Effect of Thunder-Fire Moxibustion on Pain, Quality of Life, and Tension of Multifidus in Patients with Primary Osteoporosis: A Randomized Controlled Trial.
Xu Dao-Ming,Xu Huaning,Liu Jing,Wang Tong,Wu Wenzhong,Liu Lanying,Tian Qianmo,Li Hanjun,Zhang Lili,Cao Yana
Medical science monitor : international medical journal of experimental and clinical research
BACKGROUND Primary osteoporosis is a common disease among postmenopausal women and the elderly; low back pain is the most typical clinical manifestation an is the primary reason for a clinic visit, and directly affects patients' quality of life. Anti-osteoporosis medications have undesirable side effects, and many kinds of special traditional Chinese moxibustion methods have been widely used in the clinical treatment of osteoporosis low back pain. The purpose of this study was to observe whether thunder-fire moxibustion therapy, compared to calcium supplements alone, can ease osteoporosis low back pain, improve quality of life, and reduce tension of the multifidus. MATERIAL AND METHODS Sixty-three eligible patients were enrolled in the study (7 of these patients did not finish the study and are not included in analysis). Participants were randomly divided into 2 groups: a moxibustion group that received calcium carbonate D3 and thunder-fire moxibustion therapy, and a control group that received calcium carbonate D3 only. Level of pain experienced, assessed using the visual analogue scale (VAS), and quality of life (SF-36) were measured pre-treatment, at the end of 4 weeks of treatment, and at a 1-month post-treatment evaluation. Changes in values of Young's modulus of the multifidus were also collected before and after treatment. RESULTS After 4 weeks of treatment and at 1 month after treatment had ended, low back pain in both groups was reduced relative to pre-treatment levels. The moxibustion group was significantly improved at BP, GH, SF, and MH dimensions compared to pre-treatment levels. The control group improved in BP dimensions, but not to the same extent as the moxibustion group. Similarly, after treatment for 4 weeks with moxibustion, multifidus tension was significantly reduced. CONCLUSIONS Thunder-fire moxibustion is an effective method for treating low back pain due to primary osteoporosis.
10.12659/MSM.909725
Efficacy and safety of moxibustion for chronic low back pain: A systematic review and meta-analysis of randomized controlled trials.
Chen Feng-Qin,Ge Jian-Feng,Leng Yu-Fei,Li Cheng,Chen Bin,Sun Zhi-Ling
Complementary therapies in clinical practice
INTRODUCTION:To systematically review and meta-analyze the efficacy of moxibustion in treating patients with chronic low back pain (CLBP). METHODS:A systematic search of the Cochrane Library, Web of Science, PubMed, Embase, EBSCO, CBM, Wanfang, CNKI and VIP (until November, 2019) was used to identify studies reporting pain intensity (VAS or NRS), disability (ODI or RMDQ), JOA score, and quality of life (SF-36) in patients with CLBP. Study selection, data extraction was performed critically and independently by two reviewers. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology (GRADE) was applied to test the quality of evidence from the quantitative analysis. RESULTS:Ten RCTs, including 987 patients, met the inclusion criteria. Moxibustion had a superior effect on VAS score when compared with western medicine [RR = -1.69, 95%CI(-2.40, -0.98), p < 0.00001] and acupuncture [RR = -0.47, 95%CI(-0.92, -0.02), p=0.04], but it failed to do so when compared with core stability training [RR = -0.41, 95%CI(-0.87, 0.05), p=0.08]. The result showed that moxibustion plus other active treatments (including western medicine, massage, acupuncture and core stability training) had better effects on low back pain relief compared with active treatments alone. Moxibustion showed favourable effects on disability [SMD = -3.80, 95%CI (-5.49, -2.11), p < 0.0001], JOA score [MD = 4.10, 95%CI(2.30, 5.90), p < 0.00001], and SF-36 score [MD = 13.41, 95%CI(9.68, 17.14), p < 0.00001]. The evidence level of the results from the ten studies was determined to be very low to low. CONCLUSIONS:It is difficult to draw firm conclusions that moxibustion is an effective intervention for treating CLBP due to the small sample size of eligible trails and the high risk of bias among the available articles. Rigorously designed large-scale RCTs are required to further confirm the results in this review.
10.1016/j.ctcp.2020.101130
Effect of Moxibustion on Inflammatory Cytokines for Low Back Pain: A Systematic Review, Meta-Analysis and Meta-Regression.
Therapeutics and clinical risk management
Background and Objective:Moxibustion is effective for low back pain (LBP), and inflammatory cytokines may play an important role in the mechanism of moxibustion treatment. The purpose of this meta-analysis was to explore the mechanism of moxibustion in LBP in terms of inflammatory cytokines. Methods:We searched China National Knowledge Infrastructure, Wanfang database, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, PubMed, and Web of Science to identify eligible randomized controlled trials (RCTs). There was no restriction on the publication date. Results:Thirty RCTs measuring interleukin (IL-) 1, IL-1β, IL-6, IL-12, IL-17, IL-23, and tumor necrosis factor (TNF-) α were included in this meta-analysis. Compared to controls: single moxibustion could effectively decrease levels IL-6 and IL-23 (SMD, -0.71, 95% CI: -1.25 to -0.17, = 0.01; SMD, -1.61, 95% CI: -2.20 to -1.03, < 0.01, respectively); combined moxibustion had significant effects on IL-1, IL-1β, IL-6, IL-12, IL-17, and TNF-α ( < 0.05). Overall, for LBP, single or combined moxibustion could effectively down-regulate levels of pro-inflammatory cytokines ( = 0.007 and < 0.00001, respectively). For safety of moxibustion, the incidence rate of side effects was similar to that of controls (RD, -0.01, 95% CI: -0.02 to 0.01, = 0.59). Sensitivity analysis showed that the pooled estimates were robust, and publication bias analysis showed there was a significant small study effect (Egger's test = 0.0000). High statistical heterogeneity existed between included RCTs, meta-regression showed there was no potential factor explaining the source of heterogeneity. Conclusion:For LBP, moxibustion can effectively decrease levels of IL-1, IL-1β, IL-6, IL-12, IL-17, IL-23, and TNF-α to achieve analgesia. Because the side effects of moxibustion are transient, it is relatively safe for clinical use. However, based on high heterogeneity in this meta-analysis, rigorously designed RCTs are required to further confirm the results in this review.
10.2147/TCRM.S429469
[Effects of moxibustion on pain symptoms and inflammatory factors in patients with ankylosing spondylitis of cold-damp obstruction].
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
OBJECTIVE:To observe the effects of moxibustion on pain symptoms and serum inflammatory factors in patients with ankylosing spondylitis of cold-damp obstruction. METHODS:Eighty-four patients with ankylosing spondylitis of cold-damp obstruction were randomly divided into a Zhoutian moxibustion group (42 cases, 2 cases dropped out) and a governor vessel moxibustion group (42 cases, 2 cases dropped out, 1 case discontinued). Both groups were given oral administration of sulfasalazine enteric-coated tablets as basic treatment. The governor vessel moxibustion group was treated with moxibustion box from Dazhui (GV 14) to Yaoyangguan (GV 3), one hour per treatment; the Zhoutian moxibustion group was treated with moxibustion box from Tiantu (CV 22) to Zhongji (CV 3) in addition to the governor vessel moxibustion group, two hours per treatment. Both groups were treated once every 3 days, twice a week, for a total of 9 weeks. The pain symptom scores of the two groups were observed before treatment and at the 3rd, 6th, and 9th weeks into treatment. ELISA was used to detect the levels of serum interleukin (IL)-1β, IL-18, and tumor necrosis factor-α (TNF-α) before and after treatment, and the clinical efficacy of the two groups was evaluated after treatment. RESULTS:Except for the joint pain scores at the 3rd week into treatment, the total scores and the each sub-item score of pain symptom in the two groups were lower than those before treatment at the 3rd, 6th, and 9th weeks into treatment (<0.05); at the 3rd, 6th, and 9th weeks into treatment, the total scores of pain symptom and the scores of lumbar sacral pain, back pain, joint cold pain, and limited mobility in the Zhoutian moxibustion group were lower than those in the governor vessel moxibustion group (<0.05). After treatment, the levels of serum IL-1β, IL-18 and TNF-α in both groups were lower than those before treatment (<0.05), and the levels of serum IL-1β, IL-18, and TNF-α in the Zhoutian moxibustion group were lower than those in the governor vessel moxibustion group (<0.05). The total effective rate was 90.0% (36/40) in the Zhoutian moxibustion group, which was higher than 76.9% (30/39) in the governor vessel moxibustion group (<0.05). CONCLUSION:Zhoutian moxibustion could effectively improve various pain symptoms in patients with ankylosing spondylitis of cold-damp obstruction, and reduce the expression of inflammatory factors.
10.13703/j.0255-2930.20230616-k0001
The Effects and Potential Mechanisms of Moxibustion for Rheumatoid Arthritis-Related Pain: A Randomized, Controlled Trial.
Journal of pain research
Purpose:To investigate the effects of moxibustion in relieving pain, and other clinical symptoms for patients with rheumatoid arthritis (RA), and explore the potential mechanism of moxibustion treatment for RA. Patients and Methods:Seventy qualified RA patients were randomly assigned in a 1:1 ratio to the moxibustion group or the routine group. The routine group only took oral methotrexate tablets and folic acid tablets. The moxibustion group was treated with moxibustion based on oral pharmaceutical. Moxibustion was performed two times weekly for 8 weeks, a total of 16 sessions. Patients scored their pain on a visual analog scale (VAS). The American College of Rheumatology improvement criteria of 20%, 50% and 70% (ACR20, ACR50 and ACR70) after treatment were investigated. Clinical symptoms, a disease activity score using 28 joint counts (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), health assessment questionnaire (HAQ), interleukin 1β (IL-1β), tumor necrosis factor-alpha (TNF-α), and vascular endothelial growth factor (VEGF) of RA patients were analyzed before and after treatment. Results:After treatment, the VAS scores, tender and swollen joint counts, morning stiffness scores, disease activity scores (DAS28, SDAI, CDAI), HAQ scores in the two groups were both improved, and the effects of moxibustion group were more obvious ( < 0.05). The ACR20 and ACR50 of the moxibustion group were greater than that of the routine group ( < 0.05), no significant difference of the ACR70 existed between the two groups ( > 0.05). In addition, the decreases of IL-1β, TNF-α, VEGF of the moxibustion group were better than that of the routine group ( < 0.05). Conclusion:Moxibustion could effectively relieve pain, ameliorate the clinical symptoms, and decrease the disease activity of RA. The potential mechanism may be the decrease in the level of serum inflammatory factors.
10.2147/JPR.S408814
[On the in moxibustion].
Chen Ri-Xin,Chen Yan-Qi,Xie Ding-Yi
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
The original connotation of in () was explored to provide the reference for the clinical application of moxibustion. The relevant items of the original definition of in were traced aligning with the achievements in the clinical researches on the heat-sensitive phenomena and its rule, and thus, the characteristics of in moxibustion and its inducing approaches were analyzed. A new viewpoint of the connotation of in was put forward. It is believed that is not only a somatic response to acupuncture, but also a kind of comfortable mental-physical reaction related to curative effect. On this basis, it was discussed that moxibustion on heat-sensitive acupoints could induce which conforms to the original definition described in . Additionally, the method of moxibustion for stimulating , the screening of the items on in moxibustion as well as the preliminary evaluation were introduced in the paper. It is suggested that the in moxibustion is the comprehensive responses of the mental-physical-curative effect.
10.13703/j.0255-2930.2019.10.022
[Acupoint massage, acupoint sticking combined with moxibustion for postpartum urinary retention: a randomized controlled trial].
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
OBJECTIVE:To observe the clinical efficacy of acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) for postpartum urinary retention. METHODS:A total of 120 patients with postpartum urinary retention were randomly divided a triple-combination group, a double-combination group, and a massage group, with 40 patients in each group. All groups received standard postpartum care to stimulate urination. The patients in the massage group received rapid acupoint massage at the bilateral Shuidao (ST 28); the patients in the double-combination group additionally received acupoint sticking of self-made powder at bilateral Shuidao (ST 28); the patients in the triple-combination group further received moxibustion at bilateral Shuidao (ST 28). The treatment was given once in all three groups. After 5 hours of treatment completion, bladder residual volume was measured; the time and volume of first urination as well as total urination volume after 5 hours of treatment completion were recorded; the patients' sensation of urination smoothness, satisfaction rate, length of hospital stay, and hospital costs were evaluated. RESULTS:The triple-combination group showed significantly lower residual urine volumes (<0.05), earlier first urination time (<0.05, <0.001), and higher first urination volumes and total urination volumes after 5 hours of treatment completion compared to the other two groups (<0.05, <0.001). The sensation of urination smoothness and patient satisfaction were also significantly better in the triple-combination group (<0.001, <0.05). The double-combination group had higher volume of first urination and total urination volume after 5 hours of treatment completion than the massage group (<0.05), and better sensation of urination smoothness and patient satisfaction (<0.05). There was no significant difference in the length of hospital stay and costs among the three groups (>0.05). The total effective rates were 100.0% (40/40) for the triple-combination group, 90.0% (36/40) for the double-combination group, and 70.0% (28/40) for the massage group, with the triple-combination group significantly outperforming the other two groups (<0.05, <0.001), and double-combination group outperforming the massage group (<0.05). CONCLUSION:Acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) could effectively improve urination in patients with postpartum urinary retention, and enhance patient satisfaction.
10.13703/j.0255-2930.20230603-k0001
[Clinical Observation of Heat-sensitive Moxibustion Combined with Kegel Exercise Therapy for Female Stress Urinary Incontinence].
Hu Dan,Deng Peng,Jiao Lin,Xiong Jun,Xie Ding-Yi,Chen Ri-Xin
Zhen ci yan jiu = Acupuncture research
OBJECTIVE:To compare the clinical effects of heat-sensitive moxibustion combined with kegel exercise therapy and simple kegel exercise therapy on female stress urinary incontinence. METHODS:Forty-five female patients with stress urinary incontinence were randomly divided into a treatment group (=23) and a control group (=22). Kegel exercise therapy was applied in the two groups. Heat-sensitive moxibustion was used at Zhongji (CV 3), Qihai (CV 6), Ciliao (BL 32) and Shen-shu (BL 23) in the treatment group, once a day for the first 10 times, and once every other day until 5 sessions were given, 10 times as one session. 1-hour pad test, International Incontinence Advisory Board questionnaire (ICIQ-SF) and the number of urine leakage were observed before and after treatment. And the clinical effect was evaluated. RESULTS:The curative rate of 43.48%(10/23) and the total effective rate of 95.65%(22/23) in the treatment group were respectively better than those of 18.18% (4/22) and 63.64%(14/22) in the control group (both <0.05). After treatment, 1-hour pad test and ICIQ-SF score were lower than those before treatment in the two groups, and the number of urine leakage decreased (all <0.01). The above three indexes of the treatment group were better than those of the control group (all <0.01). CONCLUSIONS:Heat-sensitive moxibustion combined with kegel exercise therapy achieves better effect than simple kegel exercise therapy on female stress urinary incontinence.
Comparison of acupuncture and moxibustion related non-surgical therapies for women with stress urinary incontinence: A systematic review and network meta-analysis of randomized controlled trials.
Explore (New York, N.Y.)
BACKGROUND:Stress urinary incontinence (SUI) significantly impacts women's health and imposes substantial mental and socio-economic burdens. Acupuncture and moxibustion, either alone or in combination with other non-surgical therapies, are recognized as effective treatments for SUI. This study aimed to assess the efficacy of various treatments for women with SUI using network meta-analysis (NMA). METHOD:We systematically searched databases up until June 30, 2022, to identify relevant randomized controlled trials (RCTs) focusing on SUI in women. Subsequently, the quality of the included studies was assessed. NMA was performed using STATA 14.0 software. RESULTS:A total of 31 RCTs involving 2922 participants were included in the analysis. A total of 18 treatment plans were identified. The treatment plan consisting of Moxibustion + PFMT + EB demonstrated the most significant reduction in ICIQ-UI-SF. Due to lack of consistency across studies, a NMA was not performed for the outcomes of effectiveness and the 1 h pad test. CONCLUSIONS:The combined intervention of Moxibustion + PFMT + EB appears to be the most effective in reducing patients' reported symptoms and improving their quality of life. However, due to the limitations of the included studies, further high-quality RCTs are necessary to reinforce the current evidence.
10.1016/j.explore.2023.11.010
Effects of Du Meridian Moxibustion Combined with Mild Moxibustion on Female Pelvic Floor Myofascial Pain Syndrome: A Retrospective Cohort Study.
Evidence-based complementary and alternative medicine : eCAM
Objective:This study aimed to investigate the efficacy and safety of moxibustion in the treatment of pelvic floor myofascial pain syndrome. Methods:A total of 80 women with pelvic floor myofascial pain syndrome (cold coagulation and blood stasis type) were included in this retrospective study and divided into a moxibustion group and a drug treatment group. Patients who received Celebrex oral analgesia, health education, and lifestyle improvement were included in the drug treatment group. The patients that received Du meridian moxibustion combined with mild moxibustion, health education, and lifestyle improvement were included in the moxibustion group. The comparison of pelvic pain, the TCM clinical symptom score, and the curative effect was made between the two groups before treatment and after 1-3 weeks of treatment, respectively. Results:An intragroup comparison showed a stepwise decrease in the VAS score and the TCM clinical symptom score of the two groups during the treatment. An intergroup comparison revealed that the VAS score of the moxibustion group was lower than that of the drug treatment group, while TCM clinical symptoms and clinical efficacy significantly improved in the moxibustion group compared to those in the drug treatment group ( < 0.05). Conclusion:Du meridian moxibustion combined with mild moxibustion alleviates pelvic floor myofascial pain syndrome, thus helping improve women's quality of life and providing patients with a more effective and safer treatment plan.
10.1155/2022/7388864
[Effect of moxibustion on postpartum urodynamics and pelvic floor function in puerperal women].
Yang Qiu-Ye,Sun Yu-Kun,Lin Zhuang-Teng
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
OBJECTIVE:To observe the effect of moxibustion on postpartum urodynamics and recovery of pelvic floor function based on the pelvic floor muscle function training. METHODS:A total of 150 puerperal women were randomly divided into an observation group (75 cases, 15 cases dropped off) and a control group (75 cases, 15 cases dropped off). The control group was treated with pelvic floor muscle function training, twice a day. Based on the treatment in the control group, the observation group was treated with moxibustion at Qihai (CV 6), Guanyuan (CV 4), Sanyinjiao (SP 6) and Zusanli (ST 36), twice a week. The treatment started on the 42nd day after delivery, totaling for 12 weeks. The urodynamic indexes (functional urethral length [FUL], stress leak point pressure [SLPP], maximum urethral closure pressure [MUCP], bladder compliance [BC], maximum urethral pressure [MUP], detrusor pressure at maximum urinary flow rate [Pdet Qmax]), the international consultation on incontinence questionnaire-urinary incontinence-short form (ICIQ-UI-SF) score and vaginal muscle voltage were observed before and after treatment. The prolapse rate of pelvic floor organ and normal rate of pelvic floor muscle strength of the two groups were recorded after treatment. RESULTS:Compared before treatment, the levels of FUL, MUCP, BC, Pdet Qmax and SLPP in the observation group after treatment were increased (<0.05), while the FUL and SLPP in the control group after treatment were increased (<0.05). After treatment, the levels of FUL, SLPP, MUCP and BC in the observation group were higher than those in the control group (<0.05). Compared before treatment, the ICIQ-UI-SF scores in the two groups after treatment were decreased (<0.01), and the vaginal muscle voltage was increased (<0.01). After treatment, the ICIQ-UI-SF score in the observation group was lower than that in the control group (<0.01), and the vaginal muscle voltage in the observation group was higher than that in the control group (<0.01). The prolapse rate of pelvic floor organ was 6.7% (4/60) in the observation group, which was lower than 20.0% (12/60) in the control group (<0.05). The normal rate of pelvic floor muscle strength in the observation group was 88.3% (53/60), which was higher than 65.0% (39/60) in the control group (<0.05). CONCLUSION:The moxibustion combined with pelvic floor muscle function training could improve postpartum urodynamics and pelvic floor muscle strength.
10.13703/j.0255-2930.20200821-k0001
Treatment of Degenerative Lumbar Spondylolisthesis by Tongdu Bushen Acupuncture, Intradermal Acupuncture, and Moxibustion Integrated Therapy Combined with Core Muscle Training Program: Study Protocol for a Randomized Controlled Clinical Trial.
Song Xiaolei,Qi Shikui,Gao Jing,Ruan Xiaodi,Yin Shuai,Wu Mingli,Fu Wenbin
Evidence-based complementary and alternative medicine : eCAM
Background:Degenerative lumbar spondylolisthesis (DLS), one of the most common causes of low back pain, is defined as the displacement of a vertebral body over the lower vertebral body with degenerative changes and the absence of fracture or defect in the vertebral ring. This disease is a common and frequently occurring disease. Currently, there are many clinical treatment methods, but there is no specific method, and most of them have the characteristics of slow effect and easy recurrence. Objective:The objective of this study is to summarize and analyze the effects of treatment of degenerative lumbar spondylolisthesis by Tongdu Bushen acupuncture, intradermal acupuncture, and moxibustion integrated therapy combined with core muscle training program (CMT) on the improvement of pain degree and dysfunction index, as well as the gait characteristics. Methods:120 patients with DLS will be recruited and randomly divided into two groups using electroacupuncture combined with the CMT group as the control group. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association score (JOA) will be used for evaluation. The spatiotemporal and kinematics parameters in gait analysis, as well as the ability of lumbar muscle contraction, fatigue resistance, relaxation, and coordination of lumbar muscle in surface electromyography (sEMG), will be used as objective observation indexes to observe the effectiveness of Tongdu Bushen acupuncture, intradermal acupuncture, and moxibustion integrated therapy combined with CMT. . Tongdu Bushen acupuncture, intradermal acupuncture, and moxibustion integrated therapy is a traditional Chinese medicine treatment for DLS. Our results will provide evidence to determine whether the integrated therapy can effectively treat DLS, as well as its advantages and safety, and lay a foundation for further research. This trial is registered with ChiCTR2100050409.
10.1155/2022/6016542
Electroacupuncture and Moxibustion-Like Stimulation Relieves Inflammatory Muscle Pain by Activating Local Distinct Layer Somatosensory Afferent Fibers.
Chen Lizhen,Wang Xiaoyu,Zhang Xiaoning,Wan Hongye,Su Yangshuai,He Wei,Xie Yikuan,Jing Xianghong
Frontiers in neuroscience
Recent studies have shown that both superficial and deep acupuncture produced clinically relevant and persistent effect on chronic pain, and several subtypes of somatic primary afferents played critical roles in acupuncture and moxibustion analgesia. However, which kind of primary afferents in the superficial and deep tissue of the acupoint is activated by acupuncture or moxibustion to relieve pain persistently remains unclear. The aim of this study is to investigate the roles of distinct peripheral afferents in different layers of the tissue (muscle or skin) in the acupoint for pain relief. Muscular A-fibers activated by deep electroacupuncture (dEA) with lower intensity (approximately 1 mA) persistently alleviated inflammatory muscle pain. Meanwhile, cutaneous C-nociceptors excited by noxious moxibustion-like stimulation (MS) and topical application of capsaicin (CAP) on local acupoint area produced durable analgesic effect. Additionally, spontaneous activity of C-fibers caused by muscular inflammation was also inhibited by dEA and CAP. Furthermore, decreases in pain behavior induced by dEA disappeared after deep A-fibers were demyelinated by cobra venom, whereas CAP failed to relieve pain following cutaneous denervation. Collectively, these results indicate that dEA and MS ameliorate inflammatory muscle pain through distinct primary afferents in different layers of somatic tissue; the former is achieved by activating muscular A-fibers, while the latter is mediated by activating cutaneous C-fibers.
10.3389/fnins.2021.695152
The clinical utility of the prone hip extension test in the diagnosis of motor control impairments associated with low back pain: A cross-sectional study using motion capture and electromyography.
Clinical biomechanics (Bristol, Avon)
BACKGROUND:The prone hip extension test is used as a clinical tool to diagnose specific motor control impairments that have been identified in individuals with chronic low back pain. However, conventional protocols for performing the test are subjective and lack evidence for their effectiveness. The objective of the current study was to quantify lumbopelvic motion and muscle activation during this test and identify which motor control patterns best distinguish individuals with low back pain from asymptomatic controls. METHODS:18 individuals with sub-acute or chronic low back pain and 32 asymptomatic controls performed the prone hip extension test while a 3D motion capture system measured lumbar and pelvic movement patterns and an electromyography system measured the muscle activation patterns of the paraspinal, gluteus maximus, and hamstring muscles. A three-stage statistical analysis was performed, the final stage being a stepwise logistic regression analysis aimed at identifying the movement and muscle activation pattern variables that best distinguished the two groups. FINDINGS:The final regression model included three lumbar kinematic variables and several electromyographic amplitude variables for the gluteus maximus and hamstring muscles during right-sided prone hip extension. The final model correctly classified 86.7 % of the control group and 83.3 % of the low back pain group. INTERPRETATION:The subject of asymmetrical gluteus maximus and hamstring muscle activation appears to be a potentially interesting area for future research on the utility of the prone hip extension test as a clinical tool in diagnosing motor control impairments associated with low back pain.
10.1016/j.clinbiomech.2024.106317
Asymmetric pelvic bracing and altered kinematics in patients with posterior pelvic pain who present with postural muscle delay.
Bussey Melanie D,Milosavljevic Stephan
Clinical biomechanics (Bristol, Avon)
BACKGROUND:The purpose of the study was to examine the muscle activity and hip-spine kinematics in a group of individuals diagnosed with posterior pelvic girdle pain and confirmed postural muscle delay during a repeated fast hip flexion task. METHODS:Twenty-four (12 pain and 12 control) age and sex matched participants performed a repeated fast hip flexion task to auditory signal. Surface EMG activity in the external and internal oblique, the multifidus, the gluteus maximus and biceps femoris in the stance-limb was examined for onset timing and EMG integral. Sagittal plane hip (swing limb) and spine kinematics were examined for group and side differences over the repeated trials. FINDINGS:While the pain group lacked significant feedforward muscle activity they displayed higher muscle activity at movement onset in the biceps femoris bilaterally (p<0.05) as well as the external oblique (p<0.05) during motion of the symptomatic side. Furthermore, the pain group experienced asymmetrical spinal range of motion with increased motion on the contralateral side (p<0.001) and reduced flexion velocity on the symptomatic side (p<0.001). INTERPRETATION:The findings support previous hypotheses regarding the effect of increased biceps activity on pelvic control during lumbo-pelvic rotation. Further, there appears to be a symptom led strategy for bracing the innominate through opposing tension in the biceps and external oblique during movement of the painful side. Such asymmetrical pelvic girdle bracing may be a strategy to increase the stability of the pelvis in light of the failed load transfer mechanism. Putatively, this strategy may increase the mechanical stress on the sacroiliac joint exacerbating pain complaints.
10.1016/j.clinbiomech.2014.11.002
Electromyographic Analysis of Gluteus Maximus, Gluteus Medius, and Tensor Fascia Latae During Therapeutic Exercises With and Without Elastic Resistance.
Bishop Barton N,Greenstein Jay,Etnoyer-Slaski Jena L,Sterling Heidi,Topp Robert
International journal of sports physical therapy
BACKGROUND:Strengthening and activation of the gluteus maximus and gluteus medius while minimizing the contribution of the tensor fascia latae are important components in the treatment of many lower limb injuries. Previous researchers have evaluated a myriad of exercises that activate the gluteus maximus (GMax) and gluteus medius (GMed), however, limited research has been performed describing the role of the addition of elastic resistance to commonly used exercises. PURPOSE:The primary purpose of this study was to determine the gluteal-to-tensor fascia latae muscle activation (GTA index) and compare electromyographic muscle activation of the GMax, GMed, and TFL while performing 13 commonly prescribed exercises designed to target the GMax and GMed. The secondary purpose of this study was to compare muscle activation of the GMax, GMed, and TFL while performing a subgroup of three matched exercises with and without elastic resistance. STUDY DESIGN:Repeated measures cohort study. METHODS:A sample of 11 healthy, physically active male and females, free of low back pain and lower extremity injuries, were recruited for the study. Surface electromyography was used to quantify the normalized EMG activation of the gluteus maximus, gluteus medius, and tensor fascia latae while performing 13 exercises. Three of these exercises were performed with and without elastic resistance. The maximal voluntary isometric contraction was established for each muscle and order in which the exercises were performed was randomized to minimize the effect of fatigue. RESULTS:The relative activation of the gluteal muscles were compared to the tensor fascia latae and expressed as the GTA index. Clams with and without resistance, running man gluteus maximus exercise on the stability trainer, and bridge with resistance, generated the highest GTA index respectively. Significant differences in activation of the TFL occurred between clams with and without resistance. CONCLUSIONS:The findings are consistent with those of previous investigators who reported that the clam exercise optimally activated the gluteal muscles while minimizing tensor fascia latae activation. LEVELS OF EVIDENCE:Level 2b.
Chronic low back pain changes the latissmus dorsi and gluteus maximus muscles activation pattern and upward scapular rotation: A cross-sectional study.
Mohamed Rania R,Abdel-Aziem Amr A,Mohammed Hatem Y,Diab Reham H
Journal of back and musculoskeletal rehabilitation
BACKGROUND:Patients with chronic low back pain (LBP) have an impaired dynamic spinal stability, which may lead to arm injuries. OBJECTIVES:To examine the latissimus dorsi and gluteus maximus muscles activation pattern and the upward scapular rotation in patients with chronic LBP. METHODS:Sixty-one right-handed males were divided into two groups: chronic LBP group (n= 31) and healthy controls (n= 30). The electromyography (EMG) activities of the right and left latissimus dorsi and gluteus maximus were recorded. The upward scapular rotation in different shoulder positions (neutral, 45∘, 90∘, 135∘ abduction and end range) was measured in both groups. RESULTS:The LBP group has a bilateral significant increased EMG of latissimus dorsi (p< 0.05) and significantly decreased EMG of gluteus maximus (p< 0.05) compared to the control group, without significant differences between the right and left sides (p> 0.05). There was a significant increase in upward scapular rotation in the LBP group relative to the control group in all shoulder abduction positions on both sides. The left side upward scapular rotation was more significant than the right (p< 0.05). CONCLUSION:Chronic LBP increased the latissimus dorsi muscle activities and decreased the gluteus maximus activities. It furthermore increased the upward scapular rotation in different shoulder abduction positions.
10.3233/BMR-200253
Running biomechanics differ during and after pregnancy compared to females who have never been pregnant.
Gait & posture
BACKGROUND:Perinatal running participation has increased recently; however, pregnancy related symptoms can limit activity. Perinatal running biomechanics could inform interventions to help perinatal individuals maintain an active lifestyle. RESEARCH QUESTION:Are perinatal running biomaechanics and muscle activation different compared to nulligravida females? METHODS:Sixteen pregnant participants completed self-selected velocity running during second trimester (2 T), third trimester (3 T), and postpartum (PP) and 16 matched controls completed these procedures once in this case control study. Kinematic, kinetic, and electromyography (EMG) data were collected using a motion capture system, force plates, and EMG electrodes. Peak trunk, pelvis, hip, knee, and ankle kinematics and hip, knee, and ankle moments during stance phase, and average and peak erector spinae (ES), gluteus maximus (GMax), and gluteus medius (GMed) EMG amplitude and duration of activation during stance and swing phases were calculated. Independent t-tests were used to compare 2 T, 3 T, and PP to control participants (α < 0.05). RESULTS:Running velocity was slower during 3 T compared to control participants. At all pregnancy timepoints compared to the control group, peak trunk contralateral rotation was smaller. During 2 T and 3 T peak hip flexor moments were smaller. At 3 T pelvis contralateral rotation was smaller, ES average amplitude was greater during swing, GMax percent duration during stance and GMed percent duration during swing were smaller. At PP trunk flexion was smaller and knee abduction was greater (all p < 0.05). CONCLUSIONS:Decreased running velocity may help offset increased demand during pregnancy. During 3 T, greater ES activation, smaller trunk and pelvis motion, and altered gluteal activation could indicate trunk rigidity combined with modified hip stabilizer muscle utilization. During PP, the rigid trunk combined with greater knee abduction may indicate hip and trunk strength deficits. Altered trunk and hip motion and activation could be relevant to pathologies such as perinatal low back, pelvic girdle, or knee pain.
10.1016/j.gaitpost.2024.02.004
Assessment of Cervical and Lumbar Kinematics in Simulated Open and Closed Kinetic Chain.
International journal of spine surgery
BACKGROUND:The pelvic girdle and spine vertebral column work as a long chain influenced by pelvic tilt. This study aims to assess the effect of open and closed chain anterior pelvic tilt (APT) or posterior pelvic tilt (PPT) on cervical and lumbar spine kinematics using an in vitro cadaveric spine model. METHODS:Three human cadaveric spines with intact pelvis were suspended with the skull fixed in a metal frame. Optotrak 3-dimensional motion system captured coordinates of pin markers at 24 different points for real-time tracking of cervical and lumbar regions. Additional geometric parameters were measured to calculate pelvic incidence and pelvic tilt. A force-torque digital gauge applied consistent force to standardize the acetabular or sacral axis' APT and PPT during simulated open- and closed-chain movements, respectively. RESULTS:In closed-chain PPT, significant differences in relative intervertebral decompression were noted between spinal levels C2/C3 (4.85 mm) and C5/C6 (1.26 mm), while compression was noted between L1/L2 (-2.54 mm) and L5/S1 (-11.84 mm) and between L3/L4 (-2.78 mm) and L5/S1 (-11.84 mm) ( < 0.05). Displacement during closed-chain PPT was significantly greater than during open-chain PPT for cervical and lumbar spines. In closed-chain APT, significant differences in relative intervertebral decompression were noted between spinal levels L1/L2 (2.87 mm) and L5/S1 (24.48 mm) and between L3/L4 (2.94 mm) and L5/S1 (24.48 mm) ( < 0.05). Pelvic incidence remained the same as the pelvis tilted anterior and posterior. CONCLUSIONS:In PPT, open-chain pelvic tilts did not produce as much cervical and lumbar intervertebral displacement compared with closed-chain pelvic tilts. In contrast, APT saw fewer differences between open- and closed-chain tilting. There was a reciprocal relationship between pelvic tilt and sacral slope, producing a constant pelvic incidence throughout all pelvic tilt angles. CLINICAL RELEVANCE:The results of this study may help determine how a patient's pelvic tilt is causing pain and using that knowledge to guide rehabilitation of stabilizing muscles. The data produced here may also be helpful in determining which rehabilitation exercises may be more difficult or prone to injury for patients with either excessive anterior or posterior pelvic tilt. LEVEL OF EVIDENCE: 5:
10.14444/8382
Effectiveness of kinesiotaping in pregnant women with sacroiliac joint pain: A randomised controlled study.
Ordahan Banu,Eriç Horasanlı Jule
International journal of clinical practice
AIM:Sacroiliac joint (SIJ) dysfunction is an especially common cause of pain during pregnancy. Treatment options during pregnancy are very limited in order to reduce pain and increase the quality of life. We aimed to determine the efficacy of kinesiotaping (KT) in the treatment of SIJ pain in pregnant women. METHODS:A total of 50 pregnant women with SIJ pain were included in the study. Patients were randomised into two groups as KT and sham KT groups. Women in the KT group underwent a total of 5 weeks of KT once per week; the sham KT group also underwent 5 weeks of KT applications, but without tension in the kinesiotape. Patients were assessed before and 5 weeks after the treatment with a visual analogue scale (VAS) for pain and the Roland-Morris Disability Questionnaire (RMDQ) and Pelvic Girdle Questionnaire (PGQ) for disability and quality of life. RESULTS:The KT and sham KT groups were similar in terms of age, parity, gravidas, gestational week and body mass index. At the beginning of the study, there were no statistically significant differences between the two groups in their VAS, RMDQ or PGQ scores. Five weeks later, the KT group showed significant improvement in all parameters, but no significant differences were observed for the sham KT group in terms of VAS, RMDQ or PGQ. CONCLUSIONS:KT treatment improved the pain levels, functioning and quality of life among pregnant women with SIJ pain.
10.1111/ijcp.14432
Minimal-contact physical interventions for pregnant women with musculoskeletal disorders: a systematic review of randomised and non-randomised clinical trials.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
This review summarised minimal-contact physical interventions and their effects on pain, disability and quality of life in pregnant women with musculoskeletal disorders. Twelve bibliographic databases were systematically searched until December 31 2020. PEDro Scale was used for quality assessments. Narrative synthesis of 10 eligible studies was conducted. Education and multimodal home exercises plus handbooks/multimodal individual/group exercises; and self-management programmes improved pain intensity, sick leave and disability in pregnant women with lumbopelvic pain. Individual home-based progressive muscle relaxation exercises; unsupervised water exercises plus information using handbooks/videos/music; group multimodal exercises plus home exercises and information/education; and partner massage plus information using booklets/photographs reduced pain intensity in pregnant women with low back pain. Non-rigid/customised lumbopelvic belts plus information reduced pain intensity more significantly than rigid belts or stabilisation exercises plus information among pregnant women with pelvic girdle pain. Minimal contact interventions are effective and may be utilised during infectious disease pandemics.
10.1080/01443615.2022.2070731
Association between muscle function and low back pain in relation to pregnancy.
Gutke Annelie,Ostgaard Hans Christian,Oberg Birgitta
Journal of rehabilitation medicine
OBJECTIVE:To investigate the association of muscle function and subgroups of low back pain (no low back pain, pelvic girdle pain, lumbar pain and combined pelvic girdle pain and lumbar pain) in relation to pregnancy. DESIGN:Prospective cohort study. SUBJECTS:Consecutively enrolled pregnant women seen in gestational weeks 12-18 (n = 301) and 3 months postpartum (n = 262). METHODS:Classification into subgroups by means of mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history and a pain drawing. Trunk muscle endurance, hip muscle strength (dynamometer) and gait speed were investigated. RESULTS:In pregnancy 116 women had no low back pain, 33% (n = 99) had pelvic girdle pain, 11% (n = 32) had lumbar pain and 18% (n = 54) had combined pelvic girdle pain and lumbar pain. The prevalence of pelvic girdle pain/combined pelvic girdle pain and lumbar pain decreased postpartum, whereas the prevalence of lumbar pain remained stable. Women with pelvic girdle pain and/or combined pelvic girdle pain and lumbar pain had lower values for trunk muscle endurance, hip extension and gait speed as compared to women without low back pain in pregnancy and postpartum (p < 0.001-0.04). Women with pelvic girdle pain throughout the study had lower values of back flexor endurance compared with women without low back pain. CONCLUSION:Muscle dysfunction was associated with pelvic girdle pain, which should be taken into consideration when developing treatment strategies and preventive measures.
10.2340/16501977-0170
Association between sleep disturbance and low back and pelvic pain in 4-month postpartum women: A cross-sectional study.
Horibe Kana,Isa Tsunenori,Matsuda Naoka,Murata Shunsuke,Tsuboi Yamato,Okumura Maho,Kawaharada Rika,Kogaki Masahumi,Uchida Kazuaki,Nakatsuka Kiyomasa,Ono Rei
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:Persistent low back and pelvic pain (LBPP) is a postpartum-specific health problem. Sleep disturbances' association with persistent LBPP is not yet clear. We aimed to examine the cross-sectional association between sleep disturbance and persistent LBPP at 4 months postpartum. METHODS:We enrolled 120 women with LBPP during pregnancy (mean age, 31.8; standard deviation, 4.9 years). The primary outcome was persistent LBPP. We assessed LBPP severity at 4 months postpartum using the Numerical Rating Scale (NRS), where women with an NRS score of ≥ 4 at 4 months postpartum were allocated to the persistent LBPP group. We assessed sleep disturbance at 4 months postpartum using the Japanese version of the Pittsburgh Sleep Quality Index with a total score of ≥ 6 indicating sleep disturbance. Moreover, we performed univariate and multiple logistic regression analyses to examine the cross-sectional association of sleep disturbance with persistent LBPP. The relevant confounding variables were age, body mass index, parity, and history of LBPP before pregnancy. RESULTS:Among the 120 women, 45 women had persistent LBPP (37.5%) with 32 (71.1%) of them reporting sleep disturbance. There was a significant association of sleep disturbance with persistent LBPP (odds ratio [OR], 2.81; 95% confidence interval [95% CI], 1.28-6.19), which remained after adjustments for confounding variables (OR, 2.98; 95% CI, 1.31-6.75). CONCLUSION:Our findings indicate that sleep disturbance is associated with persistent LBPP at 4 months postpartum; therefore, it should be taken into consideration in postpartum women with persistent LBPP.
10.1007/s00586-021-06847-8
'The core': understanding it, and retraining its dysfunction.
Key Josephine
Journal of bodywork and movement therapies
"Core stability training" is popular in both the therapeutic and fitness industries but what is actually meant and understood by this concept? And does everyone need the same training approach? This paper examines the landscape of 'the core' and its control from both a clinical and research perspective. It attempts a comprehensive review of its healthy functional role and how this is commonly changed in people with spinal and pelvic girdle pain syndromes. The common clinically observable and palpable patterns of functional and structural change associated with 'problems with the core' have been relatively little described. This paper endeavors to do so, introducing a variant paradigm aimed at promoting the understanding and management of these altered patterns of 'core control'. Clinically, two basic subgroups emerge. In light of these, the predictable difficulties that each group finds in establishing the important fundamental elements of spino-pelvic 'core control' and how to best retrain these, are highlighted. The integrated model presented is applicable for practitioners re-educating movement in physiotherapy, rehabilitation, Pilates, Yoga or injury prevention within the fitness industry in general.
10.1016/j.jbmt.2013.03.012
Effect of pelvic belt on the perception of difficulty and muscle activity during active straight leg raising test in pain-free subjects.
Suehiro Tadanobu,Yakushijin Yuri,Nuibe Ami,Ishii Sakura,Kurozumi Chiharu,Ishida Hiroshi
Journal of exercise rehabilitation
A pelvic belt decreases patient-reported perception of difficulty during the active straight leg raising (ASLR) test in individuals with pelvic girdle pain. However, the influence of a pelvic belt on the perception of difficulty during ASLR was not investigated in pain-free subjects. Therefore, this influence excluding the impact of pain is not clear. This paper aimed to clarify the effect of a pelvic belt on the perception of difficulty and muscle activity during ASLR performance in the subjective heavier side leg in pain-free subjects. Twenty pain-free female subjects participated. ASLR using the subjective heavier side leg was performed under two conditions: without and with a pelvic belt. Muscle activation of the external oblique, internal oblique, rectus abdominis, rectus femoris, and biceps femoris was measured during ASLR using a surface electromyograph. Difference in perceived difficulty in performing ASLR with and without a belt was assessed. In total, 80% of subjects had decreased perception of difficulty using a pelvic belt during ASLR. For ASLR performed with a pelvic belt, muscle activity significantly decreased in the contralateral rectus abdominis, ipsilateral external oblique, and bilateral internal oblique (<0.05), while it significantly increased in the contralateral biceps femoris (<0.05). There were no significant differences in muscle activity of the ipsilateral rectus abdominis, contralateral external oblique, and ipsilateral rectus femoris between the two conditions (>0.05). In conclusion, using a pelvic belt can decrease the perception of difficulty during ASLR, and the pelvic belt may improve impairment of load transfer between the trunk and pelvis.
10.12965/jer.1938140.070
Mechanisms Underlying Lumbopelvic Pain During Pregnancy: A Proposed Model.
Frontiers in pain research (Lausanne, Switzerland)
Up to 86% of pregnant women will have lumbopelvic pain during the 3rd trimester of pregnancy and women with lumbopelvic pain experience lower health-related quality of life during pregnancy than women without lumbopelvic pain. Several risk factors for pregnancy-related lumbopelvic pain have been identified and include history of low back pain, previous trauma to the back or pelvis and previous pregnancy-related pelvic girdle pain. During pregnancy, women go through several hormonal and biomechanical changes as well as neuromuscular adaptations which could explain the development of lumbopelvic pain, but this remains unclear. The aim of this article is to review the potential pregnancy-related changes and adaptations (hormonal, biomechanical and neuromuscular) that may play a role in the development of lumbopelvic pain during pregnancy. This narrative review presents different mechanisms that may explain the development of lumbopelvic pain in pregnant women. A hypotheses-driven model on how these various physiological changes potentially interact in the development of lumbopelvic pain in pregnant women is also presented. Pregnancy-related hormonal changes, characterized by an increase in relaxin, estrogen and progesterone levels, are potentially linked to ligament hyperlaxity and joint instability, thus contributing to lumbopelvic pain. In addition, biomechanical changes induced by the growing fetus, can modify posture, load sharing and mechanical stress in the lumbar and pelvic structures. Finally, neuromuscular adaptations during pregnancy include an increase in the activation of lumbopelvic muscles and a decrease in endurance of the pelvic floor muscles. Whether or not a causal link between these changes and lumbopelvic pain exists remains to be determined. This model provides a better understanding of the mechanisms behind the development of lumbopelvic pain during pregnancy to guide future research. It should allow clinicians and researchers to consider the multifactorial nature of lumbopelvic pain while taking into account the various changes and adaptations during pregnancy.
10.3389/fpain.2021.773988
Symmetry in Paraspinal Muscles as a Predictor of the Development of Pregnancy-Related Low Back and Pelvic Pain: A Prospective Study.
Long Gong,Fang Zhi-Yuan,Xiang-Sheng Tang,Feng Yang,Hao-Ning Ma,Qing-Ying Hao,Ping Yi,Ming-Sheng Tan
Orthopaedic surgery
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 L -L and L -S 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.
10.1111/os.13126
Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain.
Stuge Britt,Mørkved Siv,Dahl Haldis Haug,Vøllestad Nina
Manual therapy
Approximately 5-20% of postpartum women suffer from long-lasting pelvic girdle pain (PGP). The etiology and pathogenesis of PGP are still unclear. The aim of this study was to examine whether subjects with and without persisting PGP and disability differed with respect to their ability to voluntarily contract the deep abdominals (TrA and IO) and to the strength of the pelvic floor muscles (PFM). Twenty subjects (12 with persisting PGP, 8 recovered from PGP) were examined. Contractions of the deep abdominal muscles (TrA and IO) were imaged by real-time ultrasound. Vaginal palpation and observation were used to assess the women's ability to perform correct a PFM contraction. PFM strength was measured by a vaginal balloon catheter connected to a pressure transducer. The active straight leg raise test was used to assess the ability of load transfer. The results showed no statistical significant difference between the groups in increase of muscle thickness of the deep abdominal muscles (TrA; P = 0.87 and IO; P = 0.51) or regarding PFM strength (P = 0.94). The ability to voluntarily contract the deep abdominal muscles and the strength of the PFMs are apparently not associated to PGP. However, the results are based on a small sample and additional studies are needed.
10.1016/j.math.2005.07.003
The pelvic girdle questionnaire: a condition-specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain.
Stuge Britt,Garratt Andrew,Krogstad Jenssen Hanne,Grotle Margreth
Physical therapy
BACKGROUND:No appropriate measures have been specifically developed for pelvic girdle pain (PGP). There is a need for suitable outcome measures that are reliable and valid for people with PGP for use in research and clinical practice. OBJECTIVE:The objective of this study was to develop a condition-specific measure, the Pelvic Girdle Questionnaire (PGQ), for use during pregnancy and postpartum. DESIGN:This was a methodology study. METHODS:Items were developed from a literature review and information from a focus group of people who consulted physical therapists for PGP. Face validity and content validity were assessed by classifying the items according to the World Health Organization's International Classification of Functioning, Disability and Health. After a pilot study, the PGQ was administered to participants with clinically verified PGP by means of a postal questionnaire in 2 surveys. The first survey included 94 participants (52 pregnant), and the second survey included 87 participants (43 pregnant). Rasch analysis was used for item reduction, and the PGQ was assessed for unidimensionality, item fit, redundancy, and differential item functioning. Test-retest reliability was assessed with a random sample of 42 participants. RESULTS:The analysis resulted in a questionnaire consisting of 20 activity items and 5 symptom items on a 4-point response scale. The items in both subscales showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered threshold. Test-retest reliability showed high intraclass correlation coefficient estimates: .93 (95% confidence interval=0.86-0.96) for the PGQ activity subscale and .91 (95% confidence interval=0.84-0.95) for the PGQ symptom subscale. Limitations The PGQ should be compared with low back pain questionnaires as part of a concurrent evaluation of measurement properties, including validity and responsiveness to change. CONCLUSIONS:The PGQ is the first condition-specific measure developed for people with PGP. The PGQ had acceptably high reliability and validity in people with PGP both during pregnancy and postpartum, it is simple to administer, and it is feasible for use in clinical practice.
10.2522/ptj.20100357
Altered Abdominal Muscle Recruitment and Declined Physical Function in Postpartum Individuals With Pregnancy-Related Pelvic Girdle Pain: A Matched Case-Control Study.
Journal of midwifery & women's health
INTRODUCTION:The influence of pregnancy-related pelvic girdle pain (PPGP) on lumbopelvic muscles has not been comprehensively examined in postpartum individuals. Previous research also presented self-reported activity limitations without objective measures. METHODS:Thirty postpartum individuals with PPGP (PPGP group) and 30 age-, parity-, and postpartum duration-matched asymptomatic individuals (healthy group) were recruited. Transabdominal ultrasonography was used to measure muscle thickness or activation changes of the external oblique (EO), internal oblique (IO), transverse abdominals, lumbar multifidus, and pelvic floor muscles (PFMs) during rest and while performing the active straight leg raise (ASLR). Muscle changes were compared separately in the painful and nonpainful sides between the PPGP and health control group. Physical function was assessed using the ASLR fatigue (ASLRF), timed up-and-go, and 6-m walking (6MW) tests. RESULTS:The PPGP group had greater thickening changes in the bilateral IO during ASLR compared with the healthy group (nonpainful side, 16.34 vs 3.52 mm; P = .010; painful side, 18.83 vs 6.60 mm; P = .02) but became thinner in the EO (nonpainful side, -2.19 vs 19.97 mm; P < .001; painful side, -5.97 vs 21.43 mm; P < .001). Thicker IO and EO on the nonpainful side (IO, 6.60 vs 5.78 mm; P = .004; EO, 5.37 vs 4.54 mm; P = .011) and a lower bladder base (indication of PFMs) (91.87 vs 78.61 mm; P = .002) during rest were also observed in the PPGP group. Furthermore, the performance of the ASLRF and 6MW tests was poorer in the PPGP than in the healthy group (ASLRF nonpainful side, 82.36 vs 59.09 sec; P = .01; painful side, 75.73 vs 59.26 sec; P = .04; 6MW, 3.48 vs 3.17 sec; P = .02). DISCUSSION:Postpartum individuals with PPGP demonstrated altered abdominal muscle recruitment strategies during loading tasks, with objectively impaired physical functions. These findings are critical for developing effective muscle training interventions for PPGP.
10.1111/jmwh.13673
Regression of pelvic girdle pain after delivery: follow-up of a randomised single blind controlled trial with different treatment modalities.
Elden H,Hagberg H,Olsen M Fagevik,Ladfors L,Ostgaard H C
Acta obstetricia et gynecologica Scandinavica
OBJECTIVE:An earlier publication showed that acupuncture and stabilising exercises as an adjunct to standard treatment was effective for pelvic girdle pain during pregnancy, but the post-pregnancy effects of these treatment modalities are unknown. The aim of this follow-up study was to describe regression of pelvic girdle pain after delivery in these women. DESIGN:A randomised, single blind, controlled trial. SETTING:East Hospital and 27 maternity care centres in Göteborg, Sweden. POPULATION:Some 386 pregnant women with pelvic girdle pain. METHODS:Participants were randomly assigned to standard treatment plus acupuncture (n=125), standard treatment plus specific stabilising exercises (n=131) or to standard treatment alone (n=130). MAIN OUTCOME MEASURES: PRIMARY OUTCOME MEASURES:pain intensity (Visual Analogue Scale). SECONDARY OUTCOME MEASURE:assessment of the severity of pelvic girdle pain by an independent examiner 12 weeks after delivery. RESULTS:Approximately three-quarters of all the women were free of pain 3 weeks after delivery. There were no differences in recovery between the 3 treatment groups. According to the detailed physical examination, pelvic girdle pain had resolved in 99% of the women 12 weeks after delivery. CONCLUSIONS:This study shows that irrespective of treatment modality, regression of pelvic girdle pain occurs in the great majority of women within 12 weeks after delivery.
10.1080/00016340701823959
Reliability and construct validity of self-report questionnaires for patients with pelvic girdle pain.
Grotle Margreth,Garratt Andrew M,Krogstad Jenssen Hanne,Stuge Britt
Physical therapy
BACKGROUND:There is little evidence for the measurement properties of instruments commonly used for women with pelvic girdle pain. OBJECTIVE:The aim of this study was to examine the internal consistency, test-retest reliability, and construct validity of instruments used for women with pelvic girdle pain. DESIGN:This was a cross-sectional methodology study, including test-retest reliability assessment. METHODS:Women with pelvic girdle pain in pregnancy and after delivery participated in a postal survey that included the Pelvic Girdle Questionnaire (PGQ), Oswestry Disability Index (ODI), Disability Rating Index (DRI), Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and 8-item version of the Medical OUTCOMES:Study 36-Item Short-Form Health Survey questionnaire (SF-36). Test-retest reliability was assessed with a random subsample 1 week later. Internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Construct validity based on hypotheses was assessed by correlation analysis. Discriminant validity was assessed with the area under the receiver operating characteristic curve. RESULTS:All participants responded to the main (N=87) and test-retest (n=42) surveys. Cronbach alpha values ranged from .88 to .94, and ICCs ranged from .78 to .94. The MDC at the individual level constituted about 7% to 14% of total scores for the 8-item version of the SF-36, ODI, and PGQ activity subscale; about 18% to 22% for the DRI, PGQ symptom subscale, and PCS; and about 25% for the FABQ. Hypotheses were mostly confirmed by correlations between the instruments. The PGQ was the only instrument that significantly discriminated participants who were pregnant from participants who were not pregnant as well as pain locations. LIMITATIONS:A comparison of responsiveness to change of the various instruments used in this study was not undertaken, but will be carried out in a future study. CONCLUSIONS:Self-report instruments for assessing health showed good internal consistency, test-retest reliability, and construct validity for women with pelvic girdle pain. The PGQ was the only instrument with satisfactory discriminant validity, thus, it is recommended for evaluating symptoms and disability in patients with pelvic girdle pain.
10.2522/ptj.20110076
Characteristics and effects on daily lives of pelvic girdle pain during early postpartum in Beijing women, China.
Women & health
Pelvic girdle pain (PGP) is a common problem during pregnancy and postpartum and negatively affects women's well-being. Yet it is not well known in China. This study assessed PGP's intensity, location, and quality and the status of daily activities on postpartum women with pain, and explored the relationship between pain and the prevalence of depressive symptoms. A cross-sectional study recruiting 1,038 eligible women at 6 weeks postpartum from the obstetric clinic of a hospital was conducted in Beijing, China. Data were collected using self-reported questionnaires, including Introductory information form, Body chart, Number Rating Scale, McGill Pain Questionnaire-2, Pelvic Girdle Questionnaire, and Edinburgh Postnatal Depression Scale. In this study, 32.2 percent women experienced pain. The mean (SD) pain intensity score was 3.07 ± 1.60. About 50.6 percent women experienced sacroiliac joint pain, and 25.5 percent women experienced pain in a combination of locations. About 73.1 percent women experienced aching pain, and 57.5 percent experienced more than one kind of pain quality. The mean total score, which assesses activity and symptom limitations, was 21.93 ± 17.35 (percent), of which a normal sex life (1.29 ± 0.94) was made more challenging due to pain. In mental health, the prevalence of depressive symptoms coincided with the prevalence of pain ( = 0.008). Postpartum PGP still needs to be taken seriously, and women with pain require further support. The above knowledge offers information to manage pain, daily lives and depressive symptoms, contributes to think about strategies to better promote postpartum women physical and mental health in the future.
10.1080/03630242.2024.2334691
Contraction of the transverse abdominal muscle in pelvic girdle pain is enhanced by pain provocation during the task.
Mens Jan M,Pool-Goudzwaard Annelies
Musculoskeletal science & practice
BACKGROUND:Understanding of the pathogenesis of pain in the lumbopelvic region remains a challenge. It is suggested that lumbopelvic pain is related to decreased contraction of the transverse abdominal muscles (TrA). OBJECTIVE:To investigate how pain provoked by a task influences TrA contraction during that task. DESIGN:A case-control cross-sectional study. METHOD:We recruited 40 non-pregnant women with persistent pregnancy-related posterior pelvic girdle pain (PGP) and 33 parous women (healthy controls) without PGP. TrA thickness was measured by ultrasound at various levels of bilateral hip adduction, with increments of 20 N from 0 to 140 N. Pain during the tests was registered. RESULTS:After correction for the level of adduction force, TrA thickness increase during pain-provoking tests of participants with PGP was 6.3 percentage points higher than in their pain-free tests (p = 0.01) and 0.91 percentage points higher than in the pain-free tests of healthy controls (p < 0.01). CONCLUSION:TrA contraction in PGP is enhanced when a task provokes pain. These results may have consequences for the treatment of persistent pregnancy-related posterior pelvic girdle pain.
10.1016/j.msksp.2017.09.001
Subjective recovery from pregnancy-related pelvic girdle pain the first 6 weeks after delivery: a prospective longitudinal cohort study.
Gausel Anne Marie,Malmqvist Stefan,Andersen Knut,Kjærmann Inger,Larsen Jan Petter,Dalen Ingvild,Økland Inger
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:The purpose of this study was to investigate the subjective recovery from pregnancy-related pelvic girdle pain (PGP) during the first 6 weeks after delivery and to detect possible risk factors for a poor recovery. METHODS:The participants were included in this study at the routine ultrasound examination at 18 weeks of pregnancy. The women received a weekly SMS with the question "How many days during the last week has your PGP been bothersome?" The SMS-track from the final 10 weeks of pregnancy and first 6 weeks after delivery were assessed and sorted, based on individual graphs. A total of 130 women who reported PGP during pregnancy and met for clinical examination 6 weeks after delivery were included in the study. RESULTS:In all, 83% of the women experienced substantial recovery from severe or moderate PGP within 6 weeks after delivery. Of these, 44% reported a substantial recovery already within 2 weeks after delivery. More multiparous women, women reporting PGP the year before pregnancy, and women with high pain intensity during pregnancy had a poor recovery. CONCLUSIONS:The prognosis following PGP in pregnancy is good and the majority of women recovered substantially from severe and moderate pregnancy-related PGP within 6 weeks after delivery. For many women, a subjective substantial recovery occurred within 2 weeks after delivery. Predictors for a poor recovery were multiparity, PGP the year before pregnancy and a high pain intensity during pregnancy. These slides can be retrieved under Electronic Supplementary Material.
10.1007/s00586-020-06288-9
Pregnancy-related pelvic girdle pain affects balance in the second and third trimesters of pregnancy.
PloS one
INTRODUCTION:During pregnancy, many changes in the musculoskeletal system and pregnancy-related disorders affect posture and postural stability. Pregnancy-related pelvic girdle pain (PPGP) is a common disorder in pregnancy; the cause remains unknown. The purpose of the present study was to determine if PPGP affects static postural stability and its relation to the stage of pregnancy. METHODS:Sixty-three pregnant women between the ages of 18 and 45 and between the 12th and 38th weeks of gestation were included in the study. They were divided into four groups according on the trimester and the presence of PPGP. Static balance was assessed using a force plate on firm and compliant surfaces with eyes open and closed. RESULTS:Pregnant women with PPGP had significantly (p < 0.05) greater centre-of-pressure velocity and sway area compared to pregnant women without PPGP, especially in the third trimester of pregnancy. In the second trimester, only two significant differences in COP parameters were observed between pregnant women with and without PPGP. Pregnant women in the third trimester of pregnancy had significantly (p < 0.05) greater centre-of-pressure velocity and larger postural sway area compared to pregnant women in the second trimester of pregnancy, regardless of PPGP. DISCUSSION AND CONCLUSION:Pregnant women with PPGP had poorer static stability when compared to pregnant women without pain, especially in the third trimester of pregnancy. The cause could be found in the poorer ability to stabilise the trunk and pelvis, poorer proprioception, and issues with automatic movement patterns.
10.1371/journal.pone.0287221
The association between pelvic girdle pain and pelvic floor muscle function in pregnancy.
Fitzgerald Colleen M,Mallinson Trudy
International urogynecology journal
INTRODUCTION AND HYPOTHESIS:The aim of this study is to determine pelvic floor muscle (PFM) function in second trimester women with and without pelvic girdle pain (PGP). METHODS:Fifty-five pregnant women with and without PGP were recruited in the second trimester who met inclusion for self-reported pain. Vaginal examination was performed assessing superficial and deep PFM tenderness, contract/relax patterns, and muscle strength. RESULTS:Fifty-one patients (26 with PGP and 25 without) were included in the final analyses. Significantly more patients in the PGP group had bilateral levator ani and obturator internus tenderness compared with the no pain group (Fisher's exact test (FET) P < 0.001). No other significant group differences were found. CONCLUSION:There is an association between PGP and deep but not superficial PFM tenderness in pregnancy. Lack of accompanying PFM dysfunction in PGP during pregnancy may reflect pain duration.
10.1007/s00192-011-1658-y
Does a pelvic belt reduce hip adduction weakness in pregnancy-related posterior pelvic girdle pain? A case-control study.
Mens Jan M
European journal of physical and rehabilitation medicine
BACKGROUND:The cause of non-specific lumbopelvic pain is unknown. Pregnancy-related pelvic girdle pain seems to be a subgroup that deserves a specific treatment. One of the options is the use of a pelvic belt. AIM:To objectify the influence of a pelvic belt in patients with pelvic girdle pain. DESIGN:Case-control study. SETTING:Outpatient clinic. POPULATION:A total of 49 women with long-lasting posterior pelvic girdle pain and 37 parous women of the same age group without pelvic girdle pain. METHODS:Hip adduction force was measured by asking the participant to squeeze a hand-held dynamometer between the knees. This was firstly performed without a pelvic belt and then with a pelvic belt. The increase of hip adduction force after applying the pelvic belt was expressed in percentages. RESULTS:After tightening a pelvic belt hip adduction force increased 25.9±33.9% in patients with pelvic girdle pain (P<0.0001) and 1.0±8.6% in participants without (P=0.67). The difference between groups was significant (P<0.00001). CONCLUSIONS:A pelvic belt has a positive influence on hip adduction force in pregnancy-related posterior pelvic girdle pain. CLINICAL REHABILITATION IMPACT:The results show an objective positive effect of the pelvic belt in women with long-lasting pregnancy-related posterior pelvic girdle pain in a test-situation. The results support the idea that the use of a belt could be part of a multidisciplinary rehabilitation of those patients.
10.23736/S1973-9087.17.04442-2
Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study.
Stomp-van den Berg Suzanne G M,Hendriksen Ingrid J M,Bruinvels David J,Twisk Jos W R,van Mechelen Willem,van Poppel Mireille N M
Pain
The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12 weeks postpartum among working women. A total of 548 Dutch pregnant employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12 weeks postpartum. Participants received questionnaires at 30 weeks of pregnancy and at 6 and 12 weeks postpartum with demographic, work-related, pregnancy-related, fatigue, psychosocial, PGP-related and delivery-related questions. Univariate and multiple logistic regression analyses were performed. Almost half of the women experienced pain in their pelvic girdle at 12 weeks postpartum. However, the level of pain and the degree of disability due to postpartum PGP was low. Pregnancy-related predictors for PGP at 12 weeks were history of low back pain, higher somatisation, more than 8 hours of sleep or rest per day, and uncomfortable postures at work. The pregnancy and postpartum-related predictors were: more disability at 6 weeks, having PGP at 6 weeks, higher mean pain at 6 weeks, higher somatisation during pregnancy and at 6 weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP.
10.1016/j.pain.2012.08.003
Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study.
BMC musculoskeletal disorders
BACKGROUND:Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland. METHODS:This was a prospective, observational study. In phase 1, 411 women were recruited 24-72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report. RESULTS:In phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43-48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04-4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01-1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34-48.72). CONCLUSION:Although the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum.
10.1186/s12891-022-05864-y
The Effectiveness of Massage in Managing Pregnant Women with Pelvic Girdle Pain: a Randomised Controlled Crossover Feasibility Study.
International journal of therapeutic massage & bodywork
Introduction:Pelvic girdle pain is a common problem experienced during pregnancy, with high incidence rates and significant impacts on quality of life. Remedial massage might be able to provide some reduction in pain. Aim:This study aimed to investigate the feasibility of conducting a randomised controlled trial on the effectiveness of massage in treating pregnant women with pelvic girdle pain to determine its merits and viability for use in a large-scale study. Methods:A two-arm pilot randomised feasibility crossover-controlled trial. The two treatment phases were a) remedial pregnancy massage, and b) exercise. Results:Twenty-four women started the study and 19 women completed the study. Data were collected on recruitment and retention rates, crossover study design methodology, participant sub-characteristics, and acceptability of the outcome measures (pain, quality of life, and disability). Conclusion:Recruiting participants for a pregnancy-related pelvic girdle pain study is indeed feasible; however, a crossover study design is not appropriate and future studies should consider a mixed methods study design.
10.3822/ijtmb.v16i4.877
Myoelectrical activity of muscles stabilizing the sacroiliac joints before and after the use of elastic tapes in women suffering from Pregnancy-related Pelvic Girdle Pain.
Kuciel Natalia,Sutkowska Edyta,Cienska Anna,Markowska Dominika,Wrzosek Zdzislawa
Ginekologia polska
OBJECTIVES:The aim of this study was the analysis of activity of selected muscles stabilizing the sacroiliac joints in pregnant women suffering from pelvic pain and changes in the pattern in response to the implementation of Kinesio Taping (elastic tape). MATERIAL AND METHODS:Seventeen women with Pregnancy-related Pelvic Girdle Pain and 20 pregnant women without pain in the lumbar-pelvic complex were enrolled into the study. In patients with pelvic pain, the parameters describing the action of the muscles were assessed: before the tape was applied, immediately after application, 3 days into application and 5 days after the cessation of taping. In the control group, the test was carried out one time. The activity of the muscles was measured during extension of the hip from a four-point kneeling position. RESULTS:The gluteus maximus muscle shows higher resting activity values than in the control group, before and after application of the tape as well as five days after the removal of the tape. Before application, the gluteus maximus activates quicker than in the control group while the ipsilateral extensor spinae had a delayed activation when compared to the control group. CONCLUSIONS:The patterns of activation of tested muscles and their action potential values are different in the group of women with pelvic pain compared to the group without pelvic pain. The application of KT in the lumbar region appears to alter the activation of the GM muscle as well as improve activation of IES muscle during hip extension from the four-point-kneeling position.
10.5603/GP.2020.0044
Pelvic girdle pain in pregnancy: the impact on function.
Robinson Hilde Stendal,Eskild Anne,Heiberg Eli,Eberhard-Gran Malin
Acta obstetricia et gynecologica Scandinavica
BACKGROUND:The aim of this study was to determine the prevalence of self-reported pelvic girdle pain in pregnancy and study the impact on function, the use of crutches, and waking up at night, according to location of pain. METHODS:A population-based questionnaire study was performed among all women 18-40 years in two communities in Norway in 1998-99. A total of 1,817 women with a prior delivery constituted the study sample. Pelvic girdle pain was grouped into five categories: pain in anterior pelvis, in posterior pelvis, in anterior and unilateral posterior pelvis, in anterior and bilateral posterior pelvis (a complete pelvic girdle syndrome), and pelvic pain with no information on location. RESULTS:A total of 46% (843/1,817) reported pelvic girdle pain in pregnancy at one location or more. Nineteen percent reported pain in anterior pelvis only, 14% in posterior pelvis only, 4% in anterior and unilateral posterior pelvis, and 5% reported a complete pelvic girdle syndrome. A total of 7% of all pregnant women used crutches during pregnancy and 15% reported waking up at night frequently due to pelvic girdle pain. A complete pelvic girdle syndrome, as compared to pain in the anterior pelvis only, was strongly associated with the use of crutches (adjusted odds ratio (OR) 4.3; 95% confidence interval (CI) 2.5-7.4) and with waking up at night due to pain (OR 4.6; 95% CI 2.7-7.2). CONCLUSION:Pain related to the pelvic joints is common among pregnant women in Norway and may cause serious functional problems.
Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study.
Sjödahl Jenny,Gutke Annelie,Ghaffari Ghazaleh,Strömberg Tomas,Öberg Birgitta
Clinical biomechanics (Bristol, Avon)
BACKGROUND:The relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. METHODS:Sixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. FINDINGS:No significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P=0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P=0.01) and the muscles of the lower lateral abdominal wall (P<0.01). INTERPRETATION:We suggest that disturbed motor activation patterns influence women's ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements.
10.1016/j.clinbiomech.2016.04.007
The Relationship between Fear-Avoidance Beliefs and Pain in Pregnant Women with Pelvic Girdle Pain: A Cross-Sectional Study.
Rashidi Fakari Farzaneh,Simbar Masoumeh,Saei Ghare Naz Marzieh
International journal of community based nursing and midwifery
BACKGROUND:Pelvic Girdle Pain (PGP) is one of the most common problems during pregnancy. Psychological variables including attitude, belief, cognition, and fear have more effects on risk factors for back pain, compared to biomechanical factors. Moreover, fear and anxiety may be provoked by the prospect of pain, which is associated with higher levels of disability, compared to pain itself. Therefore, this study aimed to investigate the relationship between fear-avoidance beliefs and pain in pregnant women with pelvic girdle pain. METHODS:This descriptive cross-sectional study was conducted on 148 pregnant women with PGP, who referred to the healthcare centers affiliated to Shahid Beheshti University of Me-dical Sciences in Tehran, Iran from September to December 2017. The samples were selected by the multi-stage method. Data collection tools included a demographic questionnaire, Pelvic Girdle Questionnaire (PGQ) and Fear-Avoidance Beliefs Questionnaire (FABQ). Data analysis was performed in SPSS version 22, using descriptive statistics, ANOVA, t-test and multiple regression. A P-value less than 0.05 was considered significant. RESULTS:The subjects' mean age and gestational age were 29.35±5.89 years and 32.78±5.13 weeks, respectively. Mean and SD of Fear-Avoidance Beliefs (FAB) toward PGQ was 41.27±13.67 (from 66). In addition, PGQ was moderate in the majority of participants [84 (56.75%)]. Results of one-way ANOVA demonstrated a significant relationship between the mean total score and the score of dimensions of physical and occupational activities of FAB in different severities of PGQ (P<0.001). CONCLUSION:The results of this study indicated that fear-avoidance and catastrophic beliefs, in women with PGP can be predicted. According to the results of the study, FAB varied with the severity of pain. In addition, increased pain intensity was associated with elevated score of FAB.
Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review.
Weis Carol Ann,Pohlman Katherine,Draper Crystal,da Silva-Oolup Sophia,Stuber Kent,Hawk Cheryl
Journal of manipulative and physiological therapeutics
OBJECTIVE:The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of specific chiropractic care options commonly used for postpartum low back pain (LBP), pelvic girdle pain (PGP), or combination (LBP and PGP) pain. METHODS:A search strategy was developed. Interventions were those manual or other nonpharmacologic therapies commonly used by chiropractors (not requiring additional certifications). The outcomes were self-reported changes in pain or disability self-reported outcomes. We used the Scottish Intercollegiate Guideline Network checklists. Strength of the evidence (excluding cohort studies) was determined using an adapted version of the US Preventive Services Task Force criteria as described in the UK report. RESULTS:Of the 1611 published articles, 16 were included. These were 5 SRs, 10 randomized controlled trials (RCTs), and 1 cohort study. Postpartum LBP (1 RCT): moderate, favorable strength for spinal manipulation therapy/mobilization. Postpartum PGP (4 RCTs): moderate, unclear strength for exercise; and inconclusive, unclear strength for patient education. Postpartum LBP or PGP (3 SRs and 4 RCTs): inconclusive, unclear strength for exercise, self-management, and physiotherapy; while osteopathic manipulative therapy was inconclusive, favorable. CONCLUSION:No treatment option was identified as having sufficient evidence to make a clear recommendation. This SR identified a scarcity of literature regarding chiropractic care and back pain for postpartum women, as well as inconsistency among the terms LBP, PGP, and combination pain.
10.1016/j.jmpt.2020.05.006
Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth.
Gutke Annelie,Bullington Jennifer,Lund Madeleine,Lundberg Mari
Disability and rehabilitation
PURPOSE:To explore how women experience living with long-term pregnancy-related pelvic girdle pain. MATERIALS AND METHODS:Nine women with persistent pregnancy-related pelvic girdle pain of 2-13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28-42 years of age and had given birth to 2-3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis. RESULTS:The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance. CONCLUSION:The participants' narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome. IMPLICATIONS FOR REHABILITATION Chronic pregnancy-related pelvic girdle pain • Pregnancy-related pelvic girdle pain impairs women's capacity to perform meaningful activities of daily life for many years after pregnancy. • The participants' narratives highlighted that the pain interfered with their sense of identity. • It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.
10.1080/09638288.2017.1368724
Prevalence and predictors of persistent pelvic girdle pain 12 years postpartum.
Bergström Cecilia,Persson Margareta,Nergård Kari-Anne,Mogren Ingrid
BMC musculoskeletal disorders
BACKGROUND:Pelvic girdle pain (PGP) is not always a self-limiting condition. Women with more pronounced persistent PGP (PPGP) report poorer health status compared to women with less pronounced symptoms. The knowledge concerning the long-term consequences of PPGP is limited, thus more knowledge in this area is needed. The overall aim was to study the prevalence and predictors of PPGP 12 years after delivery. METHODS:This is a long-term follow-up study based on a previous cohort study that commenced in 2002. New questionnaire data 12 years postpartum were collected in 2014 and early 2015. The questionnaire was distributed to a total of 624 women from the initial cohort. RESULTS:In total, 295 women (47.3%) responded to the questionnaire where 40.3% (n = 119) reported pain to a various degree and 59% (n = 174) reported no pain. Increased duration and/or persistency of pain, self-rated health, sciatica, neck and/or thoracic spinal pain, sick leave the past 12 months, treatment sought, and prescription and/or non-prescription drugs used were all associated with an statistically significant increase in the odds of reporting pain 12 years postpartum. Widespread pain was common and median expectation of improvement score was 5 on an 11-point numeric scale (interquartile range 2-7.50). More than one of five women (21.8%) reporting pain stated that they had been on sick leave the past 12 months and nearly 11% had been granted disability pension due to PPGP. No statistically significant differences were found between respondents and non-respondents regarding most background variables. CONCLUSIONS:This study is unique as it is one of few long-term follow-up studies following women with PPGP of more than 11 years. The results show that spontaneous recovery with no recurrences is an unlikely scenario for a subgroup of women with PPGP. Persistency and/or duration of pain symptoms as well as widespread pain appear to be the strongest predictors of poor long-term outcome. Moreover, widespread pain is commonly associated with PPGP and may thus contribute to long-term sick leave and disability pension. A screening tool needs to be developed for the identification of women at risk of developing PPGP to enable early intervention.
10.1186/s12891-017-1760-5
Management of women with pregnancy-related pelvic girdle pain: an international Delphi study.
Physiotherapy
OBJECTIVES:Pregnancy-related pelvic girdle pain (PPGP) contributes to significant prenatal and postpartum impairments; however, various clinical practices exist around the conservative treatment of this condition. This study sought to reach a consensus on the essential components of PPGP management through an international Delphi survey of experts in women's health. DESIGN AND PARTICIPANTS:Eighty-seven international experts in the field of PPGP were invited to participate and surveyed over three rounds. Round 1 of the survey utilised open-ended questions to gain feedback on 16 components of PPGP management previously identified by a focus group. Feedback from panel members guided modification and refinement of questions for Rounds 2 and 3. A 5-point Likert scale was used to rate level of agreement, with a minimum threshold for consensus of ≥75% agreement set across all survey rounds. RESULTS:Forty-four of the 87 (50%) invited professionals agreed to participate in the panel, with 77% (34/44) of panellists contributing to all three rounds. Of the 16 initial components, 15 were included in Round 2. The final consensus was reached on 10 important components of assessment and management after Round 3: pain education, postural and ergonomic advice, social and lifestyle factors, psychological factors, cultural considerations, strengthening exercise, other exercise, exercise precautions, manual therapy and the use of crutches. CONCLUSION:This study identified 10 key components that should be considered in the management of PPGP. In addition, these components provide a potential framework for future research around the conservative management of PPGP.
10.1016/j.physio.2021.09.002
Breastfeeding and pelvic girdle pain: a follow-up study of 10,603 women 18 months after delivery.
Bjelland E K,Owe K M,Stuge B,Vangen S,Eberhard-Gran M
BJOG : an international journal of obstetrics and gynaecology
OBJECTIVE:To study the associations of patterns and duration of breastfeeding with the persistence of pelvic girdle pain 18 months after delivery. DESIGN:Longitudinal population study. SETTING:Norway, for the period 1999-2011. POPULATION:A follow-up of 10 603 women with singleton deliveries in the Norwegian Mother and Child Cohort Study who reported pelvic girdle pain at 0-3 months postpartum. METHODS:Data were obtained by four self-administered questionnaires and linked to the Medical Birth Registry of Norway. MAIN OUTCOME MEASURE:Pelvic girdle pain, defined as combined anterior and bilateral posterior pelvic pain, 18 months after delivery. RESULTS:Eighteen months after delivery, 7.8% of respondents (829/10,603) reported pelvic girdle pain. Breastfeeding patterns at 5 months after delivery were not associated with persistence of pelvic girdle pain. The proportion of women with pelvic girdle pain 18 months after delivery increased as the duration of breastfeeding decreased (test for trend, P < 0.001). The estimated associations attenuated after adjustment for educational level, smoking status, and body mass index, but remained statistically significant for the association between 0 and 2 months of breastfeeding and persistent pelvic girdle pain (adjusted odds ratio 1.34; 95% confidence interval 1.03-1.75). The association of short breastfeeding duration with persistent pelvic girdle pain was only present in women with body mass index ≥25 kg/m(2) . CONCLUSIONS:Breastfeeding was associated with a small beneficial effect on the recovery process of pelvic girdle pain in women with a body mass index ≥25 kg/m(2) . Among women with pelvic girdle pain, breastfeeding should be encouraged in accordance with the existing child-feeding recommendations.
10.1111/1471-0528.13118
Pregnancy-related Pelvic Girdle Pain and Pregnancy Massage: Findings from a Subgroup Analysis of an Observational Study.
International journal of therapeutic massage & bodywork
BACKGROUND:Pregnancy-related pelvic girdle pain (PPGP) significantly impacts women's lives both physically and psychologically. Given the severity and impact of PPGP on pregnancy, the authors anticipated that pregnant women with PPGP might respond differently to massage than pregnant women without PPGP. PURPOSE:The aim of the study was to further analyze a published 2017 study to assess the response of pregnancy massage in participants with and without PPGP. SETTING:Two massage clinics, one in Sydney and one in Melbourne, recruited participants from December 2016 to December 2017. PARTICIPANTS:Nineteen women with PPGP and 78 without PPGP. RESEARCH DESIGN:PPGP and non-PPGP women receiving at least one massage, with outcome measures assessed immediately prior to and after massage, and again one week postmassage. MAIN OUTCOME MEASURES:Visual analog scales for pain, stress, range of movement, sleep, and self-reported side effects of massage. RESULTS:Both groups changed significantly and similarly over time for measures of pain, stress, range of motion, and sleep (all < .05). Post hoc analysis found significant reduction in all outcome measures immediately following massage, but returned to baseline at one week postmassage for all measures except pain, which remained reduced for the PPGP group (49.79±25.68 to 34.75±34.75, = .03, effect size 0.593), and stress remained reduced in the non-PPGP group (33.36±21.54 to 24.90±19.18, = .002, effect size 0.373). The PPGP group entered the study with higher baseline levels of pain ( = .01) and a greater restriction in range of motion ( = .006) than the non-PPGP group. There was no difference in the number of side effects experienced between the two groups ( = .130). CONCLUSIONS:Although PPGP clients report greater pain and restriction in range of motion at baseline than non-PPGP clients, the response to pregnancy massage was similar. Results support a role of pregnancy massage in the management of PPGP. More research on massage for PPGP is needed to confirm a lasting effect of pain reduction from massage.
Musculoskeletal etiologies of pelvic pain.
Prather Heidi,Camacho-Soto Alejandra
Obstetrics and gynecology clinics of North America
Several musculoskeletal diagnoses are frequently concomitant with pelvic floor pathology and pain. The definition of pelvic pain itself often depends on the medical specialist evaluating the patient. Because there is variability among disorders associated with pelvic pain, patients may seek treatment for extended periods as various treatment options are attempted. Further, health care providers should recognize that there may not be a single source of dysfunction. This article discusses the musculoskeletal disorders of the pelvic girdle (structures within the bony pelvis) and their association with lumbar spine and hip disorders.
10.1016/j.ogc.2014.04.004
Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Pregnancy-related lumbopelvic pain has puzzled medicine for a long time. The present systematic review focuses on terminology, clinical presentation, and prevalence. Numerous terms are used, as if they indicated one and the same entity. We propose "pregnancy-related pelvic girdle pain (PPP)", and "pregnancy-related low back pain (PLBP)", present evidence that the two add up to "lumbopelvic pain", and show that they are distinct entities (although underlying mechanisms may be similar). Average pain intensity during pregnancy is 50 mm on a visual analogue scale; postpartum, pain is less. During pregnancy, serious pain occurs in about 25%, and severe disability in about 8% of patients. After pregnancy, problems are serious in about 7%. The mechanisms behind disabilities remain unclear, and constitute an important research priority. Changes in muscle activity, unusual perceptions of the leg when moving it, and altered motor coordination were observed but remain poorly understood. Published prevalence for PPP and/or PLBP varies widely. Quantitative analysis was used to explain the differences. Overall, about 45% of all pregnant women and 25% of all women postpartum suffer from PPP and/or PLBP. These values decrease by about 20% if one excludes mild complaints. Strenuous work, previous low back pain, and previous PPP and/or PLBP are risk factors, and the inclusion/exclusion of high-risk subgroups influences prevalence. Of all patients, about one-half have PPP, one-third PLBP, and one-sixth both conditions combined. Overall, the literature reveals that PPP deserves serious attention from the clinical and research communities, at all times and in all countries.
10.1007/s00586-003-0615-y
Pelvic girdle pain in pregnancy and early postpartum - prevalence and risk factors in a multi-ethnic cohort.
BMC musculoskeletal disorders
BACKGROUND:Pelvic girdle pain (PGP) is common during and after pregnancy. It has been assumed that Scandinavian women report more PGP than women of other ethnicities. However, there are few population-based studies on ethnic differences and few with ethnicity as risk factor for PGP. The purposes of the present study were: To examine the prevalence of self-reported PGP through pregnancy and early postpartum in a multi-ethnic cohort. To investigate how ethnicity and patient characteristics were associated with risk of PGP during pregnancy and early postpartum. To investigate if clinical and personal factors obtained in gestation week (GW) 15 were associated with PGP in GW28 and postpartum week (PPW) 14. METHODS:This study analyzed questionnaire data from 823 women from the Stork - Groruddalen mult-iethnic cohort study in Norway. Chi-square tests were used to investigate ethnic differences in prevalence of self-reported PGP, and logistic regression analyses to identify factors associated with self-reported PGP. RESULTS:Women from South-Asia and Middle East reported 10-20% higher prevalence of self-reported PGP at all time points compared with Western women. Ethnicity was associated with PGP in GW15 and PPW14, adjusted for parity. Pain locations in pelvic area (PGP locations) in GW15, especially combined symphysis and posterior PGP, gave the highest risk (OR=7.4) for PGP in GW28 and in PPW14 (OR = 3.9). Being multiparous was a risk for PGP in PPW14 (OR=1.9). CONCLUSIONS:Women of South Asian and Middle Eastern background had higher risk of self-reported PGP than Western women. Ethnicity was associated with PGP in GW15 and PPW14, after adjustments for parity. PGP locations in GW15 was the most prominent risk factor for PGP in GW28 and PPW14, whilst ethnicity was not significant in multivariable analyses.
10.1186/s12891-023-07135-w
Pelvic girdle pain 3-6 months after delivery in an unselected cohort of Norwegian women.
Gausel Anne Marie,Kjærmann Inger,Malmqvist Stefan,Dalen Ingvild,Larsen Jan Petter,Økland Inger
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE:Persistent pelvic girdle pain (PGP) after delivery is considered uncommon. The aim of this study was to assess the frequency of persistent PGP after delivery in an unselected population, its influence on the women's daily life, and potential risk factors. METHODS:The study population was drawn from a previous retrospective study of pelvic pain (PP) during pregnancy. The women were followed until 3-6 months after delivery in a prospective cohort study. All women were contacted by telephone and those with persistent PP were invited to fill in questionnaires and undergo a clinical examination. RESULTS:68 of 330 women reported persistent pain in the pelvic area 3-6 months after delivery. 47 underwent a clinical examination, after which 36 women were diagnosed with either PGP alone (n = 25), or PGP combined with low back pain (LBP) (n = 11). Affected women reported a poor subjective health status, but the pain did not have a major impact on their daily life activities. Women with 3 independent risk factors: age ≥30 years, a moderate or high Oswestry Disability Index in pregnancy, and combined PP and LBP during pregnancy, had a 27-fold increased risk for persistent PGP compared with women without these risk factors. CONCLUSION:16 % of women that reported PP during pregnancy were found to have persistent PGP 3-6 months after the delivery. Women with risk factors for persistent PGP should be identified while pregnant, and offered a follow-up examination 3 months after delivery.
10.1007/s00586-015-3959-1
Outcome Measurement Instruments and Evidence-based Recommendations for Measurement of the Pelvic Girdle Pain Core Outcome Set (PGP-COS): A Systematic Review and Consensus Process.
The journal of pain
This study provides evidence- and consensus-based recommendations for the instruments to measure the five Pelvic Girdle Pain Core Outcome Set (PGP-COS): pain frequency, pain intensity/severity, function/disability/activity limitation, health-related quality of life and fear avoidance. Studies evaluating measurement properties of instruments measuring any PGP-COS outcome in women with PGP were identified through a systematic search of MEDLINE, EMBASE and PEDro databases (inception-July 2021). The methodological quality of studies and quality of measurement properties were evaluated using the COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. Quality criteria and the synthesized evidence were graded using the modified grading of recommendations, assessment, development, and evaluation (GRADE) approach. A consensus meeting with PGP stakeholders was then held to establish recommendations, based on the evidence, for the instruments that should be used to measure the PGP-COS. Ten instruments were identified from 17 studies. No instrument showed high quality evidence for all measurement properties and/or measured all PGP-COS outcomes. Based on current evidence and consensus, the Pelvic Girdle Questionnaire (PGQ), the Short Form-8 (SF-8) and the Fear Avoidance Beliefs Questionnaire (FABQ) are recommended for measuring the PGP-COS. Future research should establish additional measurement properties of instruments and to substantiate these recommendations.
10.1016/j.jpain.2022.08.003
Pregnancy-related low back/pelvic girdle pain: Prevalence, severity, and risk factors in Zhengzhou, China.
Journal of back and musculoskeletal rehabilitation
BACKGROUND:Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) significantly affect the quality of life of pregnant women. Understanding their severity and risk factors may help prevent and alleviate such pain and their resulting dysfunction. OBJECTIVE:This study investigated the prevalence, severity, and biopsychosocial risk factors of pregnancy-related LBP and PGP in Zhengzhou, China. METHODS:The Numeric Pain Rating Scale (NPRS), Chinese version of the Roland-Morris Disability Questionnaire (RMDQ), and other questionnaires were self-administered by 1020 pregnant women undergoing treatment at a tertiary hospital between July and December 2019. Binary logistic regression was used to identify factors associated with pregnancy-related LBP and/or PGP. RESULTS:The prevalence of LBP and/or PGP during pregnancy was 63.0%, and most participants (80.4%) had both. The mean NPRS and RMDQ disability scores were 2.44 ± 2.10 and 6.66 ± 4.65, respectively. A higher gestational body mass index, LBP and/or PGP during menstruation, history of pregnancy-related LBP and/or PGP, and constant pressure were significantly associated with pregnancy-related LBP and/or PGP. Subjective support was a protective factor against LBP and/or PGP. CONCLUSION:The prevalence of LBP and/or PGP was high. The risk factors should be included in routine prenatal care to identify patients at risk of LBP and/or PGP.
10.3233/BMR-220147
Pelvic girdle pain: updating current practice.
Fishburn Sarah
The practising midwife
Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during pregnancy and exacerbated by the weight of the baby. Customary advice was for rest, support belts and to await recovery following the baby's birth. However, the outcome of this management resulted in many women experiencing short or long-term physical disability, as well as the psychological impact of pain and immobility. Recent research links an asymmetry of the pelvic joints to the incidence and severity of PGP and shows the cause is biomechanical and not due to pregnancy hormones. Evidence supports manual therapy as the effective way to resolve PGP quickly during pregnancy through a realignment and restoration of symmetry of movement in the pelvic joints, thereby avoiding the adverse long-term consequences of the condition.
The Association between Postpartum Pelvic Girdle Pain and Pelvic Floor Muscle Function, Diastasis Recti and Psychological Factors-A Matched Case-Control Study.
International journal of environmental research and public health
There is uncertainty regarding the association between abdominal morphology, pelvic floor function, and psychological factors in women with postpartum pelvic girdle pain (PGP). The aim of this case-control study was to evaluate the differences between women with and without persistent PGP regarding pelvic floor function, diastasis recti, and psychological factors 6−24 weeks postpartum. Pelvic floor manometry, palpation examination of abdominal muscles, the International Consultation on Incontinence Questionnaire Short Form, The Depression, Anxiety and Stress Scale—21, and the Pain Catastrophizing Scale were used. The PGP group presented with lower vaginal resting pressure (p < 0.001), more tenderness (p = 0.018) and impaired voluntary activation of pelvic floor muscles (p ≤ 0.001). Women with pain also had more distortion on the level of the anterior abdominal wall (p = 0.001) and more severe diastasis recti (p = 0.046) when compared to pain-free controls. Lower vaginal resting pressure was the strongest factor explaining PGP (OR 0.702, 95%CI 0.502−0.981). There were no differences in terms of the pelvic floor strength, endurance, severity of urinary incontinence and reported distress between the groups. Women with PGP 6−24 weeks postpartum differ in pelvic floor and abdominal muscle function from the pain-free controls. Vaginal resting pressure may be an important factor in pelvic girdle pain shortly postpartum. Further studies are needed to see a trend in changes over time.
10.3390/ijerph19106236
The Impact of Functional Stability Exercises on Alleviating Pelvic Girdle Pain in Pregnancy: A Review.
Cureus
Pelvic girdle pain (PGP) during pregnancy is a major source of stress for mothers. This review summarizes studies on the effectiveness of functional stability exercises (FSEs) in preventing PGP during pregnancy. FSE is a rising area of study in maternal health, focusing on core muscle groups and addressing the biomechanical changes during pregnancy. Although data shows that FSE may relieve PGP and improve the quality of life in pregnant women, the research landscape is defined by limitations and differences in intervention parameters among studies, resulting in contradictory conclusions. As a result, the efficacy of FSE in pregnant women with PGP remains inconclusive. This review can help comprise the existing research on FSE alleviating PGP in pregnancy to provide full knowledge on the topic, analyze long-term effects, and develop practice guidelines. While FSE shows promise, treating the multidimensional nature of PGP in pregnancy requires a comprehensive approach to therapy that incorporates several therapeutic modalities.
10.7759/cureus.48769
Use of Manual Therapy for Posterior Pelvic Girdle Pain.
Miles Derek,Bishop Mark
PM & R : the journal of injury, function, and rehabilitation
Use of manual therapies in the treatment of posterior pelvic pain is a common practice. The rationale for use of manual therapies is often associated with the structural movement of the sacroiliac joint. Increasing evidence has shown this not to be the case, as manual therapy's effect is more neurophysiological in nature. This article seeks to clarify the difference between the two explanations as well as to expand upon outside influences such as expectations, therapeutic alliance, and equipoise that may influence the outcome of treatment. Treatment effects may be maximized with manual therapy if clinicians have an understanding of the role of each of these variables in their treatment approach.
10.1002/pmrj.12172
Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study.
Dufour Sinéad,Vandyken Brittany,Forget Marie-Jose,Vandyken Carolyn
Musculoskeletal science & practice
BACKGROUND:The prevalence, cost and disability associated with lumbopelvic pain continues to rise despite the range of available therapeutic interventions, indicating a deficiency in current approaches. A literature base highlighting a correlation between lumbopelvic pain and pelvic floor function is developing; however, the features that characterize this correlation have yet to be fully established. PURPOSE:The purpose of this study was to determine the prevalence and characteristics of pelvic floor muscle function among women with lumbopelvic pain. METHODS:A cross-sectional study was conducted on non-pregnant women presenting with lumbopelvic pain to one of seven outpatient orthopaedic clinics in Canada. Potential participants underwent a screening process to assess for pelvic floor muscle dysfunction. RESULTS:A total of 182 women were recruited and 97 were excluded, leaving 85 participants (n = 85). Of these, 95.3% were determined to have some form of pelvic floor dysfunction. Specifically, 71% of the participants had pelvic floor muscle tenderness, 66% had pelvic floor weakness and 41% were found to have a pelvic organ prolapse. Participants with combined low back pain and pelvic girdle pain presented with higher levels of disability and increased characteristics of pelvic floor dysfunction. CONCLUSIONS:Our findings corroborate and extend recent research supporting the hypothesis that a high proportion of pelvic floor muscle dysfunction is present among women with lumbopelvic pain. Specifically, increased pelvic floor muscle pressure-pain sensitivity represented the most frequent characteristic, the clinical implications of which require further study.
10.1016/j.msksp.2017.12.001
Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials.
Journal of back and musculoskeletal rehabilitation
BACKGROUND:Pelvic girdle pain represents a group of musculoskeletal pain disorders associated with the sacroiliac joint and/or the surrounding musculoskeletal and ligamentous structures. Its physical management is still a serious challenge as it has been considered the primary cause of low back pain. OBJECTIVE:This review sought to determine the effectiveness of motor control exercises for two clinically relevant measures; i.e., pain and disability, on patients with pelvic girdle pain of sacroiliac joint origin. METHODS:This review covered only randomized controlled studies. Online databases, such as PubMed, Embase, Scopus, and Cochrane Library, were searched from January 1, 1990, to December 31, 2019. PEDro scale was used to assess the methodological quality of included studies, while Review Manager was employed to synthesize data in view of meta-analysis. The PRISMA guidelines were applied for this review. RESULTS:Twelve randomized controlled trials of moderate-to-high quality were included in this review. The studies involved 1407 patients with a mean age ranging from 25.5 to 42.1 years as well as intervention and follow-up durations from 1 week to 2 years. Motor control exercises alone for pelvic girdle pain of sacroiliac joint origin were not effective in terms of pain reduction (SMD = 0.29 [-0.64,1.22]) compared to control interventions whereas they were slightly effective in terms of disability reduction (SMD =-0.07 [-0.67, 0.53]) at short-term. The combination of motor control exercises with other musculoskeletal therapies, however, revealed to be more effective than control interventions in terms of pain reduction (SMD =-1.78 [-2.49, -1.07]; 95%CI) and lessened disability (SMD =-1.80 [-3.03, -0.56]; 95%CI) at short-term. CONCLUSION:Motor control exercises alone were not found to be effective in reducing pain at short-term. However, their combination with other musculoskeletal therapies revealed a significant and clinically-relevant decrease in pain and disability at short-term, especially in peripartum period.
10.3233/BMR-210108
Relationship between urinary incontinence and back or pelvic girdle pain: a systematic review with meta-analysis.
Bertuit Jeanne,Bakker Els,Rejano-Campo Montserrat
International urogynecology journal
INTRODUCTION AND HYPOTHESIS:Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population. METHODS:This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the "Critical Review Form for quantitative studies" (McMaster University). RESULTS:From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain. CONCLUSIONS:Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice.
10.1007/s00192-020-04670-1
Altered musculoskeletal mechanics as risk factors for postpartum pelvic girdle pain: a literature review.
Sakamoto Asuka,Gamada Kazuyoshi
Journal of physical therapy science
[Purpose] The aim of this literature review was to detect the factors associated with pelvic girdle pain persisting for over 3 months in the postpartum period. [Methods] We performed a broad literature search for eligible studies published before May 1, 2018 using electronic databases and processed the data using a review process. [Results] In the initial online search, we identified 12,174 potential studies. Finally, 22 studies met the specified criteria and were included for examination of risk factors for persistent pelvic girdle pain after delivery. Pain intensity and disability during pregnancy were risk factors for pelvic girdle pain persisting for over 6 months after delivery. The active straight leg raising test predicted the risk of persistent pelvic girdle pain after delivery. Dysfunction of the pelvic floor muscles was also a risk factor for persistent pelvic girdle pain. [Conclusion] Pain intensity and disability during pregnancy, positive provocation tests, active straight leg raising test, and musculoskeletal mechanics were positively associated with pelvic girdle pain persisting for over 3 months after delivery.
10.1589/jpts.31.831
Women's Experience of Pelvic Girdle Pain After Childbirth: A Meta-Synthesis.
Journal of midwifery & women's health
INTRODUCTION:Persistent pelvic girdle pain (PGP) and the resulting consequences may occur for more than 10 years after birth. The purpose of this meta-synthesis is to provide a new interpretation and deeper understanding of women's experience of living with PGP postpartum. METHODS:A literature review of CINAHL, PsycINFO, PubMed, Scopus, and ProQuest dissertations was conducted for any qualitative study addressing PGP after birth and published in English from 2000 to 2019. A meta-synthesis using Noblit and Hare's meta-ethnography approach was performed. RESULTS:Seven studies were found describing the experiences of women living with PGP from birth to 13 years after birth. Six themes emerged that represented women's experience: invisible pain, life being restrained, failure to perform the maternal role, experiencing downward emotional spiral, need for active social support, and adaptation to a new conditional life. DISCUSSION:The experiences of women living with PGP after birth highlight the need for holistic care. Interventions by health care providers should support the ability of women to perform daily functions and adapt to their new reality instead of a disease-focused intervention. In addition, women with PGP emphasize the importance of active social support from family members and health care providers. Future research that examines the differences between PGP during the first 3 months postpartum versus that which persists later is needed to develop targeted interventions.
10.1111/jmwh.13167
Predictive Factors for Pregnancy-Related Persistent Pelvic Girdle Pain (PPGP): A Systematic Review.
Medicina (Kaunas, Lithuania)
: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3-6 months after childbirth in women with PPGP alone or PPGP in association with pregnancy-related lower back pain (PLBP). : Eligibility criteria: Two authors independently selected studies excluding PPGP determined by a specific, traumatic, gynecological/urological cause or isolated PLBP and studies that did not include the presence/absence of PPGP as the the primary outcome. We, instead, included studies with an initial assessment in pregnancy (within 1 month of delivery) and with a follow-up of at least 3 months after delivery. : The research was performed using the databases of Medline, Cochrane, Pedro, Scopus, Web of Science and Cinahl from December 2018 to January 2022, following the indications of the PRISMA statement 2021 and the MOOSE checklist. It includes observational cohort studies in which data were often collected through prospective questionnaires (all in English). : Two independent authors performed evaluations of the risk of bias (ROB) using the quality in prognostic studies (QUIPS) tool. : An in-depth qualitative analysis was conducted because, due to a high degree of heterogeneity in the data collection of the included studies and a lack of raw data suitable for quantitative analysis, it was not possible to carry out the originally planned meta-analyses for the subgroups. : The research process led to the inclusion of 10 articles which were evaluated using the QUIPS tool: 5 studies were evaluated as low ROB and 5 were evaluated as moderate ROB. High levels of pain in pregnancy, a large number of positive provocation tests, a history of lower back pain and lumbo-pelvic pain, high levels of disability in pregnancy, neurotic behavior and high levels of fear-avoidance belief were identified as strong predictors of long-term PPGP, while there was weak or contradictory evidence regarding predictions of emotional distress, catastrophizing and sleep disturbances. : The impossibility of carrying out the meta-analysis by subgroups suggests the need for further research with greater methodological rigor in the acquisition of measures based on an already existing PPGP core predictors/outcome sets.
10.3390/medicina59122123
The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial.
Stuge Britt,Laerum Even,Kirkesola Gitle,Vøllestad Nina
Spine
STUDY DESIGN:A randomized controlled trial with stratified block design. OBJECTIVES:To evaluate a treatment program focusing on whether specific stabilizing exercises for patients with pelvic girdle pain after pregnancy reduce pain, improve functional status, and improve quality of life. SUMMARY OF BACKGROUND DATA. : The evidence of effectiveness of treatment for pelvic girdle pain is weak. Recent research has focused on the importance of activation of muscles for motor control and stability of the lumbopelvic region. To the authors' knowledge, the efficacy of applying these principles for pelvic girdle pain has not previously been evaluated in a randomized controlled trial. METHODS:Eighty-one women with pelvic girdle pain were assigned randomly to two treatment groups for 20 weeks. One group received physical therapy with a focus on specific stabilizing exercises. The other group received individualized physical therapy without specific stabilizing exercises. Assessments were administered by a blinded assessor, at baseline, after intervention and 1 year post partum. Main outcome measures were pain, functional status and quality of life. RESULTS:There were no dropouts. After intervention and at 1 year post partum, the specific stabilizing exercise group showed statistically and clinically significant lower pain intensity, lower disability, and higher quality of life compared with the control group. Group difference in median values for evening pain after treatment was 30 mm on the Visual Analog Scale. Disability was reduced by more than 50% for the exercise group; changes were negligible in the control group. Significant differences were also observed for physical tests, in favor of the specific exercise group. CONCLUSION:An individualized treatment approach with specific stabilizing exercises appears to be more effective than physical therapy without specific stabilizing exercises for women with pelvic girdle pain after pregnancy.
Treatment of Idiopathic Posterior Pelvic Girdle Pain Utilizing a Global Movement Assessment.
Geraci Michael C,Creighton Andrew
PM & R : the journal of injury, function, and rehabilitation
Treatment of posterior pelvic girdle pain, including pain generated from the sacroiliac joint [SIJ], can be challenging because the pain can become chronic. A treatment plan targeting only the painful area with isolated treatments such as injection, medication, modalities, or therapy is limited. Globally assessing the patient's kinetic chain is imperative. Identifying a patient's movement impairments within the context of the kinetic chain allows target areas leading to pain in the posterior pelvic region, including the SIJs, to be identified. Before starting an exercise program, the Movement Assessment Tests-7 (MAT-7) can be used to screen the spine, SIJs, and major joints of the extremities to identify movement impairments. Tests that comprise the MAT-7 are comprehensive yet efficient, requiring the patient to pass basic movements before progressing to more advanced movements. This allows the MAT-7 to be tailored to patients of any age or skill level. Using the MAT-7, the provider can identify the most difficult movement a patient does well, which is the starting point from which to progress a patient's therapeutic exercise program. Based on the MAT-7 screen, active therapeutic exercises are prescribed, targeting the movement impairments identified. As a patient advances through their exercise program, the MAT-7 can be applied to reassess a patient's success with the treatment plan and identify any additional target areas. This movement assessment treatment approach is reproducible, teachable, and applicable to not only posterior pelvic and SIJ pain, but also to pain in the spine and other major joints of the extremities.
10.1002/pmrj.12181
Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: A randomized controlled trial.
Haakstad Lene A H,Bø Kari
Journal of rehabilitation medicine
OBJECTIVE:To determine whether participation in a group fitness class for pregnant women can prevent and treat pelvic girdle pain and low back pain. DESIGN:An observer-blinded randomized controlled trial. PARTICIPANTS:A total of 105 sedentary, nulliparous pregnant women, mean age 30.7 years (standard deviation (SD) 4.0), mean pre-pregnancy body mass index (BMI) 23.8 (SD 4.3), were assigned to either control or exercise groups at mean gestation week 17.7 (SD 4.2). METHODS:The exercise intervention followed the guidelines of American College of Obstetricians and Gynecologists and included a 60 min general fitness class, with 40 min of endurance training and 20 min of strength training including stretching, performed at least twice per week for a minimum of 12 weeks. Outcome measures were number of women reporting pelvic girdle pain and low back pain after the intervention (mean pregnancy week 36.6 (SD 0.9)) and postpartum (mean 7.7 (SD 1.7)). RESULTS:There were no statistically significant differences between the exercisers and controls in numbers reporting the 2 conditions after the intervention (pelvic girdle pain: odds ratio (OR) = 1.34, CI = 0.56-3.20 or low back pain: OR = 1.10, CI = 0.47-2.60) or postpartum (pelvic girdle pain: OR = 0.38, CI = 0.13-1.10 or low back pain: OR = 1.45, CI = 0.54-3.94). A comparison of the women who had attended at least 80% of the weekly exercise classes with the control participants did not change the results. CONCLUSION:Participation in regular group fitness classes during pregnancy did not alter the proportion of women reporting pelvic girdle pain or low back pain during pregnancy or after childbirth.
10.2340/16501977-1906
Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial.
ElDeeb Abeer M,Abd-Ghafar Khaled S,Ayad Waled A,Sabbour Adly A
Journal of back and musculoskeletal rehabilitation
BACKGROUND:Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women. OBJECTIVE:This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP. METHODS:Forty postpartum women participated in the study. Their age ranged from 25-35 years and their body mass index (BMI) was 25-29.9 kg/m2. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively. RESULTS:Both groups (A and B) revealed a significant decrease (p= 0.001) in pain and functional disability and a significant increase (p= 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p= 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A). CONCLUSIONS:PFM training should be an essential part in rehabilitation programs of PGP postpartum.
10.3233/BMR-181258
The pelvic girdle pain deadlock: 1. Would 'deconstruction' help?
Meijer O G,Hu H,Wu W H,Prins M R
Musculoskeletal science & practice
INTRODUCTION:Pelvic Girdle Pain (PGP) is an important clinical problem that deserves more attention. Several treatment regimens have been presented that appear to be somewhat promising, but it was reported that about 10% of patients still suffer from the problems 11 years after their inception. This situation should be improved. PURPOSE:We present a personalized history, with first the acceptance of the concept of 'PGP', around 2005, and then continued problems in really understanding PGP's nature and causes. We propose to engage in 'deconstruction' of PGP, that is, disentangling the large variety of processes involved. IMPLICATIONS:Deconstructing PGP is a venture into the unknown. Still, science should proceed on the basis of what we know already. To understand PGP, experts emphasize the importance of biomechanics or of psychology, and we propose to insert 'inflammation' between these two levels of understanding, that is to say, the full development from low grade local inflammation to systemic inflammation and neuroinflammation. Inflammation is bidirectionally related to biomechanical as well as psychological processes. For clinicians, challenging our "beliefs and understanding of PGP, rather than being 'stuck' with a preferred modus operandi" has major practical implications. It requires continuous monitoring of the patient, and a willingness to change direction. More scientific disciplines are relevant to understanding, and treating, PGP than a single human being can master. Creative flexibility of clinicians would be a promising starting point to improve overall treatment effects in PGP.
10.1016/j.msksp.2020.102169
Evidence of stabilizing exercises for low back- and pelvic girdle pain - a critical review.
Brazilian journal of physical therapy
BACKGROUND:Pregnancy-related low back pain (LBP) and pelvic girdle pain (PGP) have been associated with an alteration in the strategy for lumbopelvic stabilization. Different core stabilization approaches exist, the evidence is however controversial. METHODS:This paper discusses how to improve the evidence of exercises for women suffering from LBP and PGP during and after pregnancy. Exercises should be understood in a context, where the bio-psycho-social perspective directs the prescription of exercises, targeting both psychological and physical factors. The type of exercise probably should be individually tailored to the needs and capability of the individual and it is not only about the most appropriate exercise, it is about dosage and delivery of the exercises, and it is about performance. To promote adherence the use of patient preferences, with self-defined movement goals, may be a motivational basis for behavior change. Communication skills may facilitate positive beliefs and provide a motivational foundation for empowerment, self-efficacy and for self-management. To learn by discovery where the patient learns through their own experiences, might motivate the patients to active engagement and to behavioral change. Adherence probably will increase when the patients understand the aim and the rationale behind the exercises they are prescribed. However, with high adherence to exercises that maintains an inappropriate motor pattern, LBP and PGP possibly could proceed into chronicity. CONCLUSION:Exercises need to be meaningful to the patient, relevant for daily activities, individualized according to patient preferences, guided and supervised to secure performance and quality.
10.1016/j.bjpt.2018.11.006
Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum; a systematic review and meta-analysis.
Wiezer M,Hage-Fransen M A H,Otto A,Wieffer-Platvoet M S,Slotman M H,Nijhuis-van der Sanden M W G,Pool-Goudzwaard A L
Musculoskeletal science & practice
BACKGROUND:Although pelvic girdle pain postpartum and pregnancy related low back pain postpartum (combined and named PGPP in this study) have a natural favourable course, there is a subgroup of women who have persistent complaints. The objective of this study was to identify personal-, (pre)pregnancy-, obstetric-, and child related risk factors on PGPP by means of a systematic literature review and meta-analysis. METHODS:Literature searches of PubMed, EMBASE, CINAHL and Cochrane up to October 2018 were conducted. Prospective cohort studies in English or Dutch describing three or more risk factors for PGPP were included. We assessed articles for inclusion and risk of bias. Studies with high risk of bias were excluded from data extraction. Data was extracted and checked for accuracy confirming to the CHARMS-checklist. Homogeneous variables were pooled. RESULTS:Twelve full text studies were assessed. Seven studies were excluded due to high risk of bias. Data was extracted from five studies. Multivariate analysis was not possible due to heterogeneity in included risk factors as well as outcome measures on risk factor per study. Pooled univariate significant risk factors on PGPP were: a history of low back pain, pre-pregnancy body mass index >25, pelvic girdle pain in pregnancy, depression in pregnancy, and a heavy workload in pregnancy. No significant obstetric and child related risk factors were reported. CONCLUSIONS:Risk factors on PGPP have been identified. Since multivariate analysis was not possible the outcome should be treated with care, because interaction between risk factors could not be analysed.
10.1016/j.msksp.2020.102154
The effectiveness of stabilising exercises in pelvic girdle pain during pregnancy and after delivery: A systematic review.
Almousa S,Lamprianidou E,Kitsoulis G
Physiotherapy research international : the journal for researchers and clinicians in physical therapy
BACKGROUND:Pelvic girdle pain is a common musculoskeletal disorder which affects women during pregnancy and the postpartum period. In previous years, physiotherapists have focused on managing pelvic girdle pain through stabilizing exercises. PURPOSE:The aim of this study was to systematically review studies investigating the effectiveness of the stabilizing exercises for pelvic girdle pain during pregnancy and the postpartum period. METHODS:The following electronic databases were utilized to search for eligible studies: MEDLINE, EMBASE, CINAHL, Physiotherapy Evidence Database, and Cochrane Library. Inclusion and exclusion criteria were defined a priori. The quality assessment was performed by the two reviewers independently using the PEDro scale (Physiotherapy Evidence-based Database). RESULTS:Six studies were identified as eligible with the inclusion and exclusion criteria. All studies evaluated the pain as an outcome measure. The evidence conflicted between the studies. Two studies showed that stabilizing exercises decrease pain and improve the quality of life for pregnant women when they are carried out on a regular basis. There is some limited evidence that stabilizing exercises decrease pain for postpartum women too. CONCLUSION:In summary, there is limited evidence for the clinician to conclude on the effectiveness of stabilizing exercises in treating pelvic girdle pain during pregnancy and the postpartum periods.
10.1002/pri.1699
Pelvic girdle pain and low back pain in pregnancy: a review.
Vermani Era,Mittal Rajnish,Weeks Andrew
Pain practice : the official journal of World Institute of Pain
Pregnancy-related pelvic girdle pain (PGP) and pregnancy-related low back pain (PLBP) are common problems with significant physical, psychological, and socioeconomic implications. There are several management options that are underutilized because of lack of comprehensive knowledge by health-care professionals and fear of harmful effects of treatment on the developing fetus. Interventions such as patient education, the use of pelvic belts, acupuncture, and aquatic and tailored postpartum exercises can be of some benefit to these patients. This article will focus on the diagnosis and management of PGP and PLBP, with discussion of terminology, epidemiology, risk factors, pathophysiology, and prognosis.
10.1111/j.1533-2500.2009.00327.x
Low Back Pain and Pelvic Girdle Pain in Pregnancy.
Casagrande Danielle,Gugala Zbigniew,Clark Shannon M,Lindsey Ronald W
The Journal of the American Academy of Orthopaedic Surgeons
Pregnancy has a profound effect on the human body, particularly the musculoskeletal system. Hormonal changes cause ligamentous joint laxity, weight gain, and a shift in the center of gravity that leads to lumbar spine hyperlordosis and anterior tilting of the pelvis. In addition, vascular changes may lead to compromised metabolic supply in the low back. The most common musculoskeletal complaints in pregnancy are low back pain and/or pelvic girdle pain. They can be diagnosed and differentiated from each other by history taking, clinical examination, provocative test maneuvers, and imaging. Management ranges from conservative and pharmacologic measures to surgical treatment. Depending on the situation, and given the unique challenges pregnancy places on the human body and the special consideration that must be given to the fetus, an orthopaedic surgeon and the obstetrician may have to develop a plan of care together regarding labor and delivery or when surgical interventions are indicated.
10.5435/JAAOS-D-14-00248
Pelvic girdle pain in pregnancy.
Walters Charlotte,West Simon,A Nippita Tanya
Australian journal of general practice
BACKGROUND:Pelvic girdle pain (PGP) in pregnancy is a common condition that can cause significant physical disability and has an important psychosocial impact on pregnant women and their families. It is often under-reported and poorly managed by obstetric caregivers, and this can result in poorer outcomes, reduced quality of life and chronic pain. OBJECTIVE:The objective of this article is to discuss the practical assessment and management of PGP in pregnancy. DISCUSSION:Conservative management that includes activity modification, pelvic support garments, management of acute exacerbations, physiotherapy and exercise programs can alleviate symptoms and prevent progression of symptoms. General practitioners are an integral part of the multidisciplinary team to help manage PGP.
10.31128/AJGP-01-18-4467
European guidelines for the diagnosis and treatment of pelvic girdle pain.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
A guideline on pelvic girdle pain (PGP) was developed by "Working Group 4" within the framework of the COST ACTION B13 "Low back pain: guidelines for its management", issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick's Faber, Gaenslen's test, and modified Trendelenburg's test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP.
10.1007/s00586-008-0602-4