Posterior Pelvic Pain Provocation Test Research Articles

Role of depressive symptoms on the development of pelvic girdle pain in pregnancy: A prospective inception cohort study.

Pelvic girdle pain in pregnancy is a major public health concern. For too many women, the pain condition causes disability and sick leave, has a negative impact on daily life, and breeds doubt in their view as mother, partner, and worker. The pathophysiology is unknown and causal treatment is lacking. Depression in pregnancy is common, undertreated, and previously associated with pelvic girdle pain with unclear causal direction. A prospective inception cohort study of 356 Swedish women examined them in early and late pregnancy. Women with a positive Posterior Pelvic Pain Provocation test in early pregnancy were not included. The exposure, depressive symptoms in early pregnancy, was self-reported on the Hospital Anxiety and Depression Scale, depression part (0-21). Outcome measure in late pregnancy was a graded score on the Posterior Pelvic Pain Provocation test (0-8). Covariates for statistical adjustment were identified in a directed acyclic graph. Linear robust and logistic regression were used in the statistical analyses. In early pregnancy, the 248 women with negative Posterior Pelvic Pain Provocation test had a mean score of 2.35 (± 2.3 standard deviation) on the Hospital Anxiety and Depression Scale, depression part. In a fully adjusted, multiple robust regression model a positive association was shown between Hospital Anxiety and Depression Scale score, depression part, and the Posterior Pelvic Pain Provocation test score in late pregnancy with an estimated effect of β=0.32 (95% confidence interval [CI] 0.16-0.48, p < 0.001). Dichotomization of exposure (Hospital Anxiety and Depression Scale, depression part <8/≥8) and outcome (Posterior Pelvic Pain Provocation test score 0/>0) rendered adjusted odds ratio 1.71 (95% CI 0.38-7.7) and numbers needed to treat adjusted odds ratio 5.54 (95% CI -3.4-14.5). Depressive symptoms in early pregnancy were associated with the development and intensity of pelvic girdle pain in late pregnancy. Considering the small sample size, screening and treatment for depressive symptoms in early pregnancy may enable a way to reduce and prevent disabling pelvic girdle pain in late pregnancy. Trials are needed to confirm the results.

POSTERIOR PELVIC PAIN

Background: Pregnancy related posterior pelvic pain (PRPPP) is a common complaint among pregnant females. It is one of main source for disability, absence from work and is responsible for direct and indirect economical impact. Purpose of the Study: To investigate the prevalence of pregnancy associated posterior pelvic pain and to ascertain its occurrence in three trimesters of pregnancy. Study Design: Cross sectional survey. Setting: District Head Quarter Hospital Sargodha &amp; Gynae OPDs of different clinics. Period: Jan 2013 to Dec 2013. Materials and Methods: 200 pregnant females, the range of age group was 16-42 years and participants were selected through convenience sampling technique. All pregnant females were interviewed using structured questionnaire having open and close ended questions. Posterior pelvic pain provocation test and Gaenslen’s test were performed on all females with lumbo-pelvic pain and intensity of pain was measured, using visual analogue scale. Results: 200 pregnant females were studied, 140 (70%) pregnant females were in 2nd or 3rd trimesters of pregnancy and 102 (51%) reported posterior pelvic pain, and amongst 60 pregnant females in 1st trimesters showed only 10 (5%) reported posterior pelvic pain. All pregnant females (n=112,56%) having posterior pelvic pain showed positive posterior pelvic pain tests and Intensity of pain in pregnant females with pelvic girdle pain in 1st, 2nd and 3rd trimesters measured using visual analogue scale, with mean value 6.09 ( SD= 2.16). Conclusion: About 2 in every 3rd femalesstudied; reported to have posterior pelvic pain, more in 2nd and 3rd trimesters of pregnancy as compared to 1st trimester of pregnancy. The high prevalence causes considerable health problem, physical dysfunction, and poor work performance in Pakistani pregnant females andneed more attention by health professionals and researchers.

Pelvic girdle pain in Indian postpartum women: a cross-sectional study

During pregnancy or postpartum period many women will experience some degree of pelvic girdle pain (PGP). In India, there is no information about the PGP prevalence and its associated factors evaluated during postpartum period. Purpose: To reveal the prevalence of PGP postpartum in Indian women and identify associated factors with PGP postpartum. Methods: In this cross-sectional study, 284 postpartum women completed a questionnaire and underwent clinical examinations. The clinical examination included pain provocation tests for the pelvic as well as the active straight leg raise (ASLR) test. Possible associating factors were studied by using nonparametric tests and logistic regression analysis. Results: A total of 116 postpartum women (41%) had reported PGP at the time of the examination. A stepwise logistic regression analysis was performed to reveal associated factors. In the final model, factors such as (1) Caesarean delivery (adjusted OR, 2.0; 95% CI, 1.3–4.9); (2) ASLR test score ≥4 (adjusted OR, 2.3; 95% CI, 1.2–3.3); (3) Unilateral P4 test (adjusted OR, 1.8; 95% CI, 1.1–3.0); and (4) Sitting position during feeding (adjusted OR, 1.5; 95% CI, 0.9–2.8) were associated with the PGP. Conclusion: We found a high prevalence of PGP in Indian women during the first three months of postpartum period. Our finding suggests that unilateral posterior pelvic pain provocation test (P4), ASLR test score ≥4, caesarean section delivery and sitting in breast-feeding posture were associated with increased risk of PGP during postpartum.

The Active Straight Leg Raise test in lumbopelvic pain during pregnancy

Although many properties of the Active Straight Leg Raise (ASLR) test as a diagnostic test in lumbopelvic pain (LPP) are well documented, various elements are lacking. A cross-sectional study was performed to compute sensitivity and specificity, to assess the advantages and disadvantages of various cutoff points, to analyze the relation between the ASLR test and the Posterior Pelvic Pain Provocation (PPPP) test, and to investigate the relation with confounders.Data of 110 women with LPP and 72 without LPP were available. The advantages and disadvantages of four cutoff points of ASLR, and combinations of the ASLR and PPPP, were investigated by comparing sensitivity, specificity and area under the curves (AUC) of receiver operating characteristic curves (ROC). The influence of the site of pain was analyzed by means of AUC. The relation with confounders was measured using Pearson correlation coefficients.Results show that for diagnostic use the best cutoff for the ASLR test in pregnancy is between score 0 and 1. Specificity of the ASLR test is good (88%). Sensitivity for all types of LPP during pregnancy is moderate (54%), and is larger in case of more pain and disability. When combined with the PPPP test, sensitivity of the ASLR test is larger (68%). Isolated symphyseal pain, isolated low back pain and isolated coccyx pain are not diagnosed by these two tests. The ASLR test is not influenced by age, number of previous deliveries, BMI, cause of LPP (pregnancy-related or not), the existence of urinary incontinence and/or level of fatigue.

Severity of signs and symptoms in lumbopelvic pain during pregnancy

Data on the severity of signs and symptoms of lumbopelvic pain (LPP) during pregnancy are scarce. Therefore, this cross-sectional study examines the severity of LPP and pain-related signs and symptoms.Women with an uncomplicated pregnancy of 20–30 weeks were invited to participate. They rated their pain and fatigue on a numerical rating scale, and pain location was indicated on a drawing. Disability was scored on the Quebec Back Pain Disability Scale (QBPDS) and urine incontinence on a Likert scale. Physical examination consisted of the Active Straight Leg Raise (ASLR) test, the Posterior Pelvic Pain Provocation (PPPP) test and pain score, and force during isometric bilateral hip adduction.Of all 182 participants, 60.4% reported LPP. Mean pain level was 3.6 (SD 2.2); in 20.0% of the women the score was >5. The mean score on the QBPDS was 27 (SD 16); in 20.9% the score was >40. Compared to women without LPP, women with LPP more frequently suffered back pain in the past (p<0.001), had a higher body mass index (p<0.01), more often had urinary incontinence (p<0.05), had less isometric hip adduction force (p<0.001), had more pain on isometric hip adduction (p<0.01), had a higher ASLR score (p<0.001) and more had often a positive PPPP test (p<0.001). Fatigue was not related to LPP during pregnancy.The main conclusion is that pain and disability of LPP during pregnancy can be interpreted as mild to moderate in most cases, and as severe in about 20%.

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.

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.

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.

Physical Characteristics of Women With Severe Pelvic Girdle Pain After Pregnancy

Descriptive cohort study. This study aims to further elucidate the differences in physical characteristics of women with severe pregnancy-related pelvic girdle pain (PGP). There is increasing interest in pelvic girdle pain (PGP). To our knowledge, this is the first study on a large population of patients with severe PGP, after pregnancy, based on high cutoff scores on diagnostic PGP tests. Two hundred five patients were selected from the outpatient clinic of a rehabilitation center. Patients were divided in 3 inclusion groups based on the total number of positive scores on 5 diagnostic tests; i.e., active straight leg raise test, posterior pelvic pain provocation test, long dorsal sacroiliac ligament test, and hip abduction and adduction strength tests. These inclusion groups were related to the data on trunk strength test, general provocation tests, Quebec Back Pain Disability Scale (QBPDS) and activities of daily living. A typical pattern of PGP emerges from this study. The mean group score on the active straight leg raise, posterior pelvic pain provocation, and long dorsal sacroiliac ligament tests became higher when more than 3 inclusion tests were positive. Hip abduction and adduction strength became lower with more positive tests. The QBPDS score was overall high and significantly higher for 5 positive tests compared with 3 and 4 positive tests. This shows that the number of positive tests, the individual score on the diagnostic tests, and the QBPDS could all be an indicator for severity of PGP. Among the general pain provocation tests, both the passive hip flexion test and the upper and middle sacral thrust test scored high. The maximal isometric strength of trunk muscles was below the 10th percentile compared with women without complaints and was even less for 5 positive inclusion tests. It is confirmed that there is a typical order for difficulties with daily activities for PGP patients as follows (most difficult first): standing still, cycling, walking, sitting, and lying. The study shows that the level of severity in PGP can be adequately assessed by a combination of specific tests.

Pregnancy Related Pelvic Girdle Pain and Low Back Pain in an Iranian Population

A cross-sectional study in pregnancy. To differentiate between pregnancy related pelvic girdle pain (PGP) and low back pain (LBP) in Iranian women, and investigate the prevalence of each syndrome. 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. 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. 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). 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.

Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints.

The aim of this study was to investigate the association between pregnancy-related pelvic pain (PRPP) and sacroiliac joint (SIJ) laxity. A cross-sectional analysis was performed in a group of 163 women, 73 with moderate or severe (PRPP+) and 90 with no or mild (PRPP-) PRPP at 36 weeks of pregnancy. SIJ laxity was measured by means of Doppler imaging of vibrations in threshold units (TU). Pain, clinical signs and disability were assessed with visual analog scale (VAS), posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR) test, and Quebec back pain disability scale (QBPDS), respectively. Mean SIJ laxity in the PRPP+ group was not significantly different from the PRPP- group (3.0 versus 3.4 TU). The mean left-right difference, however, was significantly higher in the PRPP+ group (2.2 TU) than in the PRPP- group (0.9 TU). In the PRPP- group, only 4% had asymmetric laxity of the SIJs in contrast to 37% of the PRPP+ group. Between the PRPP+ subjects with asymmetric and symmetric laxity of the SIJs significant differences were found with respect to mean VAS for pain (7.9 versus 7.0), positive PPPP test (59% versus 35%), positive ASLR test (85 versus 41%) and mean QBPDS score (61 versus 50). Increased SIJ laxity is not associated with PRPP. In fact, pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. However, a clear relation between asymmetric laxity of the SIJs and PRPP is found.

Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints

Objective. The aim of this study was to investigate the association between pregnancy-related pelvic pain (PRPP) and sacroiliac joint (SIJ) laxity. Methods. A cross-sectional analysis was performed in a group of 163 women, 73 with moderate or severe (PRPP+) and 90 with no or mild (PRPP−) PRPP at 36 weeks of pregnancy. SIJ laxity was measured by means of Doppler imaging of vibrations in threshold units (TU). Pain, clinical signs and disability were assessed with visual analog scale (VAS), posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR) test, and Quebec back pain disability scale (QBPDS), respectively. Results. Mean SIJ laxity in the PRPP+ group was not significantly different from the PRPP− group (3.0 versus 3.4 TU). The mean left-right difference, however, was significantly higher in the PRPP+ group (2.2 TU) than in the PRPP− group (0.9 TU). In the PRPP− group, only 4% had asymmetric laxity of the SIJs in contrast to 37% of the PRPP+ group. Between the PRPP+ subjects with asymmetric and symmetric laxity of the SIJs significant differences were found with respect to mean VAS for pain (7.9 versus 7.0), positive PPPP test (59% versus 35%), positive ASLR test (85 versus 41%) and mean QBPDS score (61 versus 50). Conclusions. Increased SIJ laxity is not associated with PRPP. In fact, pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. However, a clear relation between asymmetric laxity of the SIJs and PRPP is found.