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Hrvatin I, Rugelj D, Šćepanović D. Pregnancy-related pelvic girdle pain affects balance in the second and third trimesters of pregnancy. PLoS One 2024; 19:e0287221. [PMID: 38457422 PMCID: PMC10923470 DOI: 10.1371/journal.pone.0287221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/01/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION During pregnancy, many changes in the musculoskeletal system and pregnancy-related disorders affect posture and postural stability. Pregnancy-related pelvic girdle pain (PPGP) is a common disorder in pregnancy; the cause remains unknown. The purpose of the present study was to determine if PPGP affects static postural stability and its relation to the stage of pregnancy. METHODS Sixty-three pregnant women between the ages of 18 and 45 and between the 12th and 38th weeks of gestation were included in the study. They were divided into four groups according on the trimester and the presence of PPGP. Static balance was assessed using a force plate on firm and compliant surfaces with eyes open and closed. RESULTS Pregnant women with PPGP had significantly (p < 0.05) greater centre-of-pressure velocity and sway area compared to pregnant women without PPGP, especially in the third trimester of pregnancy. In the second trimester, only two significant differences in COP parameters were observed between pregnant women with and without PPGP. Pregnant women in the third trimester of pregnancy had significantly (p < 0.05) greater centre-of-pressure velocity and larger postural sway area compared to pregnant women in the second trimester of pregnancy, regardless of PPGP. DISCUSSION AND CONCLUSION Pregnant women with PPGP had poorer static stability when compared to pregnant women without pain, especially in the third trimester of pregnancy. The cause could be found in the poorer ability to stabilise the trunk and pelvis, poorer proprioception, and issues with automatic movement patterns.
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Affiliation(s)
- Ivana Hrvatin
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Rugelj
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Darija Šćepanović
- Gynaecological Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Gashaw M, Yitayal MM, Zemed A, Nigatu SG, Kasaw A, Belay DG, Aragaw FM, Endalew M, Tsega NT, Asratie MH, Janakiraman B. Level of activity limitations and predictors in women with pregnancy-related pelvic girdle pain: Prospective cross-sectional study. Ann Med Surg (Lond) 2022; 78:103754. [PMID: 35734740 PMCID: PMC9207037 DOI: 10.1016/j.amsu.2022.103754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background For many pregnant women, pelvic girdle pain caused by pregnancy has an impact on their daily living. Women with lumbo-pelvic pain have moderate to severe discomfort that makes daily activities like getting out of a chair, bending, and walking difficult. The aim of this study was to determine the extent of daily activity restrictions and to discover predictors of pregnancy-related pelvic girdle pain. Study design Prospective cross-sectional study. Methods This prospective cross-sectional study was undertaken from January October 2018 to October 29/2019 among 337 gravid mothers with pregnancy-related limbo-pelvic pain. A structured questionnaire adapted from the activity limitation-related pelvic girdle pain questionnaire was used for data collection. Epi-info version 7.1 for data entry and STATA version 14 for statistical analysis were used. Ordinal regression with an odds ratio of 95% confidence interval and p-value < 0.05 were cast-off to assess the association between the outcome and dependent variables. Results Among 324 pregnant women with pelvic girdle pain 96 (29.6%) had small extent level of activity limitation, 185 (57.1%) had moderate activity limitation, and 43 (13.3%) large extent level of activity limitation. Having previous children (AOR = 0.37, 95% CI:0.14, 0.98), occupation (AOR = 1.77, 95% CI: 1.06, 2.95) and taking alcohol (AOR = 0.43, 95% CI: 0.19, 0.99) were the independent predictors for activity limitation. Conclusion Nearly one-third of the participants had a modest degree of activity restriction, while more than half of the pregnant women with PPGP had a moderate to high level of restriction. Previous children, occupation, and alcohol consumption were all independent predictors of activity limitation among pregnant women. PGP and LBP are commonly reported by pregnant women all over the world. Women's during pregnancy reported limitations in activities of daily life. One-third of the pregnant women with PPGP had a modest degree of activity restriction. More than half of the pregnant women with PPGP had a moderate to high level of restriction. Having children, occupation, and alcohol consumption were independent predictors of activity limitation.
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Abstract
Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on case reports or series or retrospective clinical experience or patient surveys. Of special interest are pregnancy-induced changes in disease course or severity and likelihood for baseline recovery of function postpartum. Labor and delivery present special challenges in many conditions that affect skeletal but not smooth (uterine) muscle; so labor complications must be anticipated. Anesthesia for cesarean section surgery requires special precautions in many disorders. The types of conditions reviewed are broad and include examples of autoimmune, hereditary, and compressive/mechanical processes. Disorders include carpal tunnel syndrome and other focal neuropathies, Bell palsy, myasthenia gravis, and other neuromuscular junction disorders, acute and chronic inflammatory neuropathy, hereditary and acquired muscle diseases, spinal muscular atrophy, amyotrophic lateral sclerosis, channelopathies, autonomic neuropathy, and dysautonomia. Many commonly used therapies have fetal animal but no proven human toxicity concerns, complicating treatment and risk decisions. Weaning off effective therapeutic agents or preemptive aggressive treatment or surgery prior to planned pregnancy is an option in some conditions.
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Affiliation(s)
- Louis H. Weimer
- Correspondence to: Louis H. Weimer, M.D., Neurological Institute of New York, 710 W. 168th Street, New York, NY 10032, United States. Tel: + 1-212-305-1516, Fax: + 1-212-305-4268
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YETİŞGİN A, CİNAKLI A, ARPA N, KUL M, SATIŞ S. Risk Factors For Pregnancy Related Low Back Pain. KONURALP TIP DERGISI 2019. [DOI: 10.18521/ktd.526531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Analysis of Test-Retest Reliability, Construct Validity, and Internal Consistency of the Brazilian Version of the Pelvic Girdle Questionnaire. J Manipulative Physiol Ther 2018; 41:425-433. [DOI: 10.1016/j.jmpt.2017.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/30/2017] [Accepted: 10/19/2017] [Indexed: 11/21/2022]
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LUI NAILEE, HAROON NIGIL, CARTY ADELE, SHEN HUA, COOK RICHARDJ, SHANMUGARAJAH SUTHA, GLADMAN DAFNAD, INMAN ROBERTD. Effect of Pregnancy on Ankylosing Spondylitis: A Case-Control Study. J Rheumatol 2011; 38:2442-4. [DOI: 10.3899/jrheum.101174] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the effect of pregnancy on ankylosing spondylitis (AS).Methods.Our study aimed to determine the severity of back pain and stiffness pre-, during, and postpartum in patients with AS and controls, and corresponding extraarticular symptoms.Results.Nineteen female patients with AS (35 pregnancies) and 33 controls (77 pregnancies) were studied. Improvement in pain was reported in 51% of AS patients, predominantly in the first trimester, with significant improvement in pain than stiffness. In both groups, pain worsened in later stages, likely secondary to biomechanical loading. Postpartum pain scores in AS returned to prepartum levels in general.Conclusion.Pregnancy does not substantially aggravate disease activity or severity in AS.
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Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A, Alpantaki K. Pregnancy-related low back pain. Hippokratia 2011; 15:205-210. [PMID: 22435016 PMCID: PMC3306025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pregnancy related low back pain is a common complaint among pregnant women. It can potentially have a negative impact on their quality of life. The aim of this article is to present a current review of the literature concerning this issue.By using PubMed database and low back pain, pelvic girdle pain, pregnancy as keywords, abstracts and original articles in English investigating the diagnosis treatment of back pain during pregnancy were searched and analyzedLow back pain could present as either a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The source of the pain should be diagnosed and differentiated early.The appropriate treatment aims to reduce the discomfort and the impact on the pregnant womans quality of life. This article reveals the most common risk factors, as well as treatment methods, which may help to alleviate the pain. Some suggestions for additional research are also discussed.
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Ansari NN, Hasson S, Naghdi S, Keyhani S, Jalaie S. Low back pain during pregnancy in Iranian women: Prevalence and risk factors. Physiother Theory Pract 2010; 26:40-8. [PMID: 20067352 DOI: 10.3109/09593980802664968] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Low back pain (LBP) is a common and often disabling condition that deserves attention. Although LBP during pregnancy is a common clinical problem, only one study was found documenting prevalence of LBP during pregnancy in Iran. No investigation evaluated the diagnostic value of possible risk factors. The aims of the present, cross-sectional study were 1) to ascertain the prevalence of LBP of Iranian women during pregnancy and compare to other ethnic/cultural groups and 2) identify risk factors associated with LBP during pregnancy in Iranian women. One hundred three women were interviewed in the obstetric ward of a university hospital within 48 hours after giving birth. Possible risk factor associations were studied by using nonparametric tests, and sensitivity, specificity, positive and negative predictive, and likelihood ratio values were calculated for the interview questions about previous low back pain, LBP during menstruation, and trauma during pregnancy. The prevalence of LBP during pregnancy was found to be 57.3%, which is similar to most other countries. Pain onset was most frequently reported in the third trimester of pregnancy (40.7%) and was often reported to be in the low back area (71.2%). Almost half of the patients reported their pain as being moderate (44.1%). The logistic regression model demonstrated that the LBP during menstruation predicts a high risk for LBP during the current pregnancy. The study showed that LBP during menstruation and previous LBP may be useful tests for ruling out and ruling in LBP during pregnancy, respectively.
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Ando F, Ohashi K. Using the posterior pelvic pain provocation test in pregnant Japanese women. Nurs Health Sci 2009; 11:3-9. [PMID: 19298302 DOI: 10.1111/j.1442-2018.2008.00406.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study investigated the usefulness of the posterior pelvic pain provocation (PPPP) test for differentiating between pelvic pain and low back pain because of the different prognoses and treatment strategies. We recruited 263 Japanese women who were > 36 weeks' gestation and 213 were included. The PPPP test was applied to 154 women with self-reported lumbopelvic pain. The participants were divided into three groups: the PPPP test positive (PPPP+, n = 60) subgroup, PPPP test negative (PPPP-, n = 94) subgroup, and no pain group (n = 59). The disability scores of the PPPP+ subgroup were significantly higher than the scores of the PPPP- subgroup and no pain group. In the PPPP+ subgroup, the intensity of pelvic pain was significantly correlated with the disability scores, but that of low back pain was not. The PPPP test could be carried out by a midwife without side-effects and could detect pregnant women with impaired ability in daily life due to lumbopelvic pain.
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Affiliation(s)
- Fukiko Ando
- Department of Children and Women's Health, Area of Nursing Science, Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
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Cheng PL, Pantel M, Smith JT, Dumas GA, Leger AB, Plamondon A, McGrath MJ, Tranmer JE. Back pain of working pregnant women: identification of associated occupational factors. APPLIED ERGONOMICS 2009; 40:419-423. [PMID: 19084818 DOI: 10.1016/j.apergo.2008.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 10/07/2008] [Accepted: 11/15/2008] [Indexed: 05/27/2023]
Abstract
The objective of this study was to identify major occupational factors that were significantly correlated with back pain in pregnant women working in higher education, health care and service areas. A total of 73 working pregnant women were surveyed using questionnaires specifically designed for evaluating correlations between occupational factors and severity of back pain; 37 women were interviewed at both 20 and 34 weeks of pregnancy, 17 at 20 weeks only, and 19 were interviewed at 34 weeks only. "Rest breaks allowed" and "job autonomy" were negatively correlated with severity of back pain at 20 weeks of pregnancy. "Staying in a confined area" and "having restricted space" were positively correlated with severity of back pain at 34 weeks of pregnancy. The study suggests that allowing pregnant women to take more rest breaks and to have more job autonomy may reduce the severity of back pain during early pregnancy, and that allowing movement outside the working area and providing less restricted space may reduce back pain during late pregnancy.
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Affiliation(s)
- Pei Lai Cheng
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada K7L 3N6
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Gait in Pregnancy-related Pelvic girdle Pain: amplitudes, timing, and coordination of horizontal trunk rotations. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:1160-9. [PMID: 18661160 PMCID: PMC2527418 DOI: 10.1007/s00586-008-0703-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/29/2008] [Accepted: 06/09/2008] [Indexed: 11/22/2022]
Abstract
Walking is impaired in Pregnancy-related Pelvic girdle Pain (PPP). Walking velocity is reduced, and in postpartum PPP relative phase between horizontal pelvis and thorax rotations was found to be lower at higher velocities, and rotational amplitudes tended to be larger. While attempting to confirm these findings for PPP during pregnancy, we wanted to identify underlying mechanisms. We compared gait kinematics of 12 healthy pregnant women and 12 pregnant women with PPP, focusing on the amplitudes of transverse segmental rotations, the timing and relative phase of these rotations, and the amplitude of spinal rotations. In PPP during pregnancy walking velocity was lower than in controls, and negatively correlated with fear of movement. While patients’ rotational amplitudes were larger, with large inter-individual differences, spinal rotations did not differ between groups. In the patients, peak thorax rotation occurred earlier in the stride cycle at higher velocities, and relative phase was lower. The earlier results on postpartum PPP were confirmed for PPP during pregnancy. Spinal rotations remained unaffected, while at higher velocities the peak of thorax rotations occurred earlier in the stride cycle. The latter change may serve to avoid excessive spine rotations caused by the larger segmental rotations.
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Elden H, Ostgaard HC, Fagevik-Olsen M, Ladfors L, Hagberg H. Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. Altern Ther Health Med 2008; 8:34. [PMID: 18582370 PMCID: PMC2467402 DOI: 10.1186/1472-6882-8-34] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 06/26/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain, PGP, in pregnant women. However, the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition. The aim of the present work was to assess adverse effects of acupuncture on the pregnancy, mother, delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to standard treatment or standard treatment alone. METHODS In all, 386 women with PGP entered this controlled, single-blind trial. They were randomly assigned to standard treatment plus acupuncture (n = 125), standard treatment plus specific stabilising exercises (n = 131) or to standard treatment alone (n = 130) for 6 weeks. Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy. Adverse effects were recorded during treatment and throughout the pregnancy. Influence on the fetus was measured with cardiotocography (CTG) before-during and after 43 acupuncture sessions in 43 women. A standardised computerized method to analyze the CTG reading numerically (Oxford 8000, Oxford, England) was used. After treatment, the women rated their overall experience of the treatment and listed adverse events if any in a questionnaire. Data of analgesia and oxytocin augmentation during labour, duration of labour, frequency of preterm birth, operative delivery, Apgar score, cord-blood gas/acid base balance and birth weight were also recorded. RESULTS There were no serious adverse events after any of the treatments. Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this. The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal. CONCLUSION This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy, mother, delivery or the fetus/neonate.
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Kalus SM, Kornman LH, Quinlivan JA. Managing back pain in pregnancy using a support garment: a randomised trial. BJOG 2007; 115:68-75. [DOI: 10.1111/j.1471-0528.2007.01538.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mousavi SJ, Parnianpour M, Vleeming A. Pregnancy related pelvic girdle pain and low back pain in an Iranian population. Spine (Phila Pa 1976) 2007; 32:E100-4. [PMID: 17268252 DOI: 10.1097/01.brs.0000254123.26649.6e] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study in pregnancy. OBJECTIVES To differentiate between pregnancy related pelvic girdle pain (PGP) and low back pain (LBP) in Iranian women, and investigate the prevalence of each syndrome. SUMMARY OF BACKGROUND DATA Most of the information about PGP and LBP has been obtained in Western countries. There are few studies to investigate pregnancy related lumbopelvic pain, and, especially, differentiate between PGP and LBP in non-Western countries, particularly in the Middle East. METHODS This study included 325 pregnant women, ranging in age from 16 to 42 years. All pregnant women were interviewed using a questionnaire. Two trained physical therapists performed the posterior pelvic pain provocation test on all women with lumbopelvic pain. RESULTS A total of 161 pregnant women (49.5%) had reported lumbopelvic pain at the time of the examination. Based on the posterior pelvic pain provocation test, 91 women (28%) had PGP, 43 (13.2%) had LBP, and 27 (8.3%) had both PGP and LBP simultaneously. The intensity of pain in women with lumbopelvic pain using the visual analog scale was 5.6 (standard deviation 2.0; range 2-10). CONCLUSIONS About 1 in every 2 pregnant women studied experienced lumbopelvic pain at the time of the examination. In this study, PGP was almost 2 times more common than LBP. The high prevalence of PGP suggests that this symptom is a significant health problem in Iranian pregnant women, and needs more attention by Iranian health professionals and researchers.
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Affiliation(s)
- Sayed Javad Mousavi
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Stuge B, Mørkved S, Dahl HH, Vøllestad N. Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain. ACTA ACUST UNITED AC 2006; 11:287-96. [PMID: 16386450 DOI: 10.1016/j.math.2005.07.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Revised: 06/01/2005] [Accepted: 07/26/2005] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Britt Stuge
- University of Oslo, Section for Health Science, P.O. Box 1153, Blindern, N-0318 Oslo, Norway.
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Novaes FS, Shimo AKK, Lopes MHBDM. [Low back pain during gestation]. Rev Lat Am Enfermagem 2006; 14:620-4. [PMID: 16967171 DOI: 10.1590/s0104-11692006000400022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 04/20/2006] [Indexed: 11/22/2022] Open
Abstract
This research qualitatively analyzed the contents of national and international scientific publications, indexed in the period from 1999 to 2005, about low back pain in gestation. Around 50 % of pregnant women complain about low back pain. The physiologic modifications that occur happen in pregnancy alter the posture of pregnant women and the largest incidence of low back pain usually happens in the last three months. Specific causes remain unknown. However, treatment involves analgesics, antiphlogistics, exercises and physiotherapy. Low back pain during gestation is a symptom that causes great discomfort and, depending on the level of pain, it generates motor disability and impairs daily activities, besides causing problems to take care of the baby after birth. Some discomfort of low back pain can continue for a period of up to three years after childbirth. We see a great need for further research in this subject area, in order to provide a better quality of life for pregnant women.
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Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine (Phila Pa 1976) 2006; 31:E149-55. [PMID: 16508539 DOI: 10.1097/01.brs.0000201259.63363.e1] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cohort study in pregnancy. OBJECTIVES To differentiate between pregnancy-related pelvic girdle pain (PPGP) and lumbar pain, and to study the prevalence of each syndrome and its consequences in terms of pain, functioning, and health. SUMMARY OF BACKGROUND DATA When studying prevalence, etiology, and consequences, differentiation between PPGP and lumbar pain is important, and, to our knowledge, its consequences for functioning and health during pregnancy have not previously been studied. METHODS All women answered questionnaires (demographic data, EuroQol). Women with lumbopelvic pain completed the Oswestry Disability Index, pain intensity measures, in addition to undergoing a mechanical assessment of the lumbar spine, pain provocation tests, and active straight leg raising test. RESULTS Of 313 women, 194 had lumbopelvic pain. The PPGP subgroup comprised 54% of those women with lumbopelvic pain, lumbar pain 17%, and combined PPGP and lumbar pain 29%. Women having both PPGP and lumbar pain reported the highest consequences in terms of health and functioning. CONCLUSIONS Pain intensity, disability, and health measurements differentiate subgroups of lumbopelvic pain in pregnancy.
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Affiliation(s)
- Annelie Gutke
- Division of Physiotherapy, Department of Health and Society, Linköping University, Linköping, Sweden.
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Abstract
Exercises may help, and evidence is increasing that acupuncture reduces pain
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Padua L, Caliandro P, Aprile I, Pazzaglia C, Padua R, Calistri A, Tonali P. Back pain in pregnancy: 1-year follow-up of untreated cases. 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 2005; 14:151-4. [PMID: 15759172 PMCID: PMC3476697 DOI: 10.1007/s00586-004-0712-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Revised: 03/02/2004] [Accepted: 03/12/2004] [Indexed: 11/29/2022]
Abstract
Back Pain (BP) is one of the most frequent symptoms during the last period of pregnancy, and high incidence has been described in several studies. Until now no wide, multicenter and prospective clinical studies on the natural course of BP after pregnancy have been available. We performed a multicenter follow-up study in a sample of pregnant women using the Italian validated version of the Roland questionnaire to assess the evolution of BP after pregnancy and identify prognostic factors. Each center had to re-evaluate at least 75% of the initially enrolled women, with latency of 1 year after delivery. At the follow-up, we acquired substantial clinical data concerning the post-delivery period. The evaluation of symptom evolution was based on the Roland questionnaire. At follow-up, 53% of re-evaluated women had no BP symptoms. Moreover, there was a significant improvement of patient-oriented assessment in women who suffered BP after delivery. With regard to the predictive factors, the presence of BP before pregnancy implied a 3.1-fold higher probability of improvement after delivery. In conclusion, women without history of BP before pregnancy and who complain of these symptoms during pregnancy require greater attention, because they have a lower possibility for improvement. Conversely, in women with a history of BP, pregnancy represents a transient period of worsening symptoms, probably due to the temporary para-physiological mechanical condition.
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Affiliation(s)
- L Padua
- Department of Neurology, Università Cattolica, L.go F. Vito 1, 00168, Rome, Italy.
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Wu WH, Meijer OG, Uegaki K, Mens JMA, van Dieën JH, Wuisman PIJM, Östgaard HC. 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 2004; 13:575-89. [PMID: 15338362 PMCID: PMC3476662 DOI: 10.1007/s00586-003-0615-y] [Citation(s) in RCA: 305] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2003] [Accepted: 07/25/2003] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- W. H. Wu
- Department of Orthopaedics, Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
- Department of Orthopaedics, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province People’s Republic of China
| | - O. G. Meijer
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - K. Uegaki
- Department of Orthopaedics, Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - J. M. A. Mens
- Department of Rehabilitation Medicine, Erasmus Medical Centre, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - J. H. van Dieën
- Faculty of Human Movement Sciences, Vrije Universiteit, Room D 656, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands
| | - P. I. J. M. Wuisman
- Department of Orthopaedics, Vrije Universiteit Medical Centre (VUMC), Amsterdam, The Netherlands
| | - H. C. Östgaard
- Department of Orthopaedics, Sahlgren University Hospital, 43180 Mölndal, Sweden
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