Pregnancy-related Pelvic Pain Research Articles

Comparing the Effects of Lumbar-pelvic and Pelvic Belts on the Activity of Pelvic Muscles in Pregnant Women With Back and Pelvic Pain

Objective The physical and hormonal changes occur in pregnant women, which may cause skeletal and muscular discomforts and back and pelvic pain. If the pelvic muscles mechanism is damaged, pelvic joints may have less stability, and the joint is more exposed to shearing force. As a result of this condition, the activity pattern of these muscles of the lumbar region may change, increased muscle activity compensates for the anterior forces, and bending moments may occur, especially when the abdomen volume is increased. In previous studies, the activity of pelvic muscles in the test of active straight leg raise (ASLR) was evaluated in pregnant women without using a pelvic belt. These belts are strapped at the level of the pelvic ring and do not fully support the lumbar region. The lumbar-pelvic belt can extend below the lower angle of the scapula, completely covering the lumbar region and supporting the waist and pelvis simultaneously. As a result, the whole body acts as a unit compared to a pelvic belt. The present study aims to compare the effect of the lumbar-pelvic belt with the pelvic belt in the activity of the pelvic muscles during the ASLR test of the lower limb in pregnant women with back and pelvic pain. Materials & Methods This was a clinical trial study on 48 pregnant women with pregnancy-related back and pelvic pain referred to the Kawsar Specialized and Subspecialty Clinic in Arak City, Iran. The sampling method was convenience sampling based on inclusion and exclusion. All participants completed the written consent form, and then they were randomly divided into three groups: lumbar-pelvic belt (14 women), pelvic belt (14 women), and control (20 women). First, a demographic questionnaire was completed by the participants. Then the pelvic muscles’ muscle activity was evaluated using surface electromyography during the ASLR test at the beginning of the study and then three weeks later. Covariance analysis was used in SPSS version 26 software for data analysis, and the significance level was considered 0.05. Results After three weeks of using the devices, the activity of the right rectus femoris, left rectus femoris, right biceps femoris, and left biceps femoris muscles decreased in both groups who used the belts and increased in the control group during the ASLR test. The activity of the right biceps femoris and left biceps femoris muscles in the lumbar-pelvic belt group was significantly reduced compared to the pelvic belt group (P<0.001). Although the activity level of the right rectus femoris and left rectus femoris muscles in the lumbar-pelvic belt group decreased more than the pelvic belt group, this decrease was not statistically significant. Conclusion The activity of the rectus femoris and biceps femoris muscles during the ASLR test decreased in both groups using the pelvic belts and increased in the control group after three weeks. This finding shows the effect of both pelvic belts on improving pelvic muscle activity. However, the lumbar-pelvic belt had a greater impact on improving the activity of the biceps femoris muscles than the pelvic belt during the ASLR test.

Pilates-based therapeutic exercise for pregnancy-related low back and pelvic pain: A prospective, randomized, controlled trial.

In this study, we aimed to clarify the impact of a Pilates-based therapeutic exercise on disability, pain, mood, and sleep quality in patients with pregnancy-related lumbopelvic pain (LPP). In the single-blinded randomized controlled study conducted between January 2018 and June 2018, 34 pregnant women (mean age: 29.7±6.2 years; range, 18 to 40 years) in the second trimester (week 14-24) with LPP were randomly assigned to a control group and a Pilates group. All patients underwent usual prenatal care. In addition, the selected Pilates exercise was carried out twice a week for 60-min per session for 12 weeks in the Pilates group. The control group was not prescribed an exercise regimen; however, they were not discouraged from exercising. The primary outcome was disability; secondary outcomes were LPP, mood, and sleep quality. Disability [Roland-Morris Disability Questionnaire (RMDQ)], LPP [Visual Analog Scale (VAS)], mood [Hospital Anxiety and Depression Scale, Anxiety (HADS-A) and Depression (HADS-D) subscales], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were measured before and after 12 weeks. Adverse effects and adherence were recorded to determine exercise safety and compliance. The intention-to-treat analysis was applied. The between-group effect sizes were moderate for the RMDQ and VAS scales (d=0.4 and d=0.7, respectively) and small for the HADS-A and HADS-D scales (both d=0.2). The intention-to-treat analysis demonstrated that there was a statistically significant difference in disability, pain, and mood in favor of the Pilates group (p0.05). Adding Pilates to usual prenatal care should be considered a promising treatment option for pregnancy-related LPP.

Effect of Body Acupuncture on Pregnancy-Related Low Back Pain and Pelvic Pain: A Systematic Review

Purpose: The aim of the authors of this study was to determine the effect of body acupuncture on the symptoms of low back pain and pelvic pain suffered during pregnancy.
 Methods: In this systematic review, 8 international databases (Cinahl, PubMed, Web of Science, Google Scholar, Science Direct, Scopus, Ebsco Host, Cochrane Library) comprising the period between January 2000 and March 2020 were screened. Articles that are not in English and Turkish were excluded. Three authors screened the related articles based on the titles and abstracts independently of each other. 
 A data extraction form was filled in for each appropriate study. The quality of the studies included in the study was assessed using the Jadad scale and PRISMA guidelines.
 Results: Finally, six studies conducted in 3 countries between January 2000 and March 2020 with 838 pregnant women with complaints of low back pain and pelvic pain were included in the review. The results showed that body acupuncture reduced pregnancy-related low back pain and pelvic pain complaints and that it had no side effects.
 Conclusion: We think that body acupuncture, a non-pharmacological method, will help clinicians to relieve the symptoms of pregnancy-related pelvic pain and low back pain.

A Yoga programme approaches for pregnancy-related low back and pelvic pain

Background : One of the most common discomforts during pregnancy is relating to low back and pelvic pain. Predisposing factors include uterine growth that causes posture changes, weight gain, the influence of relaxin hormone on ligaments, previous history of back pain, parity and activity. The exercise that helps pregnant women get a power to facilitate the delivery process by a Yoga programme approaches. Purpose : To determine the effect of a Yoga programme approaches for pregnancy-related low back and pelvic pain Method : A quantitative research method. The study population was third trimester pregnancy, taken by purposive sampling technique, and got a sample of 22 participants and Questionnaire used as the research instrument test. The analysis technique used in this research is descriptive quantitative. Results: Finding that the average score of low back and pelvic pain before a Yoga programme (pre test) was 3.73 (moderate pain) with a standard deviation of 1.38. The average score after intervention at the post-test stage was 1.14 (mild pain) with a standard deviation of 0.94. (p value = 0.000 <0.05). Conclusion: There is an effect of a Yoga programme approaches for pregnancy-related low back and pelvic pain in third trimester pregnancy

The associations of pregnancy-related symptoms with health-related quality of life at midpregnancy: the PregnActive project

Aim To analyze the associations between the wide range of pregnancy-related symptoms and health-related quality of life. Material and methods A cross-sectional study was developed among 155 healthy low-risk pregnant women, aged 18–45 years, participated in the study at midpregnancy. Health-related quality of life and pregnancy symptoms were assessed using the Medical Outcome Study 36-item short form questionnaire and the Pregnancy Symptoms Inventory, respectively. Simple correlations, hierarchical linear regressions and standard multiple regressions were performed. Results Significant correlations, after adjusting for sociodemographic and anthropometric characteristics, were found between five pregnancy-related symptoms and physical component of health-related quality of life and between thirteen pregnancy-related symptoms and mental component. However, when all pregnancy symptoms were entered simultaneously into a multiple regression model, back pain and shortness of breath on the physical components, and feeling depressed and anxiety on the mental component were the main explanatory factors of health-related quality of life. Conclusion Among the wide range of pregnancy-related symptoms, back pain, hip or pelvic pain, shortness of breath, and feeling depressed and anxiety are the main symptoms affecting the physical and the mental components of health-related quality of life, respectively. An early detection of the pregnancy-related symptoms that may affect health-related quality of life enables early interventions aimed at ameliorating their negative impact on health-related quality of life and daily living activities at midpregnancy.

Sacroiliac infiltration in pregnant women guided by ultrasound. Case report

ABSTRACT BACKGROUND AND OBJECTIVES Pregnancy-related pelvic pain (PRPP) is one of the most frequent causes of pain during pregnancy, which can result in significant physical disability. It is often undertreated, as it is a condition considered normal during pregnancy and there is fear that the treatment may cause changes in the pregnant woman and the fetus. The objective of this study was to report a case of PRPP, its treatment with sacroiliac joint infiltration guided by ultrasound and to perform a literature review. CASE REPORT Pregnant woman at 35 weeks of gestation, developing PRPP originating from the left sacroiliac joint. She underwent ultrasound-guided joint infiltration with 5mL of 0.5% ropivacaine and 20mg of methylprednisolone. The patient had no pain after the procedure and remained so after delivery. CONCLUSION: Despite the few cases described in the literature, the use of pain intervention treatment in pregnant women seems safe and effective.

Effects of exercise therapy for pregnancy-related low back pain and pelvic pain: A protocol for systematic review and meta-analysis.

Background:Pregnancy-related low back pain (PLPB) and pelvic pain (PP) are common in pregnancy. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Women commonly utilize complementary exercise therapies such as yoga, motor control exercises, breathing exercises, core stability exercise, pelvic stability exercise, and so on to manage their symptoms. However, it is currently unknown whether exercise produces more beneficial effects than other treatment in patients with PLPB and PP. The aim of this study is to explore the therapeutic effect of exercise for pregnancy-related low back pain and PP.Methods:This review will only include randomized controlled trials. Published articles from July 1999 to July 2019 will be identified using electronic searches. Search strategy will be performed in 3 English databases, 1 Chinese database, and the World Health Organization International Clinical Trials Registry Platform. Two reviewers will screen, select studies, extract data, and assess quality independently. The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool and Physiotherapy Evidence Database scale. Review Manager Software (Revman5.3) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence.Results:We will provide some more practical and targeted results investigating the effect of exercise therapy (ET) for PLPB and PP in the current meta-analysis. Meanwhile, we will ascertain study progress of ET for PLPB and PP and find out defects or inadequacies of previous studies, so that future researchers could get beneficial guidance for more rigorous study.Conclusion:The stronger evidence about PLPB and PPs rehabilitative effect and safety will be provided for clinicians and policymakers.Systematic review registration:PROSPERO CRD 42017075099.

Current status of nondrug therapy for pregnancy-related low back pain and pelvic pain

Through reviewing domestic and foreign literatures of pregnancy-related low back and pelvic pain, the paper summarized non-drug therapies including the exercise therapy, Chinese medicine therapy, gear support therapy and other therapies such as virtual reality technology, as well as the application object and effect of intervention, providing evidences for guiding clinical nursing. Key words: Pregnancy; Pregnant; Low back pain; Pelvic pain

Neuraxial block and pregnancy-related low back pain

Background Pregnancy-related low back pain(PLBP) is a common pathological condition during pregnancy and postpartum. Neuraxial block is the most useful technology for analgesia during cesarean section and labor, and the causal link between neuraxial block and PLBP has been a hot topic in obstetrics research. Objective To review the research progress in the relationship between neuraxial block and PLBP. Content PLBP includes pregnancy-related lumbar pain(PLP) and pelvic girdle pain(PPGP). PLP is triggered by specific movement or posture, and usually radiates from low back to feet, while PPGP may reduce endurance in sitting, standing, and walking. In comparison with general anesthesia, neuraxial block raises incidence of PLBP because it involves tissue damages, hemorrhage, relaxation of skeletal muscles, and stretch of tendons. Tissue damage and hemorrhage during neuraxial block can be reduced by ultrasound-assisted guidance. Cautions should be taken to relieve low back pain during pregnancy with neuraxial block because of risk of failure and complications. Ultrasound-guided neuraxial block can be used for analgesia during natural labor and cesarean section. Evidence is inconsistent to support whether neuraxial block during pregnancy and delivery is a risk factor of PLBP. Trend The current evidence seems do not support that labor analgesia with neuraxial block increase the incidence of PLBP. Future studies are demanded to clarify the relationship between epidural anesthesia and short/long-term PLBP. Key words: Neuraxial block; Pregnancy-related low back pain

Anatomical landmarks of the intra-pelvic side-wall as sources of pain in women with and without pregnancy-related chronic pelvic pain after childbirth: a descriptive study

BackgroundChronic pelvic pain (CPP) affects 15–24% of women and can have a devastating impact on quality of life. Laparoscopy is often used in the investigation, although in one third of the examinations there is no visible pathology and the women may be dismissed without further investigation. Also, the contribution of skeletal, muscular, periosteal and ligamentous tissues to CPP remains to be further elucidated. The objective of the present study was to compare pain intensity provoked from anatomical landmarks of the intra-pelvic side-wall in women with pregnancy-related CPP after childbirth and women without such pain.MethodsThis is a descriptive study of 36 non-randomly selected parous women with CPP after childbirth and 29 likewise selected parous women after childbirth without CPP. Pain was determined by questionnaire and clinical examination. The primary outcome measure was reported pain intensity provoked on 13 anatomical landmarks of the intra-pelvic side-wall. All women reported their perceived pain intensity for each anatomical landmark on Likert scales and an individual sum score was calculated.ResultsWomen with chronic pelvic pain were older than women without CPP. At several intra-pelvic landmarks high intensity pain was provoked in women with CPP compared with less intense pain provoked at fewer landmarks in women without low back or pelvic pain (p < 0.0001). The average sum of pain intensity scores was about 4 times higher in women with CPP (1.3) as compared with those without low back or pelvic pain (0.3), p < 0.0001. This association remained when adjusting for the age difference between the pain groups in linear regression analysis. In addition, reported pain intensity at worst past week was independently associated with sum of pain intensity scores. The maximum individual sum of pain intensity scores among women without CPP was exceeded by that of 85% of the women with CPP.ConclusionsParous women with CPP after childbirth had a heightened pain intensity over 13 anatomical landmarks during pelvic examination compared with parous women without CPP. These results need to be confirmed in a larger cohort with different types of CPP.

The effectiveness of complementary manual therapies for pregnancy-related back and pelvic pain

Background:Low back pain and pelvic girth pain are common in pregnancy and women commonly utilize complementary manual therapies such as massage, spinal manipulation, chiropractic, and osteopathy to manage their symptoms.Objective:The aim of this systematically review was to critically appraise and synthesize the best available evidence regarding the effectiveness of manual therapies for managing pregnancy-related low back and pelvic pain.Methods:Seven databases were searched from their inception until April 2015 for randomized controlled trials. Studies investigating the effectiveness of massage and chiropractic and osteopathic therapies were included. The study population was pregnant women of any age and at any time during the antenatal period. Study selection, data extraction, and assessment of risk of bias were conducted by 2 reviewers independently, using the Cochrane tool. Separate meta-analyses were conducted to compare manual therapies to different control interventions.Results:Out of 348 nonduplicate records, 11 articles reporting on 10 studies on a total of 1198 pregnant women were included in this meta-analysis. The therapeutic interventions predominantly involved massage and osteopathic manipulative therapy. Meta-analyses found positive effects for manual therapy on pain intensity when compared to usual care and relaxation but not when compared to sham interventions. Acceptability did not differ between manual therapy and usual care or sham interventions.Conclusions:There is currently limited evidence to support the use of complementary manual therapies as an option for managing low back and pelvic pain during pregnancy. Considering the lack of effect compared to sham interventions, further high-quality research is needed to determine causal effects, the influence of the therapist on the perceived effectiveness of treatments, and adequate dose–response of complementary manual therapies on low back and pelvic pain outcomes during pregnancy.

Women's experience of low back and/or pelvic pain (LBPP) during pregnancy

Objectiveto explore the experiences of women suffering low back and/or pelvic pain during pregnancy. Designa qualitative design using focus groups. Each group was recorded with a digital audio recorder and analysed using the Newell and Burnard framework for thematic analysis. Settingan urban maternity hospital. Participantsa self-selecting sample of 14 women who had taken part in a pilot randomised controlled trial investigating reflexology for pregnancyrelated low back and / or pelvic pain. Measurements and Findingsthe group discussions were guided by a pre-determined schedule of questions designed to investigate women's experiences of pregnancyrelated low back and / or pelvic pain. Three main themes emerged:(1)The physical and emotional impact that pregnancy-related low back and / or pelvic pain had on women's lives(2)Women's attitudes towards, and knowledge about pregnancy-related low back and/or pelvic pain(3)Women's use of treatments to manage their symptoms and levels of dissatisfaction with standard advice and treatment. Key conclusionslow back and/ or pelvic pain affected women physically and emotionally during pregnancy. Their attitudes towards, and knowledge about the conditions differed. Women used a range of self-help strategies for their symptoms and there was a general sense of dissatisfaction with routine advice and treatment, a finding supported by a growing body of research. Implications for practicegiven that pregnancy-related low back and/ pelvic pain occur across the world, and affects the majority of pregnant women, heath care providers need to ensure that standard care provided is meeting women's needs.Health care professionals may require specific training in order to effectively provide individualised and evidence-based advice and support to pregnant women experiencing this pain.

Pregnancy-Related Pelvic Pain: A Neglected Field in Developing Countries.

Inadequate access to antenatal care is still a major concern in many developing countries, and reducing pregnancy-related mortality is the main goal of national and international organizations of maternal health (1, 2). Despite the significant gap to reach the millennium development goal 5 (MDG5) to put an end to all the preventable causes of maternal deaths, the importance of other apparently benign pregnancy-related disorders should not be underestimated (3). In other words, besides considering the warning signs of major causes of maternal morbidity and mortality during the antenatal visits, including hemorrhagic or hypertensive disorders, some other measures should be taken to make the gestational and puerperal period as tolerable and satisfying as possible both for mother and her family, especially in the developing countries (3, 4). Nearly, half of the pregnant females experience pelvic girdle pain (PGP), at least to some extent (5). Although this musculoskeletal pain within the pelvic area is not harmful to females or their fetuses, it is indeed disabling interferes with their motherhood, familial relationships and their profession (5, 6). Unfortunately, among the discomforts experienced by females during pregnancy, musculoskeletal complaints like PGP are not taken serious by the majority of clinicians. In a study by Pierce et al. the mean pain intensity score reported for low back or pelvic girdle pain was six out of ten and in 80% of females these rate had negative impact on their lifestyles (7). In another study by Malmqvist et al. PGP was the main cause of sick leave in Norwegian pregnant females with a mean duration of 11 weeks (8). In the same study, the principal reason not to take a leave from work was the subjects’ higher educational level besides job satisfaction and not to perceive less pain, which actually did exist (8). The pain which tends to begin as early as 18 weeks of pregnancy may persist in the postpartum period for as long as 15 months (9, 10). A number of mechanical and hormonal factors are blamed for the development of this disorder: 1) the increasing load of the gravid uterus on spine and pelvis, 2) softening of the pubic symphysis, 3) laxity of the pelvic ligaments and 4) shifting of the uterus and a change in the pelvic orientation, which result in pelvic instability (10-13). Females may have a wide range of complaints. Simply, everyday activities like getting up, turning over in bed, sitting down or walking may become painful (14, 15). The most common pain characteristics reported were dull, stabbing or cutting pain types within the pelvic area radiating to back or thighs (15). Many other aspects of a females’ life can also be greatly deteriorated (14-16). With regard to the pain management, no single medical treatment has proved to be effective till now (14-18). While, non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated in the third trimester of pregnancy and opioids are not considered safe, paracetamol is not associated with satisfactory results (14). Opioids are not generally considered harmless; however, tramadol, with weaker tendency for opioid receptors, is safely used during pregnancy without maternal or neonatal toxicity (19). Combined treatment of opioids with N-methyl-D-aspartic acid (NMDA) antagonist like ketamine seems to have better analgesic effects; though, not proved by all studies (20). Compartment block with local anesthetics is another modality to decrease opioid consumption; nonetheless, its efficacy is not established yet (16, 21). Other proposed interventions include using pelvic belts, regular exercise, physical therapy, transcutaneous nerve stimulation and acupuncture which are costly and not everyone can afford especially in the developing countries. Therefore, what seems to be practical and cost-benefit, at least at the present time, is the role of appropriate support and adequate education from health care providers to recognize the risk factors and the ways to minimize the symptoms (16). Since there seems to be a lack of knowledge and awareness about the existence of such a disability among the caregivers themselves, further investigation is required in this field (6, 16). According to recent studies, physical exercise could have alleviating effects (17, 18). However, in a systematic review by Gutke et al. among different treatment modalities for lumbopelvic pain during pregnancy, it was reported that acupuncture and pelvic belts had the strongest effect and exercise had a weak effect (22). In conclusion, it can be stated that pregnancy-related chronic pains, including pelvic girdle pain, are really disabling throughout many females’ lives, though not detrimental. While there are still many gaps in detection and appropriate management of this disorder, PGP should be considered as a major health concern in the society which deserves much more attention and support.

Interventions for preventing and treating low-back and pelvic pain during pregnancy.

More than two-thirds of pregnant women experience low-back pain and almost one-fifth experience pelvic pain. The two conditions may occur separately or together (low-back and pelvic pain) and typically increase with advancing pregnancy, interfering with work, daily activities and sleep. To update the evidence assessing the effects of any intervention used to prevent and treat low-back pain, pelvic pain or both during pregnancy. We searched the Cochrane Pregnancy and Childbirth (to 19 January 2015), and the Cochrane Back Review Groups' (to 19 January 2015) Trials Registers, identified relevant studies and reviews and checked their reference lists. Randomised controlled trials (RCTs) of any treatment, or combination of treatments, to prevent or reduce the incidence or severity of low-back pain, pelvic pain or both, related functional disability, sick leave and adverse effects during pregnancy. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We included 34 RCTs examining 5121 pregnant women, aged 16 to 45 years and, when reported, from 12 to 38 weeks' gestation. Fifteen RCTs examined women with low-back pain (participants = 1847); six examined pelvic pain (participants = 889); and 13 examined women with both low-back and pelvic pain (participants = 2385). Two studies also investigated low-back pain prevention and four, low-back and pelvic pain prevention. Diagnoses ranged from self-reported symptoms to clinicians' interpretation of specific tests. All interventions were added to usual prenatal care and, unless noted, were compared with usual prenatal care. The quality of the evidence ranged from moderate to low, raising concerns about the confidence we could put in the estimates of effect. For low-back painResults from meta-analyses provided low-quality evidence (study design limitations, inconsistency) that any land-based exercise significantly reduced pain (standardised mean difference (SMD) -0.64; 95% confidence interval (CI) -1.03 to -0.25; participants = 645; studies = seven) and functional disability (SMD -0.56; 95% CI -0.89 to -0.23; participants = 146; studies = two). Low-quality evidence (study design limitations, imprecision) also suggested no significant differences in the number of women reporting low-back pain between group exercise, added to information about managing pain, versus usual prenatal care (risk ratio (RR) 0.97; 95% CI 0.80 to 1.17; participants = 374; studies = two). For pelvic painResults from a meta-analysis provided low-quality evidence (study design limitations, imprecision) of no significant difference in the number of women reporting pelvic pain between group exercise, added to information about managing pain, and usual prenatal care (RR 0.97; 95% CI 0.77 to 1.23; participants = 374; studies = two). For low-back and pelvic painResults from meta-analyses provided moderate-quality evidence (study design limitations) that: an eight- to 12-week exercise program reduced the number of women who reported low-back and pelvic pain (RR 0.66; 95% CI 0.45 to 0.97; participants = 1176; studies = four); land-based exercise, in a variety of formats, significantly reduced low-back and pelvic pain-related sick leave (RR 0.76; 95% CI 0.62 to 0.94; participants = 1062; studies = two).The results from a number of individual studies, incorporating various other interventions, could not be pooled due to clinical heterogeneity. There was moderate-quality evidence (study design limitations or imprecision) from individual studies suggesting that osteomanipulative therapy significantly reduced low-back pain and functional disability, and acupuncture or craniosacral therapy improved pelvic pain more than usual prenatal care. Evidence from individual studies was largely of low quality (study design limitations, imprecision), and suggested that pain and functional disability, but not sick leave, were significantly reduced following a multi-modal intervention (manual therapy, exercise and education) for low-back and pelvic pain.When reported, adverse effects were minor and transient. There is low-quality evidence that exercise (any exercise on land or in water), may reduce pregnancy-related low-back pain and moderate- to low-quality evidence suggesting that any exercise improves functional disability and reduces sick leave more than usual prenatal care. Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit.Clinical heterogeneity precluded pooling of results in many cases. Statistical heterogeneity was substantial in all but three meta-analyses, which did not improve following sensitivity analyses. Publication bias and selective reporting cannot be ruled out.Further evidence is very likely to have an important impact on our confidence in the estimates of effect and change the estimates. Studies would benefit from the introduction of an agreed classification system that can be used to categorise women according to their presenting symptoms, so that treatment can be tailored accordingly.

Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain: a prospective randomized controlled trial.

To evaluate the effect of exercise programs on pregnant women with pregnancy-related low back and pelvic pain. Low back and pelvic pain during pregnancy is a major health problem due to its frequent occurrence and such pain can limit pregnant women in many of their daily activities. A randomized trial with a control group (n=48) and an intervention group (n=48). Trial registration number NCT02189356. Department of Obstetrics and Gynecology, between December 2011-May 2012, an Education and Research Hospital in Turkey. Based on the intention-to-treat principle, all pregnant women were analysed according to the group they were assigned to, regardless of whether they received the intervention or not. Participants in the intervention group received health counselling and exercised regarding low back and pelvic pain for four weeks. The pregnant women in the control group received usual care, comprised of routine clinical practice for pregnancy-related low back and pelvic pain. According to Mann-Whitney U test analysis results, there was a statistically significant difference between the control and intervention groups' Visual Analogue Scale during relaxation scores and Visual Analogue Scale during activity scores at the end of the study. According to Mann-Whitney U test analysis results, the change in the mean Oswestry Disability Index score for the intervention group and the difference in the mean scores between the two groups was statistically significant. A four-week exercise program including individualized health counselling to relieve low back and pelvic pain improved the functional status in pregnant women.

Pregnancy and low back pain: physical therapy can reduce back and pelvic pain during and after pregnancy.

Pregnancy and low back pain: physical therapy can reduce back and pelvic pain during and after pregnancy.

A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy

To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy. International research demonstrates that 25-30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness. A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy. Cochrane library (1898-2013), PubMed (1996-2013), MEDLINE (1946-2013), AMED (1985-2013), Embase (1974-2013), Cinahl (1937-2013), Index to Thesis (1716-2013) and Ethos (1914-2013). Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool. Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However, osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low. There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.

Improved function in women with persistent pregnancy-related pelvic pain after a single corticosteroid injection to the ischiadic spine: A randomized double-blind controlled trial

Background: Pregnancy-related low back and pelvic pain is a worldwide problem. A large proportion of women still experience disabling daily back pain 2 years after childbirth, resulting in major changes in activities and general well-being. In spite of this, the source of pain and effective treatment are uncertain. Objective: To evaluate the short-term effects on function of a single corticosteroid injection treatment to the ischiadic spine in women with persistent pregnancy-related pelvic pain (PPPP). Methods: Thirty-six women were allocated to injection treatment with slow-release triamcinolone and lidocain or saline and lidocain, given once at the sacrospinous ligament insertion on the ischiadic spine bilaterally with follow-up at 4 weeks. Outcome measures were Disability Rating Index (DRI), self-rated functional health (SF-36), gait speed and endurance (6MWT), and strength and endurance of trunk muscles (isometric trunk extensor and flexor tests). Results: Women in the triamcinolone group showed significantly improved DRI (p = 0.046), 6MWT (p = 0.016), and isometric trunk extensor tests (p = 0.004), as compared with the saline group. Close co-variation was shown between improved function and reduced pain intensity. Conclusions: Improved function was achieved among women with PPPP after a single injection treatment with slow-release corticosteroid. The effect was positively correlated to the reduced pain intensity.

Age at menarche and pregnancy‐related pelvic pain

Menarcheal age is a predictor of several complications related to pregnancy and diseases later in life. We aimed to study if menarcheal age is a risk factor for pregnancy-related pelvic pain. A nested case-control study was conducted within the Danish National Birth Cohort, a cohort of pregnant women, recruited during 1996-2002, and their children. In the second trimester of pregnancy the women provided information about age at menarche and potential confounders. Selection of cases (n = 2227) was based on self-reported pelvic pain during pregnancy from an interview done 6 months post-partum. The controls (n = 2588) were randomly selected among women who did not report pelvic pain. We used logistic regression analysis to calculate odds ratios (OR) for pregnancy-related pelvic pain according to age at menarche. In the cohort, 18.5% of all pregnant women reported pregnancy-related pelvic pain. Compared to women who were 12-14 years old at menarche, the adjusted OR for overall pelvic pain were 1.4 (95% confidence interval [CI] 1.1-1.7) in women 11 years or younger and 0.8 (95%CI 0.6-0.9) in women 15 years or older. The corresponding adjusted OR for severe pelvic pain were 1.6 (95%CI 1.3-2.0) and 0.7 (95%CI 0.6-0.9). When age was analyzed as a continuous variable, the odds for overall and severe pelvic pain decreased with 14% and 16%, respectively, for each increasing year. The risk of pregnancy-related pelvic pain decreased with increasing menarcheal age in an 'exposure-response' pattern. A low menarcheal age is a risk indicator and may be a risk factor for pregnancy-related pelvic pain.

Effectiveness of physical therapy for pregnancy-related low back and/or pelvic pain after delivery: A systematic review

The aim of this work was to investigate the effectiveness of physical therapy for the treatment of low back pain (LBP) and pelvic girdle pain (PGP) related to pregnancy after delivery. A systematic review of studies published since 1985 in the databases Medline, PEDro, SciELO, SCOPUS, LILACS, and the Cochrane Library was made. Studies that focused on postpartum LBP or PGP, without being related to pregnancy or in other non-pregnant patients, were excluded, as were papers addressing LBP or PGP indicating radiculopathy, rheumatism, or any other serious disease or pathologic condition. In accordance with the exclusion criteria and duplicate articles, of the 105 articles retrieved only six were considered for quality assessment with the PEDro Scale. Among these six papers, two were follow-ups, such that only four trials were included in this review. All trials used exercise for motor control and stability of the lumbopelvic region, but with different intervention approaches. The study affording the best evidence used individual guidance and adjustments given by the physiotherapists. Nevertheless, this systematic review was inconclusive and showed that more randomized clinical trials, with good quality, are needed.