Altered lumbo-pelvic-hip complex muscle morphometry and contraction change in postpartum pelvic girdle pain and asymptomatic subjects: a cross-sectional study

Objective

Lumbo-pelvic-hip complex muscle training is considered a crucial component of exercise rehabilitation for postpartum women with pelvic girdle pain (PGP). However, there is a paucity of research evidence regarding the morphological changes and contraction function of these muscles in postpartum women with PGP. Understanding the alterations in lumbo-pelvic-hip complex muscles function associated with PGP, is crucial for tailoring effective rehabilitation strategies and promoting optimal postpartum recovery. Therefore, this study aims to compare the differences in muscle thickness and contraction function of lumbo-pelvic-hip complex muscle between postpartum women with PGP and asymptomatic controls using ultrasound imaging.

Methods

One hundred and fifty postpartum women with PGP and fifty age-matched asymptomatic postpartum women were recruited in this study. Real-time musculoskeletal ultrasound was utilized to measure the resting muscle thickness of nine lumbo-pelvic-hip complex muscles, including the erector spinalis (ES), latissimus dorsi (LD), quadratus lumbalis (QL), gluteus maximus (GMax), gluteus medius (GMed), piriformis (PF), iliacus muscle (IM), rectus femoris (RF), and biceps femoris (BF). The thickness of the GMax, GMed, RF, and BF muscles were measured at maximum contraction to calculate a contraction: rest ratio.

Results

Compared to the asymptomatic women, those with PGP exhibited reduced resting thickness of the ES and GMax muscles bilaterally, as well as increased resting thickness of the right LD and IM muscles. Furthermore, the PGP group demonstrated decreased thickness of the left GMed and right RF muscles at maximum contraction. The contraction ratio was also diminished for the GMax muscles bilaterally, left GMed, and right RF in women with postpartum PGP. Conclusion: Postpartum women with PGP demonstrated reduced thickness, asymmetry, and diminished contractility of the lumbo-pelvic-hip complex muscles. Exercise prescriptions for postpartum women with PGP should incorporate targeted strengthening of the ES, GMax, GMed, and RF muscles.

Conclusion

Postpartum women with PGP demonstrated reduced thickness, asymmetry, and diminished contractility of the lumbo-pelvic-hip complex muscle. Exercise prescriptions for postpartum women with PGP should incorporate targeted strengthening of the ES, GMax, GMed, and RF muscles.

Transabdominal ultrasonography-guided biofeedback training for pelvic floor muscles integrated with stabilization exercise improved pregnancy-related pelvic girdle pain and disability: a randomized controlled trial

OBJECTIVES

Investigate effects of integrated training for pelvic floor muscles (PFM) with and without transabdominal ultrasonography (TAUS) imaging-guided biofeedback in postpartum women with pregnancy-related pelvic girdle pain (PPGP).

DESIGN

Three-arm, single-blinded randomized controlled trial SETTING: University laboratory PARTICIPANTS: Fifty-three postpartum women with PPGP randomized into stabilization exercise with TAUS-guided biofeedback (BIO+EXE), exercise (EXE), and control (CON) groups.

INTERVENTIONS

The BIO+EXE and EXE groups underwent an 8-week exercise program, with the BIO+EXE group receiving additional TAUS-guided biofeedback for PFM training during the first 4 weeks. The CON group only received a pelvic educational session.

MAIN OUTCOME MEASURES

Primary outcomes included self-reported pain (numeric rating scale) and disability (pelvic girdle questionnaire). Secondary outcomes included functional tests (active straight leg raising [ASLR] fatigue, timed up-and-go, and 6-meter walking tests) and muscle contractibility indicated by muscle thickness changes for abdominal muscles and bladder base displacement for PFM (ultrasonographic measures).

RESULTS

The BIO+EXE group had lower pain [1.8 (1.5) vs. 4.4 (1.5), mean difference -2.6, 95% confidence interval (CI) -3.9 to -1.2] and disability [14% (10) vs. 28% (21), mean difference -14, 95% CI -25 to -2] and faster walking speed [3.1 seconds (1) vs. 3.3 seconds (1), mean difference -0.2, 95% CI -1.0 to -0.2] than the CON group. The EXE group only had lower pain intensity compared to the CON group [2.7 (2.0) vs. 4.4 (1.5), mean difference -1.7, 95% CI -3.1 to -0.4]. No significant differences were observed among groups in timed up-and-go, ASLR fatigue, or muscle contractibility.

CONCLUSIONS

Integrated training for PFM and stabilization with TAUS-guided biofeedback seems to be beneficial for reducing pain and disability in postpartum women with PPGP. CONTRIBUTION OF THE PAPER.

The Efficacy of Lumbar Support on Pain, Disability, and Motor Control in Women With Postpartum Pelvic Girdle Pain: Protocol for a Randomized Controlled Trial

BACKGROUND

Pregnancy-related posterior pelvic girdle pain (PPGP) is one of the most important clinical manifestations of postpartum back pain. Those affected often complain of discomfort during daily activities. It is hypothesized that altered motor control is associated with perceived pain. Pelvic support can regulate possible underlying altered motor control mechanisms and decrease pain. However, the influence of a lumbosacral orthosis, which is broader support that allows for a wider contact area and more skin sensory stimulation to restore proper motor function, has not yet been investigated in women with postpartum PPGP.

OBJECTIVE

This study investigates the efficacy of broader lumbar support and narrower pelvic support on pain, proprioception, disability, and muscle strength in women with pregnancy-related PPGP.

METHODS

This study will be a single-center, 3-armed, participant-blinded, randomized controlled trial. In total, 84 women diagnosed with pregnancy-related PPGP will be recruited and randomly assigned into 3 groups. Intervention groups A and B will receive pelvic and lumbar supports, respectively. Group C (control) will receive only a patient education leaflet containing advice on strengthening exercises, comfortable positions, and other practical information. The study outcomes are pain, effort score during the active straight leg raising test, maximum isometric hip flexion force, maximum isometric hip external rotation force, maximum isometric trunk rotation force, and joint position reproduction of hip abduction. The study outcomes will be measured at 4 time points: baseline (T1), immediately after the intervention (T2), 4 weeks following interventions began (at this time, the intervention period is completed) (T3), and 1 week after discontinuing the interventions (T4) to evaluate the possible lasting effects of wearing supports. Multivariate analysis of variance will be used to test between- and within-group differences.

RESULTS

Recruitment for this study will be started in summer 2022 and is expected to be completed by the end of fall 2022.

CONCLUSIONS

This study will examine the efficacy of broader lumbar support as an early rehabilitative treatment for women receiving postpartum posterior pelvic pain support compared to those receiving a narrower pelvic support. We expect the broader lumbar support to impact pain management and disability better than the current narrower pelvic belt. Long-term follow-up studies will help determine whether such lumbosacral orthosis reduces pain and improves daily activities in women with pregnancy-related PPGP.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20150210021034N11; https://www.irct.ir/trial/54808.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/40553.

The Timed Up & Go test in pregnant women with pelvic girdle pain compared to asymptomatic pregnant and non-pregnant women

BACKGROUND

The Timed Up and Go (TUG) test, a standardized functional mobility test, has been proposed as a physical performance-based measure in pregnant women with pelvic girdle pain (PGP).

OBJECTIVES

This cross-sectional study aimed to investigate physical function by the use of TUG in pregnant women with PGP compared to asymptomatic pregnant and non-pregnant women, and to identify factors associated with increased TUG.

METHODS

In total, 25 pregnant women with PGP, 24 asymptomatic pregnant and 25 asymptomatic non-pregnant women participated. One-way analysis of variance was used to explore difference in TUG between the groups and multiple linear regression analyses to explore associations between TUG and potential explanatory variables.

RESULTS

The time on TUG varied among pregnant women with PGP, and was significantly higher (mean (95% CI) 6.9 (6.5, 7.3) seconds) than for asymptomatic pregnant (5.8 (5.5, 6.0), p < 0.001) and non-pregnant (5.5 (5.4, 5.6), p < 0.001) women. In the total study sample, group, increased BMI and sick leave were significantly associated with increased TUG (p-values≤0.02). In pregnant women with PGP, pain intensity was the only significant clinical factor associated with increased TUG (p = 0.002).

CONCLUSION

Pregnant women with PGP used longer time and showed larger variation in TUG than asymptomatic pregnant and non-pregnant women, this underpins that TUG targets activities relevant to PGP. Our results provide new knowledge about factors influencing TUG time. Importantly, multivariable analyses suggest that pain intensity should be considered when interpreting TUG time in pregnant women with PGP.