Kinematic and spatiotemporal gait characteristics in pregnant women with pelvic girdle pain,asymptomatic pregnant and non-pregnant women

BackgroundWalking difficulties are common among pregnant women with pelvic girdle pain. This cross-sectional study investigated the influence of pelvic girdle pain, pregnancy and speed on spatiotemporal and trunk, pelvic and hip kinematics during gait in the 2nd trimester of pregnancy.MethodsThree-dimensional gait analysis at self-selected speed was performed in 25 pregnant women with pelvic girdle pain, 24 asymptomatic pregnant and 24 non-pregnant women. Linear mixed models were used to investigate between-group differences in gait variables. Adjustment for gait speed was included in the analysis. Correlations between speed and fear of movement, disability and pain were examined using Spearman correlation coefficient (r_s).FindingsPregnant women with pelvic girdle pain walked 18% slower (estimated marginal means (95% confidence intervals) 1.18 (1.22, 1.24) meter/s) compared to asymptomatic pregnant women (1.44 (1.38, 1.50) meter/s) (P < 0.001). Moreover, with longer double limb support (5%, P = 0.04), shorter contralateral step length (3%, P = 0.03) and more restricted pelvic and hip kinematics (0.001 ≤ P ≤ 0.01) adjusted for speed. Only stance, double limb support and thoracic rotation (0.001 ≤ P ≤ 0.04) differed between asymptomatic pregnant and non-pregnant women. Speed was negatively correlated with fear of movement (r_s = −0.63, P = 0.01) and disability (r_s = −0.46, P = 0.03) in the pelvic girdle pain group.InterpretationGait is primarily influenced by pelvic girdle pain and less by pregnancy. Pregnant women with pelvic girdle pain walked slower and with a more rigid gait pattern compared to asymptomatic pregnant women, presumably related to altered load transfer. Our results may assist clinical evaluation of pelvic girdle pain, as well as direct future research.     

Using the posterior pelvic pain provocation test in pregnant Japanese women

This study investigated the usefulness of the posterior pelvic pain provocation (PPPP) test for differentiating between pelvic pain and low back pain because of the different prognoses and treatment strategies. We recruited 263 Japanese women who were > 36 weeks' gestation and 213 were included. The PPPP test was applied to 154 women with self‐reported lumbopelvic pain. The participants were divided into three groups: the PPPP test positive (PPPP+, n = 60) subgroup, PPPP test negative (PPPP?, n = 94) subgroup, and no pain group (n = 59). The disability scores of the PPPP+ subgroup were significantly higher than the scores of the PPPP? subgroup and no pain group. In the PPPP+ subgroup, the intensity of pelvic pain was significantly correlated with the disability scores, but that of low back pain was not. The PPPP test could be carried out by a midwife without side‐effects and could detect pregnant women with impaired ability in daily life due to lumbopelvic pain.     

Abdominal and pelvic floor muscle function in women with and without long lasting pelvic girdle pain

Approximately 5-20% of postpartum women suffer from long-lasting pelvic girdle pain (PGP). The etiology and pathogenesis of PGP are still unclear. The aim of this study was to examine whether subjects with and without persisting PGP and disability differed with respect to their ability to voluntarily contract the deep abdominals (TrA and IO) and to the strength of the pelvic floor muscles (PFM). Twenty subjects (12 with persisting PGP, 8 recovered from PGP) were examined. Contractions of the deep abdominal muscles (TrA and IO) were imaged by real-time ultrasound. Vaginal palpation and observation were used to assess the women's ability to perform correct a PFM contraction. PFM strength was measured by a vaginal balloon catheter connected to a pressure transducer. The active straight leg raise test was used to assess the ability of load transfer. The results showed no statistical significant difference between the groups in increase of muscle thickness of the deep abdominal muscles (TrA; P = 0.87 and IO; P = 0.51) or regarding PFM strength (P = 0.94). The ability to voluntarily contract the deep abdominal muscles and the strength of the PFMs are apparently not associated to PGP. However, the results are based on a small sample and additional studies are needed.     

Insulin disappearance rate in pregnant and non-pregnant women, and in non-pregnant women given GHRIH

The half-life of injected monocomponent insulin, as judged by radioimmunoassay, has been found to be 3-3 1/2 min in a group of healthy women. This value is unaffected by pregnancy. Tests were repeated in non-pregnant women during an infusion of GHRIH to ensure that endogenous insulin secretion was suppressed by the dose of insulin given. Similar values were obtained.     

Evidence and individualization: Important elements in treatment for women with postpartum pelvic girdle pain

The aim of our study was to elucidate patients' experiences of a treatment program for postpartum pelvic girdle pain. The written information given by 47 women regarding their experiences with the treatment program was analyzed by qualitative content analysis. Three categories were identified from the patients' experiences: 1) "Treatment means involvement"; 2) "The interchange of knowledge and experience"; and 3) "Perceived change and meaning." The treatment required the participants' involvement, individual adaptation, and focusing on the importance of building their capacity to master daily activities. The therapists were skilled, interested in each patient, and listened attentively. The program was evidence based and put into practice on a personalized basis. The dialogs of the therapist and patient were experienced as meaningful, creating insight, knowledge, and hope. The treatment facilitated a feeling of being in charge of their own bodies. The dialog and the individualized guidance seemed to be experienced as positive for the women's coping of their daily life. By being active agents in managing their pelvic girdle pain and therapy, they learned to set proximal goals. Perceived hope and self-efficacy appeared to be essential for developing a capacity for self-management and an enhanced ability to benefit from appropriate learning experiences.     

Evidence and individualization: Important elements in treatment for women with postpartum pelvic girdle pain

The aim of our study was to elucidate patients' experiences of a treatment program for postpartum pelvic girdle pain. The written information given by 47 women regarding their experiences with the treatment program was analyzed by qualitative content analysis. Three categories were identified from the patients' experiences: 1) “Treatment means involvement”; 2) “The interchange of knowledge and experience”; and 3) “Perceived change and meaning.” The treatment required the participants' involvement, individual adaptation, and focusing on the importance of building their capacity to master daily activities. The therapists were skilled, interested in each patient, and listened attentively. The program was evidence based and put into practice on a personalized basis. The dialogs of the therapist and patient were experienced as meaningful, creating insight, knowledge, and hope. The treatment facilitated a feeling of being in charge of their own bodies. The dialog and the individualized guidance seemed to be experienced as positive for the women's coping of their daily life. By being active agents in managing their pelvic girdle pain and therapy, they learned to set proximal goals. Perceived hope and self-efficacy appeared to be essential for developing a capacity for self-management and an enhanced ability to benefit from appropriate learning experiences.     

Mechanics of pelvic girdle stability and self-bracing in SIJ-related pelvic girdle pain: a review

Abstract

Background:

Pelvic girdle mechanics and control is a rapidly evolving area of research. Our traditional understandings were firmly grounded in theory borrowed from the fields of engineering (mechanical and structural) but have since began to branch out into neuroscience and motor control. The melding of mechanical concepts with those of neuroscience have led to a much better understanding of the effect of pain on the function of the pelvic girdle, specifically functional load transfer. Yet our understanding of the aetiology of pain particularly, chronic pain and recurrent pain pathways, is elusive.

Objectives:

The aim of the current review was to assess the mechanical and motor control components to pelvic girdle stability and propose a hypothetical model for mechanical aetiology of chronic posterior pelvic girdle pain.

Results:

A potentially new paradigm is offered on the current models of insufficient versus excessive force closure. The proposed model takes into account dynamic movement scenarios where the effect of anticipatory postural adjustment (APA) would be responsible for engaging local muscles to effectively elicit self-bracing of the sacroiliac joints (SIJ) for load transfer. When this mechanism fails the system would rely on compensatory postural adjustment (CPA) reliant on aberrant global muscle activation to stiffen the lumbar–pelvic–hip complex.

Conclusions:

For load transfer to be successful the pelvic girdle must be stabilized. The author has shown how disturbance of a component of this dynamic link may destabilize and disrupt the load transfer mechanism, resulting in low back pain of SIJ origin.     

妊娠相关骨盆痛患者的行走步态与运动协调

背景:妊娠相关骨盆痛患者常常有不同程度的行走功能障碍,但具体发病机制尚未阐明.目的:通过了解妊娠相关骨盆痛患者步行速度、步态与胸廓、骨盆和腰椎的运动协调的变化,探讨妊娠相关骨盆痛运动病理机制.方法:比较12名健康孕妇和12名患有妊娠相关骨盆痛孕妇的步态运动,计算其胸廓、骨盆和腰椎在水平面上节段性旋转的幅度、各个节段旋转的时间差和节段间的相对相以及脊柱整体旋转的幅度.结果与结论:妊娠相关骨盆痛患者的步行速度较对照组慢,并且与运动恐惧感呈负性相关.患者胸廓、骨盆和腰椎的旋转幅度较大,而且有较大的个体间差异.脊柱的旋转在两组间没有差别.患者快速步行时胸廓旋转的峰值出现在步态周期的早期而相对相却较小,也许这可以避免骶髂关节和脊柱过度旋转的转矩.     

Predictors for postpartum pelvic girdle pain in working women: The Mom@Work cohort study

The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12 weeks postpartum among working women. A total of 548 Dutch pregnant employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12 weeks postpartum. Participants received questionnaires at 30 weeks of pregnancy and at 6 and 12 weeks postpartum with demographic, work-related, pregnancy-related, fatigue, psychosocial, PGP-related and delivery-related questions. Univariate and multiple logistic regression analyses were performed. Almost half of the women experienced pain in their pelvic girdle at 12 weeks postpartum. However, the level of pain and the degree of disability due to postpartum PGP was low. Pregnancy-related predictors for PGP at 12 weeks were history of low back pain, higher somatisation, more than 8 hours of sleep or rest per day, and uncomfortable postures at work. The pregnancy and postpartum-related predictors were: more disability at 6 weeks, having PGP at 6 weeks, higher mean pain at 6 weeks, higher somatisation during pregnancy and at 6 weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP.     

Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study

BackgroundThe relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain.MethodsSixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation.FindingsNo significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P = 0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P = 0.01) and the muscles of the lower lateral abdominal wall (P < 0.01).InterpretationWe suggest that disturbed motor activation patterns influence women's ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements.     

Radiosteriometric analysis of movement in the sacroiliac joint during a single-leg stance in patients with long-lasting pelvic girdle pain

Background

Chamberlain's projections (anterior–posterior X-ray of the pubic symphysis) have been used to diagnose sacroiliac joint mobility during the single-leg stance test. This study examined the movement in the sacroiliac joint during the single-leg stance test with precise radiostereometric analysis.

Methods

Under general anesthesia, tantalum markers were inserted into the dorsal sacrum and the ilium of 11 patients with long-lasting and severe pelvic girdle pain. After two to three weeks, a radiostereometric analysis was conducted while the subjects performed a single-leg stance.

Findings

Small movements were detected in the sacroiliac joint during the single-leg stance. In both the standing- and hanging-leg sacroiliac join, a total of 0.5 degree rotation was observed; however, no translations were detected. There were no differences in total movement between the standing- and hanging-leg sacroiliac joint.

Interpretation

The movement in the sacroiliac joint during the single-leg stance is small and almost undetectable by the precise radiostereometric analysis. A complex movement pattern was seen during the test, with a combination of movements in the two joints. The interpretation of the results of this study is that, the Chamberlain examination likely is inadequate in the examination of sacroiliac joint movement in patients with pelvic girdle pain.     

Dynamic hip kinematics in patients with hip osteoarthritis during weight-bearing activities

BackgroundThere is an interest in quantifying the hip kinematics of patients with end-stage hip disorders before total hip arthroplasty. The purpose of the present study was to obtain dynamic hip kinematics under four different conditions, including deep flexion and rotation, in patients with osteoarthritis of the hip.MethodsContinuous X-ray images were obtained in 14 patients during gait, chair-rising, squatting, and twisting, using a flat panel X-ray detector. These patients received computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial X-ray images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the pelvis and femur during the movement cycle of each activity.FindingsFor gait, chair-rising, and squatting, the maximum hip flexion angles averaged 22°, 64°, and 68°, respectively. The pelvis was tilted anteriorly by an average of around 7° during the full gait cycle. For chair-rising and squatting, the maximum absolute values of anterior/posterior pelvic tilt averaged 8°/17° and 6°/18°, respectively. Hip flexion showed maximum flexion angle on the way of movement due to further anterior pelvic tilt during both chair-rising and squatting. For twisting, the maximum absolute values of internal/external hip rotation averaged 3°/13°.InterpretationPatients with hip osteoarthritis prior to total hip arthroplasty demonstrated the limited ranges of coordinated motion of the pelvis, femur, and hip joint during each activity, especially in deeply flexed and rotated postures.     

Acupuncture treatment of pregnant women with low back and pelvic pain – an intervention study

Scand J Caring Sci; 2010; 24; 175–182
Acupuncture treatment of pregnant women with low back and pelvic pain – an intervention study
Objective:  To describe patients' experience of acupuncture treatment in low back and pelvic pain during pregnancy.
Design:  An intervention study carried out between September 2000 and December 2001, involving 40 pregnant women.
Participants:  The study population consisted of healthy pregnant women presenting with low back and pelvic pain at maternity health care centres within a defined area in southern Sweden.
Intervention:  Two groups of women received acupuncture treatment from gestational week 20 (group 1) or week 26 (group 2) respectively, for a period of 6 weeks divided into eight sessions of 30 minutes each.
Measurements:  Pain assessment was carried out using Pain-O-Meter and visual analogue scale (POM-VAS), Short-Form McGill Questionnaire (SF-MPQ), Short-Form-36: Health Survey Questionnaire (SF-36), followed by telephone interviews 2–3 months after delivery.
Findings:  The results of POM-VAS, SF-MPQ and SF-36 showed a relief of pain in both groups. In group 2, an improvement in several SF-36 variables was noted in spite of increased physical restrictions. Telephone interviews confirmed that expectations of treatment were fulfilled. Using content analysis the main category, limitations in daily life , was identified, with subcategories pain , and psychological well-being .
Conclusion:  It may be advantageous to begin acupuncture therapy later in pregnancy to maximise pain relief.     

Frontal and transverse plane hip kinematics and gluteus maximus recruitment correlate with frontal plane knee kinematics during single-leg squat tests in women

Background

Hip muscle dysfunction may be associated with knee valgus that contributes to problems like patellofemoral pain syndrome. The purpose of this study was to (1) compare knee and hip kinematics and hip muscle strength and recruitment between “good” and “poor” performers on a single-leg squat test developed to assess hip muscle dysfunction and (2) examine relationships between hip muscle strength, recruitment and frontal plane knee kinematics to see which variables correlated with knee valgus during the test.

Methods

Forty-one active women classified via visual rating as “good” or “poor” performers on the test participated. Participants completed 5-repetition single-leg squat tests. Isometric hip extension and abduction strength, gluteus maximus and gluteus medius recruitment, and 3-dimensional hip and knee kinematics during the test were compared between groups and examined for their association with frontal plane knee motion.

Findings

“Poor” performers completed the test with more hip adduction (mean difference = 7.6°) and flexion (mean difference = 6.3°) than “good” performers. No differences in knee kinematics, hip strength or hip muscle recruitment occurred. However, the secondary findings indicated that increased medial hip rotation (partial r = 0.94) and adduction (partial r = 0.42) and decreased gluteus maximus recruitment (partial r = 0.35) correlated with increased knee valgus.

Interpretation

Whereas hip muscle function and knee kinematics did not differ between groups as we'd hypothesized, frontal plane knee motion correlated with transverse and frontal plane hip motions and with gluteus maximus recruitment. Gluteus maximus recruitment may modulate frontal plane knee kinematics during single-leg squats.