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Background: A substantial number of women have postpartum lumbopelvic pain (LBPP). Additionally, many postpartum women stay for long inactivity. Therefore, we examined the impact of sedentary behav...

Objective To determine the asymmetry in the paraspinal muscle before pregnancy and evaluate its association with pregnancy‐associated lumbopelvic pain (LPP). Methods This was a prospective case–control study conducted from January 2017 and December 2018. A total of 171 subjects (mean age ± SD, 27.4 ± 5.8 years) were finally divided into the LBP group, PGP group, and no LPP group. Each subject was asked to follow a standardized clinical imaging protocol before the pregnancy. The area of muscles (multifidus, erector spinae, and psoas muscles) on the axial slice at mid‐disc of L4–L5 and L5–S1 were segmented and then the cross‐sectional area (CSA) of a particular muscle was measured by outlining the innermost fascial border surrounding each muscle. The mean value of F‐CSA's ratio to T‐CSA (F/T CSA) was used to determine whether the bilateral paraspinal muscle was asymmetrical. Total muscle CSA (T‐CSA) represents the sum of CSA of interested three muscles. The signal intensity can distinguish fat and muscle tissue in a different range. Based on this, functional CSA (F‐CSA), represented by fat‐free area, was evaluated quantitively by excluding the signal of the deposits of intramuscular fat. Total muscle CSA (T‐CSA), functional CSA (F‐CSA), and the ratio of F‐CSA to T‐CSA (F/T CSA) were measured unilaterally and compared between groups. Logistic regression was performed to determine the risk factors for pregnancy‐associated LPP. The Pearson correlation coefficient was performed to test the relationship between asymmetry in F/T‐CSA and pain rating. Results A total of 124 subjects (72.5%) (28.5 ± 5.2 years) had LPP during pregnancy. Forty‐eight (38.7%) individuals had low back pain (LBP) and 76 (61.3%) had pelvic girdle pain (PGP). Seventy‐six women (44.4%) were determined to have asymmetry in paraspinal muscle according to the definition in this methods section. The duration of follow‐up was 24 months postpartum. A total of 39 (31.5%) women unrecovered from LPP. F/T‐CSA was significantly decreased for LBP in the PGP group than in the and control group (0.03 ± 0.02 vs 0.05 ± 0.03 vs 0.12 ± 0.05, P 0.05). Asymmetry in the paraspinal muscle (adjusted OR = 1.5), LBP (adjusted OR = 1.6), LPP in a previous pregnancy (adjusted OR = 1.4), sick leave ≥90 days (adjusted OR = 1.2), and heavy labor (adjusted OR = 1.2) were risk factors for the unrecovered LPP during pregnancy. Conclusions Asymmetrical muscular compositions could lead to abnormal biomechanics for the segmental motions. Lateral‐directed physical training and stretching may help decrease the occurrence and severity of this condition., Asymmetrical muscular compositions could lead to abnormal biomechanics for the segmental motions. Lateral‐directed physical training and stretching may help decrease the occurrence and severity of this condition.

Pelvik kuşak ağrısı (PKA) yaygın olarak görülen bir kas-iskelet sistemi hastalığıdır. Gebelik, travma, artrit ve osteoartrit ile ilişkili olarak artan PKA, hormonal, biyomekanik, travmatik, metabolik, genetik, psikolojik, nörofizyolojik ve dejeneratif faktörlere bağlı olarak ortaya çıkmaktadır. PKA ağrı ve aktivite limitasyonu gibi durumlara yol açarak yaşam kalitesinde azalmaya yol açmaktadır. PKA’lı bireylerde açığa çıkan bu durumların hasta bildirimli ve performansa yönelik sonuç ölçümleriyle değerlendirilmesi, tedavi programının planlaması ve etkinliğinin gösterilmesi açısından önemli rol oynamaktadır. Bu çalışmanın amacı PKA’lı bireylerin tanı ve değerlendirilmesinde kullanılan klinik testleri ile hasta bildirimli ve performansa dayalı sonuç ölçümlerini derlemektir. Bu amaçla PubMed, Google Scholar ve ScienceDirect veri tabanlarında ilgili anahtar sözcükler kullanılarak 1 Aralık 2020 tarihine kadar yayımlanmış olan çalışmalarda tarama yapılmıştır. PKA’lı bireylerin tanısında kullanılan klinik testler ve değerlendirilmesinde kullanılan hasta bildirimli ve performansa dayalı sonuç ölçümleri psikometrik analizlerle sunulmuş, gerek performansa dayalı sonuç ölçümleri ve gerekse bunların karşılaştırıldığı çalışmaların oldukça az sayıda olduğu görülmüştür. Bu derlemenin bulgularının PKA’lı bireylerle çalışan tüm sağlık profesyonelleri ve araştırmacılar için yol gösterici olacağı düşünülmektedir., Pelvic girdle pain (PGP) is a common musculoskeletal disease. PGP, which increases in relation to pregnancy, trauma, arthritis and osteoarthritis, arises due to hormonal, biomechanical, traumatic, metabolic, genetic, psychological, neurophysiological and degenerative factors. PGP causes a decrease in quality of life by causing conditions such as pain and activity limitation. Assessment of these conditions in individuals with PGP by patient notification and performance-based outcome measurements play an important role in terms of planning the treatment program and its effectiveness. This study aimed to compile clinical tests and outcome measures used in the diagnosis and evaluation of individuals with PGP. For this aim, the studies published in PubMed, Google Scholar, and ScienceDirect databases were searched using the relevant keywords 1 December 2020. The clinical tests used for diagnosis and patient-reported and performance-based outcome measures used in the evaluation of individuals with PGP have been presented with psychometric analysis, and it has been observed that there are very few studies that compared both performance-based outcome measures and these. It is thought that the findings of this review will be a guide for all health professionals and researchers working with individuals with PGP.

INTRODUCTION Pelvic girdle pain (PGP) is the most common musculoskeletal concern in pregnancy. The Active Straight Leg Raise (ASLR) test is diagnostic. Sacroiliac joint (SIJ) belts are included in multimodal therapy, but there is no established predictive measure to determine which pregnant women will benefit. OBJECTIVE To determine if the ASLR score is immediately reduced by SIJ belt application and whether PGP pain and function improves after 4 weeks of belt use. DESIGN Prospective observational cohort study. SETTING Academic medical center. PARTICIPANTS Pregnant women at least 18 years of age in the second or third trimester of pregnancy with posterior PGP and ASLR score of 2 to 10. INTERVENTIONS Four-week SIJ belt use. MAIN OUTCOME MEASURES ASLR, Numerical Rating Scale (NRS), Pelvic Girdle Questionnaire (PGQ), Perceived Global Impression of Improvement (PGII). RESULTS Sixty-three women enrolled. On multivariable analysis, immediate belted ASLR score was -2.70 points lower than the non-belted ASLR score (P

Persistent low back and pelvic pain (LBPP) is a postpartum-specific health problem. Sleep disturbances’ association with persistent LBPP is not yet clear. We aimed to examine the cross-sectional association between sleep disturbance and persistent LBPP at 4 months postpartum. We enrolled 120 women with LBPP during pregnancy (mean age, 31.8; standard deviation, 4.9 years). The primary outcome was persistent LBPP. We assessed LBPP severity at 4 months postpartum using the Numerical Rating Scale (NRS), where women with an NRS score of ≥ 4 at 4 months postpartum were allocated to the persistent LBPP group. We assessed sleep disturbance at 4 months postpartum using the Japanese version of the Pittsburgh Sleep Quality Index with a total score of ≥ 6 indicating sleep disturbance. Moreover, we performed univariate and multiple logistic regression analyses to examine the cross-sectional association of sleep disturbance with persistent LBPP. The relevant confounding variables were age, body mass index, parity, and history of LBPP before pregnancy. Among the 120 women, 45 women had persistent LBPP (37.5%) with 32 (71.1%) of them reporting sleep disturbance. There was a significant association of sleep disturbance with persistent LBPP (odds ratio [OR], 2.81; 95% confidence interval [95% CI], 1.28–6.19), which remained after adjustments for confounding variables (OR, 2.98; 95% CI, 1.31–6.75). Our findings indicate that sleep disturbance is associated with persistent LBPP at 4 months postpartum; therefore, it should be taken into consideration in postpartum women with persistent LBPP.

Background Pelvic girdle pain (PGP) is a multifactorial condition with a partly unknown etiology. This condition can be mentally and physically compromising both during and after pregnancy. To provide all-around preventive measures to improve the recovery from PGP, it is a necessity for obstetricians and orthopaedists to develop predictive studies about the worse prognosis for this condition. Therefore, this study aims to determine whether personality traits can predict the consequences of long-term pregnancy-related PGP. Methods This was a prospective study conducted from January 2015 to August 2018. A total of 387 pregnant women were enrolled in this study. According to whether they had experienced PGP during the past 4 weeks, the subjects were classified into no PGP and PGP groups. Persistent PGP after the pregnancy was defined as a recurrent or continuous visual analog score (VAS) pain rating of ≥3 for more than 1 week. The Quick Big Five Personality Test (QBFPT) was used to assess personality traits. Data were obtained by mail or in the clinic. The authors collected data including age, BMI, educational level, annual household income, cesarean delivery, breastfeeding, unexpected sex of the baby, parity, sick leave, no or rare ability to take rest breaks at work, and PGP in the previous pregnancy. Results Of 387 included women, 264 subjects experienced PGP during the pregnancy with a mean age of 26.3 ± 4.5 years. A total of 80 of 264 (30.3%) women experienced persistent PGP after the pregnancy. Persistent PGP after the pregnancy was associated with higher levels of neuroticism (OR = 2.12, P = 0.001). Comparing women with persistent PGP, those who reported higher levels of extraversion and conscientiousness were more likely to recover from this condition (OR = 0.65, P = 0.001; OR = 0.78, P = 0.010, respectively). Besides, neuroticism was positively associated with higher pain scores (r = 0.52, P = 0.005). However, extraversion and conscientiousness domains showed negative correlations with pain score (r = − 0.48, P = 0.003; r = − 0.36, P = 0.001). Conclusions Personality traits were significantly associated with the outcomes of PGP.

Background: Pelvic girdle dysfunction is a common musculoskeletal disorder among pregnant women. It is a disabling condition affecting the ability of a pregnant woman to perform her daily functional activities. The scope of digital health in delivering rehabilitation services is growing exponentially, especially in the present COVID -19 pandemic crisis.Case description: A 29-year-old primigravida, at 32 weeks of gestation with severe pelvic girdle pain during bed transitions, sought physiotherapy consultation via video call, as she expressed difficulty in accessing Physiotherapy services due to the present pandemic crisis. Physiotherapy consultation was provided in 4 weekly sessions using a real-time video-based telerehabilitation program and the patient performed unsupervised exercise sessions for 30 minutes for 5 days per week for 4 weeks. The plan of care included muscle energy techniques, pelvic cloth belt, strengthening, stabilization exercises and stretching.Outcomes: The patient completed four sessions including evaluation and treatment and there was a reduction of pain scores for bed transitions from NPRS 8/10 during session one to NPRS 0/10 during session four. The Pelvic girdle dysfunction questionnaire showed a decrease in percentage scores from 54.6 to 4 at the end of physiotherapy sessions.Conclusion: Telerehabilitation was successfully used to manage a pregnant woman with pelvic girdle dysfunction.

Background Many women develop pelvic girdle pain (PGP) during pregnancy and about 10% have chronic pain several years after delivery. Self-administered pain provocation tests are one way to diagnose and evaluate this pain. Their validity in post-partum women is not yet studied. The purpose of this study was to evaluate the validity of self-administered test for assessment of chronic pregnancy-related PGP several years after delivery. Methods Women who previously have had PGP during pregnancy and who participated in one of three RCT studies were invited to a postal follow up of symptoms including performance of self-administered tests after two, 6 or 11 years later, respectively. In total, 289 women returned the questionnaire and the test-results. Of these, a sub-group of 44 women with current PGP underwent an in-person clinical examination. Comparisons were made between test results in women with versus without PGP but also, in the sub-group, between the self-administered tests and those performed during the clinical examination. Results Fifty-one women reported PGP affecting daily life during the last 4 weeks, and 181 reported pain when performing at least one of the tests at home. Those with chronic PGP reported more positive tests (p p = 0.305), either for anterior or posterior PGP. There were no significant differences of the results between the tests performed self-administered vs. during the clinical examination. Conclusion A battery of self-administered tests combined with for example additional specific questions or a pain-drawing can be used as a screening tool to diagnose chronic PGP years after delivery. However, the modified SLR test has limitations which makes its use questionable.

Study Design: Two-group, pretest–posttest randomized clinical trial.Purpose: To evaluate the efficacy of the muscle energy technique (MET) and Kinesiotaping (KT) in addition to conventional physiotherapy among patients with mechanical sacroiliac joint dysfunction (SIJD).Overview of Literature: Patients with SIJD suffer from lower back and gluteal pain, as well as stiffness, due to restricted pelvic joint movement. To restore function and reduce pain among individuals with mechanical SIJD, the MET and KT may be helpful. However, a limited number of studies have compared MET and KT in mechanical SIJD.Methods: A total of 40 male and female participants aging between 30 and 50 years experiencing unilateral pain around the gluteal area, groin area, and lower limbs for more than 4 weeks but less than 1 year will be selected. Patients will then be randomized into two groups: METCp (n=20) and KTCp groups (n=20). The METCp group will receive MET along with conventional physiotherapy, while the KTCp group will receive conventional physiotherapy with KT. Both groups will receive three alternating days of treatment per week that will continue for 4 weeks. The modified Oswestry Disability Index, a digital pressure algometer, and sacroiliac joint motion testing will be used for evaluation. Between- and within-group pre- and post-intervention results for mechanical SIJD were compared using the Wilcoxon signed-rank test/paired t-test and Mann-Whitney U -test/independent t -test.Results: Modified Oswestry Disability Index, digital pressure algometer, and sacroiliac joint motion will be measured at baseline, 2nd week during intervention, and 4th week at the end of interventionConclusions: The present study will provide data regarding the effects of MET and KT among patients with mechanical SIJD.

Many observational studies have suggested the existence of a link between urinary incontinence (UI) and lumbopelvic pain. The aim of our study is to evaluate the association between UI and back pain (BP) or pelvic girdle pain (PGP) in the adult population. This systematic review with meta-analysis was registered in PROSPERO under the number 2019:CRD42019120047. Literature was sought in the Medline, Embase, and PEDro databases. The search was limited to English, Spanish, and French records, and was conducted from inception until November 2019. Observational studies evaluating the association between UI and BP/PGP were selected by two independent reviewers. Quality assessment was performed using the “Critical Review Form for quantitative studies” (McMaster University). From the 2,055 retrieved articles, 18 were selected. Both qualitative (n = 18) and quantitative analysis (n = 7) were performed. Fifteen out of 18 studies (83%) found a positive association between UI and BP or PGP for at least one type of incontinence. Pooled estimates were OR 1.61, 1.53, and 1.51 for stress, urgency, and mixed urinary incontinence respectively. A similar degree of association between women and men was found. Subjects with stress and mixed incontinence showed greater likelihoods of mild pain compared with severe pain, although severe pain was more frequently associated with urgency incontinence than mild pain. Our results support the association between UI and BP/PGP, which seems to be independent of gender-based differences. The strength of this association depends on pain or incontinence subtypes. Clinicians should be aware of the relationship in their clinical practice.

PURPOSE This study aimed to evaluate postpartum maternal health and training outcomes of females who were competing or training as elite athletes before or during pregnancy. METHODS Online databases were searched up to August 26, 2020. Studies of any design and language were eligible if they contained information on the relevant population (postpartum athletes [any period after pregnancy]), exposure (engaged in the highest level of sport immediately before or during pregnancy), comparators (sedentary/active controls), and outcomes: maternal (breastfeeding initiation and duration, postpartum weight retention or loss, bone mineral density, low back or pelvic girdle pain, incontinence [prevalence or severity of stress, urge or mixed urinary incontinence, fecal incontinence], injury, anemia, diastasis recti, breast pain, depression, anxiety) and training (

To identify and critically appraise studies evaluating psychometric properties of functionally oriented diagnostic classification systems for Non-Specific Chronic Low Back Pain (NS-CLBP). This review employed methodology consistent with PRISMA guidelines. Electronic databases and journals: (PubMed, EMBASE, Cochrane, PEDro, CINAHL, Index to chiropractic literature, ProQuest, Physical Therapy, Journal of Physiotherapy, Canadian Physiotherapy and Physiotherapy Theory and Practice) were searched from inception until January 2020. Included studies evaluated the validity and reliability of NS-CLBP diagnostic classification systems in adults. Risk of bias was assessed using a Critical Appraisal Tool. Twenty-two studies were eligible: Five investigated inter-rater reliability, and 17 studies analyzed validity of O’Sullivan’s classification system (OCS, n = 15), motor control impairment (MCI) test battery (n = 1), and Pain Behavior Assessment (PBA, n = 1). Evidence from multiple low risk of bias studies demonstrates that OCS has moderate to excellent inter-rater reliability (kappa > 0.4). Also, two low risk of bias studies support of OCS-MCI subcategory. Three tests within the MCI test battery show acceptable inter- and intra-rater reliability for clinical use (the "sitting knee extension," the “one leg stance,” and the “pelvic tilt” tests). Evidence for the reliability and validity of the PBA is limited to one high bias risk study. Multiple low risk of bias studies demonstrate strong inter-rater reliability for OCS classification specifically OCS-MCI subcategory. Future studies with low risk of bias are needed to evaluate reliability and validity of the MCI test battery and the PBA.

ContextOsteopathic manipulative medicine (OMM) has been shown to successfully alleviate some pregnancy-related pain. However, most of the published data focuses on the third trimester and postpartum period or musculoskeletal indications.ObjectiveTo explore OMM use among obstetrical providers and determine the frequency of use by trimester and by clinical indications across multiple types of women’s healthcare practices in Southern and Central Maine.MethodsAn anonymous, 43-item survey, presented in English, was emailed to 172 eligible providers (physicians, nurse practitioners, and certified nurse midwives with obstetrics privileges at one of two main delivery centers in southern and central Maine) via an encrypted database system in January 2018. Follow-up email reminders were sent weekly for three weeks. Questions addressed use of OMM for specific indications, knowledge of OMM, and perceived barriers use of OMM.ResultsThe survey response rate was 73 of 172 (42%); 95% of respondents were physicians (n=69). Due to the low response rate of non-physicians, only data from physicians was included in the study. Data were summarized descriptively as frequencies (n [%]). The highest rates of OMM utilization were during the third trimester (35 [51.5%]) and postpartum (41 [60.3%]) periods, while the lowest rates of utilization were in the intrapartum (eight [11.9%]) and first trimester periods (26 [38.3%]). Osteopathic physicians (n=19) used OMM more frequently in the first, second, and third trimesters, as well as the intrapartum period (10 [52.6%]; 11 [57.9%]; 14 [73.7%]; and six [31.6%], respectively) compared with their allopathic physician (n=50) counterparts (nine [8%]; 15 [30%]; 21 [42%]; and two [4%], respectively). While osteopathic physicians reported higher frequencies of OMM use and referral for non-musculoskeletal indications such as constipation, edema, and nasal congestion (13 [68.4%]; 11 [57.9%]; 10 [52.6%], respectively), musculoskeletal complaints were the most frequently cited indication for OMM use among both osteopathic and allopathic physicians (low back, 67 [97.1%]; pelvis, 65 [94.2%]; coccyx, 50 [72.5%]; and head, 49 [71%]).ConclusionThese results suggest that more education is needed about OMM use in the obstetric population, particularly during early trimesters and the intrapartum period, as well as for visceral and lymphatic complaints of pregnancy.

Pregnancy-induced pelvic girdle pain (PGP) and low back pain (LBP) is common in post-natal women's. We conducted the study to evaluate the effectiveness of a modified sacroiliac belt on pelvic girdle pain in post-natal women. A total of 26 post-natal women between the age group of 18-35 years were selected and randomized into Group 1(N=13) received conventional sacroiliac belt, conventional physiotherapy and Group 2 (n=13) received modified sacroiliac belt along with conventional physiotherapy. Pre-assessment of pelvic girdle was assessed by (Pelvic Girdle Pain Questionnaire) PGPQ, and low back pain was assessed by Roland Morris low back pain and disability questionnaire (RMQ) and Post-interventional assessment was taken for the same after three months. Intragroup statistical analysis for PGPQ revealed not significant in post-intervention for Group 1 where P-value 0.3023 and was extremely significant for Group 2 (P value

This paper seeks to review the important musculoskeletal issues that arise for pregnant and postpartum women. It outlines the background, diagnosis, and management of these musculoskeletal issues; reviews the existing and recent literature; and offers clinical opinions from the perspective of women’s health PM&R physicians. Existing and recent literature on pelvic girdle pain, lumbosacral back pain, pubic symphysis separation, transient osteoporosis, rectus diastasis, and postpartum neuropathy offer some new insights on management, which is often context-dependent. Management requires individualized physical therapy and precautions for delivery and postpartum. Emerging alternatives like acupuncture for pelvic girdle pain (PGP) and surgical reconstruction for diastasis recti abdominis (DRA) may be considered. The various musculoskeletal pathologies that occur in the peripartum period can produce significant disability for women. With timely diagnosis and treatment, however, these musculoskeletal issues are often transient in nature and do not result in long-term functional deficits.

This review identified exercise therapies for specific diagnoses underlying pregnancy-related low back (PLBP) and pelvic girdle pain (PPGP). We describe the biomechanical changes that may lead to sacroiliac dysfunction during pregnancy, pubic symphysis dysfunction, diastasis recti in the peripartum period, and pregnancy-related low back pain. Our focus was to examine the impact of exercise on each condition. We consolidated updated guidelines for physical activity throughout pregnancy, explored whether exercise is effective for stabilizing the low back and pelvic girdle in pregnant and postpartum patients as well as reviewed the absolute and relative contraindications to physical activity during pregnancy. PLBP and PPGP stem from multiple etiologies and can affect women during their pregnancy and in the postpartum period. Exercise during pregnancy is recommended for the cardiorespiratory fitness of pregnant women, appears to reduce disability and sick leave from work, and is considered to be relatively safe except for noted contraindications.

Purpose The purpose of this systematic review was to evaluate fetal and maternal pregnancy outcomes of elite athletes who had participated in competitive sport immediately before conception. Methods Online databases were searched up to March 24, 2020. Studies of any design and language were eligible if they contained information on the relevant population (pregnant women), exposure (engaged in elite sport immediately before pregnancy), and outcomes (birth weight, low birth weight, macrosomia, preterm birth, fetal heart rate and pulse index, cesarean sections, instrumental deliveries, episiotomies, duration of labor, perineal tears, pregnancy-induced low back pain, pelvic girdle pain, urinary incontinence, miscarriages, prenatal weight gain, inadequate/excess prenatal weight gain, maternal depression or anxiety). Results Eleven unique studies (n = 2256 women) were included. We identified "low" certainty evidence demonstrating lower rates of low back pain in elite athletes compared with active/sedentary controls (n = 248; odds ratio, 0.38; 95% confidence interval, 0.20-0.73; I2 = 0%) and "very low" certainty evidence indicating an increased odds of excessive prenatal weight gain in elite athletes versus active/sedentary controls (n = 1763; odds ratio, 2.47; 95% confidence interval, 1.26-4.85; I2 = 0%). Low certainty evidence from two studies (n = 7) indicated three episodes of fetal bradycardia after high-intensity exercise that resolved within 10 min of cessation of activity. No studies reported inadequate gestational weight gain or maternal depression or anxiety. There were no differences between elite athletes and controls for all other outcomes. Conclusions There is "low" certainty of evidence that elite athletes have reduced odds of experiencing pregnancy-related low back pain and "very low"certainty of evidence that elite athletes have increased the odds of excessive weight gain compared with active/sedentary controls. More research is needed to provide strong evidence of how elite competitive sport before pregnancy affects maternal and fetal outcomes.PROSPERO Registration: CRD42020167382.

Objective The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic. Methods We included procedures that were commonly used by chiropractors and not requiring additional certifications. Outcomes were self-reported changes in pain or disability. We used the Scottish Intercollegiate Guideline Network checklists to assess outcomes. For strength of evidence, we used the adapted version of the US Preventive Services Task Force criteria as described in the UK report. Results Fifty articles were included from 18 SRs, 30 randomized controlled trials (RCTs), and 2 cohort studies. Pregnancy LBP (7 SRs and 12 RCTs): moderate, favorable evidence for electrotherapy and osteopathic manipulative therapy; inconclusive, favorable strength for chiropractic care, exercise, and support devices; and inconclusive, unclear strength for spinal manipulative therapy. Pregnancy PGP (4 SRs and 4 RCTs): inconclusive, favorable strength for exercise; and inconclusive, unclear evidence for patient education, information, and support devices. Pregnancy LBP or PGP (13 SRs and 12 RCTs): moderate, unclear evidence for complementary and alternative medicine; moderate, unclear evidence for exercise; inconclusive, favorable evidence for multimodal care, patient education, and physiotherapy; and inconclusive, unclear strength for spinal manipulative therapy, osteopathic manipulative therapy, and support devices. Conclusion Although there is a lack of conclusive evidence, many of the interventions have moderate or unclear but favorable evidence.

Background Pelvic girdle pain (PGP) is a commonly reported maternal morbidity that negatively impacts the well-being of women during pregnancy and extends long term into the post-partum period. The burden of maternal morbidity; including pregnancy-related PGP; has been overlooked in Ethiopia to date. This study aimed to determine the prevalence and identify factors associated with pelvic girdle pain during pregnancy in North West Ethiopia. Methods A hospital-based cross-sectional study was conducted among pregnant women visiting the antenatal care clinic in Obstetrics ‘outpatient department at the University of Gondar comprehensive specialized hospital in Gondar. Data were collected by interview method using structured questionnaires, patient medical record reviews, and physical measurements. Univariate and multivariable logistic regression model analyses were used to identify factors associated with PGP. Results A total of 424 participants with gestational ages ranging from 6 to 39 weeks participated in this study. The age of the study participants ranged from 18 to 44 years with a mean age of (27 ± 4.6 years). The overall cumulative prevalence of pelvic girdle pain among pregnant women was 103 (24.3%),95% CI (20.3, 28.8). The major associated factors with pelvic girdle pain were previous history of pelvic girdle pain (AOR 16.08; 95% CI, 8.47–30.51), previous history of back pain (AOR 1.66; 95% CI, 1.5–4.24) and having children (AOR 1.42; 95% CI, 1.29–3.76). Conclusion One-quarter of pregnant Ethiopian women reported pelvic girdle pain. PGP must be considered as major pregnancy-related morbidity, and progress in the intervention of PGP is vital to enhance the quality of life in this population.

Background: Back pain (BP) could be present either as a pelvic girdle pain between the posterior iliac crest and the gluteal fold or as a lumbar pain over and around the lumbar spine. The management aims to reduce the discomfort and the impact on the pregnant woman’s quality of life. Purpose: The study aimed to determine the effect of back-stretch (BS) exercise on the perception of BP during pregnancy. Design and methods: A quasi-experimental pretest-posttest control group research design was used. The study was conducted in Gottigere health center, Bangalore, Karnataka, India. The BS exercise intervention was provided to the mothers of the study group. Data were collected from 60 antenatal mothers, 30 in the study, and control group, respectively who were in their 28-32 weeks of gestation by using a non-probability purposive sampling technique. The intensity of BP was estimated using the visual analogues scale. Findings: The comparison between the study and control group has proved a remarkable BP reduction among the antenatal mothers after BS exercise in the study group. The post-test mean intensity of BP was lesser than the pre-test mean intensity of BP (48.73< 54.83) among mothers of the study group (P≤0.001). The antenatal mothers of the control group did not have a statistically significant reduction in the level of BP. Conclusion: The BS exercise is effective in reducing BP among antenatal mothers during their antenatal period.

Menurut IASP ( International Association of the Study of Pain) nyeri didefinisikan sebagai “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or describe interm of such damage”. Nyeri adalah rasa inderawi dan pengalaman emosional yang tidak menyenangkan akibat adanya kerusakan jaringan yang nyata atau yang berpotensi rusak atau sesuatu yang tergambarkan seperti itu.Kelainan muskuloskeletal yang sering dialami oleh wanita hamil adalah berupa nyeri lumbopelvis pada kehamilan (pelvic girdle pain) dan nyeri kronis lumbal (low back pain).Adapun yang menyebabnya adalah faktor hormonal, faktor mekanis dan vaskuler. Manajemen untuk nyeri kronis pada wanita hamil dapat dilakukan melalui manajemen non farmakologis dan manajemen farmakologis. Manajemen non farmakologis dapat dikerjakan dengan cara fisioterapi, terapi distraksi, terapi musik, guided imaginary dan relaksasi. Untuk manajemen farmakologis, obat – obatan yang dapat diberikan adalah asetaminofen, NSAID dan analgesik opioid. Management Chronic Pain in Pregnancy Abstract According to the IASP (International Association of the Study of Pain) pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or describe the interim of such damage". Pain is a sensation and or emotional experience unpleasant and disturbing as a result of tissue damage, or potential tissue damage. Musculoskeletal disorders are often experienced by pregnant women is pelvic girdle pain and chronic pain lumbar. The etiology of that is the hormonal factor, mechanical factors and vascular factors. Management of chronic pain in pregnancy can be done through non-pharmacological management and pharmacological management. Non pharmacological management can be done by means of physiotherapy, distraction therapy, music therapy, guided imaginary and relaxation. For pharmacological management can be given is acetaminophen, NSAIDs and opioid analgesics.

Objective The purpose of this study was to determine the point prevalence of low back pain (LBP), pelvic girdle pain (PGP), and/or combination pain (COMBO pain) and period prevalence (presence or absence of any of those pains), as well as to identify risk factors at 1, 3, and 6 months postpartum in a Canadian population. Methods Participants from a previous pregnancy study participated in a postpartum survey administered over the telephone at 1, 3, and 6 months following delivery. The survey included questions about LBP, PGP, or COMBO pain during the postpartum period, as well as questions related to risk factors (Canadian Task Force Classification II-3). Results At 1, 3, and 6 months postpartum, responses from 46, 58, and 64 participants, respectively, demonstrated that 15%–21% of women experienced LBP and up to 4% of women experienced COMBO pain (point prevalence). At no time point was PGP reported to occur alone. Period prevalence of back pain for the participants returned to pre-pregnancy levels at each time point. Back pain during pregnancy was the only risk factor identified for back pain at 3 and 6 months postpartum. Conclusion This study demonstrated that 76% to 80% of respondents were pain free at 1, 3, and 6 months postpartum. Pregnancy-related back pain was the only risk factor associated with postpartum-related pain at the 1 to 3 and 3 to 6 month time interval. Identification of site-specific postpartum-related back pain may assist in determination of management and treatment plans for this population.

BACKGROUND Pain severity of postpartum pelvic girdle pain (PGP) does not seem closely related to the symphysis gap. OBJECTIVE To determine the relationship between the pubic symphysis gap and postpartum PGP in women treated with the squeeze-and-clap maneuver. DESIGN Retrospective study. SETTING Hospital Clinic PATIENTS: 32 patients with postpartum PGP. METHODS The patients were grouped by the pubic symphysis gap as: group A (6-11 mm), group B (12-20 mm), and group C (21-30 mm). MAIN OUTCOME MEASUREMENTS GP severity was measured by visual analogue scale (VAS). The symphysis gap was measured on radiographs. All patients were treated with the squeeze-and-clap maneuver. The VAS scores and the symphysis gaps at the first clinic visit and the second clinic visit 4-8 weeks later were analyzed. RESULTS There was no significant difference in VAS scores between the three groups at the first clinic visit and the second clinic visit. VAS scores of the three groups were all significantly decreased at the second clinic visit compared with the first clinic visit (all P < .001). The symphysis gap was significantly decreased in group C at the second clinic visit (P = 0.004), but not in group A and group B. CONCLUSION Pubic symphysis separation was not associated with pain severity of postpartum PGP.

Background: Pregnancy-related pelvic girdle pain (PPGP) significantly impacts women’s lives both physically and psychologically. Given the severity and impact of PPGP on pregnancy, the authors anticipated that pregnant women with PPGP might respond differently to massage than pregnant women without PPGP. Purpose: The aim of the study was to further analyze a published 2017 study to assess the response of pregnancy massage in participants with and without PPGP. Setting: Two massage clinics, one in Sydney and one in Melbourne, recruited participants from December 2016 to December 2017. Participants: Nineteen women with PPGP and 78 without PPGP. Research Design: PPGP and non-PPGP women receiving at least one massage, with outcome measures assessed immediately prior to and after massage, and again one week post-massage. Main Outcome Measures: Visual analog scales for pain, stress, range of movement, sleep, and self-reported side effects of massage. Results: Both groups changed significantly and similarly over time for measures of pain, stress, range of motion, and sleep (all p < .05). Post hoc analysis found significant reduction in all outcome measures immediately following massage, but returned to baseline at one week post-massage for all measures except pain, which remained reduced for the PPGP group (49.79±25.68 to 34.75±34.75, p = .03, effect size 0.593), and stress remained reduced in the non-PPGP group (33.36±21.54 to 24.90±19.18, p = .002, effect size 0.373). The PPGP group entered the study with higher baseline levels of pain (p = .01) and a greater restriction in range of motion (p = .006) than the non-PPGP group. There was no difference in the number of side effects experienced between the two groups (p = .130). Conclusions: Although PPGP clients report greater pain and restriction in range of motion at baseline than non-PPGP clients, the response to pregnancy massage was similar. Results support a role of pregnancy massage in the management of PPGP. More research on massage for PPGP is needed to confirm a lasting effect of pain reduction from massage.

In this study, we investigated how women struggling with long-term pelvic girdle pain after giving birth experienced and coped in their daily life. We conducted individual interviews with 9 women with pain between 3 and 26 years after giving birth. We found that pelvic girdle pain results in significant challenges, influencing women’s relationships with their children, partners and wider network. The pain demands careful planning and time for rest, influences women’s ability to work, and creates feelings of isolation and shame. The informants connect the lack of formal diagnostic criteria for the condition to the low level of societal recognition.

Purpose: The scope of this study is women’s descriptions of symptoms experienced through persistent pregnancy-related lumbopelvic pain (PPLP) as well as their strategies to cope with the condition. Methods: This is a mixed-method study based on questionnaire responses and inductive interviews with 12 Swedish women with self-reported PLP during pregnancy 2002 partaking in a 12-year postpartum follow-up questionnaire cohort. Test of statistical differences between the interview cohort and the total cohort was performed and the interviews were analysed through inductive qualitative content analysis. Results: The questionnaire data showed that the interview sample reported significantly more pain than the questionnaire respondents but resembled the questionnaire respondents on most other characteristics. The theme “Balancing avoidance and activity” and its sub-themes illustrate the strategies the participants used to manage their situation on a daily basis. The pain was a constant reminder that led to evaluation of pros and cons for physical, social, and mental activities as well as the search for therapies and treatments. Conclusions: For the women who participated in the interviews, living with persistent pregnancy-related lumbopelvic pain caused limitations and negatively affected various and major parts of life to a far greater extent than previously known. Implications for rehabilitation: Persisting pregnancy-related lumbopelvic pain affects various and major parts of life, including working, physical and social activities, and psychological well-being. Rehabilitation should focus on individualized physical activities and effective coping strategies. Effort should be put into helping the patient find fulfilling explanatory reasons for the persisting pregnancy-related lumbopelvic pain.

Background: Women with generalized joint hypermobility may be at increased risk of pregnancy-related pelvic girdle pain, but evidence is inconclusive. Objectives: In this prospective cohort study of 283 pregnant women in Norway, we aimed to study the association of generalized joint mobility with pelvic girdle pain, and to evaluate if pre-pregnancy body mass index was a modifier of the association. Methods: Generalized joint hypermobility was defined as a score of >= 5/9 positive tests on the Beighton score measured in early pregnancy. Primary outcome was evening pain intensity in gestation week 30, measured by a 100 mm visual analogue scale. We applied linear regression analyses to estimate age-adjusted unstandardized beta coefficients. Results: Evening pain intensity was similar among women with Beighton score >= 5/9 and women with Beighton score < 5/9 (age-adjusted mean difference 2.8 mm; 95% CI: -9.2 to 14.9 mm). Women with Beighton score >= 5/9 and pre-pregnancy body mass index >= 25 kg/m(2), reported higher evening pain than women with Beighton score < 5/9 and pre-pregnancy body mass index = 25 kg/m(2) reported higher evening pain compared to women with normal joint mobility and body mass index

Pelvic girdle pain is a common problem during pregnancy and postpartum with significant personal and societal impact and costs. Studies examining the effectiveness of interventions for pelvic girdle pain measure different outcomes, making it difficult to pool data in meta-analysis in a meaningful and interpretable way to increase the certainty of effect measures. A consensus-based core outcome set for pelvic girdle pain can address this issue. As a first step in developing a core outcome set, it is essential to systematically examine the outcomes measured in existing studies.The objective of this systematic review was to identify, examine and compare what outcomes are measured and reported, and how outcomes are measured, in intervention studies and systematic reviews of interventions for pelvic girdle pain and for lumbopelvic pain (which includes pelvic girdle pain).We searched PubMed, Cochrane Library, PEDro and Embase from inception to the 11th May 2018. Two reviewers independently selected studies by title/abstract and by full text screening. Disagreement was resolved through discussion. Outcomes reported and their outcome measurement instruments were extracted and recorded by two reviewers independently. We assessed the quality of reporting with two independent reviewers. The outcomes were grouped into core domains using the OMERACT filter 2.0 framework.A total of 107 studies were included, including 33 studies on pelvic girdle pain and 74 studies on lumbopelvic pain. Forty-six outcomes were reported across all studies, with the highest amount (26/46) in the 'life impact' domain. 'Pain' was the most commonly reported outcome in both pelvic girdle pain and lumbopelvic pain studies. Studies used different instruments to measure the same outcomes, particularly for the outcomes pain, function, disability and quality of life.A wide variety of outcomes and outcome measurements are used in studies on pelvic girdle pain and lumbopelvic pain. The findings of this review will be included in a Delphi survey to reach consensus on a pelvic girdle pain - core outcome set. This core outcome set will allow for more effective comparison between future studies on pelvic girdle pain, allowing for more effective translation of findings to clinical practice.El dolor de la cintura pélvica es un problema común durante el embarazo y el posparto con un impacto personal y social significativo. Los estudios que examinan la efectividad de intervenciones para el dolor de la cintura pélvica miden diferentes resultados, lo que dificulta el agrupamiento de los datos en un metanálisis para aumentar la certeza de las medidas del efecto. Un conjunto de resultados principales basado en un consenso puede abordar este problema. Primero, para desarrollar un conjunto de resultados principales, es esencial examinar sistemáticamente los resultados utilizados en los estudios existentes.El objetivo de esta revisión sistemática fue identificar, examinar y comparar qué resultados se miden y reportan, y cómo se los miden, en estudios de intervención y revisiones sistemáticas de intervenciones para el dolor de la cintura pélvica y para el dolor lumbopélvico.Se realizaron búsquedas en PubMed, Cochrane Library, PEDro y Embase desde el inicio hasta el 11 mayo 2018. Dos revisores seleccionaron independientemente los estudios por título/resumen y texto completo. El desacuerdo se resolvió por discusión. Los resultados reportados y sus instrumentos de medición fueron extraídos por dos revisores independiente. Se evaluó la calidad de informe con dos revisores independientes. Los resultados se agruparon en dominios principales utilizando el filtro OMERACT 2.0.Se incluyeron 107 artículos: 33 artículos sobre el dolor de la cintura pélvica y 74 artículos sobre el dolor lumbopélvico. Se informaron 46 resultados, principalmente (26/46) en el dominio “Impacto en la vida”. “El Dolor” fue el resultado más frecuente. Los estudios utilizaron diferentes instrumentos para medir los mismos resultados, particularmente para los resultados dolor, función, discapacidad y calidad de vida.Se utiliza una amplia variedad de resultados y mediciones de resultados en estudios sobre el dolor de la cintura pélvica y el dolor lumbopélvico. Los resultados de esta revisión se incluirán en una encuesta Delphi, obtener para llegar a un consenso sobre un conjunto de resultados principales. Este conjunto de resultados principales permitirá una comparación más efectiva entre estudios sobre el dolor de la cintura pélvica, lo que permitirá un análisis más efectivo en la práctica clínica.

Up to 86% of pregnant women will have lumbopelvic pain during the 3rd trimester of 36 pregnancy and women with lumbopelvic pain experience lower health-related quality of life 37 during pregnancy than women without lumbopelvic pain. Several risk factors for pregnancy-38 related lumbopelvic pain have been identified and include history of low back pain, previous 39 trauma to the back or pelvis and previous pregnancy-related pelvic girdle pain. During 40 pregnancy, women go through several hormonal and biomechanical changes as well as 41 neuromuscular adaptations which could explain the development of LBPP, but this remains 42 unclear. The aim of this article is to review the potential pregnancy-related changes and 43 adaptations (hormonal, biomechanical and neuromuscular) that may play a role in the 44 development of lumbopelvic pain during pregnancy. This narrative review presents different 45 mechanisms that may explain the development of lumbopelvic pain in pregnant women. A 46 hypotheses-driven model on how these various physiological changes potentially interact in the 47 development of lumbopelvic pain in pregnant women is also presented. Pregnancy-related 48 hormonal changes, characterized by an increase in relaxin, estrogen and progesterone levels, 49 are potentially linked to ligament hyperlaxity and joint instability, thus contributing to 50 lumbopelvic pain. In addition, biomechanical changes induced by the growing fetus, can 51 modify posture, load sharing and mechanical stress in the lumbar and pelvic structures. Finally, 52 neuromuscular adaptations during pregnancy include an increase in the activation of 53 lumbopelvic muscles and a decrease in endurance of the pelvic floor muscles. Whether or not a 54 causal link between these changes and lumbopelvic pain exists remains to be determined. This 55 proposed model proposed a better understanding of the mechanisms behind the development of 56 lumbopelvic pain during pregnancy to guide future research. It should allow clinicians and 57 researchers to consider the multifactorial nature of lumbopelvic pain while taking into account 58 the various changes and adaptations during pregnancy.

Objective. To develop a conceptual model of patho- and sanogene­sis of the sacroiliac joint (SIJ) osteoarthritis on base of the known data about the SIJ, the results of our own biomechanical studies of this joint, its ligaments and stabilizing muscles by finite element modelling, data of clinical verification of these results. Methods. The object of the model is the SIJ as a link, which connects thespine and pelvis. The proposed conceptual model is based on the M.Panjabi hypothesis of chronic lumbar pain in the case of partial dama­ge to ligaments, which leads to muscle dysfunction. Results. Anew conceptual model of SIJ osteoarthritis was developed. In this model we tried to take into account the limitations of the existing SIJ stability hypotheses and models of the appearance ofthepelvic girdle pain, SIJ dysfunction and SIJ arthrosis. Themodel is based on theresults of our own research. It was proved, that patients with SIJ osteoarthritis have an asymmetry of the width ofthejoint slits, theinclination of the sacrum and pelvis, sacral rotation, hyperlordosis in the LV–SI segment. These factors lead toa shift ofthehorizontal axis of sacral rotational mobility relative tothe pelvic bones. This horizontal axis shift leads to the instabili­ty oftheSIJ on one side of the joint, and to the functional block on another side. Theresults of these functional changes were damage ofthe SIJ ligaments-stabilizers, dysfunction of the SIJ muscles-stabilizers, degenerative changes ofSIJ elements and pain. The deve­loped model allows toexplain the distortion of muscular response pattern in patients with improper SIJ biomechanics in conditions ofSIJ osteoarthritis. The increase of the SIJ biomechanics changes enlarges thethemuscle response pattern distortion. Conclusions. The developed conceptual model explains many clinical manifestations oftheSIJ osteoarthritis and will help to understand better themechanics ofthepelvic girdle pain in such conditions, will improve theresults ofdiagnosis and treatment., Мета. На підставі відомих уявлень про крижово-клубовий суглоб (ККС), результатів власних біомеханічних досліджень методом скінченних елементів особливостей цього суглоба, його зв’язок і м’язів-стабілізаторів, їхньої клінічної верифікації розробити концептуальну модель пато- ісаногенезу артрозу ККС. Методи. Об’єктом моделювання була система ККС як ланка, що з’єднує хребет ітаз. За основу передбачуваної концептуальної моделі взято модель М. Panjabi виникнення хронічного поперекового болю в разі часткового ушкодження зв’язок, що призводить до порушення функції м’язів. Результати. Розроблено нову концептуальну модель розвитку артрозу ККС, в якій ми намагалися врахувати обмеження наявних моделей стабільності ККС і появу хребтово-тазового болю, виникнення дисфункції та розвитку артрозу ККС. Модель побудована за результатами власних досліджень. Доведено, що у хворих на артроз ККС є асиметрія ширини суглобових щілин, нахил крижів і таза, ротація крижів, гіперлордоз ухребтовому руховому сегменті LV–SІ. Це призводить до зсуву горизонтальної осі ротаційної рухомості крижів щодо тазових кісток і, відповідно, виникнення, з одного боку, нестабільності ККС, а з іншого, — функціонального блока. Унаслідок цього виникають ушкодження зв’язок-стабілізаторів ККС, біль іпорушення функції м’язів-стабілізаторів суглоба і дегенеративні зміні в його елементах. Розроблена модель дає змогу пояснити зміну патерна м’язової відповіді в пацієнтів із порушенням біомеханіки ККС за умов артрозу. Чим більше змінюється біомеханіка ККС, тим більше спотворюється патерн м’язової відповіді. Висновки. Розроблена концептуальна модель пояснює багато клінічних проявів артрозу ККС і допоможе кращому розумінню механізму виникнення хребтово-тазового болю за таких умов, дозволить поліпшити результати діагностики та лікування.

During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.

Background Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment, and long-term follow-up of PPSS. Methods This follow-up study included 19 out of 21 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbopelvic pain (LPP) were offered a clinical examination. Results 1) PPSS was diagnosed after a normal postpartum period of 24 to 50 h by blood tests (n = 19/19), ultrasonography (n = 9 /19), computer tomography (n = 8/19) or magnetic resonance imaging (n = 16/19) Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and different physiotherapeutic interventions. Women with PPSS more frequently were primiparous (n = 14/19, p = 0.001), had an instrumental delivery (n = 14/19, p = 0.003), longer time of active labour (p = 0.01) and second stage of labour (p = 0.001) than women in the regional registry. 2) Ten out of 19 (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p p = 0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p = 0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS) HADS-Anxiety, 7 versus 2, p = 0.010; and HADS-Depression, 1 versus 0, p = 0.028) than women with no pain. 3). Of the eight women who were clinically assessed, one had lumbar pain and seven had pelvic girdle pain (PGP). Conclusions In the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP at follow-up, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors, long-term consequences, and adequate treatment for this rare pregnancy complication.

Pelvic girdle pain (PGP) during pregnancy is common and, indeed, has always been considered normal. It is commonly associated with moderate to severe pain that impairs everyday activities such as getting up from a chair, bending, walking, working in the home and caring for children, as well as, of course, paid employment. Also, PGP is a frequent cause of sick leave during pregnancy. The aetiology of PGP is poorly understood and there is no official nomenclature, no effective evidence- based preventive measures or treatment, known risk factors or detailed knowledge of the clinical course of the various subgroups of this condition. Objectives The objectives for this project were to determine the prevalence of PGP during pregnancy in a random population of women, detect factors associated with the development of this condition, explore what influences taking sick leave due to PGP, and examine whether pregnant women with PGP, who have been sub-grouped on the basis of two clinical tests, differ with regards to demographic characteristics and/or the clinical course of PGP during the second half of their pregnancy. Methods The thesis consists of three papers, based on two separate data collections at Stavanger University Hospital. Paper I and II originate from a retrospective cohort study conducted in 2009, in which women giving birth at Stavanger University hospital in a 4-month period were asked to fill in a questionnaire on demographic features, pain, disability, PGP, pain-related activities of daily living, sick leave in general and for PGP, frequency of exercising before and during pregnancy, and Oswestry Disability Index. Inclusion criteria were singleton pregnancy of at least 36 weeks and competence in the Norwegian language. Drawings of the pelvic and low back area were used for the localization of pain. PGP intensity was then rated retrospectively on a numerical rating scale. Non-parametric tests, multinomial logistic regression and sequential linear regression analysis were used in the statistical analysis. Paper III originate from a prospective longitudinal cohort study carried out in 2010. Inclusion criteria were the as for the retrospective data collection and took place at the second-trimester routine ultrasound examination. All eligible women (n=503) filled in questionnaires and answered a weekly SMS question during pregnancy until delivery. Women with pain in the pelvic area underwent a clinical examination following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Results Paper I report that nearly 50% of the women experienced moderate and severe PGP during pregnancy. Approximately half of them had PGP syndrome, whereas the other half experienced lumbopelvic pain. Ten percent of the women experienced moderate and severe LBP alone. These pain syndromes increased sick leave and impaired general level of function during pregnancy. Approximately 50% of women with PGP had pain in the area of the symphysis pubis. The analysis of risk factors did not present a unidirectional and clear picture. In Paper II PGP is reported to be a frequent and major cause of sick leave during pregnancy among Norwegian women, which is also reflected in activities of daily living as measured with scores on all Oswestry disability index items. In the multivariate analysis of factors related to sick leave and PGP were work satisfaction, problems with lifting and sleeping, and pain intensity risk factors for sick leave. Also, women with longer education, higher work satisfaction and fewer problems with sitting, walking, and standing, were less likely to take sick leave in pregnancy, despite the same pain intensity as women being on sick leave. In Paper III, 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests. Conclusions Pelvic pain in pregnancy is a health care challenge in which moderate and severe pain develops rather early and has important implications for society. The observed associations between possible causative factors and moderate and severe LBP and PGP in the analysis of the retrospective data may, together with results from other studies, bring some valuable insights into their multifactorial influences and provide background information for future studies. Some pregnant women with PGP show a higher pain tolerance, most likely dependant on education, associated with work situation and/or work posture, which decreases sick leave. These issues are recommended to be further examined in a prospective longitudinal study since they may have important implications for sick leave frequency during pregnancy. If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic pain of more than 5 days per week throughout the remainder of pregnancy could be predicted. Increased individual control over work situation and an active lifestyle, including regular exercise before and during pregnancy, may serve as a PGP prophylactic.

Lumbo-pelvic pain is a common and non-specific problem during pregnancy and postpartum. Although perinatal pyogenic sacroiliitis is uncommon during this time, it might be difficult to distinguish from reactive sacroiliitis in women who are experiencing significant lower back and pelvic girdle pain, as the symptoms and signs are not clear and the tests are not definitive. A 34-year-old primigravida went to the emergency department with severe lower back pain radiating to the right gluteal region and down to the back of the right thigh. This pain began 12 days prior to her presentation and eventually worsened to the point that she could not stand or walk. Her vital signs were within normal ranges, and she was experiencing a fever. Apart from a slight widening of the symphysis pubis, her pelvic and lumbo-sacral pain X-rays revealed no important findings. With the clinical impression of right lumbo-pelvic pain, the patient was admitted for pain management and further inquiries. Despite the fact that the antibiotherapy was prescribed to treat a urinary tract infection, the significant recovery of the patient’s symptoms, even in the absence of a definitive culture of aspirate from the right sacroiliac joint, supported the diagnosis of pyogenic sacroiliitis.

Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term "pregnancy-related sacroiliac joint pain." All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.

ObjectiveTo investigate if there are differences between acupuncture and transcutaneous electrical nerve stimulation (TENS) as treatment for pelvic girdle pain (PGP) in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and physical activity (PA).DesignRandomised controlled trial.Setting and participantsPregnant women (n=113) with clinically verified PGP in gestational weeks 12–28, recruited from maternity healthcare centres, randomised (1:1) into two groups. Exclusion criteria: any obstetrical complication, systemic disease or previous disorder that could contradict tests or treatment.InterventionsThe intervention consisted of either 10 acupuncture sessions (two sessions per week) provided by a physiotherapist or daily home-based TENS during 5 weeks.Primary outcome variablesDisability (Oswestry Disability Index), functioning (Patient Specific Functional Scale), work ability (Work Ability Index) and PA-level according to general recommendations.Secondary outcome variablesFunctioning related to PGP (Pelvic Girdle Questionnaire), evening pain intensity (Numeric Rating Scale, NRS), concern about pain (NRS), health (EuroQoL 5-dimension), symptoms of depression/catastrophising (Edinburgh Postnatal Depression Scale/Coping Strategies Questionnaire).ResultsNo mean differences were detected between the groups. Both groups managed to preserve their functioning and PA level at follow-up. This may be due to significantly (pConclusionTreating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity and also less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active.Trial registration number12726. https://www.researchweb.org/is/sverige/project/127261

ObjectivesEvaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.DesignA multicentre inter-rater reliability study.SettingThree primary care rehabilitation centres in Sweden.ParticipantsA total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order.Outcome measuresInter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging).ResultsVaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres.ConclusionsVaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging.Trial registration numberNCT03703804.

Objective: The prevalence of musculoskeletal problems in pregnancy can vary according to trimester. Early diagnosis and treatments are important to prevent the development of chronic problems. This study was conducted to identify the most common musculoskeletal problems according to trimester, experienced by pregnant women. Material and methods: A total of 120 pregnant women who admitted to physical medicine and rehabilitation clinic, evaluated retrospectively in this study. Application complaints, the diagnosis and the trimester of the pregnant women and also age, weight, height, number of pregnancy, working status, presence of secondary disease were recorded. Results: In the first trimester, the most experienced musculoskeletal problems were low back pain (26.3%), pelvic girdle pain (26.3%) and carpal tunnel syndrome (26.3%). The most frequent problem in the second trimester was lower back pain (43.6%) followed by cramp (32.7%) and pelvic girdle pain (30.9%). Finally, in the third trimester, low back pain (34.8%), cramp (32.6%) and pedal edema (32.6%) were the most reported problems. Conclusion: The prevalence of musculoskeletal problems in pregnancy can vary according to socio-cultural and environmental factors. Determining the most common musculoskeletal problems experienced in pregnancy in a specific region is important for early diagnosis, increasing quality of life and preventing the development of chronic disorders.

Pain related to pregnancy can occur anytime between conception to the postpartum period. Pregnancy and the following months after birth are a time of physical change to the woman’s body, with significant hormonal effects. We present a case of a young female with chronic pain several years after her second pregnancy that presented a diagnostic challenge. She was initially diagnosed with persistent pelvic girdle pain (PGP) type 2, responded somewhat to appropriately targeted pelvic floor therapy, with a plateau in her progress. The diagnosis was revised to PGP type 4, with some improvement in pain with customized therapy. Her treatment again changed with a focus on sacroiliac joint (SIJ) dysfunction and iliopsoas tendinopathy with excellent and complete resolution of her pain. The overlapping nature of these diagnoses caused a significant challenge in creating a tailored physical therapy approach to her pain that eventually led to her final diagnosis being one of exclusion. Treatment was focused on optimization of joint mobility and tissue lengthening, with the resolution of her pain.

Introduction Ear acupuncture carried out in primary care by trained midwives, with no specialist training in acupuncture, may be effective in alleviating pregnancy-related lower back and/or posterior pelvic girdle pain (LBPGP). The objective of this study was to assess the effect of ear acupuncture associated with standard obstetric care, in the primary-care setting, on LBPGP experienced by pregnant women. Material and methods This four-group, multicenter, randomized controlled trial was conducted at 18 public primary care centers in three regions in Spain, with the participation of 220 pregnant women at 24-36 weeks of gestation, aged 18 years or more, diagnosed with pregnancy-related LBPGP and who had not previously received ear acupuncture. The trial was conducted from March 2014 to December 2016. Participants were randomly assigned (1:1:1:1) to receive standard obstetric care plus two sessions (over 2 weeks) of verum ear acupuncture, or nonspecific ear acupuncture, or placebo ear acupuncture, or standard obstetric care alone. The primary outcome was change in pain intensity, assessed using a visual analog scale (0-100 mm) from baseline to the end of treatment (T2). Secondary outcomes included change or presence of pain at 3 months (T3) and at 1 year (T4) postpartum, and changes in responses to the Roland-Morris disability questionnaire (RMDQ) and Short Form-12 Health Survey (SF-12) at the end of treatment. Results A total of 55 women were randomized to each group, and 205 completed the study. With respect to baseline values, the reduction in pain intensity among the verum ear acupuncture group vs standard obstetric care was significantly greater, both at T2 (65.8%, 95%CI 56.2-75.3 vs 25.1%, 95%CI 15.3-34.9) and at T3 (93.8%, 95%CI 88.7-99.0 vs 67.9%, 95%CI 55.3-80.5). Moreover, significant changes were found in the verum ear acupuncture group vs standard obstetric care at T2, in reduced RMDQ scores (70.9%, 95%CI 61.8-80.1 vs 21.2%, 95%CI 8.6-33.7) and in increased SF-12 scores on the physical scale (40.5%, 95%CI 31.5-49.4 vs 8.1%, 95%CI 0.8-15.5). Conclusions After 2 weeks of treatment, ear acupuncture applied by midwives and associated with standard obstetric care significantly reduces lumbar and pelvic pain in pregnant women, improves quality of life and reduces functional disability.

Females during pregnancy commonly encounter back pain at some point of time. Unfortunately, this symptom is quiet carried away and often neglected by the health care providers. Low back pain in pregnancy can have a significant impact both psychologically and physiologically as well. In the present study we intended to find out the prevalence rate for this symptom among the South Indian population by formulating a questionnaire proforma. There was a 27.82 % prevalence rate for low back pain in our study. Though we did not differentiate the back pain as lumbar pain and pelvic girdle pain, quiet a majority of the patients (40%) were facing mild to moderate disabilities because of the pain. The mean duration at the onset of the symptoms was 26 weeks of pregnancy. The mean age of the patients with low back pain was 26 years.Identification of the back pain symptoms during pregnancy is needed so as to assess and provide proper management to such patients.

Sacroiliac joint (SIJ) pain is the most common type of pelvic girdle pain in youngsters with sedentary lifestyle, the incidence of which being 60% of all lower back pain. The pelvic girdle is stabilized by ligaments (sacrotuberous and sacrospinous ligaments) as well as by local muscles. Hamstrings along with sacrotuberous ligament provide posterior stability during functional activities. A 30 year old IT professional presented with acute onset of low back pain and difficulty in transition from sit to stand, walking & sitting for a long duration. Physical examination revealed disturbed Standing hip flexion test (SHFT), disturbed lumbo-pelvic rhythm, severely tight hamstrings & poor stability of pelvis. Based on the clinical findings, he was diagnosed as acute sacroiliac joint pain with anterior rotation of innominate. Manual therapy was aimed to achieve joint movement & correction of asymmetry, which led to significant short term functional recovery. Addition of hamstrings flexibility & core stability training resulted in functional betterment through correction of the asymmetry was not accomplished. Therefore, we can derive that the nociception that occurred was due to stress on the SIJ restricting the functional activity. Improvement in the functional ability and physiological movement of SIJ can be attained by correcting the muscle functions through manual therapy, exercise training, and pain rehabilitation. Keywords: Hamstrings tightness, Sacroiliac joint, Pelvic girdle pain, Sedentary lifestyle, Innominate.

Background Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women. Objective This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP. Methods Forty postpartum women participated in the study. Their age ranged from 25-35 years and their body mass index (BMI) was 25-29.9 kg/m2. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively. Results Both groups (A and B) revealed a significant decrease (p= 0.001) in pain and functional disability and a significant increase (p= 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p= 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A). Conclusions PFM training should be an essential part in rehabilitation programs of PGP postpartum.

Pregnancy-related lumbopelvic pain has been a serious and common problem since ancient time. The present review article focuses on terminology, types, clinical presentation, and management of these problems. There are two entities regarding pregnancy-related lumbopelvic pain: pelvic girdle pain (PGP), and pregnancy-related low back pain (LBP). There are multiple mechanisms behind these disabilities. Age, multiparty, heavy weight lifting, hard physical activity, previous LBP, and low education increase the prevalence. About one-half of women with pregnancy-related lumbopelvic pain have PGP, one-third LBP, and one-sixth have both conditions. Overall, the literature reveals that PGP deserves serious attention from the clinical and economic standpoints.

Background: Lumbosacral plexus entrapment syndrome (LPES) is a little-known but common cause of chronic lumbopelvic and lower extremity pain. The authors document the clinical course of 61 patients who were diagnosed and treated for LPES between May 2016 and October 2018. The study is aimed to evaluate the efficacy of our proposed diagnostic and conservative treatment protocol for LPES, clinically.Methodology: This is a retrospective cohort study of patients suffering from LPES. Patients were included in this study if they compatible symptoms with LPES with symptoms of low back, pelvic, groin, genital, thigh or calf pain after other more common etiologies have been excluded. Additionally, these patients had at least 5 positive provocative Tinel’s tests applied to various lumbopelvic and lower extremity (LPLE) nerve branches yielding => 7 (numeric rating scale) NRS, and weakness of one or more myotomes of the lower body. The group in its entirety was treated with gentle strengthening of the psoas major and piriformis muscles. The primary outcome measure was patient reported satisfaction and improvement including: Full, significant, moderate, slight, or no improvement in pain and symptoms. Patients were followed for up to two years.Results: The most common complaints amongst the patient pool were low back, groin, pelvic, posterior/lateral calf pain. Additionally, 17 patients (28%) stated that everything in the LPLE hurts, consistent with plexalgia. 13 patients were lost to follow-up as they did not reschedule treatment, for unknown reasons. Amongst the remaining 48 patients, 25 recovered fully (52%), 12 significantly (25%), and five moderately (10,4%). Five patients had a slight improvement (10,4%), and two no improvement whatsoever (4%). The average recovery times were mostly consistent with the time of affliction. Patients with a symptom duration of less than one year, generally recovered within 4 months. One to four years, within 10,5 months. Five to nine years, 7,5 months. And, finally, more than 10 years, within 18 months.Conclusion: Non-specific pain syndromes in the LPLE where other causes have been excluded, may be attributable to underlying LPES. In this study, a high correlation between the diagnostic & interventional protocols, and beneficial patient outcomes were demonstrated. However, more statistical and long-term research is needed.Citation: Larsen K, Chien GCC. Lumbosacral plexus entrapment syndrome. Part Two: Symptomology and rehabilitative trials. Anaesth pain & intensiv care 2019;23(2):138-144

Background: Pregnancy related non-specific low back pain (PNSLBP) and pelvic girdle pain (PGP) affect almost half of pregnant women, causing substantial disability for some. These diagnoses...

A pelvic belt decreases patient-reported perception of difficulty during the active straight leg raising (ASLR) test in individuals with pelvic girdle pain. However, the influence of a pelvic belt on the perception of difficulty during ASLR was not investigated in pain-free subjects. Therefore, this influence excluding the impact of pain is not clear. This paper aimed to clarify the effect of a pelvic belt on the perception of difficulty and muscle activity during ASLR performance in the subjective heavier side leg in pain-free subjects. Twenty pain-free female subjects participated. ASLR using the subjective heavier side leg was performed under two conditions: without and with a pelvic belt. Muscle activation of the external oblique, internal oblique, rectus abdominis, rectus femoris, and biceps femoris was measured during ASLR using a surface electromyograph. Difference in perceived difficulty in performing ASLR with and without a belt was assessed. In total, 80% of subjects had decreased perception of difficulty using a pelvic belt during ASLR. For ASLR performed with a pelvic belt, muscle activity significantly decreased in the contralateral rectus abdominis, ipsilateral external oblique, and bilateral internal oblique (P0.05). In conclusion, using a pelvic belt can decrease the perception of difficulty during ASLR, and the pelvic belt may improve impairment of load transfer between the trunk and pelvis.