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Tidsskrift For Den Norske Laegeforening... Nov 2010Pelvic girdle pain (PGP) usually presents during pregnancy. About 25% of all pregnant women and 5% of all women suffer from postpartum lumbopelvic pain causing them to... (Review)
Review
BACKGROUND
Pelvic girdle pain (PGP) usually presents during pregnancy. About 25% of all pregnant women and 5% of all women suffer from postpartum lumbopelvic pain causing them to seek medical help. This article discusses possible causes, diagnostic aspects and treatment of PGP.
MATERIAL AND METHOD
The paper is based on literature identified through non-systematic searches in PubMed, Medline, Embase, Cinahl and Cochrane. Only randomized controlled trials were considered for effect of treatment.
RESULTS
Possible underlying mechanisms are hormonal, biomechanical, inadequate motor control and stress of ligament structures. The diagnosis should be based on pain location and several clinical tests. Characteristic signs are problems with walking, standing and sitting. There is evidence for the existence of PGP subgroups that require different treatment. It is well documented that individualized physiotherapy focused on body awareness and specific functional training, has a good and long-lasting effect. Patients with PGP may benefit from reassuring information based on medical history and clinical examination. When needed, patients may be referred to targeted individualized physiotherapy which is continuously evaluated. Few seem to have effect of general or stabilizing exercises.
INTERPRETATION
General or stabilizing exercises seem to have miner effect in a number of women.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Pelvic Floor; Pelvic Pain; Physical Therapy Modalities; Pregnancy; Pregnancy Complications; Puerperal Disorders
PubMed: 21052118
DOI: 10.4045/tidsskr.09.0702 -
Physical Therapy Dec 2022The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic...
OBJECTIVE
The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum.
METHODS
Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted.
RESULTS
Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = -3.13 [95% CI = -5.77 to -0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = -6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain.
CONCLUSION
The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed.
IMPACT
This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.
Topics: Humans; Female; Pelvic Girdle Pain; Prospective Studies; Longitudinal Studies; Postpartum Period; Pelvic Floor; Diastasis, Muscle
PubMed: 36326139
DOI: 10.1093/ptj/pzac152 -
Ugeskrift For Laeger Dec 1992Pelvic insufficiency during pregnancy, pelvic girdle relaxation, is defined as a condition with pain at the pubic symphysis and/or the sacroiliac joint developing in... (Review)
Review
Pelvic insufficiency during pregnancy, pelvic girdle relaxation, is defined as a condition with pain at the pubic symphysis and/or the sacroiliac joint developing in connection with pregnancy or delivery. No unambiguous criteria for the diagnosis of pelvic girdle relaxation exist but the following findings occur: Direct tenderness at the pubic symphysis and/or sacroiliac joint, waddling gait, pain on change of position, positive Trendelenburg's sign, iliac compression test, iliac gapping test and sacral pressure test. The frequency is 7.6-18.5 per 1000 deliveries. The incidence is increased in multiparae and women with occupations which strain the back. Recurrence occurs in 41-77%. The condition appears for the first time usually in the 5th-8th months of pregnancy. The majority of patients recover shortly after delivery but in some a condition of prolonged pain persists. The cause of pelvic girdle relaxation is unknown. Hormonal and biomechanical factors are considered to be of significance. No increased mobility in the pelvic joints nor general hypermobility have been demonstrated. Treatment is symptomatic and consists of information, instruction in relief and psychosocial support. Exercises and a trochanter belt may be useful. No controlled investigations of the value of treatment are available.
Topics: Back Pain; Diagnosis, Differential; Female; Humans; Pelvis; Pregnancy; Pregnancy Complications; Pubic Symphysis; Sacroiliac Joint
PubMed: 1471273
DOI: No ID Found -
The Journal of Experimental Biology Sep 2016Movements of the pelvic girdle facilitate terrestrial locomotor performance in a wide range of vertebrates by increasing hind limb excursion and stride length. The...
Movements of the pelvic girdle facilitate terrestrial locomotor performance in a wide range of vertebrates by increasing hind limb excursion and stride length. The extent to which pelvic movements contribute to limb excursion in turtles is unclear because the bony shell surrounding the body presents a major obstacle to their visualization. In the Cryptodira, which are one of the two major lineages of turtles, pelvic anatomy indicates the potential for rotation inside the shell. However, in the Pleurodira, the other major suborder, the pelvis shows a derived fusion to the shell, preventing pelvic motion. In addition, most turtles use their hind limbs for propulsion during swimming as well as walking, and the different locomotor demands between water and land could lead to differences in the contributions of pelvic rotation to limb excursion in each habitat. To test these possibilities, we used X-ray reconstruction of moving morphology (XROMM) to compare pelvic mobility and femoral motion during walking and swimming between representative species of cryptodire (Pseudemys concinna) and pleurodire (Emydura subglobosa) turtles. We found that the pelvis yawed substantially in cryptodires during walking and, to a lesser extent, during swimming. These movements contributed to greater femoral protraction during both walking and swimming in cryptodires when compared with pleurodires. Although factors related to the origin of pelvic-shell fusion in pleurodires are debated, its implications for their locomotor function may contribute to the restriction of this group to primarily aquatic habits.
Topics: Animals; Biomechanical Phenomena; Discriminant Analysis; Femur; Joints; Male; Motion; Pelvis; Regression Analysis; Rotation; Swimming; Turtles; Walking; X-Rays
PubMed: 27340204
DOI: 10.1242/jeb.141622 -
JBR-BTR : Organe de La Societe Royale... 2013
Topics: Anti-Inflammatory Agents, Non-Steroidal; Female; Humans; Magnetic Resonance Imaging; Pelvis; Spondylarthritis; Tendinopathy; Young Adult
PubMed: 23971180
DOI: 10.5334/jbr-btr.261 -
Manual Therapy May 2007The diagnosis and classification of pelvic girdle pain (PGP) disorders remains controversial despite a proliferation of research into this field. The majority of PGP... (Review)
Review
The diagnosis and classification of pelvic girdle pain (PGP) disorders remains controversial despite a proliferation of research into this field. The majority of PGP disorders have no identified pathoanatomical basis leaving a management vacuum. Diagnostic and treatment paradigms for PGP disorders exist although many of these approaches have limited validity and are uni-dimensional (i.e. biomechanical) in nature. Furthermore single approaches for the management of PGP fail to benefit all. This highlights the possibility that 'non-specific' PGP disorders are represented by a number of sub-groups with different underlying pain mechanisms rather than a single entity. This paper examines the current knowledge and challenges some of the common beliefs regarding the sacroiliac joints and pelvic function. A hypothetical 'mechanism based' classification system for PGP, based within a biopsychosocial framework is proposed. This has developed from a synthesis of the current evidence combined with the clinical observations of the authors. It recognises the presence of both specific and non-specific musculoskeletal PGP disorders. It acknowledges the complex and multifactorial nature of chronic PGP disorders and the potential of both the peripheral and central nervous system to promote and modulate pain. It is proposed that there is a large group of predominantly peripherally mediated PGP disorders which are associated with either 'reduced' or 'excessive' force closure of the pelvis, resulting in abnormal stresses on pain sensitive pelvic structures. It acknowledges that the interaction of psychosocial factors (such as passive coping strategies, faulty beliefs, anxiety and depression) in these pain disorders has the potential to promote pain and disability. It also acknowledges the complex interaction that hormonal factors may play in these pain disorders. This classification model is flexible and helps guide appropriate management of these disorders within a biopsychosocial framework. While the validity of this approach is emerging, further research is required.
Topics: Arthralgia; Chronic Disease; Female; Humans; Pain Measurement; Pelvic Pain; Prognosis; Risk Factors; Sacroiliac Joint; Severity of Illness Index; Socioeconomic Factors; Somatoform Disorders; Stress, Psychological
PubMed: 17449432
DOI: 10.1016/j.math.2007.02.001 -
Physiotherapy Jun 2021To investigate whether women with diastasis recti abdominis (DRA) have weaker abdominal muscles and higher prevalence of pelvic floor disorders (PFD), low back, pelvic...
Women with diastasis recti abdominis might have weaker abdominal muscles and more abdominal pain, but no higher prevalence of pelvic floor disorders, low back and pelvic girdle pain than women without diastasis recti abdominis.
OBJECTIVE
To investigate whether women with diastasis recti abdominis (DRA) have weaker abdominal muscles and higher prevalence of pelvic floor disorders (PFD), low back, pelvic girdle and abdominal pain than women without DRA.
DESIGN
Cross sectional study of women with and without DRA.
SETTING
University study.
PARTICIPANTS
Seventy-two parity and age matched women with and without DRA.
MAIN OUTCOME MEASURES
Maximal abdominal muscle strength and endurance were assessed with a dynamometer and with a curl-up test. Women reported whether they experienced PFD, low back pain, pelvic girdle pain or abdominal pain. Those experiencing PFD or pain completed the Pelvic Floor Distress Inventory-short form 20 (PFDI-20), the Oswestry Disability Index (ODI), the Pelvic Girdle Questionnaire (PGQ) or questions about abdominal pain, respectively.
RESULTS
Maximal abdominal strength standing with 30° hip flexion was significantly lower in women with DRA (mean difference -12.9Nm, 95%CI: -24.4 to -1.5; P=0.028), but adjusted analyses showed no significant difference (mean difference -11.9Nm, 95%CI: -26.5 to 2.6; P=0.106). Adjusted analyses showed significant higher prevalence of abdominal pain in women with DRA (OR: 0.02, 95%CI: 0.00 to 0.61, P=0.026). There was no difference between the groups in PFD, low back and pelvic girdle pain.
CONCLUSION
Women with DRA tend to have weaker abdominal muscles and higher prevalence of abdominal pain, but no higher prevalence of PFD, low back or pelvic girdle pain than women without DRA.
Topics: Abdominal Pain; Cross-Sectional Studies; Female; Humans; Pelvic Floor; Pelvic Floor Disorders; Pelvic Girdle Pain; Pregnancy; Prevalence; Rectus Abdominis
PubMed: 33691943
DOI: 10.1016/j.physio.2021.01.008 -
Rheumatology (Oxford, England) Oct 2020There is currently no diagnostic test for PMR. A characteristic pattern of extracapsular inflammation as assessed by contrast-enhanced MRI (ceMRI) has recently been...
OBJECTIVE
There is currently no diagnostic test for PMR. A characteristic pattern of extracapsular inflammation as assessed by contrast-enhanced MRI (ceMRI) has recently been described in the pelvis of patients with PMR. We aimed to evaluate the performance of inflammatory ceMRI signals at predefined pelvic sites as a diagnostic test for PMR.
METHODS
Pelvic MRI scans of patients with pelvic girdle pain (n = 120), including 40 patients with an expert diagnosis of PMR and 80 controls with other reasons for pelvic pain were scored by three blinded radiologists, who evaluated the degree of contrast enhancement at 19 predefined tendinous and capsular pelvic structures. Different patterns of involvement were analysed statistically.
RESULTS
The frequency of bilateral peritendinitis and pericapsulitis including less common sites, such as the proximal origins of the m. rectus femoris and m. adductor longus, differed significantly between PMR cases and controls: 13.4 ± 2.7 vs 4.0 ± 2.3. A cut-off of ≥10 inflamed sites discriminated well between groups (sensitivity 95.8%, specificity 97.1%). Bilateral inflammation of the insertion of the proximal m. rectus femoris or adductor longus tendons together with ≥3 other bilaterally inflamed sites performed even better (sensitivity 100%, specificity 97.5%).
CONCLUSION
This study confirms that a distinctive MRI pattern of pelvic inflammation (bilateral peritendinitis and pericapsulitis and the proximal origins of the m. rectus femoris and m. adductor longus) is characteristic for PMR. The high sensitivity and specificity of the set of anatomical sites evaluated suggests their clinical usefulness as a confirmatory diagnostic test.
Topics: Bursitis; Buttocks; Case-Control Studies; Contrast Media; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pelvic Bones; Pelvic Girdle Pain; Polymyalgia Rheumatica; Quadriceps Muscle; Retrospective Studies; Sensitivity and Specificity; Tendinopathy
PubMed: 32077962
DOI: 10.1093/rheumatology/keaa014 -
Clinical Biomechanics (Bristol, Avon) Dec 2020Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used...
BACKGROUND
Pelvic girdle pain is prevalent during pregnancy, and women affected report weight-bearing activities to be their main disability. The Stork test is a commonly used single-leg-stance test. As clinicians report specific movement patterns in those with pelvic girdle pain, we aimed to investigate the influence of both pregnancy and pelvic girdle pain on performance of the Stork test.
METHODS
In this cross-sectional study, 25 pregnant women with pelvic girdle pain, 23 asymptomatic pregnant and 24 asymptomatic non-pregnant women underwent three-dimensional kinematic analysis of the Stork test. Linear mixed models were used to investigate between-group differences in trunk, pelvic and hip kinematics during neutral stance, weight shift, leg lift and single leg stance.
FINDINGS
Few and small significant between-group differences were found. Pregnant women with pelvic girdle pain had significantly less hip adduction during single leg stance compared to asymptomatic pregnant women (estimated marginal means (95% confidence intervals) -1.1° (-2.4°, 0.3°) and 1.0° (-0.4°, 2.4°), respectively; P = 0.03). Asymptomatic pregnant women had significantly less hip internal rotation compared to non-pregnant women 4.1° (1.6°, 6.7°) and 7.9° (5.4°, 10.4°), respectively (P = 0.04) and greater peak hip flexion angle of the lifted leg in single leg stance 80.4° (77.0°, 83.9°) and 74.1° (70.8°, 77.5°), respectively (P = 0.01). Variation in key kinematic variables was large across participants in all three groups.
INTERPRETATION
Our findings indicate that trunk, pelvic and hip movements during the Stork test are not specific to pregnancy and/or pelvic girdle pain in the 2nd trimester. Instead, movement strategies appear unique to each individual.
Topics: Adult; Asymptomatic Diseases; Biomechanical Phenomena; Cross-Sectional Studies; Female; Humans; Movement; Pelvic Girdle Pain; Pelvis; Pregnancy; Rotation; Torso; Weight-Bearing
PubMed: 32920251
DOI: 10.1016/j.clinbiomech.2020.105168 -
Acta Obstetricia Et Gynecologica... Oct 2023Pelvic girdle pain in pregnancy is a major public health concern. For too many women, the pain condition causes disability and sick leave, has a negative impact on daily...
INTRODUCTION
Pelvic girdle pain in pregnancy is a major public health concern. For too many women, the pain condition causes disability and sick leave, has a negative impact on daily life, and breeds doubt in their view as mother, partner, and worker. The pathophysiology is unknown and causal treatment is lacking. Depression in pregnancy is common, undertreated, and previously associated with pelvic girdle pain with unclear causal direction.
MATERIAL AND METHODS
A prospective inception cohort study of 356 Swedish women examined them in early and late pregnancy. Women with a positive Posterior Pelvic Pain Provocation test in early pregnancy were not included. The exposure, depressive symptoms in early pregnancy, was self-reported on the Hospital Anxiety and Depression Scale, depression part (0-21). Outcome measure in late pregnancy was a graded score on the Posterior Pelvic Pain Provocation test (0-8). Covariates for statistical adjustment were identified in a directed acyclic graph. Linear robust and logistic regression were used in the statistical analyses.
RESULTS
In early pregnancy, the 248 women with negative Posterior Pelvic Pain Provocation test had a mean score of 2.35 (± 2.3 standard deviation) on the Hospital Anxiety and Depression Scale, depression part. In a fully adjusted, multiple robust regression model a positive association was shown between Hospital Anxiety and Depression Scale score, depression part, and the Posterior Pelvic Pain Provocation test score in late pregnancy with an estimated effect of β = 0.32 (95% confidence interval [CI] 0.16-0.48, p < 0.001). Dichotomization of exposure (Hospital Anxiety and Depression Scale, depression part <8/≥8) and outcome (Posterior Pelvic Pain Provocation test score 0/>0) rendered adjusted odds ratio 1.71 (95% CI 0.38-7.7) and numbers needed to treat adjusted odds ratio 5.54 (95% CI -3.4-14.5).
CONCLUSIONS
Depressive symptoms in early pregnancy were associated with the development and intensity of pelvic girdle pain in late pregnancy. Considering the small sample size, screening and treatment for depressive symptoms in early pregnancy may enable a way to reduce and prevent disabling pelvic girdle pain in late pregnancy. Trials are needed to confirm the results.
Topics: Pregnancy; Female; Humans; Pelvic Girdle Pain; Cohort Studies; Depression; Prospective Studies; Pelvic Pain; Pregnancy Complications
PubMed: 36965059
DOI: 10.1111/aogs.14562