Pain Provocation Tests Research Articles

Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle

ObjectiveKinesio Taping (KT) is a therapeutic method used by physical therapists and athletic trainers in combination with other treatment techniques for various musculoskeletal and neuromuscular problems. However, no research has evaluated the effect of KT in patients with low back pain (LBP). The purpose of this case was to describe the application of posterior pelvic tilt taping (PPTT) with Kinesio tape as a treatment for chronic LBP and to reduce the anterior pelvic tilt angle. DesignCase report. Case descriptionThe patien was a 20-year-old female amateur swimmer with a Cobb’s angle (L1–S1) of 68°, a sacral horizontal angle of 45°, and pain in both medial buttock areas and sacroiliac joints. We performed PPTT with Kinesio tape for 2 weeks (six times per week for an average of 9h each time). ResultsThe patient’s radiographs showed that the Cobb’s angle (L1–S1) had decreased from 68° to 47° and that the sacral horizontal angle had decreased from 45° to 31°. Reductions in hypomobility or motion asymmetry, as assessed by the motion palpation test, and in pain, as measured by the pain-provocation tests, were observed. On palpation for both medial buttock areas in the prone position, the patient felt no pain. The patient experienced no pain or stiffness in the low back area while performing forward flexion in the standing position with knees fully extended when washing dishes in the sink. ConclusionsThe case study demonstrated that PPTT intervention favourably affected the pelvic inclination and sacral horizontal angle, leading to beneficial effects on sacroiliac joint dysfunction (SIJD) and medial buttock pain. Additional research on the clinical effects of this taping procedure requires greater numbers of athletes with SIJD or LBP who have inappropriate anterior pelvic tilt angles and hyperlordosis.

Diagnostic performance of clinical tests for sacroiliac joint pain

Background: An updated review of the diagnostic clinical tests available for sacroiliac joint (SIJ) pain has yet to be undertaken.Objective: To evaluate the diagnostic performance of clinical tests for SIJ pain based on a systematic review.Methods: Five electronic databases were searched. Studies that examined the SIJ pain provocation tests with sensitivity and specificity data in patients (age ⩾18 years) with non-specific, non-pregnancy related low back pain and/or buttock pain, with or without lower extremity symptoms, were selected. Studies related to SIJ dysfunction were excluded. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool has been used to evaluate the quality of all included studies.Results: Six studies were included in this systematic review and the QUADAS scores are similar for all selected studies. The diagnostic performance of most clinical tests was poor with low specificity (0·03–0·95), sensitivity (0·08–0·90), and positive likelihood ratio (0·3–1·4), when used in isolation. The thigh thrust is the most sensitive test (0·88), the distraction test is most specific (0·81), and the compression test has the strongest positive likelihood ratio (2·20). Three or more positive pain provocation tests showed optimal sensitivity (0·85–0·94) and specificity (0·78–0·79) values with high positive likelihood ratios (4·02–4·29).Conclusion: Pain location below the lumbosacral junction overlying the SIJ with at least three or more positive SIJ pain provocation tests (thigh thrust, distraction, and compression) should be considered for the clinical diagnosis of SIJ pain.

A Process of Subgroup Identification in Non‐specific Low Back Pain Using a Standard Clinical Examination and Cluster Analysis

Non-specific low back pain (NSLBP) accounts for over 85% of all low back pain. Homogenous subgroups may exist within this diagnosis. This study derived a clinical examination and evaluated the examination's ability to identify homogenous subgroups in NSLBP. Patients with NSLBP were examined using a standardized clinical examination. Each patient was examined by two physiotherapists. Data were analysed for item reliability and the presence of distinct subgroups using cluster analysis. Cross-validation of the clusters identified was conducted. Three hundred and one patients were examined. The inter-tester reliability of the majority of items was moderate to substantial (52% of items with kappa > 0.40). A K-means cluster analysis of the two data sets revealed agreement on the presence of two subgroups. One group (n = 47, 16%) had higher fear avoidance beliefs, anxiety and disability. They were more likely to be provoked by pain provocative tests. They were also more likely to be judged as having central sensitization and a dominant psychosocial component to their presentation. The identification of a group of hypervigilant NSLBP patients should allow the interventions to be targeted towards this group. A valid, standardized clinical examination does contribute to the diagnostic management of NSLBP.

Algometry with a clothes peg compared to an electronic pressure algometer: a randomized cross-sectional study in pain patients

BackgroundHypersensitivity of the central nervous system is widely present in pain patients and recognized as one of the determinants of chronic pain and disability. Electronic pressure algometry is often used to explore aspects of central hypersensitivity. We hypothesized that a simple pain provocation test with a clothes peg provides information on pain sensitivity that compares meaningfully to that obtained by a well-established electronic pressure algometer. "Clinically meaningful" was defined as a medium (r = 0.3-0.5) or high (r > 0.5) correlation coefficient according to Cohen's conventions.MethodsWe tested 157 in-patients with different pain types. A calibrated clothes peg was applied for 10 seconds and patients rated the pain intensity on a 0 to 10 numerical rating scale. Pressure pain detection threshold (PPdt) and pressure pain tolerance threshold (PPtt) were measured with a standard electronic algometer. Both methods were performed on both middle fingers and ear lobes. In a subgroup of 47 patients repeatability (test-retest reliability) was calculated.ResultsClothes peg values correlated with PPdt values for finger testing with r = -0.54 and for earlobe testing with r = -0.55 (all p-values < 0.001). Clothes peg values also correlated with PPtt values for finger testing with r = -0.55 (p < 0.001). Test-retest reliability (repeatability) showed equally stable results for clothes peg algometry and the electronic algometer (all r-values > 0.89, all p-values < 0.001).ConclusionsInformation on pain sensitivity provided by a calibrated clothes peg and an established algometer correlate at a clinically meaningful level.

The relationship between pelvis inclination, exercise and low back pain (LBP) during pregnancy

Background: Pain in the lower region of the back and pelvis - also called "Low Back Pain" (LBP) - is very frequent during pregnancy. According to many authors it is a major complaint of more than half of all pregnant women; it causes mental and physical discomfort. The etiology of LBP during pregnancy is still not fully known. Objective: The main aim of our research was to objectify the relationship between the presence of LBP, the training level of the postural muscles and the degree of the pelvic inclination of women in the third trimester of pregnancy. That is why the relationship between pelvic inclination and LBP occurrence is compared within the context of two groups - reasonable physically active as compared to physically inactive women. Methods: Twenty-seven pregnant probands aged 20 - 35 years and in the second half of their third trimester were included in the experiment. All of them complained of pain in their lumbar spine and in the pelvicarea. They were divided into two groups: 14 physically inactive women and 13 physically active women, who have been performing physical activity for at least 135 minutes per week for at least 1 year before conception and for at least 90 minutes per week during pregnancy. The exercises were focused on the functioning of the postural system, e.g. yoga, Pilatespilatek and exercises by Mojzisova. We measured the inclination of the pelvis (using non-invasive anthropometric measuring) and observed the presence of pain in the selected area: clinically via the Patrick-Faber test and posterior pelvic pain provocation test and subjectively with the aid of a standardized LBP related survey. The statistical methods used were the t-test, the median and Wilcoxon-White test and the Spearman factor of serial correlations. Results: We observed a statistically significant difference between the pelvic inclination of physically active and inactive women (using a t-test for non-pair values with a significance level of p = 0.01). Another significant difference was evident between the subjective pain sensation of regularly exercising and non-exercising women, which was proven by both the median and the Wilcoxon-White tests (p = 0.01). A significant relationship between pelvic inclination and the sensation of pain classified in a survey by means of a 1-10 scale was proven by the Spearman factor of serial correlations (p = 0.01). Conclusions: Using mathematical statistical methods, our study has proven the important role of physical activity during pregnancy - its relationship to pain sensation and to the degree of pelvic inclination. We consider these results to be very important, especially from the perspective of LBP prevention during pregnancy.

INFLUENCE OF ANTERIOR PAIN ON RESULTS FROM ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Objective: To examine the impact of residual pain on functional outcomes two years after arthroscopic anterior cruciate ligament (ACL) reconstruction and compare the types of graft used during the procedure (patellar vs. flexor). Method: A retrospective epidemiological study on 129 ACL reconstructions with a mean follow-up of 28 months was conducted. The presence, intensity and location of the anterior pain were investigated. Pain provocation tests were conducted, sensitivity was analyzed and functional scores were applied (IKDC, femoropatellar and SF-36), comparing the results with the type of graft used. Results: Anterior pain was present in 28% of patients with a mean intensity of 2.9 in 10. When pain was present, the functional scores decreased significantly. Abnormalities of knee sensitivity and gait occurred frequently with use of the patellar tendon, but there was no statistical difference regarding the presence of pain. Conclusion: The presence of anterior pain in ACL reconstructions, even if minimal, has a deleterious effect on the final outcome over the medium term. Because of the influence of graft harvesting on the presence of abnormalities of knee sensitivity and gait, choosing the graft should take into account the patient's professional and sports activities.

Clinical characteristics and treatment for patients with low back and leg pain caused by lumbar annular tears

To investigate whether annular tears is a cause of low back and radiating leg pain and explore the clinical characteristics and treatment for patients with this condition. A total of 34 patients with low back and radiating leg pain, but without lumbar disc herniation on CT (computed tomography) or MRI (magnetic resonance imaging), were examined by electrophysiological studies and discography to identify whether there were or not annular tears and nerve root injury and decipher the relations between them. The series included 15 males and 19 females with an average age of 45.6 years old and the average duration of symptoms was 25.8 months. All patients with annular tears and positive pain provocation test were treated by local windowing decompression and debridement of nucleus pulposus after failed conservative treatment. The pre- and post-operative functions and pain were evaluated by JOA (Japanese Orthopedic Association) and VAS (visual analog scale) scores respectively. The average follow-up was 17.4 months. The clinical manifestations included low back and radiating leg pain, intermittent claudication and nerve root injury. No significant abnormalities were discovered on X-ray and CT scan. T2W images of magnetic resonance demonstrated a low intensity or black disc in all patients and high-intensity zone (HIZ) (n = 21). Electromyography showed nerve root injury (n = 27). Abnormality of conduction velocities of common peroneal nerve (n = 7) and tibial nerve (n = 3) were found. Thirty-four patients with 38 discs displayed pain reproduction on contrast injection during discography and the sites of annular tears were confirmed on CT scan after discography. Pre- and post-operative average JOA scale score was 8.7 points and 13.5 points, the recovery ratio 76.2% and the excellent and good outcomes 88.2%. Pre- and post-operative average VAS score was 8.6 points and 2.8 points. And the recovery rate was 80.5%. The annular tears result in low back and radiating leg pain. And the typical characteristics are low back and radiating leg pain, intermittent claudication and nerve root injury. MRI and electrophysiological studies play an important role in diagnosing this condition. Lumbar discography is the decisive method and prerequisite of selecting surgery. Local windowing decompression and debridement of nucleus pulposus is a simple and effective method.

Pelvic girdle pain: Potential risk factors in pregnancy in relation to disability and pain intensity three months postpartum

The objective of this prospective cohort study was to examine how results of clinical tests on women with pelvic girdle pain (PGP) in late pregnancy were associated with disability and pain intensity 12 weeks postpartum controlling for socio-demographical and psychological factors. Out of the 283 women clinically examined in gestation week 30, 179 were considered afflicted from PGP and constituted the study sample. Potential risk factors were assessed by questionnaires (at inclusion and in gestation week 30) and clinical examination in gestation week 30. The clinical examination included pain provocation tests for the pelvis as well as the active straight leg raise test. We used pain intensity and disability (disability rating index, DRI) as response variables, derived from questionnaires 12 weeks postpartum. Using multivariable linear regression analyses, sum of pain provocation tests and pre-pregnancy low back pain (LBP) were significantly associated with DRI 12 weeks postpartum. Furthermore, sum of pain provocation tests and number of pain sites were significantly associated with pain intensity. In conclusion, we found that when including results of clinical tests as risk factors together with socio-demographical and psychological factors in multivariable regression models, the clinical risk factors are the ones that remain significant. These results are of clinical importance because they seem to have the potential to identify women with a poor prognosis.

Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms

The majority of women recover from pregnancy-related lumbopelvic pain within 3 months of delivery. Since biomechanical and hormonal changes from pregnancy are largely reversed by 3 months postpartum, consequently, it is assumed that other factors might interfere with recovery. Relative to the fear-avoidance model and with reference to previous studies, we chose to investigate some pre-decided factors to understand persistent lumbopelvic pain. The evaluation of lumbopelvic pain postpartum is mostly based on self-administered questionnaires or interviews. Clinical classification of the lumbopelvic pain may increase our knowledge about postpartum subgroups. Two hundred and seventy-two consecutively registered pregnant women evaluated at 3 months postpartum, answered questionnaires concerning disability (Oswestry disability index), pain intensity on visual analog scale, health-related quality of life (HRQL, EQ5D), activity level, depressive symptoms (Edinburgh postnatal Depression Scale) and kinesiophobia (Tampa Scale for Kinesiophobia). Women were classified into lumbopelvic pain subgroups according to mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Multiple linear regression analysis was performed to explain the variance of disability. Thirty-three percent of postpartum women were classified with lumbopelvic pain; 40% reported moderate to severe disability. The impacts were similar among subgroups. Pain intensity, HRQL and kinesiophobia explained 53% of postpartum disability due to lumbopelvic pain. In conclusion, one of three postpartum women still had some lumbopelvic pain and the impacts were equivalent irrespective of symptoms in lumbar or pelvic areas. The additional explanations of variance in disability by HRQL and kinesiophobia were minor, suggesting that pain intensity was the major contributing factor.

Pelvic girdle pain - associations between risk factors in early pregnancy and disability or pain intensity in late pregnancy: a prospective cohort study

BackgroundRecent studies have shown high prevalence rates for pelvic girdle pain (PGP) in pregnancy. Some risk factors for developing PGP have been suggested, but the evidence is weak. Furthermore there is almost no data on how findings from clinical examinations are related to subsequent PGP. The main purpose for this study was to study the associations between socio-demographical, psychological and clinical factors measured at inclusion in early pregnancy and disability or pain intensity in gestation week 30.MethodsThis is a prospective cohort study following women from early to late pregnancy. Eligible women were recruited at their first attendance at the maternity care unit. 268 pregnant women answered questionnaires and underwent clinical examinations in early pregnancy and in gestation week 30. We used scores on disability and pain intensity in gestation week 30 as outcome measures to capture the affliction level of PGP. Multiple linear regression analysis was used to study the associations between potential risk factors measured in early pregnancy and disability or pain intensity in gestation week 30.ResultsSelf-reported pain locations in the pelvis, positive posterior pelvic pain provocation (P4) test and a sum of pain provocation tests in early pregnancy were significantly associated with disability and pain intensity in gestation week 30 in a multivariable statistic model. In addition, distress was significantly associated with disability. The functional active straight leg raise (ASLR) test, fear avoidance beliefs and the number of pain sites were not significantly associated with either disability or pain intensity.ConclusionsThe results suggest that a clinical examination, including a few tests, performed in early pregnancy may identify women at risk of a more severe PGP late in pregnancy. The identification of clinical risk factors may provide a foundation for development of targeted prevention strategies.

Examination of musculoskeletal chest pain—An inter-observer reliability study

Background and purpose The musculoskeletal system is recognized as a possible source of pain in patients with chest pain. The objectives of the present study were (1) to investigate the interobserver reliability of an overall diagnosis of musculoskeletal chest pain using a standardized examination protocol in a cohort of patients with chest pain suspected to be of non-cardiac origin, (2) to investigate the interobserver reliability of the single components of the protocol, and finally, (3) to investigate the importance of clinical experience on the level of interobserver reliability. Methods and results Eighty patients with acute chest pain were recruited from a cardiology department. Four observers (two chiropractors and two chiropractic students) performed a physical examination and an extended manual examination of the spine and chest wall. Percentage agreement, Cohen9s Kappa and ICC were calculated for observer pairs and overall. Musculoskeletal chest pain was diagnosed in 44.0 % of patients. Interobserver kappa values were substantial for the chiropractors and overall, and moderate for the students. For single items of the protocol, both pairs showed fair to substantial agreement regarding pain provocation tests and poor to fair agreement regarding spinal segmental dysfunction tests. Conclusions Suspected musculoskeletal chest pain can be identified with substantial interobserver reliability using this standardized protocol if used by experienced and trained observers. Agreement for individual components of the protocol showed, however, considerable variation. Provided training of observers, the examination protocol can be used in selected patients and can be implemented in pre- and post-graduate clinical training.

The Nordic back pain subpopulation program: Can low back pain patterns be predicted from the first consultation with a chiropractor? A longitudinal pilot study

BackgroundIt is widely believed that non-specific low back pain (LBP) consists of a number of subgroups which should be identified in order to improve treatment effects. In order to identify subgroups, patient characteristics that relate to different outcomes are searched for. However, LBP is often fluctuating or recurring rather than clearly limited in time. Therefore it would be relevant to consider outcome after completed treatment from a longitudinal perspective (describing "course patterns") instead of defining it from an arbitrarily selected end-point.AimsThe objectives of this pilot study were to investigate the interobserver reliability of a diagnostic classification system and to evaluate whether diagnostic classes or other baseline characteristics are associated with the LBP course pattern over a period of 18 weeks.MethodsPatients visiting one of 7 chiropractors because of LBP were classified according to a diagnostic classification system, which includes end-range loading, SI-joint pain provocation tests, neurological examination and tests for muscle tenderness and abnormal nerve tension. In addition, age, gender, duration of pain and presence of leg pain were registered in the patient's file. By weekly SMS-messages on their mobile phones, patients were asked how many days they had LBP the preceding week, and these answers were transformed into pain course patterns and the total number of LBP days.ResultsA total of 110 patients were included and 76 (69%) completed follow-up. Thirty-five patients were examined by two chiropractors. The agreement regarding diagnostic classes was 83% (95% CI: 70 - 96). The diagnostic classes were associated with the pain course patterns and number of LBP days. Patients with disc pain had the highest number of LBP days and patients with muscular pain reported the fewest (35 vs. 12 days, p < 0.01). Men had better outcome than women (17 vs. 29 days, p < 0.01) and patients without leg pain tended to have fewer LBP days than those with leg pain (21 vs.31 days, p = 0.06). Duration of LBP at the first visit was not associated with outcome.ConclusionsThe study indicated that there is a clinically meaningful relationship between diagnostic classes and the course of LBP. This should be evaluated in more depth.

Pelvic girdle pain, clinical tests and disability in late pregnancy

The objective of this cross-sectional study was to explore the associations between pain locations, responses to the posterior pelvic pain provocation (P4) test, responses to the active straight leg raise (ASLR) test and disability in late pregnancy.283 women in gestation week 30 (mean age 31.3 years; 59% nullipara) completed a questionnaire (including pain drawing and Disability Rating Index, DRI). A physiotherapist blinded for the questionnaire data assessed responses to the P4 and ASLR tests. The pain drawing was used to: 1) distinguish between Pelvic girdle pain (PGP) and low back pain (LBP); 2) discriminate between pain locations within the pelvic area.A large variation was found in DRI within each pain location group. Women with PGP were more afflicted than the women with LBP and those without PGP. Highest DRI score was reported by women having combined symphysis pain and bilateral posterior pain. The multivariate analyses showed that results from P4 and ASLR contributed independently to DRI. Taken together, pain location combined with responses to P4 and ASLR tests are relevant when evaluating affliction in pregnant women with possible PGP.

Corticosteroid Injection Treatment to the Ischiadic Spine Reduced Pain in Women With Long-Lasting Sacral Low Back Pain With Onset During Pregnancy

Randomized double blind controlled clinical trial. To evaluate the pain relief effect of locally injected corticosteroid treatment in women with long-lasting sacral low back pain with onset during pregnancy. Pregnancy-related low back pain is a global problem. Almost 1 of 10 women still experienced disabling daily back pain 2 years after childbirth with high impact on the individual, family, and society. On spite of this, the sources of pain and effective treatment are uncertain. Thirty-six women were allocated to injection treatment, with slow-release triamcinolone and lidocaine or saline and lidocaine, given at the sacrospinous ligament insertion on the ischiadic spine bilaterally with 4 weeks follow-up time. Primary outcome measure was reported pain intensity on visual analogue scale and secondary outcome measures number of pain-drawing locations and pain-provoking test results. RESULTS.: The triamcinolone treatment group had significantly reduced pain intensity, number of pain locations, and pain-provoking test results between baseline and follow-up as compared with the saline treatment group. The absolute median change of visual analogue scale score in the triamcinolone treatment group was -24 mm and in the saline group +4.5 mm (P < 0.05). A reduced number of pain drawing locations was reported by 16 of 18 women in the triamcinolone group as compared with 10 of 18 in the saline group (P < 0.05). In the triamcinolone treatment group, 17 of 18 women had an improved pain provocation test result as compared with 9 of 18 in the saline treatment group (P < 0.01). The anatomic region around the sacrospinous ligament insertion on the ischial spine is suggested to be one source of long-lasting sacral low back pain with onset during pregnancy. The pain was relieved by slow-release corticosteroid injection treatment to the ischial spine.

Composite sacroiliac joint pain provocation tests: A question of clinical significance

True sacroiliac (SI) joint pain arises for well-established pathological reasons. For example, SI joint infection is characterised by non-specific, diffuse and poorly localised pain that makes an initial clinical diagnosis difficult, even though the condition is a prima facie SI joint lesion. On the other hand, the putative sacroiliac joint pain of the ‘sacroiliac joint syndrome’ that is by definition not associated with morphological and radiological abnormality, is a symptom commonly observed in clinical practice. Such a presentation possesses a typically well-localisable pain in the region overlying the posterior sacroiliac joint. The contention is that composite SI joint pain provocation tests, whilst of arguably statistical ‘significance’, may lack clinical significance particularly in the light of anatomical research that presents an alternative patho-anatomic basis for localisable sacroiliac pain and may offer a rational basis for diagnosis and treatment.

The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain

Pregnancy-related lumbopelvic pain has varying clinical presentations and effects among subgroups. Different lumbopelvic pain subgroups require different specific management approaches which require the differentiation between lumbar and pelvic girdle pain (PGP). Thirty-one consecutive pregnant women with non-specific lumbopelvic pain were evaluated by two examiners and classified into lumbar pain, PGP, or combined pelvic girdle and lumbar pain. A standard history about different positions/activities of daily life such as bending, sitting, standing, walking, and lying, was followed by a standardised mechanical assessment of the lumbar spine (Mechanical Diagnosis and Therapy), including tests of repeated end-range movements to standing and lying, pelvic pain provocation tests (distraction test, posterior pelvic pain provocation test, Gaenslen's test, compression test, and sacral thrust) a hip-rotation range-of-motion test, the active straight-leg-raising test, and a neurological examination. Agreement for the three syndromes (lumbar pain, PGP, or combined pelvic girdle and lumbar pain) was 87% (27/31), with a kappa coefficient of 0.79 (95% CI 0.60–0.98). It was possible to perform the classification procedure throughout pregnancy. There was substantial agreement between the two examiners for the classification of non-specific lumbopelvic pain into lumbar pain and PGP in pregnant women.

Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs

The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.

Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain

The aim of this study was to investigate sensitivity and specificity of self-administrated tests aimed at pain provocation of posterior and/or anterior pelvis pain and to investigate pain intensity during and after palpation of the symphysis. A total of 175 women participated in the study, 100 pregnant women with and 25 pregnant women without lumbopelvic back pain and 50 non-pregnant women. Standard pain provocation tests were compared with self assessed tests. All women were asked to estimate pain during and after palpation of the symphysis. For posterior pelvic pain, the self-test of P4 and Bridging test had the highest sensitivity of 0.90 versus 0.97 and specificity of 0.92 and 0.87. Highest sensitivity for self-test for anterior pelvic pain was pulling a mat 0.85. Palpation of symphysis was painful and persistency of pain was the longest among women who fulfilled the criteria for symphyseal pain. There were overall significant differences between the groups concerning intensity and persistency of pain (P < 0.001). Our results indicate that pregnant women can perform a screening by provocation of posterior pelvic pain by self-tests with the new P4 self-test and the Bridging test. Palpation of the symphysis is painful and should only be used as a complement to history taking, pain drawing and pulling a MAT-test.

Using the posterior pelvic pain provocation test in pregnant Japanese women

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.

Prognostic factors for recovery from postpartum pelvic girdle pain

Pelvic girdle pain (PGP) has a high incidence during pregnancy and in some women pain will persist for years. Most studies have used pain as the outcome measure, and little attention is given to functioning or disability. A better understanding of prognostic factors for recovery seems important for clinical care and treatment. The aim of the present paper was to identify prognostic factors for recovery from postpartum PGP and disability, and to determine the impacts of prognostic factors when pain intensity and disability are used as outcome measures. Seventy-eight women with diagnosed PGP were included 6-16 weeks postpartum. Possible prognostic factors were obtained through clinical tests and questionnaires at baseline. The clinical tests were posterior pelvic pain provocation (P4) test, active straight leg raise (ASLR) test and pain provocation of long dorsal sacroiliac ligament (LDL). One year postpartum outcome measures were obtained by Oswestry disability index (ODI ver 2.0) and worst evening pain (VAS 0-100). Multiple linear regression and logistic regression analyses were used to identify significant prognostic factors. At baseline 60% believed they would recover and 40% were uncertain or believed they would not recover. Fifty per cent had a history of low back pain (LBP), and 20% had high emotional distress (HSCL25-item > or =1.75). About 75% had positive LDL and P4 at both sides and 24% had pain located to all three pelvic joints. Forty per cent had ASLR scores of at least 4 (sum score range 0-10). Multivariate analyses showed consistently that ASLR and belief in improvement were statistical significant predictors for both disability and pain as outcome measures. ASLR score <4 predicted 10 points lower ODI and 19 points lower evening pain compared with having ASLR score of at least 4. Pain location was a statistical significant predictor in only one analysis. History of LBP or high psychological distress was not prognostic for recovery. ASLR test and belief in improvement are predictors of clinical significance in women having PGP postpartum.