Pregnancy-related Pelvic Girdle Pain Research Articles

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.

Water Aerobics Reduces Sick Leave due to Low Back Pain During Pregnancy

To compare the effect of a land-based, physical exercise program versus water aerobics on low back or pelvic pain and sick leave during pregnancy. Randomized controlled clinical trial. Three antenatal care centers. 390 healthy pregnant women. A land-based physical exercise program or water aerobic once a week during pregnancy. Sick leave, pregnancy-related low back pain or pregnancy-related pelvic girdle pain, or both. Water aerobics diminished pregnancy-related low back pain (p=.04) and sick leave due to pregnancy-related low back pain (p=.03) more than a land-based physical exercise program. Water aerobics can be recommended for the treatment of low back pain during pregnancy. The benefits of a land-based physical exercise program are questionable and further evaluation is needed.

Pelvic Girdle Pain and Lumbar Pain in Pregnancy: A Cohort Study of the Consequences in Terms of Health and Functioning

A cohort study in pregnancy. 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. 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. 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. 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. Pain intensity, disability, and health measurements differentiate subgroups of lumbopelvic pain in pregnancy.

Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery: Short-term results of a randomized clinical trial [ISRCTN08477490

BackgroundFor the moment, scientific evaluation of programs on treatment of pregnancy-related pelvic girdle and/or low back pain after delivery is hardly available with only one study with a positive result, suggesting uncertainty about the optimal approach. Investigators draw particular attention to biomedical factors but there is growing evidence that biopsychosocial factors appear to be even more important as a basis of an intervention program.MethodsWe studied the effectiveness of a tailor-made program with respect to biopsychosocial factors (intervention group) in women with pregnancy-related pelvic girdle and/ or low back pain versus usual care based on a pain contingent basis (control group) shortly after delivery in a randomized controlled trial. Women with severe complaints shortly after delivery were selected from a longitudinal prospective cohort study (n = 7526), aimed at pregnancy-related pelvic girdle and/or low back pain in the Netherlands. A concealed block randomization was performed after collecting baseline data. Researchers were blinded to treatment assignment. Outcomes were evaluated within the domains of the biopsychosocial approach. Primary outcome concerned limitations in activities (RDQ). Follow-up measurements were performed 12 weeks after delivery.ResultsSince May 2001 until July 2003, 869 women out of the cohort made a request for treatment by a physiotherapist, 10 days after delivery. Because of a quick recovery in two weeks time, we included only 126 women three weeks after delivery. There was a statistically significant and clinically relevant difference in improvement on the primary outcome (RDQ) between the two groups in favor of the experimental intervention.ConclusionThe results favored the hypotheses. Women's worries about their condition were major targets in the experimental intervention. The prognosis after delivery, especially in de first weeks, turned out to be favorable.

Etiology of atopy in infancy: The KOALA Birth Cohort Study

The aim of the KOALA Birth Cohort Study in the Netherlands is to identify factors that influence the clinical expression of atopic disease with a main focus on lifestyle (e.g., anthroposophy, vaccinations, antibiotics, dietary habits, breastfeeding and breast milk composition, intestinal microflora composition, infections during the first year of life, and gene-environment interaction). The recruitment of pregnant women started in October 2000. First, participants with 'conventional lifestyles' (n = 2343) were retrieved from an ongoing prospective cohort study (n = 7020) on pregnancy-related pelvic girdle pain. In addition, pregnant women (n = 491) with 'alternative lifestyles' with regard to child rearing practices, dietary habits (organic, vegetarian), vaccination schemes and/or use of antibiotics, were recruited through organic food shops, anthroposophic doctors and midwives, Steiner schools, and dedicated magazines. All participants were enrolled between 14 and 18 wk of gestation and completed an intake questionnaire on family history of atopy and infant care intentions. Documentation of other relevant variables started in the pregnant mother and covered the first and third trimester as well as early childhood by repeated questionnaires at 14-18, 30, and 34 wk of gestation and 3, 7, 12, and 24 months post-partum. A subgroup of participants, including both conventional and alternative lifestyles, was asked to consent to maternal blood sampling, breast milk and a faecal sample of the infant at 1 month post-partum, capillary blood at age 1 yr, venous blood and observation of manifestation of atopic dermatitis during home visits at the age of 2 yr (using the UK working party criteria and the severity scoring of atopic dermatitis index), and buccal swabs for DNA isolation from child-parent trios. From the start, ethical approval and informed consent procedures included gene-environment interaction studies. Follow-up at 3 and 7 months post-partum was completed with high response rates (respectively 90% and 88% in the conventional group, and 97% and 97% in the alternative group). The home visits at 2 yr of age will be completed in 2005. Preliminary results show that we have succeeded in recruiting a large population with various lifestyle choices with a fairly large contrast with regard to dietary habits (including organic foods, vegetarian diet), vaccination schemes and/or use of antibiotics. We have also been able to collect a large number of faecal samples (n = 1176) and capillary blood samples at age 1 yr (n = 956). Furthermore, a large proportion of the participants have consented with genetic studies. Mid 2006 we expect to report our first results on the relationship between the various exposures in early life and childhood atopy. An outline of the focus and design of the KOALA Birth Cohort Study is presented.

The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain

Many patients with pregnancy-related pelvic girdle pain experience relief of pain when using a pelvic belt, which makes its use a common part of the therapy, but there is no in vivo proof of the mechanical effect of the application of a pelvic belt. The influence of a pelvic belt on sacroiliac joint laxity values was tested in 25 subjects with pregnancy-related pelvic girdle pain by means of Doppler imaging of vibrations in prone position with and without the application of a pelvic belt. The belt was adjusted just below the anterior superior iliac spines (high position) and at the level of the pubic symphysis (low position). Sacroiliac joint laxity values decreased significantly during both applications of a pelvic belt (P<0.001). The application of a pelvic belt in high position decreased sacroiliac joint laxity to a significantly greater degree than the application of a belt in low position (P=0.006). The decrease of laxity significantly correlated with the decrease of the score on the active straight leg raise test (r=0.57 for the low position, P=0.003 and r=0.54 for the high position, P=0.005). Application of a pelvic belt significantly decreases mobility of the sacroiliac joints. The decrease of mobility is larger with the belt positioned just caudal to the anterior superior iliac spines than at the level of the pubic symphysis. The findings are in line with the biomechanical predictions and might be the basis for clinical studies about the use of pelvic belts in pregnancy-related pelvic girdle pain.

Etiology and prognosis of pregnancy-related pelvic girdle pain; design of a longitudinal study

BackgroundAbsence of knowledge of pregnancy-related pelvic girdle pain (PPGP) has prompted the start of a large cohort study in the Netherlands. The objective of this study was to investigate the prevalence and incidence of PPGP, to identify risk factors involved in the onset and to determine the prognosis of pregnancy-related pelvic girdle pain.Methods/design7,526 pregnant women of the southeast of the Netherlands participated in a prospective cohort study. During a 2-year period, they were recruited by midwives and gynecologists at 14 weeks of pregnancy. Participants completed a questionnaire at baseline, at 30 weeks of pregnancy, at 2 weeks after delivery, at 6 months after delivery and at 1 year after delivery. The study uses extensive questionnaires with questions ranging from physical complaints, limitations in activities, restriction in participation, work situation, demographics, lifestyle, pregnancy-related factors and psychosocial factors.DiscussionThis large-scale prospective cohort study will provide reliable insights in incidence, prevalence and factors related to etiology and prognosis of pregnancy-related pelvic girdle pain.

Treatment of pregnancy-related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study [ISRCTN08477490

BackgroundPregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-to-day activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program.Methods/designThis pragmatic randomized controlled trial is designed to evaluate the effectiveness of a tailor-made treatment program with respect to biopsychosocial factors in primary care. The effect of the experimental intervention and usual care are evaluated as they are applied in primary health care. The trial is embedded in a cohort study that is designed as a longitudinal, prospective study, which studies prevalence, etiology, severity and prognosis during pregnancy until one year after delivery. The present paper focuses on choices regarding recruitment procedures, in-/exclusion criteria and the development of a well-timed intervention.DiscussionThis section briefly discusses the actions taken to minimize bias in the design, the proper time-window for the experimental intervention and the contrast between the experimental intervention and usual care.

Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence.

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.

Gait coordination in pregnancy: transverse pelvic and thoracic rotations and their relative phase

Objective. To examine the effects of pregnancy on the coordination of transverse pelvic and thoracic rotations during gait. Design. Gait of healthy pregnant women and nulligravidae was studied during treadmill walking at predetermined velocities ranging from 0.17 to 1.72 m/s. Background. Pelvis–thorax coordination during walking is altered in women with postpartum pregnancy-related pelvic girdle pain. This coordination has not been investigated in a healthy pregnant population. Methods. Comfortable walking velocity was established. Amplitudes of pelvic and thoracic rotations were calculated. Their coordination was characterized by relative Fourier phase and its standard deviation. Results. Comfortable walking velocity was significantly reduced. The amplitudes of pelvic and thoracic rotations were somewhat reduced, with significantly smaller intra-individual standard deviations. Also pelvis–thorax relative Fourier phase was somewhat smaller, its intra-individual standard deviation was negatively correlated with week of pregnancy, and significantly lower at velocities ⩾1.06 m/s. Conclusions. The general pattern of gait kinematics in pregnant women is very similar to that of nulligravidae. Still, it appears that pregnant women experience difficulties in realizing the more anti-phase pelvis–thorax coordination that is required at higher walking velocities. Relevance The present study shows that gait in healthy pregnancy is remarkably normal, but some differences in pelvis–thorax coordination were detected. In healthy pregnancy, anti-phase pelvis–thorax coordination appears difficult, but less so than in pregnancy-related pelvic girdle pain. Better understanding of gait in healthy pregnancy may provide insight into the gait problems of women with pregnancy-related pelvic girdle pain.

Pelvic girdle pain may be an overlooked hormone adverse effect

A high proportion of pregnant women report low back or pelvic girdle pain during pregnancy (1). The location of the pain can be verified by pain provocation tests (2,3). In most women, the pregnancy-related pain ceases within 6 months. However, among women who have experienced pain from all three pelvic joints (symphysis and sacroiliac joints), one-fifth still have disabling pelvic girdle pain 2 years postpartum (4). The etiology of the pain is uncertain. A 42-year-old woman was admitted to the Department of Rheumatology because of disabling pelvic girdle pain and arthralgia. In childhood, she had swollen knees after German measles. She has had psoriasis since her teens but is asymptomatic today. She had used oral contraception from 16 until 33 years of age. She was gravida 2, para 2 with parturition in 1991 and 1994. During her pregnancies, she suffered from pelvic girdle pain from the first trimester. In the second trimester, she was bedridden due to disabling pain. Her first delivery was performed vaginally at term and the second by caesarean section preterm owing to preeclampsia. Six months after the deliveries she had improved. Six months after her last delivery, she had a levonorgestrel intrauterine system (LNG IUS) inserted. It was replaced in the autumn of 1999. From December 1999, she experienced increasing pelvic girdle pain, without being pregnant, with the same pain location as during previous pregnancies. She worked at this time as an assistant nurse, often performing heavy lifting tasks. She tried to remain at work by using analgesics and reducing physical activity during leisure time but the severe pain made her unable to continue working. Despite sick-leave, the pain increased to a disabling level. She was unable to load her pelvis at all, even straining at stool. She was dependent on help for her daily living activities. Investigation at the Department of Rheumatology showed no clinical or laboratory signs of inflammatory rheumatic disease. X-ray of her spine, pelvis and hips was normal. On the recommendation of the Department of Rheumatology, the LNG IUS was removed in January 2002. Afterwards, she experienced gradually diminishing pelvic girdle pain and could participate in a rehabilitation program. Ten months after the extraction, she could manage daily living activities and could go for a walk of 3 km. A remarkable deterioration and later improvement was experienced by this woman with previous pregnancy-related pelvic girdle pain after replacement and removal of an LNG IUS. During treatment with hormone contraceptives, that is both pills and intrauterine implants, symphysiolysis has been reported in a few cases. The three cases reported to the Swedish Registry for Adverse Effects of Drugs from 1982 until 2002 were all disabled owing to symphysiolysis. However, their pelvic girdle pain was reversible after ceased exposure. The woman presented here had used the pill for 16 years before her first pregnancy. During her pregnancies, she had disabling pelvic girdle pain and then her uterine device was changed at a time when she had a heavy mechanical load on her back and pelvis. If there was an additional hormonal contribution to the exacerbation of the pelvic girdle pain, an increased level of circulating levonorgestrel after reinsertion of the LNG IUS could be of importance. Whether there is a causal relationship between the exposure to this implant and development of pelvic pain cannot be assessed in this case. In view of the dramatic deterioration in this case, we consider it necessary to draw prescribers' attention to this possibility and to the importance of reporting any other similar cases to their registry of adverse effects of drugs.

Maternity support binder helps low back pain of pregnancyCarr CA. Use of a maternity support binder for relief of pregnancy-related back pain. J Obstet Gynecol Neonat Nurse 2003;32:495–502

Objective. To examine the effects of pregnancy on the coordination of transverse pelvic and thoracic rotations during gait.Design. Gait of healthy pregnant women and nulligravidae was studied during treadmill walking at predetermined velocities ranging from 0.17 to 1.72 m/s.Background. Pelvis–thorax coordination during walking is altered in women with postpartum pregnancy-related pelvic girdle pain. This coordination has not been investigated in a healthy pregnant population.Methods. Comfortable walking velocity was established. Amplitudes of pelvic and thoracic rotations were calculated. Their coordination was characterized by relative Fourier phase and its standard deviation.Results. Comfortable walking velocity was significantly reduced. The amplitudes of pelvic and thoracic rotations were somewhat reduced, with significantly smaller intra-individual standard deviations. Also pelvis–thorax relative Fourier phase was somewhat smaller, its intra-individual standard deviation was negatively correlated with week of pregnancy, and significantly lower at velocities ⩾1.06 m/s.Conclusions. The general pattern of gait kinematics in pregnant women is very similar to that of nulligravidae. Still, it appears that pregnant women experience difficulties in realizing the more anti-phase pelvis–thorax coordination that is required at higher walking velocities.Relevance The present study shows that gait in healthy pregnancy is remarkably normal, but some differences in pelvis–thorax coordination were detected. In healthy pregnancy, anti-phase pelvis–thorax coordination appears difficult, but less so than in pregnancy-related pelvic girdle pain. Better understanding of gait in healthy pregnancy may provide insight into the gait problems of women with pregnancy-related pelvic girdle pain.