers on knee loading patterns, articular contact stresses, and risk for osteoarthritis and other musculoskeletal disorders will require additional research. LEVEL OF EVIDENCE II.
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Ramachandra P, Kumar P, Kamath A, Maiya AG. Effect of intrinsic and extrinsic foot muscle strengthening exercises on foot parameters and foot dysfunctions in pregnant women: a randomised controlled trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Preetha Ramachandra
- Associate Professor, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pratap Kumar
- Professor and Head-Unit I, Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Asha Kamath
- Professor and Head, Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arun G Maiya
- Dean and Professor, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Wong JKL, McGregor AH. Spatiotemporal gait changes in healthy pregnant women and women with pelvic girdle pain: A systematic review. J Back Musculoskelet Rehabil 2019; 31:821-838. [PMID: 29865027 DOI: 10.3233/bmr-170828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Gait is affected in women with pelvic girdle pain (PGP), a musculoskeletal condition affecting 20% of pregnant women. Whilst there is evidence of spatiotemporal changes in gait during healthy pregnancy, less is known in relation to women with PGP. Appreciating gait characteristics during healthy pregnancy could inform our understanding of the role of gait in PGP. PURPOSE The purpose of this review was to systematically analyse differences in the spatiotemporal parameters of gait in healthy pregnant women and those with PGP, and to make recommendations to improve research methods in investigating gait in PGP women. METHODS The review was undertaken following the PRISMA guidelines. Three databases and pre-existing literature were electronically and manually searched. Study selection and data extraction were conducted by two reviewers. Quality assessment was performed using the NHLBI tool for Observational Cohort and Cross-sectional Studies. RESULTS The search returned 2925 results. Fourteen studies were selected for data extraction. Twelve studies investigated gait in healthy pregnant women and two in PGP women. Studies employed either a cohort or cross-sectional design and used various methods to assess gait. Three, nine and two studies were high, medium and low in quality, respectively. Direct comparisons between studies were impeded due to incomparable gestational time-points investigated, in addition to variations in gait parameters and definitions used. CONCLUSION Evidence from studies on healthy pregnant women could inform future research on PGP women, for which current evidence is scarce. We recommend the standardisation of critical factors to allow inter-study comparisons for a meta-analysis.
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Affiliation(s)
- Joanna K L Wong
- Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK
| | - Alison H McGregor
- Biodynamics Lab, Charing Cross Hospital, Charing Cross Campus, Imperial College London, London, UK
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Flores D, Connolly CP, Campbell N, Catena RD. Walking balance on a treadmill changes during pregnancy. Gait Posture 2018; 66:146-150. [PMID: 30195216 DOI: 10.1016/j.gaitpost.2018.08.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/24/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Altered standing balance during pregnancy has been previously reported. To date, body center of mass (bCOM) motion has not been used to track balance changes in this population. We recently compared three methods to determine the torso center of mass (tCOM) location (via force plate acquired center of pressure calculation, using Pavol surface anthropometry measurements, and a combination of the two) to use in calculating the bCOM during pregnancy. RESEARCH QUESTION This current research explored two questions: (1) does walking balance change during pregnancy, and (2) do the methods for identifying tCOM location affect the resulting balance measures? METHODS Fifteen pregnant women were recruited to perform 60-second trial of treadmill walking at 4-week intervals from 12 weeks gestation until delivery. Walking balance was measured as bCOM motion within the base of support. Gestation time and anthropometric model (force plate, Pavol, and combination) were repeated-measures independent variables in a general linear mixed model analysis. RESULTS There was a significant decrease in walking balance during pregnancy. As gestation progressed, we observed non-linear changes in the bCOM motion within the base of support over time, with some changes starting early in pregnancy and others not starting until late 2nd trimester. The anthropometric model used to locate the bCOM significantly influences balance measures. The results of this study indicate that the force plate method is more appropriate for locating the tCOM in the anterior and lateral directions. SIGNIFICANCE The results of this study will inform clinicians and patients about the gestational stage-associated changes in balance during pregnancy that increase the risk of falling and injury. Researchers should also carefully consider the method for locating the bCOM.
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Affiliation(s)
- Daniel Flores
- Gait and Posture Biomechanics Lab, Washington State University, 101A Physical Education Building, Pullman, WA, 99164-1410, USA
| | - Christopher P Connolly
- Exercise Physiology and Performance Lab, Washington State University, 101A Physical Education Building, Pullman, WA, 99164-1410, USA
| | - Nigel Campbell
- Moscow Pullman OB/GYN, 1205 SE Professional Mall Blvd. Suite 102, Pullman, WA, 99163, USA
| | - Robert D Catena
- Gait and Posture Biomechanics Lab, Washington State University, 101A Physical Education Building, Pullman, WA, 99164-1410, USA.
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Stock JD, Calderón Díaz JA, Rothschild MF, Mote BE, Stalder KJ. Objective evaluation of female feet and leg joint conformation at time of selection and post first parity in swine1. J Anim Sci 2018; 96:3549-3557. [PMID: 29893887 PMCID: PMC6127821 DOI: 10.1093/jas/sky227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/08/2018] [Indexed: 11/14/2022] Open
Abstract
Feet and legs of replacement females were objectively evaluated at selection, i.e., approximately 150 d of age (n = 319) and post first parity, i.e., any time after weaning of first litter and before second parturition (n = 277) to 1) compare feet and leg joint angle ranges between selection and post first parity; 2) identify feet and leg joint angle differences between selection and first 3 wk of second gestation; 3) identify feet and leg joint angle differences between farms and gestation days during second gestation; and 4) obtain genetic variance components for conformation angles for the two time points measured. Angles for carpal joint (knee), metacarpophalangeal joint (front pastern), metatarsophalangeal joint (rear pastern), tarsal joint (hock), and rear stance were measured using image analysis software. Between selection and post first parity, significant differences were observed for all joints measured (P < 0.05). Knee, front and rear pastern angles were less (more flexion), and hock angles were greater (less flexion) as age progressed (P < 0.05), while the rear stance pattern was less (feet further under center) at selection than post first parity (only including measures during first 3 wk of second gestation). Only using post first parity leg conformation information, farm was a significant source of variation for front and rear pasterns and rear stance angle measurements (P < 0.05). Knee angle was less (more flexion; P < 0.05) as gestation age progressed. Heritability estimates were low to moderate (0.04-0.35) for all traits measured across time points. Genetic correlations between the same joints at different time points were high (>0.8) between the front leg joints and low (<0.2) between the rear leg joints. High genetic correlations between time points indicate that the trait can be considered the same at either time point, and low genetic correlations indicate that the trait at different time points should be considered as two separate traits. Minimal change in the front leg suggests conformation traits that remain between selection and post first parity, while larger changes in rear leg indicate that rear leg conformation traits should be evaluated at multiple time periods.
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Affiliation(s)
- Joseph D Stock
- Department of Animal Science, Iowa State University, Ames, IA
| | - Julia A Calderón Díaz
- Pig Development Department, Teagasc Moorepark Grassland Research and Innovation Centre, Pig Development, Fermoy, Co. Cork, Ireland
| | | | - Benny E Mote
- Department of Animal Science, University of Nebraska - Lincoln, Lincoln, NE
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Miller EK, Tanaka MJ, LaPorte DM, Humbyrd CJ. Pregnancy-Related Ligamentous Laxity Mimicking Dynamic Scapholunate Instability: A Case Report. JBJS Case Connect 2018; 7:e54. [PMID: 29252884 DOI: 10.2106/jbjs.cc.16.00268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 29-year-old woman presented with spontaneous, isolated, total palmar scaphoid subluxation in the left hand approximately 6 weeks postpartum. She had a positive Watson scaphoid shift test, with an easily subluxable and reducible scaphoid unilaterally. She was diagnosed with scapholunate ligamentous laxity with dynamic instability. Approximately 4 months after stopping lactation, she had complete resolution of the scapholunate subluxation; there was no recurrence of symptoms over the next 5 years of follow-up. CONCLUSION Women can have manifestations of pregnancy and lactation-related ligamentous laxity, including scapholunate instability, which may spontaneously resolve upon cessation of lactation.
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Affiliation(s)
- Emily K Miller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Smith M, Galbraith W, Blumer J. Reducing Low Back and Posterior Pelvic Pain During and After Pregnancy Using OMT. J Osteopath Med 2018; 118:487-488. [PMID: 29946672 DOI: 10.7556/jaoa.2018.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Opala-Berdzik A, Błaszczyk JW, Świder D, Cieślińska-Świder J. Trunk forward flexion mobility in reference to postural sway in women after delivery: A prospective longitudinal comparison between early pregnancy and 2- and 6-month postpartum follow-ups. Clin Biomech (Bristol, Avon) 2018; 56:70-74. [PMID: 29807274 DOI: 10.1016/j.clinbiomech.2018.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/13/2018] [Accepted: 05/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been documented that pregnancy-related increased connective tissue laxity may persist postpartum; however, it is still unclear for how long. This longitudinal study aimed to compare total trunk forward flexion mobility in women between their first trimester of pregnancy and at 2- and 6-month postpartum follow-ups. We also searched for a correlation between women's trunk flexibility and their postural stability in the sagittal plane. METHODS Seventeen healthy women participated in the study. Data were collected at their 7-12 weeks gestation appointments and at 6-10 and 25-28 weeks postpartum. At each session, the women performed a finger floor distance test, and data were collected on their waist circumference and BMI. The women's center of foot pressure mean velocity in the anterior-posterior direction was computed from 30-s long quiet-standing trials on a stationary force plate. FINDINGS Total trunk forward flexion mobility was significantly higher at 2 and 6 months postpartum compared to that in early pregnancy (P < 0.05). At 6 months postpartum, a moderate negative correlation between finger floor distance test values and their anterior-posterior center of foot pressure mean velocity was observed (r = -0.6, P < 0.05). INTERPRETATION Increased total trunk flexibility may be present in women 6 months postpartum. During that period, women with higher trunk flexibility may be more likely to present higher anterior-posterior postural sway velocity in quiet standing.
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Affiliation(s)
- Agnieszka Opala-Berdzik
- Department of Physiotherapy in Internal Diseases, Academy of Physical Education, Katowice, Poland.
| | - Janusz W Błaszczyk
- Department of Human Motor Behavior, Academy of Physical Education, Katowice, Poland; Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Dariusz Świder
- Institute of Computer Science, Silesian University of Technology, Gliwice, Poland
| | - Joanna Cieślińska-Świder
- Department of Physiotherapy of the Nervous and Locomotor Systems, Academy of Physical Education, Katowice, Poland
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Jones DL, Philippi MT, Maak TG, Aoki SK. Progressive osteoarthritis during pregnancy several years following hip arthroscopy for femoroacetabular impingement. J Orthop 2018; 15:475-479. [PMID: 29881180 DOI: 10.1016/j.jor.2018.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/25/2018] [Indexed: 12/29/2022] Open
Abstract
Case A 28-year-old with borderline left hip dysplasia who underwent arthroscopic acetabuloplasty, femoral osteochondroplasty, and labral repair for femoroacetabular impingement. She did well for 8 years, though required arthroscopic capsulolabral adhesion release 2 years after the initial procedure. After this period of stability, she developed left hip pain during pregnancy. Radiographs demonstrated progressive osteoarthritis that lead to total hip arthroplasty at age 37. Conclusion The physiologic and hormonal changes during pregnancy leading to increased ligamentous laxity may put vulnerable patients with hip dysplasia and iatrogenic instability at increased risk for progression of osteoarthritis.
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Affiliation(s)
- Daniel Lee Jones
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | | | - Travis Gardner Maak
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Stephen Kenji Aoki
- University of Utah, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA
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Mahmood AK, Moen A, Stafne SN, Robinson HS, Vøllestad NK, Salvesen KÅ, Mørkved S, Gjerstad J. The MMP9 rs17576 A>G polymorphism is associated with increased lumbopelvic pain-intensity in pregnant women. Scand J Pain 2018; 18:93-98. [PMID: 29794283 DOI: 10.1515/sjpain-2017-0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/25/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Matrix metalloproteinase 9 (MMP9) is an enzyme that may affect degradation of several extracellular matrix (ECM) components in the pelvic ligaments during pregnancy. Previous studies indicate that genetic variations in the gene encoding MMP9 may affect the enzymatic activity. One such genetic variant is a single nucleotide polymorphism (SNP), rs17576 A>G. In this study we investigated whether the MMP9 SNP rs17576 A>G may be associated with increased lumbopelvic pain in 838 pregnant woman. The study was registered with ClinicalTrials.gov (NCT 00476567) on May 21, 2007. METHODS Lumbopelvic pain-intensity was measured by visual analog scale (VAS) at two time points during pregnancy, T1 (18-22 weeks), T2 (32-36 weeks) and 3 months after delivery. Blood samples were collected at each point and SNP genotyping was carried out using predesigned TaqMan SNP genotyping assays. RESULTS The results showed a significant association between the number of G alleles and pain-intensity in the evening at T2. The pain among G/G carriers was higher than among A/G carriers, which in turn was higher than among the A/A carriers. The most pronounced association between the G allele and pain-intensity was observed in primiparae. CONCLUSIONS We conclude that the MMP9 rs17576 A>G polymorphism is associated with increased lumbopelvic pain-intensity during pregnancy. The present data support the hypothesis that lumbopelvic pain during pregnancy may be related to a relaxin - MMP9 - tissue remodeling mechanism. IMPLICATIONS The present findings may be important for future mechanistic studies on how MMP9 rs17576 A>G may affect changes in the ECM components in pelvic ligaments and lumbopelvic pain-intensity during pregnancy.
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Affiliation(s)
| | - Aurora Moen
- National Institute of Occupational Health, Oslo, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hilde Stendal Robinson
- Department of Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department of Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kjell Åsmund Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Siv Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Ramachandra P, Kumar P, Kamath A, Maiya AG. Do Structural Changes of the Foot Influence Plantar Pressure Patterns During Various Stages of Pregnancy and Postpartum? Foot Ankle Spec 2017; 10:513-519. [PMID: 28027667 DOI: 10.1177/1938640016685150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The foot of a pregnant woman undergoes morphological changes with the advancement of pregnancy. It is important to understand the structural changes of the foot during pregnancy and postpartum because any such change may alter the plantar pressure pattern and the entire foot biomechanics. METHOD Primigravidae with a gestational age of 12 weeks or less, aged between 18 and 35 years were included in the study. They were prospectively studied across 5 time periods during pregnancy and postpartum. The measures recorded were length, width, navicular height, truncated foot length and normalized navicular height, truncated ratio of the foot, and the static plantar pressure pattern. Repeated-measures ANOVA was done to analyze the changes across various time periods. RESULTS All the foot parameters, except foot length and truncated foot length, showed significant differences across various time periods of pregnancy and postpartum (P < .001). It was found that the static plantar pressures also varied significantly (P ≤ .001).The maximum pressure was recorded at the hindfoot of the dominant leg. CONCLUSION The feet of pregnant women tend to get pronated as pregnancy advances but do not reach baseline values even at 6 weeks postpartum. Pregnant women tend to bear more weight on the dominant foot with an increased static hindfoot pressure as pregnancy progresses. LEVELS OF EVIDENCE Prognostic study, Level I: Prospective.
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Affiliation(s)
- Preetha Ramachandra
- Department of Physiotherapy, SOAHS Manipal University (PR), Manipal, Karnataka, India.,KMC, Manipal University (PK, AK), Manipal, Karnataka, India.,Manipal College of Allied Health Sciences (AGM), Manipal, Karnataka, India
| | - Pratap Kumar
- Department of Physiotherapy, SOAHS Manipal University (PR), Manipal, Karnataka, India.,KMC, Manipal University (PK, AK), Manipal, Karnataka, India.,Manipal College of Allied Health Sciences (AGM), Manipal, Karnataka, India
| | - Asha Kamath
- Department of Physiotherapy, SOAHS Manipal University (PR), Manipal, Karnataka, India.,KMC, Manipal University (PK, AK), Manipal, Karnataka, India.,Manipal College of Allied Health Sciences (AGM), Manipal, Karnataka, India
| | - Arun G Maiya
- Department of Physiotherapy, SOAHS Manipal University (PR), Manipal, Karnataka, India.,KMC, Manipal University (PK, AK), Manipal, Karnataka, India.,Manipal College of Allied Health Sciences (AGM), Manipal, Karnataka, India
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Varol T, Göker A, Cezayirli E, Özgür S, Tuç Yücel A. Relation between foot pain and plantar pressure in pregnancy. Turk J Med Sci 2017; 47:1104-1108. [PMID: 29154449 DOI: 10.3906/sag-1601-185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: Hormonal and structural changes that occur during pregnancy cause alterations in body biomechanics. These alterations reach their peak in the last trimester. Adaptive changes that appear in the foot result in pain in the foot and ankle. Pedobarography is a noninvasive measurement method that can be used to understand the origin of such pain. Materials and methods: One hundred and thirty-one pregnant women who did not have a foot or ankle problem prior to pregnancy volunteered to take part in the study. Pain was quantified by a visual analog scale (VAS). A cut-off value of 2.95 was taken to divide the subjects into two groups: Group 1 (n = 70) with VAS scores of <2.95 and Group 2 (n = 61) with VAS scores of ?2.95. Plantar pressure measurements were taken by Tekscan HR Mat using midgait protocol. Results: Forces experienced by the total right foot area, right forefoot, and the midfoot for both feet were significantly higher in Group 2 (P < 0.05). Contact area was significantly larger in Group 2 (P < 0.05). Conclusion: Results indicate that presence and severity of foot pain during pregnancy are related to the force distribution along the foot, especially at midfoot and the contact area.
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Kerbourc'h F, Bertuit J, Feipel V, Rooze M. Pregnancy and Pelvic Girdle Pain Analysis of Center of Pressure During Gait. J Am Podiatr Med Assoc 2017; 107:299-306. [PMID: 28880594 DOI: 10.7547/15-087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND A woman's body undergoes many changes during pregnancy, and it adapts by developing compensatory strategies, which can be sources of pain. We sought to analyze the effects of pregnancy and pelvic girdle pain (PGP) on center of pressure (COP) parameters during gait at different speeds. METHODS Sixty-one healthy pregnant women, 66 women with PGP between 18 and 27 weeks of pregnancy, and 22 healthy nonpregnant women walked at different velocities (slow, preferential, and fast) on a walkway with built-in pressure sensors. An analysis of variance was performed to determine the effects of gait speed and group on COP parameters. RESULTS In healthy pregnant women and women with PGP, COP parameters were significantly modified compared with those in nonpregnant women (P < .01). Support time was increased regardless of gait speed, and anteroposterior COP displacement was significantly decreased for women with PGP compared with healthy pregnant women. In addition, mediolateral COP displacement was significantly decreased in pregnant women compared with nongravid women. CONCLUSIONS Gait speed influenced COP displacement and velocity parameters, and gait velocity potentiated the effect of pregnancy on the different parameters. Pelvic girdle pain had an influence on COP anteroposterior length only. With COP parameters being only slightly modified by PGP, the gait of pregnant women with PGP was similar to that of healthy pregnant women but differed from that of nonpregnant women.
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Affiliation(s)
- Floriane Kerbourc'h
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Jeanne Bertuit
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Marcel Rooze
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Bruxelles, Belgium
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Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:48-69. [PMID: 28145611 DOI: 10.1002/ajmg.c.31538] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The hypermobile type of Ehlers-Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue. It has been described largely in those with musculoskeletal complaints including joint hypermobility, joint subluxations/dislocations, as well as skin and soft tissue manifestations. Many patients report activity-related pain and some go on to have daily pain. Two undifferentiated syndromes have been used to describe these manifestations-joint hypermobility syndrome and hEDS. Both are clinical diagnoses in the absence of other causation. Current medical literature further complicates differentiation and describes multiple associated symptoms and disorders. The current EDS nosology combines these two entities into the hypermobile type of EDS. Herein, we review and summarize the literature as a better clinical description of this type of connective tissue disorder. © 2017 Wiley Periodicals, Inc.
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Desseauve D, Pierre F, Gachon B, Decatoire A, Lacouture P, Fradet L. New approaches for assessing childbirth positions. J Gynecol Obstet Hum Reprod 2017; 46:189-195. [PMID: 28403977 DOI: 10.1016/j.jogoh.2016.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/24/2016] [Accepted: 10/27/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND An overview of labor based only on epidemiological data cannot identify or explain the mechanisms involved in childbirth. Data about the position that women should take in giving birth are discordant. None of the studies of birth positions adequately define or describe them or their biomechanical impact (pelvic orientation, position of the back). The measurement of the effect of one position relative to that of another requires precise definitions of each position and of their maternal biomechanical consequences, as well as safe measurement methods. METHODOLOGY We have developed a system to analyze the position of labor by quantifying the posture of the woman's body parts (including thighs, trunk, and pelvis), using an optoelectronic motion capture device (Vicon™, Oxford Metrics) widely used in human movement analysis and a system for measuring the lumbar curve (Epionics spine system). A specific body model has also been created to conduct this biomechanical analysis, which is based on external markers. With this methodology and model, it should be possible to define: (1) the hip joint angles (flexion/extension, abduction/adduction, internal/external rotation); (2) the ante/retroversion of the pelvis; (3) the lumbar curve. DISCUSSION This methodology could become a reference for assessing delivery postures, one that makes it possible to describe the relation between the postures used in the delivery room and their impact on the pelvis and the spine in an integrated and comprehensive model. TRIAL REGISTRATION No. Eudract 2013-A01203-42.
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Affiliation(s)
- D Desseauve
- Department of obstetrics and gynecology and reproductive medicine, university hospital of Poitiers, university of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France; Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France.
| | - F Pierre
- Department of obstetrics and gynecology and reproductive medicine, university hospital of Poitiers, university of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - B Gachon
- Department of obstetrics and gynecology and reproductive medicine, university hospital of Poitiers, university of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - A Decatoire
- Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France
| | - P Lacouture
- Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France
| | - L Fradet
- Institut PPRIME UP3346 CNRS-Université de Poiters-ENSMA, Team Robotics, Biomechanics Sport and Health, 86360 Chasseneuil du Poitou-Futuroscope, France
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Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy? Int Urogynecol J 2017; 28:1223-1231. [PMID: 28083713 DOI: 10.1007/s00192-016-3252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. METHODS This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. RESULTS MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. CONCLUSION LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.
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Desseauve D, Fradet L, Lacouture P, Pierre F. Position for labor and birth: State of knowledge and biomechanical perspectives. Eur J Obstet Gynecol Reprod Biol 2017; 208:46-54. [DOI: 10.1016/j.ejogrb.2016.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/10/2016] [Indexed: 11/27/2022]
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Anselmo DS, Love E, Tango DN, Robinson L. Musculoskeletal Effects of Pregnancy on the Lower Extremity A Literature Review. J Am Podiatr Med Assoc 2017; 107:60-64. [PMID: 28271938 DOI: 10.7547/15-061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pregnant women are often burdened with musculoskeletal symptoms of the lower extremity due to the physical, hormonal, and anatomical changes that occur throughout pregnancy. These symptoms are associated with musculoskeletal dysfunctions, modified gait, joint laxity, muscle imbalance, and increased body mass. This article reviews the literature involving the lower-extremity changes experienced by women during pregnancy and their respective pathophysiologic causes.
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Affiliation(s)
- Derek S. Anselmo
- Department of Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Ebony Love
- Department of Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Dana N. Tango
- Gait Study Center, Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Lesly Robinson
- Department of Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA
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Harrison KD, McCrory JL. Caliper Method Versus Digital Photogrammetry for Assessing Arch Height Index in Pregnant Women. J Am Podiatr Med Assoc 2016; 106:406-410. [PMID: 28033044 DOI: 10.7547/14-077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot anthropometry may be altered during pregnancy. Pregnant women often report lower-extremity pain that may be related to these alterations. The Arch Height Index Measurement System is a common method of foot arch assessment; however, the required calipers are costly and are not widely available. Thus, we compared the reliability of a digital photogrammetry method of arch height index (AHI) assessment with that of the Arch Height Index Measurement System. METHODS Ten pregnant women (mean ± SD: age, 29 ± 4 years; height, 166.9 ± 6.8 cm; weight, 63.3 ± 8.8 kg) in their second trimester were recruited to participate, along with a control group of 10 nulliparous weight-matched women (mean ± SD: age, 22 ± 2 years; height, 164.6 ± 4.8 cm; weight, 61.5 ± 8.1 kg). During the second and third trimesters, and once postpartum, AHI was assessed using calipers and using digital photogrammetry. Mixed model absolute agreement type intraclass correlation coefficient (ICC) was used to determine correlation between the two methods for sitting and standing AHI. RESULTS The ICC results for sitting AHI only (0.819-0.968) were reasonable for clinical measures; ICC values for standing AHI (0.674-0.789) did not reach values deemed reasonable for clinical use. CONCLUSIONS Caliper and digital photogrammetry methods of AHI assessment are correlated in pregnant women; however, for standing AHI, the correlation is not sufficient for clinical use. Photogrammetry may still be appropriate for clinical use, as long as values from this method are not substituted directly for results obtained from calipers.
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Affiliation(s)
- Kathryn D. Harrison
- Division of Exercise Physiology, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, WV
| | - Jean L. McCrory
- Division of Exercise Physiology, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, Morgantown, WV
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AGUIAR LILIANA, ANDRADE CARLOS, BRANCO MARCO, SANTOS-ROCHA RITA, VIEIRA FILOMENA, VELOSO ANTÓNIO. GLOBAL OPTIMIZATION METHOD APPLIED TO THE KINEMATICS OF GAIT IN PREGNANT WOMEN. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Morphological changes are associated to pregnancy, such as weight gain and increased volume of the trunk. The soft tissue artifact can also increase with these characteristics and affect the real joint kinematics. The main objective of this study was to understand the effect of using three different constraining sets in the lower limb joints, in the amount of soft tissue artifact (STA) of pregnant women, in order to obtain the most appropriated joint set to be used in gait and in this population. The ankle, knee and hip joints were modeled respectively with the following characteristics: (1) Universal–revolute–spherical (URS), (2) spherical–revolute–spherical (SRS) and (3) spherical–spherical–spherical (SSS). The six degrees of freedom (6DOF) model was used as the basis for comparison and considered the one with the highest error associated to the STA. In pregnant women, the URS model seems to affect more the kinematic variables when compared with the 6DOF model. Assuming that the kinematic error associated with pregnant women is increased due to the STA, the URS model may be affecting more the angular kinematics of the knee joint. SSS model seems to be more appropriated to analyze gait in second trimester pregnant women.
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Affiliation(s)
- LILIANA AGUIAR
- Laboratory of Biomechanics and Functional Morphology, Neuromechanics Research Group of Human Movement, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
| | - CARLOS ANDRADE
- Laboratory of Biomechanics and Functional Morphology, Neuromechanics Research Group of Human Movement, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
| | - MARCO BRANCO
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Portugal
| | - RITA SANTOS-ROCHA
- Laboratory of Biomechanics and Functional Morphology, Neuromechanics Research Group of Human Movement, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Portugal
| | - FILOMENA VIEIRA
- Laboratory of Biomechanics and Functional Morphology, Neuromechanics Research Group of Human Movement, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
| | - ANTÓNIO VELOSO
- Laboratory of Biomechanics and Functional Morphology, Neuromechanics Research Group of Human Movement, CIPER, Faculty of Human Kinetics, University of Lisbon, Portugal
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Weis CA, Grondin D, Vernon H. The Effect of Phase of Menstrual Cycle on Joint Mobility in the Cervical Spine and Extremities in Nulliparous Women: A Cross-Sectional Study. J Manipulative Physiol Ther 2016; 39:393-400. [PMID: 27346859 DOI: 10.1016/j.jmpt.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/01/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the range of motion (ROM) of various joints in women throughout the menstrual cycle to determine whether there would be a difference in the ROM between the luteal and follicular phases during extension at the fifth metacarpophalangeal joint and bilateral rotation of the cervical spine in young adult nulliparous women. METHODS Sixteen nulliparous women of childbearing age (mean age, 26 years) were recruited from the academic institution where the study was being performed. Participants were randomized into and tested during either the luteal or follicular phases of the menstrual cycle. In the following month, participants were tested in the opposite phases of the menstrual cycle. All testing was performed by a doctor of chiropractic. Differences in ROM were measured in single joint movements (fifth digit hyperextension) and in multijoint movements (bilateral cervical rotation) using an electromagnetic sensor system. RESULTS No significant effects of phase were found on peak ROM of the fifth digit or during cervical spine rotation (left, right, or bilaterally), irrespective of trial. CONCLUSION There is no difference in ROM of the cervical spine or the fifth metacarpophalangeal joint, regardless of the phase of menses, suggesting there is likely no hormonal influence on these structures during the follicular or luteal phases.
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Affiliation(s)
- Carol Ann Weis
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, Toronto, Canada.
| | - Diane Grondin
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Howard Vernon
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, Toronto, Canada
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Gachon B, Desseauve D, Fradet L, Decatoire A, Lacouture P, Pierre F, Fritel X. [Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects]. Prog Urol 2016; 26:385-94. [PMID: 26952013 DOI: 10.1016/j.purol.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The role of pregnancy in pelvic floor disorders occurrence remains poorly known. It might exist a link between changes in ligamentous laxity and changes in pelvic organ mobility during this period. Our objective was to conduct a non-systematic review of literature about changes in pelvic organ mobility as well as in ligamentous laxity during pregnancy and postpartum. METHODS From the PubMed, Medline, Cochrane Library and Web of Science database we have selected works which pertains clinical assessment of pelvic organ mobility (pelvic organ prolapse quantification), ultrasound assessment of levator hiatus and urethral mobility, ligamentous laxity assessment during pregnancy and postpartum. RESULTS Clinical assessments performed in these works show an increase of pelvic organ mobility and perineal distension during pregnancy followed by a recovery phase during postpartum. Pelvic floor imaging shows an increase of levator hiatus area and urethral mobility during pregnancy then a recovery phase in postpartum. Different authors also report an increase of ligamentous laxity (upper and lower limbs) during pregnancy followed by a decrease phase in postpartum. CONCLUSION Pelvic organ mobility, ligamentous laxity, levator hiatus and urethral mobility change in a similarly way during pregnancy (increase of mobility or distension) and postpartum (recovery). LEVEL OF EVIDENCE 3.
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Affiliation(s)
- B Gachon
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France.
| | - D Desseauve
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - L Fradet
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - A Decatoire
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - P Lacouture
- CNRS UPR 3346, Futuroscope, institut Pprime - Axe RoBioSS, université de Poitiers ENSMA, 86360 Futuroscope, France
| | - F Pierre
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - X Fritel
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Inserm CIC-P 1402, centre d'investigation clinique pluri-thématique du CHU de Poitiers, 86021 Poitiers, France; CESP UMR Inserm U1018, équipe 7 : genre, santé sexuelle et reproductive, 94270 Kremlin-Bicêtre, France
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Comparison between overweight due to pregnancy and due to added weight to simulate body mass distribution in pregnancy. Gait Posture 2015; 42:511-7. [PMID: 26410476 DOI: 10.1016/j.gaitpost.2015.07.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/15/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
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.
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Effects of exercise and Kinesio taping on abdominal recovery in women with cesarean section: a pilot randomized controlled trial. Arch Gynecol Obstet 2015; 293:557-65. [DOI: 10.1007/s00404-015-3862-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/17/2015] [Indexed: 12/15/2022]
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Hui KS. Report of a pregnant lady with bilateral elbow dislocation caused by acute fall injury. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(15)30027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Eshed I, Miloh-Raz H, Dulitzki M, Lidar Z, Aharoni D, Liberman B, Lidar M. Peripartum changes of the sacroiliac joints on MRI: increasing mechanical load correlating with signs of edema and inflammation kindling spondyloarthropathy in the genetically prone. Clin Rheumatol 2015; 34:1419-26. [DOI: 10.1007/s10067-015-2976-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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