Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review
ABSTRACT To determine the level of evidence for altered mechanical and motor control of the pelvis being associated with pregnancy-related pelvic girdle pain (PPGP).
This systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six different databases were used for the electronic search. Observational cohorts, cross sectional or case-control studies focused on the association between altered kinematic/kinetic and motor control of the pelvis and PPGP during pregnancy were included. Study selection was conducted by two reviewers who firstly screened for titles, then for abstracts and finally for full articles. The Newcastle-Ottawa scale and the guidelines proposed by the Cochrane back review group were used to assess risk of bias and quality of evidence, respectively.
354 references were identified, and after excluding unwanted articles, 10 studies met the final inclusion criteria. Studies not related to motor control or pelvic mobility were the main reason for exclusion. Seven studies were case-control and three were prospective cohort studies. Seven studies were ranked as high while three were ranked as low quality. Among the high quality studies, six found association between PPGP and altered motor control and mobility of the pelvis.
The level of evidence for an association between PPGP and altered motor control and kinematic or kinetic parameters of the pelvis was found to be moderate.
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ABSTRACT: Pelvic girdle pain (PGP) is frequently managed by physiotherapists. Little is known about current physiotherapy practice and beliefs in the management of PGP disorders. The primary aim of this study was to investigate current practice and beliefs in management of PGP among physiotherapists working in Norway and Australia. A secondary aim was to compare current practice with clinical guidelines. A questionnaire was developed and electronically distributed to physiotherapists in Norway (n=65) and Australia (n=77). Treatment and management were determined via responses to 2 case vignettes (during pregnancy, not related to pregnancy), with participants selecting their four primary preferences for treatment and management from a list of 33 possibilities. During pregnancy, ‘education around instability’ and ‘soft tissue treatment’ were selected amongst the most common interventions by physiotherapists in both countries. Norwegian physiotherapists selected ‘pelvic floor exercises’ more frequently, while Australian physiotherapists more commonly selected ‘correcting functional impairments’. In the other case, common responses from both countries were ‘hip strengthening in weight bearing’ and ‘correction of functional impairments’. Norwegian physiotherapists selected ‘general physical exercise’ and ‘general education’ more frequently, while Australian physiotherapists more commonly selected ‘hip strengthening in non-weight bearing’ and ‘muscular relaxation of the abdominal wall/pelvic floor’. Beliefs about PGP were generally positive in both groups while knowledge of and adherence to clinical guidelines were limited. The findings provide direction for future research related to the management and treatment of PGP, and targets for education of physiotherapists working in this area.Manual Therapy 01/2014; 20(1). DOI:10.1016/j.math.2014.07.005 · 1.76 Impact Factor
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ABSTRACT: Background context Disorders of the sacroiliac joint are challenging to diagnose. This is partially due to similarity in symptom presentation to other lumbar spinal disorders and poor visibility of the joint on imaging studies. The pubic symphysis is clearly visualized in the anteroposterior view on plain film radiographs. As a closed ring, changes in the anterior and posterior portion of the pelvis may be reciprocal. The purpose of this study was to assess the correlation between pubic symphyseal changes observed on X-ray and SI joint disorders. Methods Thirty patients with a confirmed diagnosis of SI joint disorders were compared with 30 patients with low back pain without the evidence of SI joint involvement. Plain film radiographs were blinded and independently reviewed by two orthopedic surgeons. Changes in the pubic symphysis were classified as (0) no change, (1) osteoarthritic degeneration, (2) vertical displacement, or (3) ligament ossification. Results There was no significant difference between groups in age, gender, or parturition status. The majority of both groups were female. Mean (±SD) subject age was 61 (±11) and 59 (±9) years, and parity was 44 % and 39 % for the study and control groups, respectively. The prevalence of observable changes in the pubic symphysis was 97 % in the study group and 30 % in the control group (p Conclusion Results of this study suggest that pubic symphyseal changes in the presence of low back pain and positive provocative maneuvers could serve as a marker for SI joint disease. Further investigation of the potential relationship between SI joint symptoms and symphyseal changes should be examined.European Journal of Orthopaedic Surgery & Traumatology 12/2014; DOI:10.1007/s00590-014-1575-0 · 0.18 Impact Factor
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ABSTRACT: Pelvic girdle pain (PGP) is a common condition during or after pregnancy with pain and disability as most important symptoms. These symptoms have a wide range of clinical presentation. Most doctors perceive pregnancy related pelvic girdle pain (PPGP) as 'physiologic' or 'expected during pregnancy', where no treatment is needed. As such women with PPGP mostly experience little recognition. However, many scientific literature describes PPGP as being severe with considerable levels of pain and disability and socio-economic consequences in about 20% of the cases. We aimed to (1) inform the gynecologist/obstetrician about the etiology, diagnosis, risk factors, and treatment options of PPGP and (2) to make a proposition for an adequate clinical care path. A systematic search of electronic databases and a check of reference lists for recent researches about the diagnosis, etiology, risk factors and treatment of PPGP. Adequate treatment is based on classification in subgroups according to the different etiologic factors. The various diagnostic tests can help to make a differentiation in the several pelvic girdle pain syndromes and possibly reveal the underlying biomechanical problem. This classification can guide appropriate multidimensional and multidisciplinary management. A proposal for a clinical care path starts with recognition of gynecologist and midwife for this disorder. Both care takers can make a preliminary diagnosis of PPGP and should refer to a physiatrist, who can make a definite diagnosis. Together with a physiotherapist, the latter can determine an individual tailored exercise program based on the influencing bio-psycho-social factors.03/2013; 5(1):33-43.