Self efficacy associated with regression from pregnancy-related pelvic girdle pain and low back pain following pregnancy.

BACKGROUND: Self-efficacy, one's ability to deal with pain, disability, and other symptoms through self-management techniques, positively affect the quality of life in patients with chronic diseases. Pregnancy-related back pain is a common musculoskeletal disorder pre- and postnatally. Hence, the study aimed to determine whether self-efficacy is associated with the development of back pain during pregnancy. METHODS: Between February 2020 and February 2021, a prospective case-control study was performed. Women with back pain were included. The self efficacy was assessed by the Chinese version of the General Self-efficacy Scale (GSES). Pregnancy-related back pain was measured using a self-reported scale. No regression from pregnancy-related back pain is defined as a recurrent or persistent pain score ≥ 3 over a week around 6 months postpartum. Women experiencing back pain during pregnancy are classified according to whether having a regression. This problem can be divided into pregnancy-related low back pain (LBP) and posterior girdle pain (PGP). The differences in variables were compared between groups. RESULTS: A total of 112 subjects have completed the study finally. These patients were followed up with an average of 7.2 months after childbirth ranging from six to 8 months. 31 subjects (27.7%) of the included women did not report regression 6 months postpartum. The mean self efficacy was 25.2 (SD:10.6). Patients with no regression tended to be older (LBP:25.9 ± 7.2 vs.31.8 ± 7.9, P = 0.023; PGP: 27.2 ± 7.9 vs. 35.9 ± 11.6, P < 0.001*), have a lower self efficacy (LBP:24.2 ± 6.6 vs.17.7 ± 7.1, P = 0.007; PGP: 27.6 ± 6.8 vs. 22.5 ± 7.0, P = 0.010), and need high daily physical demand in their vocations (LBP:17.4% vs. 60.0%, P = 0.019; PGP: 10.3% vs. 43.8%, P = 0.006) when compared to those with regression. Multivariate logistic analysis shows that risk factors for no regression from pregnancy-related back pain included LBP (OR = 2.36, 95%CI = 1.67-5.52, P < 0.001), pain ratings of the onset of back pain during pregnancy≥3(OR = 2.23, 95%CI = 1.56-6.24, P = 0.004), low self efficacy (OR = 2.19, 95%CI = 1.47-6.01, P < 0.001), and high daily physical demand in their vocations (OR = 2.01, 95%CI = 1.25-6.87, P = 0.001). CONCLUSIONS: Low self efficacy makes the women experience about two-fold risk to experience no regression from pregnancy-related back pain. Evaluation for self efficacy is simple enough to be used to improve perinatal health.

The effect of gestational diabetes mellitus on occurrence of the pelvic girdle pain and symptom severity in pregnant women.

The primary objective of this study was to examine the effect of gestational diabetes mellitus (GDM) on pelvic girdle pain (PGP) occurrence and symptom severity. Pregnant women who were with/without GDM, 20-40 years of age, and also in the second and third trimesters of pregnancy were included in the study. PGP provocation tests were administered to 187 pregnant women to determine the presence and severity of PGP. Based on the test results, the study subjects were divided into two groups; Group 1 (GDM+, PGP+; n:32) and Group 2 (GDM-, PGP+; n:35). Both groups were asked to fill in the Pelvic Girdle Questionnaire (PGQ). The relationship between the presence of GDM and the presence of PGP was found to be significant (p = .043). It was found the groups were similar in view of pain, and also in PGQ total/subscale scores (p > .05). Although GDM has no effect on symptom severity, it has been determined that it may relate to the development of PGP. Therefore, early interventions (nutrition, exercise, belt using, etc.) are recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with a previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. Clinical Trial Number: 04769375Impact of StatementWhat is already known on this subject? Gestational diabetes mellitus and pelvic girdle pain are pathologies that develops secondary to pregnancy-related systemic and biomechanical changes.What do results on this study add? GDM may related the development of PGP.What are the implications of these findings for clinical practice and/or further research? Early interventions (nutrition, exercise, belt using, etc.) and strict control of pregnant women in view of PGP is recommended to prevent the development of PGP in pregnant women with a family history of diabetes, with previous diagnosis of diabetes and/or with GDM detected in their previous pregnancies. The evaluation of pregnant women for PGP before administering interventions, such as exercise and diet (both decrease the pro-inflammatory markers), following the diagnosis of GDM and the measurement of plasma anti- and pro-inflammatory marker values in the same time period will further reveal the relationship between GDM and PGP.

Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up.

BACKGROUND: Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment, and long-term follow-up of PPSS. METHODS: This follow-up study included 19 out of 21 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbopelvic pain (LPP) were offered a clinical examination. RESULTS: 1) PPSS was diagnosed after a normal postpartum period of 24 to 50 h by blood tests (n = 19/19), ultrasonography (n = 9 /19), computer tomography (n = 8/19) or magnetic resonance imaging (n = 16/19) Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and different physiotherapeutic interventions. Women with PPSS more frequently were primiparous (n = 14/19, p = 0.001), had an instrumental delivery (n = 14/19, p = 0.003), longer time of active labour (p = 0.01) and second stage of labour (p = 0.001) than women in the regional registry. 2) Ten out of 19 (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p < 0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p = 0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p = 0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS) HADS-Anxiety, 7 versus 2, p = 0.010; and HADS-Depression, 1 versus 0, p = 0.028) than women with no pain. 3). Of the eight women who were clinically assessed, one had lumbar pain and seven had pelvic girdle pain (PGP). CONCLUSIONS: In the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP at follow-up, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors, long-term consequences, and adequate treatment for this rare pregnancy complication.

Risk factors for pregnancy-related pelvic girdle pain: a scoping review.

BACKGROUND: Pregnancy-related Pelvic Girdle Pain (PPGP) is a common complaint. The aetiology remains unclear and reports on risk factors for PPGP provide conflicting accounts. The aim of this scoping review was to map the body of literature on risk factors for experiencing PPGP. METHODS: We searched the databases PubMed, Embase, CINAHL, PsycINFO, MIDIRS, and ClinicalTrial.gov (3 August 2020). We selected studies with two reviewers independently. Observational studies assessing risk factors for PPGP were included. Studies examining specific diagnostic tests or interventions were excluded. RESULTS: We identified 5090 records from databases and 1077 from ClinicalTrial.gov. Twenty-four records met the inclusion criteria. A total of 148 factors were examined of which only 14 factors were examined in more than one study. Factors that were positively associated with PPGP included a history of low back or pelvic girdle pain, being overweight/obese, already having a child, younger age, lower educational level, no pre-pregnancy exercise, physically demanding work, previous back trauma/disease, progestin-intrauterine device use, stress, depression and anxiety. CONCLUSIONS: A large number of factors have been examined as potential risk factors for PPGP, but there is a lack of repetition to be able to draw stronger conclusions and pool studies in systematic reviews. Factors that have been examined in more than five studies include age, body mass index, parity and smoking. We suggest a systematic review be conducted to assess the role of these factors further in the development of PPGP.

Arcuate Pubic Ligament Injury-An Unknown Cause of Athletic Pubalgia.

A case report is presented that gives new insight into a very rare cause of athletic pubalgia. Up till now, no case has been published in literature about the relevance of an arcuate pubic ligament (APL) injury in athletic pubalgia. The APL or inferior pubic ligament is a thick triangular arch of ligamentous fibers connecting the 2 pubic bones below. The main function of the APL is to stabilize the symphysis pubis. The rupture of this ligament can lead to groin pain due to lack of stabilization of the symphysis pubis. Despite the importance of the anatomical and clinical function of the APL, very limited research is available about injuries of this ligament. This report describes a case of a traumatic left APL rupture, confirmed by magnetic resonance imaging, causing longstanding left groin pain in an amateur athlete.

The effects of pelvic belt use on pelvic alignment during and after pregnancy: a prospective longitudinal cohort study.

BACKGROUND: Pelvic alignment changes during pregnancy and post-childbirth. Pelvic belts exert external forces that compress and stabilize the joints, and therefore, could influence pelvic alignment. However, limited information is available regarding this potential effect. Therefore, the purpose of this study is to investigate the influence of pelvic belt use on pelvic alignment during and after pregnancy. METHODS: Data of 201 pregnant women in late pregnancy and 1 month after childbirth were used. Pelvic alignment measurements, including anterior and posterior pelvic width, pelvic asymmetry, and pelvic belt use during and after pregnancy were investigated. Participants were divided into four groups according to pelvic belt use: before and after childbirth (BAC), before childbirth only (BC), after childbirth only (AC), and non-use (NU). Then, an initial one-way ANOVA was conducted to compare the amount of change in pelvic alignment from late pregnancy to post-childbirth between the groups. After the initial analysis, a multivariate regression analysis was performed to determine the statistically significant differences between the groups to consider other factors that influenced pelvic alignment such as age, BMI, number of previous childbirths, vaginal delivery and pelvic asymmetry in late pregnancy. Next, a cutoff point for subgroup stratification based on the weekly duration of pelvic belt use and inter-group changes in pelvic alignment were compared. RESULTS: As the result of the initial one-way ANOVA, the decrease in pelvic asymmetry from during pregnancy to postpartum for BAC was greater than that for AC. Moreover, multiple regression analysis showed that the effect of pelvic belt that was revealed in the initial analysis was statistical significance even after adjustment for other factors. Moreover, pelvic asymmetry in the BAC group decreased, compared to being increased or unchanged in the NU and AC groups when the group cutoff time was 7 h per week. CONCLUSIONS: Continuous and extended use of pelvic belts during and after pregnancy might be related to modifications of pelvic asymmetry in the perinatal period. Therefore, the instruction of correct and comfortable usage and the recommendation of continuous use of pelvic belt especially during pregnancy are required for prevention of some discomforts related to pelvic malalignment.

Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Pregnant Ontario Population.

OBJECTIVE: The purpose of the current pilot study is to determine the point and period prevalence of site-specific back pain, low back pain (LBP), pelvic girdle pain (PGP), and combined pain (Combo Pain) in pregnant women at a large urban centre in Ontario. METHODS: Point and period prevalence for LBP, PGP, and Combo Pain were determined using a questionnaire and accompanying pain diagram. Women were included in the study if they were healthy, of child-bearing age (18-45 years), currently experiencing a singleton pregnancy (any trimester), and proficient in the English language. RESULTS: Data collected from 287 women were included in the analysis. Three-quarters of women suffered from some sort of pregnancy-related back pain. The point and period prevalences for women who were experiencing LBP, PGP, and Combo Pain were 15.7%, 17.8%, and 15.3% and 33.4%, 27.9%, and 30.7%, respectively. Secondary analyses demonstrated that increasing GA and suffering from both pains at some point prior to pregnancy (Prior Both) increased the risk of experiencing PGP and Combo Pain during pregnancy, respectively. CONCLUSION: The current study demonstrates that 76% of sampled women experienced pregnancy-related back pain and the prevalence of site-specific pain (LBP, PGP, and Combo Pain) increases with increased gestation. Risk factors include advanced GA and experiencing both types of pain prior to pregnancy (Prior Both). Furthermore, it is suggested that a standard definition of pain by location should be developed and employed so that future studies can elucidate appropriate prevention strategies and treatment options for each.

[Relationship between perineal characteristics and symptoms and pelvic girdle pain: A literature review]. / Caractéristiques et symptômes pelvi-périnéaux dans les douleurs de la ceinture pelvienne : une revue de la littérature.

INTRODUCTION: Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms. OBJECTIVES: A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP. METHODS: A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale. RESULTS: Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm2±2.7, control 13.7 cm2±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3). CONCLUSION: This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning pelvic floor release effect in PGP.

Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain - a pilot randomized trial.

BACKGROUND: Pregnancy-related pubic symphysis pain is relatively common and can significantly interfere with daily activities. Physiotherapist-prescribed pelvic support belts are a treatment option, but little evidence exists to support their use. This pilot compared two pelvic belts to determine effectiveness (symptomatic relief), tolerance (comfort) and adherence (frequency, duration of use). METHODS: Unblinded, 2-arm, single-center, randomized (1:1) parallel-group trial. Twenty pregnant women recruited from the community (Dunedin, New Zealand), with physiotherapist-diagnosed symphyseal pain, were randomly allocated to wear either a flexible or rigid belt for three weeks. One author, not involved in data collection, randomized the allocation to trial group. The unblinded primary outcome was the Patient Specific Functional Scale (PSFS). Secondary outcomes were pain intensity during the preceding 24 hours and preceding week (visual analogue scale [VAS]), and disability (Modified Oswestry Disability Questionnaire [MODQ]). Duration of use (hours) was recorded daily by text messaging. Participants were assessed at baseline, by weekly phone interviews and at intervention completion (three weeks). To assess comfort, women wore the alternate belt in the fourth week. RESULTS: Twenty pregnant women (mean ± SD age, 29.4 ± 6.5 years; mean gestation at baseline, 30.8 ± 5.2 weeks) were randomized to treatment groups (flexible = 10, rigid =10) and all were included in analysis. When adjusted for baseline, PSFS scores were not significantly different between groups at follow up (mean difference -0.1; 95% CI: -2.5 to 2.3; p =0.94). Pain in the preceding 24 hours reached statistical significance in favor of the flexible belt (VAS, p = 0.049). Combining both groups' data, function and pain were significantly improved at three weeks (mean difference -2.3; 95% CI: 1.2 to 3.5; p< 0.001). Belts were worn for an average of 4.9 ± 2.9 hours per day; women preferred the flexible belt. No adverse events were reported. CONCLUSION: These preliminary results suggest the flexible pelvic support belt may be more effective in reducing pain and is potentially better tolerated than a rigid belt. Based on these data, a larger trial is both feasible and clinically useful. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614000898651 , 25th August, 2014.

Application of Tensegrity Massage to Relive Complications After Mastectomy--Case Report.

PURPOSE: The case study was to determine the effectiveness of tensegrity massage in a patient after mastectomy. DESIGN: Tensegrity massage was performed in a 50-year-old woman after mastectomy. The purpose of the massage was to normalize the tension of musculo-ligamento-fascial system in the chest, shoulder girdle, and back. METHODS: The patient was subjected to a series of six massage sessions, 45 minutes each, twice a week. FINDINGS: The applied massage therapy contributed to the reduction of the postoperative scar tenderness and painfulness, to the relaxation of the muscular tone within the shoulder girdle, and to the improvement of the patient's general feeling. CONCLUSIONS: Tensegrity massage is an effective therapy in the elimination of pain and abnormal tissue tension induced by extensive scarring after mastectomy. CLINICAL RELEVANCE: The presented massage procedure had a positive effect immediately after the therapy and after 1-month follow-up.

Hormonal contraception and pelvic girdle pain during pregnancy: a population study of 91,721 pregnancies in the Norwegian Mother and Child Cohort.

STUDY QUESTION: Is pre-pregnancy hormonal contraception use associated with the development of pelvic girdle pain during pregnancy? SUMMARY ANSWER: In contrast to combined oral contraceptive pills, long lifetime exposure to progestin-only contraceptive pills or the use of a progestin intrauterine device during the final year before pregnancy were associated with pelvic girdle pain. WHAT IS ALREADY KNOWN: Pelvic girdle pain severely affects many women during pregnancy. Smaller studies have suggested that hormonal contraceptive use is involved in the underlying mechanisms, but evidence is inconclusive. STUDY DESIGN, SIZE, DURATION: A population study during the years 1999-2008. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 91,721 pregnancies included in the Norwegian Mother and Child Cohort Study. Data were obtained by two self-administered questionnaires during pregnancy weeks 17 and 30. MAIN RESULTS AND THE ROLE OF CHANCE: Pelvic girdle pain was present in 12.9% of women who had used combined oral contraceptive pills during the last pre-pregnancy year, 16.4% of women who had used progestin-only contraceptive pills, 16.7% of women who had progestin injections and 20.7% of women who had used progestin intrauterine devices, compared with 15.3% of women who did not report use of hormonal contraceptives. After adjustment for other study factors, the use of a progestin intrauterine device was the only factor based on the preceding year associated with pelvic girdle pain [adjusted odds ratios (OR) 1.20; 95% confidence interval (CI): 1.11-1.31]. Long lifetime exposure to progestin-only contraceptive pills was also associated with pelvic girdle pain (adjusted OR 1.49; 95% CI: 1.01-2.20). LIMITATIONS, REASONS FOR CAUTION: The participation rate was 38.5%. However, a recent study on the potential biases of skewed selection in the Norwegian Mother and Child Cohort Study found the prevalence estimates but not the exposure-outcome associations to be influenced by the selection. WIDER IMPLICATIONS OF THE FINDINGS: The results suggest that combined oral contraceptives can be used without fear of developing pelvic girdle pain during pregnancy. However, the influence of progestin intrauterine devices and long-term exposure to progestin-only contraceptive pills requires further study. STUDY FUNDING/COMPETING INTEREST(S): The present study was supported by the Norwegian Research Council. None of the authors has a conflict of interest.

Mode of delivery and persistence of pelvic girdle syndrome 6 months postpartum.

OBJECTIVE: We sought to study the association between mode of delivery and persistent pelvic girdle syndrome (PGS) (pain in anterior and bilateral posterior pelvis) 6 months postpartum. STUDY DESIGN: We followed up 10,400 women with singleton deliveries in the Norwegian Mother and Child Cohort Study who reported PGS in pregnancy week 30 (1999 through 2008). Data were obtained by 3 self-administered questionnaires and linked to the Medical Birth Registry of Norway. RESULTS: Planned cesarean section was associated with the presence of severe PGS 6 months postpartum (adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4-3.9). In women who used crutches during pregnancy, emergency (adjusted OR, 2.0; 95% CI, 1.0-4.0) and planned (adjusted OR, 3.3; 95% CI, 1.9-5.9) cesarean section were each associated with severe PGS. CONCLUSION: The results suggest an increased risk of severe PGS 6 months postpartum in women who underwent a cesarean section vs women who had an unassisted vaginal delivery.

Pelvic Girdle Pain in Pregnancy: A Review.

Importance: Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies. Objective: The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain. Evidence Acquisition: Electronic databases (PubMed and Embase) were searched from 1980 to 2021 with the only limitation being that the articles were in English. Studies were selected that examined associations between pelvic pain/pelvic girdle pain and pregnancy. Results: There were 343 articles identified. After reviewing the abstracts, 88 were used in this review. Pelvic girdle pain is a common condition of pregnancy, affecting a reported 20% of pregnant women. The pathophysiology is poorly understood and likely multifactorial, involving both hormonal and biomechanical changes that occur during pregnancy. Several risk factors have been identified. This diagnosis is most commonly made based on symptoms related to pelvic pain during pregnancy. Treatment should be multimodal, including pelvic girdle support, stabilizing exercises, analgesia, and potentially complementary therapies. The effects on future pregnancies are uncertain, although some limited information suggests an increased risk of recurrent PGP in subsequent pregnancies. Conclusions: Pelvic girdle pain in pregnancy is a common condition that is often overlooked as a normal part of pregnancy but has a significant impact on quality of life during, after, and in subsequent pregnancies. Multimodal therapies are available and are largely low cost and noninvasive. Relevance: Our aim is to increase the awareness of pelvic girdle pain in pregnancy as a common but often underdiagnosed and undertreated condition.

Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review.

PURPOSE: The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy. METHODS: PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using six different databases. Observational cohorts, cross-sectional or case-control studies focused on the association between relaxin levels and PPGP during pregnancy were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Newcastle-Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group. RESULTS: 731 references were identified. Six articles met the inclusion criteria and were considered for this systematic review. The main reason for the studies exclusion was PPGP related to gynaecological reasons. Five studies were case-control and one study was a prospective cohort. Four studies were ranked as high while two were ranked as low quality. Among the high quality studies, three found no association between PPGP and relaxin levels. CONCLUSIONS: Based on these findings, the level of evidence for the association between PPGP and relaxin levels was found to be low. PPGP assessment and controlling for risk factors were found to increase bias leaving uncertainty in interpretation of these findings and a need for further research.

Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review.

PURPOSE: To determine the level of evidence for altered mechanical and motor control of the pelvis being associated with pregnancy-related pelvic girdle pain (PPGP). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Pelvic girdle pain during pregnancy and puerperium.

Pelvic girdle pain (PGP) is a term used specifically to pregnancy-related pain in the lumbosacral, sacroiliac and symphysis pubis joints. Pregnancy-induced hormonal and physical changes increase the risk of musculoskeletal problems in pregnancy. The severity of these conditions varies from mild self-limiting pain to a severe disabling condition. PGP is common in pregnancy and while most can be managed as outpatients, a few patients require inpatient admission for further investigations and management. Prompt identification of these conditions is essential to avoid serious disability. Lack of awareness and failure of recognition not only results in women feeling isolated, but may also result in long-term morbidity. In this review, we explore the aetiology, presentation, risk factors, risk of recurrence, differential diagnosis and multidisciplinary management of these conditions. We also enclose obstetric guidelines to increase the awareness of the health professionals.

Occurrence of combined pain in the lumbar spine, pelvic girdle and pubic symphysis among pregnant women in the extreme south of Brazil. / Ocorrência de dor combinada na coluna lombar, cintura pélvica e sínfise púbica entre gestantes do extremo sul do Brasil.

OBJECTIVES: To estimate the prevalence and characterize the occurrence of low back pain (LBP), posterior pelvic girdle pain (PPGP) and pubic symphysis pain (PSP) among pregnant women resident in Rio Grande, RS. METHODS: This was a cross-sectional study of all postpartum women who gave birth in 2016. Two pictures were used to investigate the presence of LBP, PPGP and PSP, both isolated and combined. Multinomial logistic regression was used to evaluate the factors associated with each symptom. RESULTS: LBP was reported by 42.2%, PSP by 4.9%, and PPGP by 2%, while LBP + PSP was reported by 9%, LBP and PPGP by 2.8% and PPGP + PSP by 1.1%, and pain in all three regions was reported by 3.9% of the sample. The more advanced the age of the pregnant women, the risk for LBP and of LBP combined with one of the pelvic girdle regions was reduced, while the risk for PPGP + PSP was increased. Depression during pregnancy increased the risk for all symptom combinations. CONCLUSION: This study provided a detailed description of the occurrence of the evaluated outcomes and its associated factors. Studies like this are rare in Brazil, especially a census with low rates of losses and refusals. The high prevalence of the evaluated symptoms suggests that it should be investigated routinely in prenatal care, taking into account the age of the pregnant women, depressive symptoms and those experiencing combined or intense pain.

Form and Force Closure of the Sacroiliac Joints.

The principles of form and force closure were introduced to describe the complex mechanism of sacroiliac joint (SIJ) stability. Form closure refers to a theoretical stable state of a joint with close fitting articular surfaces, where no extra forces are needed to maintain the stable state of the system during loading and unloading situations. If the sacrum would fit in the pelvis with perfect form closure, no lateral compressional forces would be needed to maintain stability. However, such a construction would make mobility practically impossible. Force closure is the theoretical state where lateral force and friction resulting in joint compression, are required for the joint to withstand a vertical load. Structures that contribute to SIJ stability via "form closure" include (1) the configuration of the interfacing joint surfaces, along with dorsocranial "wedging" of the sacrum into the ilia; (2) the corresponding ridges and grooves of the articular surfaces of the SIJs and resultant high coefficient of friction; and (3) the integrity of the binding ligaments, which are among the strongest in the body. Shearing forces absorbed in the SIJ occur because of a combination of person-specific anatomical features. This results in unique form and force closure situations that provide effective and tailored joint accommodation that balance both friction and compression in the joint. Force closure occurs because of altered joint reaction force via taut ligaments, fascia, muscles, and the ground reaction force they are reacting to at the moment. In the ideal state, force closure creates a perpendicular compressive reaction force to the SIJ to adapt and overcome the forces of gravity. In order for force closure to be effective, sacral nutation must occur and is considered to be anticipatory for joint loading. Sacral nutation results in tensing all of the dorsal SIJ ligaments (interosseous, dorsal sacroiliac) with the exception of one, the long dorsal ligament (LDL). This prepares the pelvis to absorb and increase in load. As a result, the posterior ilium are pressed together causing an increase in SIJ compression. This review will discuss the importance of understanding form and force closure principles because they are related to understanding the relationship of anatomy and function of the SIJ.

Building a Collaborative Model of Sacroiliac Joint Dysfunction and Pelvic Girdle Pain to Understand the Diverse Perspectives of Experts.

BACKGROUND: Pelvic girdle pain (PGP) and sacroiliac joint (SIJ) dysfunction/pain are considered frequent contributors to low back pain (LBP). Like other persistent pain conditions, PGP is increasingly recognized as a multifactorial problem involving biological, psychological, and social factors. Perspectives differ between experts and a diversity of treatments (with variable degrees of evidence) have been utilized. OBJECTIVE: To develop a collaborative model of PGP that represents the collective view of a group of experts. Specific goals were to analyze structure and composition of conceptual models contributed by participants, to aggregate them into a metamodel, to analyze the metamodel's composition, and to consider predicted efficacy of treatments. DESIGN: To develop a collaborative model of PGP, models were generated by invited individuals to represent their understanding of PGP using fuzzy cognitive mapping (FCM). FCMs involved proposal of components related to causes, outcomes, and treatments for pain, disability, and quality of life, and their connections. Components were classified into thematic categories. Weighting of connections was summed for components to judge their relative importance. FCMs were aggregated into a metamodel for analysis of the collective opinion it represented and to evaluate expected efficacy of treatments. RESULTS: From 21 potential contributors, 14 (67%) agreed to participate (representing six disciplines and seven countries). Participants' models included a mean (SD) of 22 (5) components each. FCMs were refined to combine similar terms, leaving 89 components in 10 categories. Biomechanical factors were the most important in individual FCMs. The collective opinion from the metamodel predicted greatest efficacy for injection, exercise therapy, and surgery for pain relief. CONCLUSIONS: The collaborative model of PGP showed a bias toward biomechanical factors. Most efficacious treatments predicted by the model have modest to no evidence from clinical trials, suggesting a mismatch between opinion and evidence. The model enables integration and communication of the collection of opinions on PGP.