Prevalence of Sacroiliac Joint Dysfunction in Postpartum Women-A Cross Sectional Study

Abstract

Background: Since past 100 years SI joint has been a topic of interest in medicine. Hippocrates was one who described pelvic separation during labor. He said it remained so even after birth. Well-known spine specialists reported that SI joint dysfunction can be the main source of SI joint and low back pain. The purpose of study was to find out the age wise prevalence of sacroiliac joint dysfunction in females and to find the severity of sacroiliac joint dysfunction in primipara and multipara subjects.
Method: Approval of Institutional ethical committee was obtained. Written informed consent in their own language was obtained from all the subjects. Subjects were briefed about the procedure and purpose of the study. The tests like posterior pain provocation test and March test was conducted.
Conclusion: We found that 26% of postpartum women suffered with SIJ dysfunction which was unreported. Prevalence of SI joint dysfunction was highest in Full Term Normal Delivery (FTND) than lower segment Cesarian section (LSCS).

Full text

Prevalence of Sacroiliac Joint Dysfunction in Postpartum Women-A Cross
Sectional Study
Paneri Sandeep Ghodke*, Dhiraj Shete and Deepak Anap
Department of Physiotherapy, DVVPF’s College of Physiotherapy, Ahmednagar, India
*Corresponding author: Ghodke PS, Department of Physiotherapy, DVVPF’s College of Physiotherapy, Ahmednagar, India, Tel: 7066827729; E-mail:
panerighodke247@gmail.com
Received date: September 04, 2017; Accepted date: September 19, 2017; Published date: September 26, 2017
Copyright: © 2017 Ghodke PS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Since past 100 years SI joint has been a topic of interest in medicine. Hippocrates was one who
described pelvic separation during labor. He said it remained so even after birth. Well-known spine specialists
reported that SI joint dysfunction can be the main source of SI joint and low back pain. The purpose of study was to
find out the age wise prevalence of sacroiliac joint dysfunction in females and to find the severity of sacroiliac joint
dysfunction in primipara and multipara subjects.
Method: Approval of Institutional ethical committee was obtained. Written informed consent in their own language
was obtained from all the subjects. Subjects were briefed about the procedure and purpose of the study. The tests
like posterior pain provocation test and March test was conducted.
Conclusion: We found that 26% of postpartum women suffered with SIJ dysfunction which was unreported.
Prevalence of SI joint dysfunction was highest in Full Term Normal Delivery (FTND) than lower segment Cesarian
section (LSCS).
Keywords: Primipara; Multipara; Postpartum; Musculoskeletal
disorders; Sacroiliac joint
Introduction
Background
Pregnancy is the most important event in every woman’s life. e
feeling of carrying a little soul within her for 9 months is a period of
joy, where there is a transition of a woman to mother. Lot of
physiological changes takes place during pregnancy, in a woman’s body
to bear the baby in the womb. Risk of low back pain increases among
people with sedentary lifestyle.
Weight gained during pregnancy is 20-40 pounds that clearly shis
the body center of gravity anteriorly. Neuromechanical adaptations to
pregnancy refer to change in gait, postural parameters.
Musculoskeletal disorders include low back pain, cramps, and hip
pain. It causes increased lordosis further stressing lower back [1].
Laxity of muscle causes intervertebral disc instability, disc bulge and
overall compression of lower spine [2].
ere occurs stretching of the abdominal muscle so as to
accommodate the expanding uterus. As they stretch they lose their
ability to perform the function of maintaining body posture. is leads
to increased stress on the torso so as to support the low back region
[3]. In most of the cases it starts from rst trimester and it disappears
aer 6 months of delivery. Postpartum is a period that begins
immediately aer birth of child extending about 6 weeks. In some of
the cases, the change doesn’t resolve it persist, acquiring a chronic
character.
Sacroiliac joint is the joint between the sacrum and ilium bones of
pelvis which are connected by strong ligaments. e joint is strong; it
transfers the weight from lower limb to spine with irregular elevation
and depression that produces interlocking of two bones [4]. It is
hypomobile in nature and stabilized European guidelines are published
and dened sacroiliac joint dysfunction as a pain experienced between
posterior iliac crest and gluteal fold particularly in vicinity of sacroiliac
joint. e pain may radiate to posterior thigh. e endurance capacity
for standing, walking and sitting is diminished [5].
e possible eects of pregnancy on sacroiliac joint are several. e
ligaments that stabilizes the joint stretches to allow for delivery of baby
and they return to normal aer birth, if they remain loose, the joint
laxity may allow enough repetitive new movement at joint to cause
pain.
Alternatively, the new permitted movement could result in
producing a locked rather than a moving joint. It has been suggested
that hormone relaxin increases 10 fold in concentration during
pregnancy. As the structure of pelvis and lower spine soen,
discomfort may result particularly in sacroiliac joint. ough it is a
normal process, it can put abnormal wear and excessive stress on
sacroiliac joint [6,7].
Sacroiliac joint dysfunction is commonest cause of low back pain in
any adult age group. ough the predisposing factors for same are
dierent and vary from males to females. As the sacroiliac joint is one
of the strained joint in the body which causes many discomforts and
disabilities to the suerer.
e pregnancy is series of changes in female body which causes
extra stress on both sacroiliac joint contributed by increased size of
abdomen and loosening of supporting structures of sacroiliac joint due
Journal of Physiotherapy & Physical
Rehabilitation Ghodke et al., Physiother Rehabil 2017, 2:3
DOI: 10.4172/2573-0312.1000149
Research Article OMICS International
Physiother Rehabil, an open access journal
ISSN:2573-0312
Volume 2 • Issue 3 • 1000149

to relaxin [8]. e postpartum period is the period of baby care where
mother tends to ignore her problems which contribute to prolong and
repeated suering. e studies done on prevalence on sacroiliac joint
dysfunction in postpartum female is less and severity of problem is
more, my study focuses on the same topic [9]. Hence the purpose of
study was to nd out the age wise prevalence of sacroiliac joint
dysfunction in females and to nd the severity of sacroiliac joint
dysfunction in primipara and multipara subjects.
Methodology
is was an observational study which was conducted at D.V.V.P.F’S
Vikhe Patil Memorial hospital for a period of one year. Approval of
Institutional ethical committee was obtained. 50 subjects were selected
for this study by means of simple random sampling. Written informed
consent in their own language was obtained from all the subjects.
Subjects were informed about the procedure and purpose of the study.
e age group selected for this study was 18 to 35 years. Participants
included were of postpartum day 4 of to 7, with history of low back
pain and complaining of pelvic girdle pain.
Participants excluded were with a recent history/signs or symptoms
indicative of serious cause of pain that may be inammatory, infective,
traumatic, neoplastic, degenerative and metabolic and history of
chronic low back pain that requires surgery. Posterior pain provocation
test and March test was performed on each participant for diagnosis of
SI dysfunction. While testing for posterior pain provocation test the
patient was in supine lying position. While testing one hip was exed
to 90 degree. Using one hand to palpate the sacroiliac joint, examiner
thrusts down through the hip and knee on text side. Pain in the
sacroiliac joint on thrusting was considered as a positive test. While
testing for March test the patient was in standing and examiner
palpates PSIS. e patient was then asked to stand on one leg while
pulling the opposite knee toward the chest. If the sacroiliac joint on the
side on which knee is exed (ipsilateral side) moves minimally or up
indicates the test positive.
Result
e demographic data was collected and prevalence was obtained
shown in Tables 1 and 2 and Figures 1-3.
Figure 1: Number of participants aected.
Figure 2: Number of FTND participants aected.
Figure 3: Number of LSCS participants aected.
No of subjects: 50 Prevalence: 26%
Mean of age: 23.96 Mean of BMI: 221.78
Table 1: Prevalence of SI joint dysfunction.
No of subjects (FTND): 11 Prevalence: 36.36%
No of subjects (LSCS): 39 Prevalence: 23.07%
Table 2: Prevalence of SI joint dysfunction in full term normal delivery
(FTND) and lower segment Cesarian section (LSCS).
Discussion
Series of physiological changes occurs in woman’s body during
pregnancy which includes-weight gain, changes in posture, and
ligament and joint laxity along with changes in the strength of muscle
tendons [10]. Low back pain in pregnancy is generally due to changes
in body mechanics that occur during the carrying of a child. During
pregnancy, a woman generally gains weight to about 20 and 40 pounds.
is shis the body’s centre of gravity anteriorly and increases the
moment arm of forces applied to the lumbar spine. In a study by
Citation: Ghodke PS, Shete D, Anap D (2017) Prevalence of Sacroiliac Joint Dysfunction in Postpartum Women-A Cross Sectional Study.
Physiother Rehabil 2: 149. doi:10.4172/2573-0312.1000149
Page 2 of 4
Physiother Rehabil, an open access journal
ISSN:2573-0312
Volume 2 • Issue 3 • 1000149

Stapleton et al. 61.8% of women reported low back pain during
pregnancy, claimed that pain was at least moderately severe, 9%
claimed they were completely disabled by pain.
Sacroiliac joint is the joint between the sacrum and ilium bones of
pelvis which are connected by strong ligaments. It is hypomobile in
nature and stabilized by spinal muscles and anterior abdominal
muscles. e SIJ ROM is small-less than 4° of rotation and upto 1.6
mm of translation [11,12]. Sacroiliac joint dysfunction is dened as a
pain experienced between posterior iliac crest and gluteal fold
particularly in vicinity of sacroiliac joint. e pain may radiate to
posterior thigh. In pregnant populations with back pain, SIJ pain
probability is found nearly to be 89% [5].
Factors contributing to this symptom include-pelvic changes as well
as alterations to loading. is is due to combination of-mechanical,
hormonal, circulatory, and psychosocial factors. It has been suggested
that hormone relaxin increases 10 fold in concentration during
pregnancy. As the structure of pelvis and lower spine soen,
discomfort may result particularly in sacroiliac joint. ough it is a
normal process, it can put abnormal wear and excessive stress on
sacroiliac joint. Discomfort will contribute to changes in the posterior
pelvic region, particularly the sacroiliac joints. According to a study,
conducted by Jennifer and her colleagues on ‘Pregnancy and low back
pain’, concluded that women with previous lumbar problems or
chronic back pain conditions are at high risk of back pain during
pregnancy, with pain occurring twice as oen as in those with no prior
complaints. e study also concludes that women, who experience
back pain during one pregnancy, have an 85% chance of experiencing
back pain during a subsequent pregnancy.
e major biomechanical factor associated with this is increased
abdominal load, decrease pelvic stability, laxity of sacroiliac joint [13].
ough studies have shown increased body mass index (BMI) to may
be a risk factor but there are studies with conicting results. Orvieto et
al. found that BMI was signicantly higher in those who experience
pain compared to those who not [14]. Younger age, multiple parity and
sedentary lifestyle increases the risk of low back pain as compared to
patients who engage in a more active lifestyle [15,16].
Our study concluded that out of 50 subjects, the prevalence of
sacroiliac joint dysfunction amongst post-partum women is 26%. Our
results are similar to study done by Ramachandra et al. who proved
that the prevalence of pelvic girdle pain (PGP) when compared
between second and third trimester, reported to be less in the third
trimester. Approximately 10% of women claim that it hindered them
from working and more than 80% reported that it hampered their
daily routine including housework, childrearing, and job performance
[17].
Nore´n et al. report back pain as the leading cause of sick leave
during pregnancy in Scandinavian countries, with an estimated cost of
$2.5 billion in 1990 [18,19]. My study is the rst of its kind showing the
statistics of women aected by SIJ dysfunction during postpartum in
Maharashtra, India. No further studies have been conducted about the
economy or productivity being aected due to SIJ dysfunction in
postpartum period which makes this study even more necessary and
important.
Conclusion
We found that 26% of postpartum women suered with SIJ
dysfunction which was unreported. Prevalence of SI joint dysfunction
was highest in Full Term Normal Delivery (FTND) than Lower
segment Cesarian section (LSCS). But they neglected such discomforts
until it aected their daily routine. Hence, it is important to
understand the discomforts that commonly are prevalent even aer
pregnancy, which will help health professionals to form a structured
intervention as a part of prevention, and will in turn help the women
to take care of their health aer pregnancy.
Acknowledgement
I am thankful to Late Dr. Dhiraj Shete, who le us alone in the
midway, for his guidance and enthusiastic support along with
mentorship as a Research Guide and Supervisor in my professional and
personal upliment. I owe my research to him.
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Citation: Ghodke PS, Shete D, Anap D (2017) Prevalence of Sacroiliac Joint Dysfunction in Postpartum Women-A Cross Sectional Study.
Physiother Rehabil 2: 149. doi:10.4172/2573-0312.1000149
Page 3 of 4
Physiother Rehabil, an open access journal
ISSN:2573-0312
Volume 2 • Issue 3 • 1000149