DOCSLIB.ORG

Pregnancy-Related Pelvic Girdle Pain and Its Relationship with Relaxin Levels During Pregnancy: a Systematic Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pregnancy-Related Pelvic Girdle Pain and Its Relationship with Relaxin Levels During Pregnancy: a Systematic Review Eur Spine J DOI 10.1007/s00586-012-2162-x REVIEW ARTICLE Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review Daniela Aldabe • Daniel Cury Ribeiro • Stephan Milosavljevic • Melanie Dawn Bussey Received: 13 September 2011 / Revised: 11 January 2012 / Accepted: 18 January 2012 Ó Springer-Verlag 2012 Abstract Conclusions Based on these findings, the level of evi- Purpose The present systematic review assessed the level of dence for the association between PPGP and relaxin levels evidence for the association between relaxin levels and preg- was found to be low. PPGP assessment and controlling for nancy-related pelvic girdle pain (PPGP) during pregnancy. risk factors were found to increase bias leaving uncertainty Methods PRISMA guidelines were followed to conduct in interpretation of these findings and a need for further this systematic review. Electronic search was carried out research. using six different databases. Observational cohorts, cross- sectional or case–control studies focused on the association Keywords Pregnancy-related pelvic girdle pain Á between relaxin levels and PPGP during pregnancy were Relaxin Low back pain Pregnancy Systematic review Á Á Á included. Studies selection was conducted by two review- ers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Introduction Newcastle–Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group. Pregnancy-related pelvic girdle pain (PPGP) is a common Results 731 references were identified. Six articles met musculoskeletal disorder affecting approximately 20% of the inclusion criteria and were considered for this sys- all pregnant women [1]. Women who experience this dis- tematic review. The main reason for the studies exclusion order frequently present with reduced capacity for func- was PPGP related to gynaecological reasons. Five studies tional activities [2], and are three times more likely to have were case–control and one study was a prospective cohort. post-partum depressive symptoms [3]. Although the aeti- Four studies were ranked as high while two were ranked as ology of PPGP remains unknown, several studies suggest it low quality. Among the high quality studies, three found no is linked to increased pelvic mobility leading to pelvic joint association between PPGP and relaxin levels. instability and pain [4–6]. Validated biomechanical models of the pelvis support the concept of the sacroiliac joint (SIJ) being stabilized by active and passive structures surrounding the pelvis [7, 8]. D. Aldabe (&) M. Dawn Bussey School of PhysicalÁ Education, University of Otago, For instance, it has been shown that pelvic ligaments, such 56 Union Street, Dunedin 9016, New Zealand as the long dorsal, the iliolumbar and the sacrotuberous e-mail: [email protected] play key roles in pelvic stabilization such as, preventing excessive nutation and contranutation [9, 10]. Additionally, D. C. Ribeiro S. Milosavljevic Centre for PhysiotherapyÁ Research, School of Physiotherapy, active structures such as gluteus maximus, erector spinae, University of Otago, 325 Great King Street, Dunedin 9016, the biceps femoris and the thoracolumbar fascia attach to New Zealand these ligaments and to the sacroiliac joint (SIJ) and contribute to stabilization [10–12]. The sacrospinous and sacrotuber- D. C. Ribeiro Otago Polytechnic, Otago Institute of Sport and Adventure, ous ligaments also improve pelvic stability by providing 41 Harbour Terrace, Private Bag, Dunedin 1910, New Zealand proprioceptive information regarding pelvic position [13]. 123 Eur Spine J Consequently, some studies advocate the use of a pelvic belt 3. Study population: pregnant women in any stage of during pregnancy to structurally stabilise the pelvic girdle, pregnancy with no age limits. relative to the SIJ, as a useful intervention for reducing No language restriction was imposed. PPGP symptoms [14, 15]. However, the effectiveness of such intervention is still in debate [16]. Exclusion criteria were Relaxation of the pelvic ligaments is a physical change 1. Randomised and literature review studies, as well as, required during pregnancy and delivery. Such change thesis and dissertations; begins at the tenth to twelfth week of pregnancy [17] and is 2. Studies unrelated to PPGP or where PPGP has not considered to be a consequence of hormonal changes that been defined as a musculoskeletal disorder. occur about the same time [18]. Relaxin, a peptide hor- mone of the insulin-like growth factor family, has been associated with collagen remodelling in mammalians, Information sources including guinea pig, mouse, and human [19–21]. Secreted by the corpus luteum and placenta from early pregnancy, The electronic search was carried out using the following this hormone level increases to a considerable level during databases: Medline (1966 to July 2011), Amed (1985 to the first trimester, remaining steady at this level until late July 2011), EMBASE (1988 to July 2011), Proquest (July pregnancy and then becoming serologically undetectable in 2011), Web of Science (July 2011) and Scopus (July 2011). the first few days post-partum [22]. It is believed that relaxin increases pelvic laxity, and predisposes separation Search of the pubic symphysis, by altering the structure of colla- gen [23]. However, experimental studies have not shown a A literature search was carried out to identify all available direct relationship between high levels of relaxin and published articles on the relation and/or association increased pelvic mobility or peripheral joint mobility in between PPGP and relaxin levels. The identification of pregnant women [5, 24]. terms used in the search and the search strategy were Debate exists within the literature regarding the poten- developed in consultation with a health sciences librarian at tial role of the hormone relaxin in the manifestation of the University of Otago. The search terms were based on PPGP. While some studies argue relaxin loosens the pelvic keywords from previous publications as well as database- ligaments and increases instability [17, 23, 25, 26] others specific search terms [subject terms, subject headings (SH) do not accept that such relationship has been proven [1, and MeSh]. A string search was created adding ‘OR’ and 27]. These conflicting arguments have created a need for a ‘AND’ to combine the keywords and the subjects areas. systematic review to determine the level of evidence for The keywords used related to relaxin and PPGP were pregnant women with higher levels of relaxin being more ‘relaxin’ or ‘hormone’ or ‘reproductive hormone’ and likely to develop PPGP. To our knowledge, no previous ‘pelvic girdle pain’ or ‘low back pain’ or ‘pelvic pain’ or systematic review has addressed this question. ‘peripartum pelvic pain’ or ‘posterior pelvic pain’ or ‘pelvic insufficiency’. Additionally, one author (DA) scanned the reference lists of retrieved articles. Methodology Study selection The review was conducted following the guidelines described by the PRISMA Statement [28]. For more details All studies identified through the electronic search were Ò regarding to the methods of this systematic review, a stored in Endnote software (v.14 Thomson Reuters). protocol developed prior to the research was constructed Duplicate results were identified and removed by the and is available from the corresponding author upon principal investigator (DA). During screening by DA and request. DCR all titles were identified through electronic search as well as additional records identified through other sources. At the second stage of selection of studies, summary and Eligibility criteria full-text articles were screened, by the same two assessors (DA and DCR), against the predetermined inclusion and Inclusion criteria were exclusion criteria. Titles, abstracts and manuscript were not 1. Observational studies such as cohort, cross-sectional blinded for journal titles, authors and institutions, since and case–control; blinding has previously been shown not to affect the 2. Studies focusing on the causal relationship between study selection and data extraction [29]. If multiple PPGP and relaxin levels during pregnancy; reporting from the same study was found, only one study 123 Eur Spine J was included with all others referenced. Disagreement studies that quantified relaxin levels using enzyme-linked between the reviewers during the screening process was immunosorbent assay (ELISA) and presented its coeffi- determined by consensus. If consensus could not be reached cients of variation and serum samples were blindly ana- a third reviewer (MB) provided the majority opinion. lysed. Studies measuring relaxin concentrations using ELISA, without the above information described, or por- Data collection process cine radioimmunoassay were not awarded any point. This quality assessment restriction was due to the high vari- Data extraction from selected studies followed guidelines ability shown in studies using ELISA [39] and the con- proposed by the Cochrane Back Review Group [30]. This siderable differences observed between porcine and human was firstly performed by the principal investigator (DA) relaxin levels during pregnancy [40]. and subsequently confirmed by DCR. The following data Inter-rater reliability for assessment of risk of bias agree- were extracted: study design, year of the study, sample size ment between reviewers was measured by means of Kappa population, gestational
Load more

Recommended publications
  • Pelvic Girdle Pain, Hypermobility Spectrum Disorder and Hypermobility-Type Ehlers-Danlos Syndrome: a Narrative Literature Review
    Journal of Clinical Medicine Review Pelvic Girdle Pain, Hypermobility Spectrum Disorder and Hypermobility-Type Ehlers-Danlos Syndrome: A Narrative Literature Review Ahmed Ali 1,* , Paul Andrzejowski 1, Nikolaos K. Kanakaris 1 and Peter V. Giannoudis 1,2,* 1 Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK; [email protected] (P.A.); [email protected] (N.K.K.) 2 NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds LS7 4SA, UK * Correspondence: [email protected] (A.A.); [email protected] (P.V.G.) Received: 23 October 2020; Accepted: 4 December 2020; Published: 9 December 2020 Abstract: Pelvic girdle pain (PGP) refers specifically to musculoskeletal pain localised to the pelvic ring and can be present at its anterior and/or posterior aspects. Causes such as trauma, infection and pregnancy have been well-established, while patients with hypermobile joints are at greater risk of developing PGP. Research exploring this association is limited and of varying quality. In the present study we report on the incidence, pathophysiology, diagnostic and treatment modalities for PGP in patients suffering from Hypermobility Spectrum Disorder (HSD) and Hypermobility-Type Ehlers-Danlos Syndrome (hEDS). Recommendations are made for clinical practice by elaborating on screening, diagnosis and management of such patients to provide a holistic approach to their care. It appears that this cohort of patients are at greater risk particularly of mental health issues. Moreover over, they may require a multidisciplinary approach for their management. Ongoing research is still required to expand our understanding of the relationship between PGP, HSD and hEDS by appropriately diagnosing patients using the latest updated terminologies and by conducting randomised control trials to compare outcomes of interventions using standardised patient reported outcome measures.
    [Show full text]
  • Peripartum Pubic Symphysis Diastasis—Practical Guidelines
    Journal of Clinical Medicine Review Peripartum Pubic Symphysis Diastasis—Practical Guidelines Artur Stolarczyk , Piotr St˛epi´nski* , Łukasz Sasinowski, Tomasz Czarnocki, Michał D˛ebi´nski and Bartosz Maci ˛ag Department of Orthopedics and Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland; [email protected] (A.S.); [email protected] (Ł.S.); [email protected] (T.C.); [email protected] (M.D.); [email protected] (B.M.) * Correspondence: [email protected] Abstract: Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications. Keywords: pubic symphysis separation; pubic symphysis diastasis; pubic symphysis; pregnancy; PSD 1. Introduction The proper development of a fetus is made possible due to numerous adaptive Citation: Stolarczyk, A.; St˛epi´nski,P.; changes in women’s bodies, including such complicated systems as: endocrine, nervous Sasinowski, Ł.; Czarnocki, T.; and musculoskeletal. With regard to the latter, those changes can be observed particularly D˛ebi´nski,M.; Maci ˛ag,B. Peripartum Pubic Symphysis Diastasis—Practical in osteoarticular and musculo-ligamento-fascial structures. Almost all of those changes Guidelines. J. Clin. Med.
    [Show full text]
  • Chronic Sacroiliac Joint and Pelvic Girdle Pain and Dysfunction
    Chronic Sacroiliac Joint and Pelvic Girdle Pain and Dysfunction Successfully Holly Jonely, PT, ScD, FAAOMPT1,3 Melinda Avery, PT, DPT1 Managed with a Multimodal and Mehul J. Desai, MD, MPH2,3 Multidisciplinary Approach: A Case Series 1The George Washington University, Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, Washington, DC 2The George Washington University, School of Medicine & Health Sciences, Department of Anesthesia & Critical Care, Washington, DC 3International Spine, Pain & Performance Center, Washington, DC ABSTRACT PGP, impairments of the SIJ are not lim- Case 2 Background and Purpose: Sacroiliac ited to intraarticular pain and often include A 30-year-old nulliparous female with joint (SIJ) or pelvic girdle pain (PGP) account impairments of the surrounding muscles or a chronic history of right posterior pelvic for 20-40% of all low back pain cases in the connective tissues, as well as, aberrant and pain following an injury as a college athlete United States. Diagnosis and management asymmetrical movement patterns within the participating in crew. She reported slipping of these disorders can be challenging due to region of the lumbo-pelvic-hip complex.7 in a boat and falling onto her sacrum. Her limited and conflicting evidence in the lit- These impairments have a negative impact previous conservative management included erature and the varying patient presentation. on the PG’s role in support and load trans- physical therapy that emphasized pelvic The purpose of this case series is to describe fer between the lower extremities and trunk. manipulations, use of a pelvic belt, and stabi- the outcome observed in 3 patients present- This ariabilityv in observed impairments lization exercises.
    [Show full text]
  • Acupuncture for Pregnancy-­Related Low Back Pain and Pelvic Girdle Pain
    Journal of Pelvic, Obstetric and Gynaecological Physiotherapy, Spring 2017, 120, 74–77 GOOD PRACTICE STATEMENT Acupuncture for pregnancy- related low back pain and pelvic girdle pain Introduction The AACP (2012) defines the forbidden points This statement is based on a synthesis of the best as Large Intestine (LI) 4, Spleen (SP) 6, and available current evidence. It will be subject to Bladder (BL) 60 and 67 because of the risk periodic review as the evidence base evolves. It of uterine contractions (Betts & Budd 2011; should be noted that the statement offers guid- Cummings 2011) since these points are used in ance, and should not be regarded as prescrip- traditional Chinese medicine to facilitate induc- tive; such general advice will always require to tion and turning breech babies. Furthermore, be modified in line with the needs of any indi- BL31, BL32, BL33 and BL34 (the sacral fora- vidual patient and the clinician’s experience. mina) and abdominal points are to be specifical- All acupuncture should be performed accord- ly avoided because these may compromise cir- ing to the guidelines of the British Acupuncture culation to the developing foetus (Betts & Budd Council, the British Medical Acupuncture Society 2011), or potentially approximate the uterus if and the Acupuncture Association of Chartered the needle enters the foramen. Physiotherapists (AACP) (www.acupuncturesafety. Cummings (2011) theorized that acupuncture org.uk). is safe to use in pregnancy, and that forbidden points can be employed. Elden et al. (2005, 2008) found that forbidden points (i.e. LI4, BL32, BL33 Background and BL60) have not been found to cause serious The incidence of pregnancy-related low back adverse events, and no significant harmful effects pain (LBP) and pelvic girdle pain (PPGP) is were reported several randomized controlled tri- reported to be approximately 20% (Wu et al.
    [Show full text]
  • Pregnancy-Related Low Back Pain and Pelvic Girdle Pain (PGP)
    Pregnancy-related low back pain and pelvic girdle pain (PGP) Information for patients Women's Health Physiotherapy PROUD TO MAKE A DIFFERENCE SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST We have written this booklet to answer some of the common questions that women ask about Pregnancy-Related Pelvic Girdle Pain (PGP) and back pain in pregnancy. PGP was previously known as Symphysis Pubis Dysfunction (SPD). What is PGP? PGP is the term used for pain in and around your pelvis. This may be in your lower back, buttocks, hips, groin or pubic bone. Sometimes you may have pain down one or both legs. PGP can be mild or severe. The sooner it is treated, the more likely you are to cope and feel better. How common is PGP? One in five women (20%) are likely to experience PGP at some point in their pregnancy. The good news is that 94% of women fully recover in the first 6 weeks after their baby is born without needing physiotherapy treatment. It is more common later in pregnancy. Sacroiliac joint (at the back) Symphysis pubis joint (at the front) Hip joint (at the side) page 2 of 20 What causes back and PGP in pregnancy? There are various reasons for developing PGP in pregnancy: • Most PGP is caused by your pelvic joints moving unevenly. As your baby grows in the uterus (womb), the extra weight and the change in the way you sit or stand can put more strain on your joints. The average weight gain during pregnancy is 12-15 kg (1.5 - 2 stone).
    [Show full text]
  • Pregnancy-Related Pelvic Girdle Pain
    PREGNANCY-RELATED PELVIC GIRDLE PAIN Pelvic girdle pain is pain in the pelvic joints that may develop during or after pregnancy. Pelvic pain may occur because of: • Standing on one leg (e.g. dressing – putting on • changes to your posture pants) • increased pressure on your pelvis due to the • Moving from sitting to standing growth of your baby • High impact exercise (e.g. running and jumping • hormonal changes which soften the ligaments activities) that support the pelvis. Managing your pelvic girdle pain These changes can place increased strain on the pelvic joints making the joints inflamed and painful. To avoid increasing pelvic girdle pain: • Don’t push through pain. What you might feel • Take smaller steps when walking. • Clicking, locking or grinding in the pelvic joints. • Walk shorter distances. • Pain in the front or the back of the pelvis, • Reduce heavy lifting and pushing and pulling buttocks, groin and/or radiating into the thighs. activities such as vacuuming. The shaded areas in the picture below are where • Break up large tasks into smaller activities. pain commonly occurs. • Rest in between activities. • Keep your knees together when rolling in bed. • Roll under rather than over when rolling in bed. • Sleep on your side with a pillow in between your legs. • Get in and out of bed with your knees together (see the diagram below). FRONT BACK Activities that may increase your pelvic girdle pain • Prolonged walking • Fast walking • Getting in and out of the car or bed • Rolling in bed • Lying flat • Deep squatting or lunging • Going up and down stairs PREGNANCY-RELATED PELVIC GIRDLE PAIN – FEBRUARY 2019 PAGE 1 OF 2 Tips to reduce your pelvic girdle pain • Use an ice pack on the painful area for 20–30 minutes every 2–3 hours.
    [Show full text]
  • Pelvic Girdle Pain and Pregnancy
    Information for you Published in June 2015 Pelvic girdle pain and pregnancy About this information This information is for you if you are pregnant and want to know what might be causing the pain in your pelvic girdle joints and what you can do about it. If you are a partner, relative or friend of someone with pelvic girdle pain (PGP), you may also find it helpful. What is pelvic girdle pain? The pelvic girdle is a ring of bones around your body at the base of your spine. PGP is pain in the front and/or the back of your pelvis that can also affect other areas such as the hips or thighs. It can affect the sacroiliac joints at the back and/or the symphysis pubis joint at the front. PGP used to be known as symphysis pubis dysfunction (SPD). Sacroiliac joints The pelvic girdle showing the sacroiliac Symphysis pubis joint joints and the symphysis pubis joint PGP is common, affecting 1 in 5 pregnant women, and can affect your mobility and quality of life. Pain when you are walking, climbing stairs and turning over in bed are common symptoms of PGP. However, early diagnosis and treatment can relieve your pain. Treatment is safe at any stage during or after pregnancy. 1 What causes PGP? The three joints in the pelvis work together and normally move slightly. PGP is usually caused by the joints moving unevenly, which can lead to the pelvic girdle becoming less stable and therefore painful. As your baby grows in the womb, the extra weight and the change in the way you sit or stand will put more strain on your pelvis.
    [Show full text]
  • Low Back and Pelvic Pain in Women Across the Lifespan : from Adolescence to Peripartum to Menopause
    Low Back and Pelvic Pain in Women Across the Lifespan : From Adolescence to Peripartum to Menopause I. Impact of low back and pelvic disorders on women a. Low back pain “is the leading cause of activity limitation and work absence throughout much of the world, and it causes an enormous economic burden on individuals, families, communities, industry, and governments. (Hoy 2010, Lidgren 2003, Steenstra 2005, Kent 2005, Thelin 2008) b. Definition of low back pain and pelvic pain i. Low back pain (LBP) is defined as 1. Pain between the 12th rib and gluteal fold (Vleeming 2008) 2. “Pain between inferior margin of 12th rib and inferior gluteal folds that is bad enough to limit usual activities or change the daily routine for more than 1 day . This pain can be with or without pain going down into the leg. This pain does not include pain from feverish illness or menstruation. “ (Dionne 2008) ii. Pelvic girdle pain (PGP) is defined as pain between the posterior iliac crests and gluteal fold (Vleeming 2008) iii. Chronic pelvic pain is defined as non-cyclic pain in the lower abdomen and/or pelvis lasting 3-6 or more months, not exclusively associated with intercourse or menstruation. c. Pelvic floor dysfunction i. Urinary incontinence ii. Urgency/frequency iii. Obstructed defecation iv. Constipation v. Fecal incontinence vi. Prolapse vii. Dyspareunia viii. Sexual dysfunction ix. Chronic pelvic pain d. Prevalence of LBP and PGP in women across lifespan i. LBP 1. Variability in the literature due to based on relation to temporality and topography and minimum episode duration (Hoy 2010, Calvo- Munoz 2013) a.
    [Show full text]
  • The Comorbidity of Low Back Pelvic Pain and Risk of Depression and Anxiety in Pregnancy in Primiparous Women Rosa Virgara1,4* , Carol Maher2 and Gisela Van Kessel3
    Virgara et al. BMC Pregnancy and Childbirth (2018) 18:288 https://doi.org/10.1186/s12884-018-1929-4 RESEARCH ARTICLE Open Access The comorbidity of low back pelvic pain and risk of depression and anxiety in pregnancy in primiparous women Rosa Virgara1,4* , Carol Maher2 and Gisela Van Kessel3 Abstract Background: Approximately 50% of Australian women experience low back pain in pregnancy, with somewhere between 8 and 36% of women suffering from pregnancy related depression/anxiety. Both low back and pelvic pain and depression and anxiety are associated with poor maternal health outcomes, including increased sick leave, higher rates of functional disability, and increased access to healthcare. It also impacts upon time and mode of delivery with an increase in inductions and elective caesarean sections. For babies of women with depression and anxiety preterm birth, low birth weight and intrauterine growth restriction are all common complications. Given these poor health outcomes, it is important to determine the co-morbidity of low back and pelvic pain and depression/anxiety in pregnancy. Methods: A cross sectional study of a hospital based sample of 96 nulliparous women were assessed at 28 weeks as part of their routine antenatal appointment. Data was collected via interview and clinical records and included the Edinburgh Depression Scale (EDS), the Numerical Rating Scale (NRS) and the Modified Oswestry Low Back Pain Disability Questionnaire (MODQ). Spearman’s correlation co-efficients, prevalence ratios and ANOVA were used to determine comorbidity. Results: 96 women consented to participation in the study. All study outcomes were moderately correlated. There were three main findings: One, there was a positive correlation between low back and pelvic girdle pain (LBPP) and depression/anxiety was rho = 0.39, p < 0.001, between LBPP and functional disability was rho = 0.51, p < 0.001 and between risk of depression/anxiety and functional disability was rho = 0.54, p < 0.001.
    [Show full text]
  • Effect of Acupressure on Postpartum Low Back Pain, Salivary Cortisol, Physical Limitations, and Depression: a Randomized Controlled Pilot Study
    Effect of acupressure on postpartum low back pain, salivary cortisol, physical limitations, and depression: a randomized controlled pilot study Hsuesh-Yu Cheng, MBA, RN, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 80830, Taiwan, China Carol Shieh, DNSc, MPH, RNC-OB, FAAN, Department of Community and Health Systems, Indiana University School of Nursing, Indiana 600, USA Bei-Yu Wu, Dr., Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 80830, Taiwan, China Yu-Fen Cheng, MBA, RN, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 80830, Taiwan, China This research was supported by the Chang Gung Memorial Hospital: The effects of acupressure on postpartum low back pain (No: CMRPG8G0941). Correspondence to: Ms., Yu-Fen Cheng, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, No.123, Ta Pei Rd., Niaosong Dist., Kaohsiung City 833, Taiwan, China Email: [email protected] Telephone: +886-7-731-7123 Ext. 2182 Fax number: +886-7-731-7123 Ext. 2451 ____________________________________________________ This is the author's manuscript of the article published in final edited form as: Cheng, H.U., Shieh, C., Wu, B.W., & Cheng, Y.F. (2020). A randomized controlled pilot study: The effects of acupressure on postpartum low back pain, salivary cortisol, physical limitations, and depression. Journal of Traditional Chinese Medicine, 40(1), 128-136. ISSN 0255-2922 Abstract OBJECTIVE: To investigate the effect of acupressure on postpartum low back pain (LBP), salivary cortisol, physical limitations, and postpartum depression. METHODS: Participants were 70 postpartum women who were randomly assigned to either an intervention (n = 35) or a control (n = 35) group.
    [Show full text]
  • Pregnancy-Related Low Back and Pelvic Girdle Pain
    Pregnancy-related low back and pelvic girdle pain With reference to joint hypermobility and treatment Licentiate thesis ANNE LINDGREN ABSTRACT Lindgren A, 2020. Pregnancy-related low back and pelvic girdle pain with reference to cause and treatment. Objectives: To explore if joint mobility, as a measure of connective tissue quality, could be a predictor for pregnancy-related low back pain after preg- nancy and to evaluate local corticosteroid injection treatment in women with persistent pelvic girdle pain long after childbirth. Material and methods: To investigate joint mobility in relation to pain, 200 women were examined repeatedly from early pregnancy until three months after delivery. Their mobility in left fourth finger abduction in early pregnancy was compared with clinically assessed low back and pelvic pain 3 months after delivery. To evaluate local corticosteroid injection treatment, 36 women with persistent PGP were included in a randomised controlled trial (RCT) and ran- domised to either corticosteroid injection or saline injection on one occasion at the ischial spine bilaterally, with a follow-up after four weeks. In both stud- ies, the women were asked about obstetric history, to complete a pain drawing, estimate their level of pain on a visual analogue scale (0-100) and estimate how they manage their everyday activities on a questionnaire, Disability Rat- ing Index (DRI). In the RCT, the 36 women also completed Short Form 36 (SF-36), a quality of life questionnaire, six-minute walk test (6MWT), and isometric trunk flexion and extension were examined. Results: Women with low back and pelvic pain three months after pregnancy had increased finger laxity in early pregnancy.
    [Show full text]
  • Acupuncture for Pelvic and Back Pain in Pregnancy: a Systematic Review Carolyn C
    Reviews Obstetrics www.AJOG.org OBSTETRICS Acupuncture for pelvic and back pain in pregnancy: a systematic review Carolyn C. Ee, MBBS, BAppSci (Chinese Medicine/Human Biology); Eric Manheimer, MS; Marie V. Pirotta, MBBS, PhD; Adrian R. White, MA, MD, BM BCh sleep in late pregnancy, and both acupunc- The objective of our study was to review the effectiveness of needle acupuncture in ture and physiotherapy may improve treating the common and disabling problem of pelvic and back pain in pregnancy. Two pain.13 Several case reports and -1 retro small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met spective case series have suggested that the inclusion criteria. Acupuncture, as an adjunct to standard treatment, was superior to acupuncture may relieve pelvic and back standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women pain in pregnancy.14-17 with well-defined pelvic pain had greater relief of pain with a combination of acupuncture Complementary and alternative ther- and standard treatment, compared to standard treatment alone or stabilizing exercises and apies are growing in popularity and are standard treatment. We used a narrative synthesis due to significant clinical heterogeneity used by more than a third of the US pop- between trials. Few and minor adverse events were reported. We conclude that limited ulation.18 They continue to be used- dur evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. ing pregnancy,19 and 60% of women Additional high-quality trials are needed to test the existing promising evidence for this with lower back pain in pregnancy report relatively safe and popular complementary therapy.
    [Show full text]