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BMC Musculoskeletal Disorders Jul 2016Pelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term... (Comparative Study)
Comparative Study
BACKGROUND
Pelvic girdle pain (PGP) is a multifactorial condition, which can be mentally and physically compromising both during and after pregnancy. However, long-term pregnancy-related PGP has been poorly investigated. This longitudinal follow-up study uniquely aimed to describe prevalence and predictors of PGP and its consequences on women's health and function up to 11 years after pregnancy.
METHODS/DESIGN
A postal questionnaire was sent to 530 women who participated in 1 of 3 randomized controlled studies for PGP in pregnancy. Women who reported experiencing lumbopelvic pain were offered a clinical examination. Main outcome measure was the presence of long term PGP as assessed by an independent examiner. Secondary outcomes were: working hours/week, function (the Disability Rating Index, and Oswestry Disability Index), self-efficacy (the General Self-Efficacy Scale), HRQL (Euro-Qol 5D and EQ-Visual scale), anxiety and depression, (Hospital anxiety and depression scale,) and pain-catastrophizing (Pain Catastrophizing Scale), in women with PGP compared to women with no PGP.
RESULTS
A total of 371/530 (70 %) women responded and 37/ 371 (10 %) were classified with long-term PGP. Pregnancy-related predictors for long-term PGP were number of positive pain provocation tests (OR = 1.79), history of low back pain (LBP) (OR = 2.28), positive symphysis pressure test (OR = 2.01), positive Faber (Patrick's) test (OR = 2.22), and positive modified Trendelenburg test (OR = 2.20). Women with PGP had significantly decreased ability to perform daily activities (p < .001), lower self-efficacy (p = 0.046), decreased HRQL (p < .001), higher levels of anxiety and depression (p < .001), were more prone to pain catastrophizing, and worked significantly fewer hours/week (p = 0.032) compared to women with no PGP.
CONCLUSIONS
This unique long-term follow up of PGP highlights the importance of assessment of pain in the lumbopelvic area early in pregnancy and postpartum in order to identify women with risk of long term pain. One of 10 women with PGP in pregnancy has severe consequences up to 11 years later. They could be identified by number of positive pain provocation tests and experience of previous LBP. Access to evidence based treatments are important for individual and socioeconomic reasons.
Topics: Adult; Age Factors; Anxiety; Body Mass Index; Catastrophization; Chronic Pain; Depression; Female; Follow-Up Studies; Humans; Longitudinal Studies; Low Back Pain; Middle Aged; Pain Measurement; Pelvic Girdle Pain; Postpartum Period; Pregnancy; Pregnancy Complications; Prevalence; Quality of Life; Randomized Controlled Trials as Topic; Risk Factors; Self Efficacy; Sick Leave; Surveys and Questionnaires; Young Adult
PubMed: 27406174
DOI: 10.1186/s12891-016-1154-0 -
Cureus Oct 2021Pregnancy-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... (Review)
Review
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.
PubMed: 34786225
DOI: 10.7759/cureus.18619 -
Developmental Dynamics : An Official... May 2011Genes expressed in the somatopleuric mesoderm, the embryonic domain giving rise to the vertebrate pelvis, appear important for pelvic girdle formation. Among such genes,...
Genes expressed in the somatopleuric mesoderm, the embryonic domain giving rise to the vertebrate pelvis, appear important for pelvic girdle formation. Among such genes, Pbx family members and Emx2 were found to genetically interact in hindlimb and pectoral girdle formation. Here, we generated compound mutant embryos carrying combinations of mutated alleles for Pbx1, Pbx2, and Pbx3, as well as Pbx1 and Emx2, to examine potential genetic interactions during pelvic development. Indeed, Pbx genes share overlapping functions and Pbx1 and Emx2 genetically interact in pelvic formation. We show that, in compound Pbx1;Pbx2 and Pbx1;Emx2 mutants, pelvic mesenchymal condensation is markedly perturbed, indicative of an upstream control by these homeoproteins. We establish that expression of Tbx15, Prrx1, and Pax1, among other genes involved in the specification and development of select pelvic structures, is altered in our compound mutants. Lastly, we identify potential Pbx1-Emx2-regulated enhancers for Tbx15, Prrx1, and Pax1, using bioinformatics analyses.
Topics: Animals; Computational Biology; Female; Gene Expression Regulation, Developmental; Homeodomain Proteins; In Situ Hybridization; Male; Mice; Paired Box Transcription Factors; Pelvis; Pre-B-Cell Leukemia Transcription Factor 1; Proto-Oncogene Proteins; T-Box Domain Proteins; Transcription Factors
PubMed: 21455939
DOI: 10.1002/dvdy.22617 -
Homo : Internationale Zeitschrift Fur... Apr 2023Discussions of the evolution of sexual dimorphism in torso shape and the pectoral region assume that this dimorphism exists independently of body size. We test this... (Comparative Study)
Comparative Study
Discussions of the evolution of sexual dimorphism in torso shape and the pectoral region assume that this dimorphism exists independently of body size. We test this assumption in two human populations and further examine what is needed to understand sexual dimorphism in the pectoral region. Modern human males have broad shoulders and narrow hips relative to females, lending males a more triangular torso. The wider female pelvis is commonly attributed to obstetric pressures while the broader male pectoral girdle has been argued to be an adaptation that improves hunting or intrasexual competition. While sexual dimorphism in the pelvic girdle is known to exist after adjusting for body size across human populations, most studies of sexual dimorphism in the pectoral girdle have not adjusted the data to account for sexual size dimorphism or compared different ancestral groups. The aforementioned hypotheses explaining sexual dimorphism in the clavicle and scapula as products of natural selection are predicated on the untested assumption that sex differences do not scale with body size. This study tests this assumption by comparing various measurements of the pectoral girdle, the pelvic girdle, and six pectoral-pelvic indices of black and white South Africans of known sex and height to test whether the sexes and ancestral groups will differ in these values after adjusting for differences in body size. Comparisons of ancestral groups reveal that white South Africans have larger pectoral and pelvic dimensions than black South Africans, but that blacks have larger index values than whites. Regardless of differences in ancestry and body size, males have significantly broader pectoral regions as indicated by comparisons of both individual pectoral measurements and pectoral-pelvic indices. This pattern of sexual dimorphism is reversed in the pelvic region where females have larger skeletal elements. In addition to finding both absolute and relative differences in mean values for the pectoral and pelvic skeleton, females and males and blacks and whites differ in the scaling relationship of these traits, suggesting different allometric trajectories for these bones that may be explained by their distinct evolutionary functions, their adaptations to specific environments, or by changes in lengths due to age. These results suggest that sexual dimorphism in the pectoral region is not a product of scaling and that differences in this region reflect adaptive forces acting in unique ways on each sex, consistent with the assumptions of earlier evolutionary explanations.
Topics: Female; Humans; Male; Black People; Sex Characteristics; Pelvic Bones; White People; South Africa; Bones of Upper Extremity; Race Factors; Sex Factors; Body Height; Biological Evolution
PubMed: 36628541
DOI: 10.1127/homo/2023/1486 -
BMJ (Clinical Research Ed.) Jul 2005Exercises may help, and evidence is increasing that acupuncture reduces pain
Exercises may help, and evidence is increasing that acupuncture reduces pain
Topics: Acupuncture Therapy; Exercise Therapy; Female; Humans; Pelvic Pain; Pregnancy; Pregnancy Complications
PubMed: 16051994
DOI: 10.1136/bmj.331.7511.249 -
The Protein Journal Aug 2021The limb-girdle muscular dystrophies (LGMD) are a collection of genetic diseases united in their phenotypical expression of pelvic and shoulder area weakness and... (Review)
Review
The limb-girdle muscular dystrophies (LGMD) are a collection of genetic diseases united in their phenotypical expression of pelvic and shoulder area weakness and wasting. More than 30 subtypes have been identified, five dominant and 26 recessive. The increase in the characterization of new genotypes in the family of LGMDs further adds to the heterogeneity of the disease. Meanwhile, better understanding of the phenotype led to the reconsideration of the disease definition, which resulted in eight old subtypes to be no longer recognized officially as LGMD and five new diseases to be added to the LGMD family. The unique variabilities of LGMD stem from genetic mutations, which then lead to protein and ultimately muscle dysfunction. Herein, we review the LGMD pathway, starting with the genetic mutations that encode proteins involved in muscle maintenance and repair, and including the genotype-phenotype relationship of the disease, the epidemiology, disease progression, burden of illness, and emerging treatments.
Topics: Genotype; Humans; Muscular Dystrophies, Limb-Girdle; Mutation
PubMed: 34110586
DOI: 10.1007/s10930-021-10006-9 -
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 -
BMC Pregnancy and Childbirth May 2018To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of...
BACKGROUND
To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum.
METHODS
Fifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used.
RESULTS
Women experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70-2.71, and aOR = 2.83, 95% CI 2.25-3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women.
CONCLUSIONS
Women with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP.
Topics: Adolescent; Adult; Body Mass Index; Body Weight; Child; Educational Status; Female; Humans; Menarche; Morning Sickness; Nausea; Norway; Pelvic Girdle Pain; Postpartum Period; Pregnancy; Prevalence; Surveys and Questionnaires; Time Factors; Young Adult
PubMed: 29739355
DOI: 10.1186/s12884-018-1764-7 -
Acta Obstetricia Et Gynecologica... Oct 2023Pelvic girdle pain during and after pregnancy is a major public health problem with significant daily problems for affected women and their families. There is now... (Observational Study)
Observational Study
INTRODUCTION
Pelvic girdle pain during and after pregnancy is a major public health problem with significant daily problems for affected women and their families. There is now accumulating evidence that pregnancy-related pelvic girdle pain originates from the sacroiliac joints and the pubic symphysis as well as their extra-articular ligaments. However, the heritability of the disease remains to be determined. We hypothesized that there is an increased familial risk of pregnancy-related pelvic girdle pain.
MATERIAL AND METHODS
A population-based national database linkage registry study of approximately 9.3 million individuals within 4.2 million families in Sweden with a recruitment period from 1997 to 2018. The Swedish Multi-generation register was used to find female pairs of twins, full siblings, half-siblings and first cousins where both in the pairs had a completed pregnancy. The outcome measure was diagnosis of pregnancy-related pelvic girdle pain (International Classification of Diseases-10 O26.7 [1997-2018]) in the first pregnancy. Data was obtained from the Swedish Hospital Discharge Register, the Swedish Outpatient Care Register, the Swedish Medical Birth Register, the Primary Healthcare Register, and Medical Treatment Register. Cox regression analysis was used to calculate adjusted estimated effect of the exposure variable familial history of pregnancy-related pelvic girdle pain on the outcome variable pregnancy-related pelvic girdle pain at first birth.
RESULTS
From the registers, 1 010 064 women pregnant with their first child within 795 654 families were collected. In total, 109 147 women were diagnosed with pregnancy-related pelvic girdle pain. The adjusted hazard ratio for a familial risk of pregnancy-related pelvic girdle pain was 2.09 (95% CI 1.85-2.37) among twins (monozygotic and dizygotic), 1.78 (95% CI 1.74-1.82) in full siblings, 1.16 (95% CI 1.06-1.28) in half-siblings from the mother, 1.09 (95% CI 1.024-1.16) in half-siblings from the father and 1.09 (95% CI 1.07-1.12) in first cousins.
CONCLUSIONS
This nationwide observational study showed a familial clustering of pregnancy-related pelvic girdle pain. The hazard ratio for the condition was associated with the degree of relatedness, suggesting that heredity factors contribute to the development of pregnancy-related pelvic girdle pain. There is no causal treatment available for pregnancy-related pelvic girdle pain and further studies are now encouraged to clarify the specific genetic factors that contribute to the disease and for future targeted interventions.
Topics: Female; Humans; Pregnancy; Family; Genetic Predisposition to Disease; Heredity; Pelvic Girdle Pain; Pregnancy Complications; Sweden
PubMed: 37470484
DOI: 10.1111/aogs.14646 -
Acta Obstetricia Et Gynecologica... 2008Increased levels of relaxin, a hormone structurally belonging to the insulin-like growth factor family, has been associated with both pelvic girdle pain and type 1...
OBJECTIVE
Increased levels of relaxin, a hormone structurally belonging to the insulin-like growth factor family, has been associated with both pelvic girdle pain and type 1 diabetes in pregnancy. However, an association between pelvic girdle pain in pregnancy and diabetes has not been investigated. The aim of this study was to investigate whether or not an association exists between diabetes and pelvic girdle syndrome.
DESIGN
Cross-sectional questionnaire study.
SETTING
All women 18-40 years old, in two municipalities in Norway during 1998-1999 were eligible for the study. Sample. A total of 1,816 women with at least one prior delivery constituted the study sample.
METHODS
Pelvic girdle syndrome during last pregnancy was the outcome variable, defined as pain in the anterior pelvis and bilateral posterior pelvis. The impact of diabetes on developing pelvic girdle syndrome was estimated as odds ratios in logistic regression analyses.
RESULTS
Diabetes increased the risk of pelvic girdle syndrome (adjusted odds ratio 7.3; 95% confidence interval: 1.8-28.5). In addition, age > or =25 years at delivery and obesity (body mass index > or =35) were associated with pelvic girdle syndrome. Parity and time since delivery were not significantly associated with pelvic girdle syndrome.
CONCLUSIONS
The results in multivariate analyses indicate an association between pelvic girdle syndrome and diabetes. The causes of pelvic girdle pain are not known. However, our results encourage further exploration of hormonal factors.
Topics: Adolescent; Adult; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Female; Humans; Logistic Models; Multivariate Analysis; Pelvic Pain; Pregnancy; Pregnancy in Diabetics
PubMed: 18763174
DOI: 10.1080/00016340802345944