Musculoskeletal Effects of Pregnancy on the Lower ExtremityA Literature Review

Are physical fitness, a history of childbirth and injury history related to knee valgus in female Canadian Armed Forces members during a bodyweight overhead squat movement?

OBJECTIVES

A history of childbirth is associated with musculoskeletal injury (MSKi) in female members of the Canadian Armed Forces (CAF). While previous injury and pregnancy impact knee kinematics, it is unclear if a history of childbirth is associated with medial knee displacement (MKD) in an overhead squat movement screen. The aim of this study is to examine the relationship between MKD and (1) MSKi and (2) parity status in female CAF members.

METHODS

24 nulliparous and 21 parous female participants employed by the CAF completed a comprehensive physical fitness assessment of muscular flexibility, power, strength, endurance, aerobic capacity and a bodyweight overhead squat movement screen (recorded using two-dimensional video, and hip-knee-ankle angle measured using Kinovea software). Interactions between MKD, parity status and MSKi history were assessed by one-way analysis of variance and two-way analysis of covariance (ANCOVA) (adjusted for age).

RESULTS

An interaction between parity status and acute injury of the lower extremity was observed (F=4.379, p=0.043, η2 =0.099) in MKD of the right knee. The two-way ANCOVA examining acute injury of the lumbopelvic hip complex (lower back, pelvis, hip) yielded an interaction between acute injury to the lumbopelvic hip complex and parity status (F=4.601, p=0.038, η2=0.103) in MKD asymmetry.

DISCUSSION

Parous participants with acute injury to the lower extremity had larger MKD than parous without this injury type. Parous participants without acute injury to the lumbopelvic hip complex had greater MKD asymmetry than nulliparous without this injury type. Our findings suggest that researchers and clinicians should consider parity status in conjunction with MSKi history when assessing knee kinematics in female military members.

Voice Quality of Life and Musculoskeletal Symptoms of Pregnant Women

INTRODUCTION

Quality of life in terms of voice and musculoskeletal symptoms can be affected, especially at the end of pregnancy when major physical changes occur.

OBJECTIVE

To analyze the results of vocal self-assessment and musculoskeletal symptoms of pregnant women in the second and third trimester.

METHODS

Forty-nine pregnant women in the second and third trimester aged between 18 and 40years were examined using the Nordic Musculoskeletal Questionnaire and the Voice-Related Quality of Life Questionnaire. The data were statistically analyzed using the R environment (R Core Team, 2019) with parametric (Student's t, chi-square, and Wald) and nonparametric (Mann-Whitney and Wilcoxon) tests, taking into account a nominal significance level of 5%.

RESULTS

Voice-related quality of life: mean total score and socio-emotional domain significantly within the normal values; physical domain significantly below the normal value; larger number of pregnant women significantly below the normal value in the physical domain. Nordic Musculoskeletal Questionnaire: most of the examined aspects showed a significant negative response; there was a positive significance for the presence of pain and tingling in the lower back; pregnant women with musculoskeletal complaints and impairments showed a significant decrease in the three domains of voice-related quality of life, mainly in the physical domain.

CONCLUSION

Pregnant women showed a deterioration in the physical domain of voice-related quality of life and the presence of pain and tingling in the lower back. Pregnant women who had discomfort and musculoskeletal impairments also showed a deterioration in voice-related quality of life, mainly in the physical domain.

Associations Between Rank, Sex, and Parity With Musculoskeletal Injuries Sustained During Annual Military Physical Fitness Test

ABSTRACT

Edwards, CM, da Silva, DF, Puranda, JL, Souza, SCS, Semeniuk, K, and Adamo, KB. Associations between rank, sex, and parity with musculoskeletal injuries sustained during annual military physical fitness test. J Strength Cond Res 38(2): 367-373, 2024-Musculoskeletal injuries pose a significant threat to the well-being of military personnel. Attempts to use physical employment standard test results as predictors of injury are underway, but little is known about injuries sustained during the tests. This study sought to identify body regions most likely to be reported as injured during the annual Canadian Armed Forces (CAF) physical fitness evaluation. In addition, sex, rank, and parity status are explored as possible associated factors for injury. A total of 1,796 actively serving CAF members were categorized by sex (1,030 male participants; 766 female participants), rank (1,142 Non-Commissioned Members [NCM]; 638 Officers), and parity (314 parous female participants; 435 nulliparous female participants). Sex, rank, and parity were associated with body regions reportedly injured during an annual CAF fitness assessment (significance p ≤ 0.05). When compared with male participants, female participants were more likely to be injured {aOR: 1.797 (95% [confidence interval] CI: 1.45-2.23)} and more prone to injury of the wrist (adjusted odds ratio [aOR]: 1.933 [95% CI: 1.20-3.12]), hip (aOR: 3.445 [95% CI: 2.07-5.728]), or lower back (aOR: 1.55 [95% CI: 1.18-2.04]). Non-Commissioned Members were more likely to injure the neck (aOR: 2.14 [95% CI: 1.18-3.88]) or shoulder (aOR: 2.03 [95% CI: 1.31-3.15]), when compared with Officers. Parous female participants reported pelvis/abdomen injury at a higher rate than the nulliparous group (5 vs. 1.7%, p = 0.019). Injuries sustained during an annual CAF fitness assessment differ based on sex, rank, and parity. Canadian Armed Forces female participants, NCM, and parous female participants may require specific physical fitness support in preparation for the annual physical fitness test.

Does a history of childbirth impact injury prevalence and mental health in female military members?

The effect of parity status on the prevalence and impact of musculoskeletal injury (MSKi) among female Canadian Armed Forces (CAF) members is unknown. This study aims to identify whether a history of childbirth and pregnancy-related complications are associated with MSKi occurrence among female members of the CAF. From September 2020 to February 2021, data were collected via an online questionnaire that assessed MSKi, reproductive health, and barriers to recruitment and retention in the CAF. Actively serving, female members were included in this analysis stratified by parous (n = 313) or nulliparous (n = 435) status. Descriptive analysis and binary logistic regressions were used to identify prevalence and adjusted odds ratios (aOR) of repetitive strain injuries (RSI), acute injuries, and body regions affected. Covariates included in aOR: age, body mass index, and rank. A p value of <0.05 was considered significant and 95% confidence intervals (CI) were reported. Female members with a history of childbirth were more likely to report an RSI (80.9% vs. 69.9%, OR = 1.57, CI: 1.03 to 2.40), and when stratified by body region, were more likely to have an RSI of the wrist (30.0% vs. 20.5%, aOR = 1.62, CI: 1.09 to 2.40), and foot (39.3% vs. 24.1%, aOR = 1.79, CI: 1.24 to 2.59). When compared to the nulliparous group, parity did not influence prevalence of acute injuries. MSKi and mental health perceptions were different for females who experienced postpartum depression, miscarriage, or preterm birth. Childbirth and pregnancy-related complications impact prevalence of some RSI among female CAF members. Thus, specific health and fitness support may be needed for parous female CAF members.

Sex Differences in Biological Systems and the Conundrum of Menopause: Potential Commonalities in Post-Menopausal Disease Mechanisms

Sex-specific differences in biology and physiology likely start at the time of conception and progress and mature during the pre-puberty time frame and then during the transitions accompanying puberty. These sex differences are impacted by both genetics and epigenetic alterations during the maturation process, likely for the purpose of preparing for successful reproduction. For females, later in life (~45-50) they undergo another transition leading to a loss of ovarian hormone production at menopause. The reasons for menopause are not clear, but for a subset of females, menopause is accompanied by an increased risk of a number of diseases or conditions that impact a variety of tissues. Most research has mainly focused on the target cells in each of the affected tissues rather than pursue the alternative option that there may be commonalities in the development of these post-menopausal conditions in addition to influences on specific target cells. This review will address some of the potential commonalities presented by an integration of the literature regarding tissue-specific aspects of these post-menopausal conditions and data presented by space flight/microgravity (a condition not anticipated by evolution) that could implicate a loss of a regulatory function of the microvasculature in the risk attached to the affected tissues. Thus, the loss of the integration of the paracrine relationships between endothelial cells of the microvasculature of the tissues affected in the post-menopausal environment could contribute to the risk for post-menopausal diseases/conditions. The validation of this concept could lead to new approaches for interventions to treat post-menopausal conditions, as well as provide new understanding regarding sex-specific biological regulation.

Risk factors for accidental falls during pregnancy - a systematic literature review

INTRODUCTION

Falls during pregnancy occur in 25-27% of women and can cause serious harm to both the mother and the fetus. The objective of this systematic review was to identify intrinsic and extrinsic risk factors for falls during pregnancy by reviewing original studies and addressing possible forms of prevention.

METHODS

We searched PubMed, Cochrane library, and Web of Science databases for studies assessing risk factors for falling after a fall has occurred or by using posturographic assessment.

RESULTS

Fourteen studies were included in the review. The identified extrinsic risk factors include slippery floors, cluttered areas, uneven ground, inappropriate shoes, hurrying, walking on stairs, carrying additional loads, poor lighting or obstructed view, sedentary lifestyle and working in physically demanding jobs. The identified intrinsic factors include age less than 30, height more than 160 cm, advanced pregnancy, unintended pregnancy, multiparity, hyperemesis gravidarum, low back pain, gestational diabetes, increase in abdominal circumference, lower ankle stiffness and joint laxity. Physical activity, maternity support belts, and education are possible strategies for fall prevention.

CONCLUSION

Our systematic review identified 13 intrinsic and 11 extrinsic risk factors for falling during pregnancy. With the knowledge of risk factors and the optimal prevention strategy, healthcare providers could incorporate this information in the treatment of pregnant women and reduce the risk of falling.

Community-based non-pharmacological interventions for improving pain, disability and quality of life in pregnant women with musculoskeletal conditions: protocol for a systematic review with meta-analyses

INTRODUCTION

Twenty five per cent of pregnant women with musculoskeletal pain have disabling symptoms that negatively influence quality of life. Studies have reported varying effects of non-pharmacological interventions including exercise, manipulation and pelvic belts for pregnant women with musculoskeletal problems. The overall effectiveness and acceptability of these interventions is uncertain due to lack of synthesised evidence. This protocol is for the first systematic review of community-based non-pharmacological interventions for improving pain, disability and quality of life in pregnant women with musculoskeletal conditions from studies published until August 2020.

METHODS AND ANALYSIS

A detailed search of PubMed, CINAHL, CENTRAL, Global Index Medicus, African Index Medicus, African Journal Online, Western Pacific Region Index Medicus, Latin American and Caribbean Centre on Health Science Information, Index Medicus for South-East Asia Region, IRIS (WHO digital publications), British Library for Development Studies and Google Scholar. Additional studies will be located from the reference list of identified studies and relevant systematic reviews. The databases will be searched from inception to August 2020. Appraisal of study quality will be performed with the Mixed Methods Appraisal Tool. Data will be synthesised using a mixed-studies synthesis design-the convergent synthesis. The description of interventions in all study designs will be summarised narratively. Meta-analyses will be used to statistically summarise the effectiveness of interventions in randomised controlled trials and the factors that influence these. Other quantitative studies will be summarised narratively to answer the objectives. Thematic synthesis will be used to summarise results of qualitative studies. The outcomes of interest include pain, disability and quality of life. This paper is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 guidelines.

ETHICS AND DISSEMINATION

Ethical clearance is not required. Findings will be presented at conferences and published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42020189535.

Influence of type 1 diabetes on the postural control of women in the third gestational trimester

BACKGROUND

Diabetes can cause biomechanical alterations that may be responsible for additional changes to those existing in a regular gestational period. The way a maternal body responds when affected by diabetes has not been clearly understood. This study aimed to describe the influence of type 1 diabetes on pregnant women's postural control.

METHODS

Forty pregnant women in their third gestational trimester were allocated in two equal groups - the control group and the type 1 diabetic group. The variables related to postural control and balance were assessed using photogrammetry (head protrusion; cervical lordosis; thoracic kyphosis; lumbar lordosis; pelvic anteversion, knee flexion, tibiotarsal and foot inclination angles were measured), and baropodometry (anteroposterior and mediolateral distance trajectory of the center of pressure, amplitude and average speed of displacement of the center of pressure).

FINDINGS

The results of the type 1 diabetic group showed, in the postural analysis, lower head protrusion and pelvic anteversion angles, while there was higher cervical lordosis, thoracic kyphosis, and lumbar lordosis angles. In the baropodometry, the anteroposterior distance and the amplitude of the center of pressure displacement with eyes open and closed were higher.

INTERPRETATION

The findings suggest that type 1 diabetes mellitus in the third trimester of pregnancy is associated with postural changes, a decrease in the active ankle range of motion and increase in the anteroposterior oscillation of the center of pressure, with negative repercussions for postural control.