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Should all women with pregnancy-related pelvic girdle pain be treated with exercise?Bromley, R., Bagley, Pamela J. 08 1900 (has links)
No / This paper presents the main findings of a systematic literature review that was
undertaken to investigate whether physiotherapist-guided exercise is effective in
reducing the severity of pregnancy-related pelvic girdle pain (PPGP). Seven
electronic databases were systematically searched. Studies that met the inclusion
criteria were assessed for methodological quality and internal validity. Five primary
randomized controlled trials (RCTs) and one post-partum follow-up study were
included in the review. The authors of all six studies incorporated advice and
physiotherapist-guided exercise, either in a group setting or as part of an individualized
exercise programme, into at least one of their intervention groups, with or
without the addition of a pelvic support belt, acupuncture or other physiotherapy
treatment modality. Two of the primary RCTs found that exercise and advice
effectively reduced pre-partum PPGP. One study concluded that exercise had no
additional value beyond simply supplying a pelvic support belt and advice. The
results of another trial supported the use of physiotherapist-guided stabilization
exercises for the treatment of post-partum PPGP. Yet another study did not find
any differences between the intervention groups involved. The works included in
this review all reported that PPGP reduced over time, regardless of the intervention
used to treat it, suggesting that the greatest factor influencing the resolution of
PPGP is time rather than exercise. The findings do not support the routine use of
physiotherapist-guided exercise in the treatment of all women with PPGP. Advice,
information and a non-elastic pelvic support belt should be offered to women with
pre-partum PPGP, whereas patients with persistent symptoms of post-partum
PPGP should receive individualized physiotherapist-guided exercise aimed at stabilizing
the pelvic area as part of a wider package of physiotherapy treatment.
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Effects of water and land based exercise programmes on women experiencing pregnancy-related pelvic girdle pain: a randomized controlled feasibility studyScott, K.L., Hellawell, Michael 06 1900 (has links)
No / This study aimed to address whether a water exercise programme improves pain and quality of life in pregnant patients with Pelvic Girdle Pain (PGP) compared to a land-based exercise programme and the feasibility of undertaking a large-scale research programme. Twenty-three participants with diagnosed PGP, recruited at St George’s Hospital London, were randomised into two groups (water or land exercise). Each group received, four, once-weekly exercise sessions on land or water. Exercise effects on PGP were measured using the Pelvic Girdle Pain Questionnaire (PGPQ) (primary outcome), Visual Analogue Scale (VAS), Patient Specific Functional Score (PSFS) and Active Straight Leg Raise (ASLR). Quality of life was measured using the Subjective Exercise Experience Scale (SEES). Outcomes were assessed at baseline and post four weeks exercise. Results showed there was a clinically significant improvement shown in all outcome measures in the water group, compared to the land group. A statistical difference between groups was shown for ASLR (p=0.036), Positive Well-Being (p=0.000) and Fatigue levels (p=0.011). No statistical difference was shown for PGPQ (p=0.056), PSFS (p=0.530) and Psychological Distress (p=0.712) scores. Exercise in water appears to offer a clinical benefit for patients experiencing PGP compared to a land exercise, particularly with Fatigue, Positive Well-Being and ASLR scores. Statistical differences between groups are limited by small sample size and that no power calculation was used in this study. Methodology and results provide support for a larger study on this topic to provide more definitive conclusions to support the use of water-based therapy for PGP. / The full text may be available depending on permission from the publisher.
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The association of variations in hip and pelvic geometry with pregnancy-related sacroiliac joint pain based on a longitudinal analysis / 妊娠期仙腸関節痛と骨盤帯ジオメトリーの関連Ji, Xiang 25 March 2019 (has links)
京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21703号 / 人健博第69号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 山田 重人, 教授 古田 真里枝, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM
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Fysioterapeuters upplevelser och erfarenheter av att arbeta med patienter som har graviditetsrelaterad bäckengördelsmärta. / Physiotherapists views on and experiences from working with patients with pregnancy-related pelvic girdle pain.Luckmeier, Johanna, Leander, Viktoria January 2022 (has links)
Bakgrund: Graviditetsrelaterad bäckengördelsmärta är vanligt förekommande bland kvinnor under och efter en graviditet. Detta påverkar kvinnorna negativt i stor utsträckning både fysiskt och psykiskt. Fysioterapi är en viktig och betydelsefull behandlingsform vid detta tillstånd, men evidensen kring fysioterapeutiska åtgärder är inte helt klarlagd och mer forskning behövs. Syfte: Studien syftade till att utforska och beskriva fysioterapeuterss upplevelser av och erfarenheter frångällandeav fysioterapeutiska åtgärder för patienter medvid graviditetsrelaterad BGS. Metod: Studien var en kvalitativ intervjustudie som baserades på sex semi-strukturerade intervjuer. Informanterna var fysioterapeuter som arbetade med kvinnor som har graviditetsrelaterad bäckengördelsmärta. Ett bekvämlighetsurval tillämpades vid rekrytering av informanter. Data analyserades genom en kvalitativ innehållsanalys. Resultat: Fyra kategorier och tolv underkategorier identifierades i analysprocessen. De fyra kategorierna var: Ett givande och utmanande arbete där patientbemötandet har stor betydelse, Undersöknings-metodik varierar mellan fysioterapeuterna, Erfarenheter och upplevelser av behandlingsåtgärder varierar mellan fysioterapeuterna och Fysioterapi är ett viktigt och betydelsefullt arbetsområde med stort behov av utveckling., med sammanlagt tolv subkategorier. Konklusion: Fysioterapeuter som arbetar med graviditetsrelaterad bäckengördelsmärta är betydelsefulla och gör stor skillnad. Det framkom att det finns ett stort behov av utveckling inom området för att kunna förbättra och effektivisera vården. Vidare forskning behövs därför för att möjliggöra utveckling och fylla existerande kunskapsluckor. / Background: Pregnancy-related pelvic girdle pain is common among women during and after pregnancy. This affects women negatively both physically and mentally. Physiotherapy is an important and significant form of treatment for this condition, but the evidence regarding physiotherapeutic interventions is not fully clarified and more research is needed. Purpose: The purpose of this study was to describe physiotherapist’s views on and experiences from physiotherapeutic interventions for patients with pregnancy-related pelvic girdle pain. Method: The study was a qualitative interview study based on six semi-structured interviews. The informants were physiotherapists who worked with women who have pregnancy-related pelvic girdle pain. A convenience selection sampling was applied when recruiting informants. The data were analyzed through using a qualitative content analysis. Results: Four categories and twelve subcategories were identified in the analysis process. The four categories were: A rewarding and challenging work where the encounter with the patient is of great importance, Examination methodology varies between the physiotherapists, Physiotherapists views and experience of treatment variesvaries, and Physiotherapy is an important and significant area of work with great need of development., with a total of twelve subcategories. Conclusion: Physiotherapists who work with pregnancy-related pelvic girdle pain are important and make a big difference. It emerged that there is a great need for development in the area to be able to improve and make the care more effective. Further research is therefore needed to enable development and fill existing knowledge gaps.
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Effekten av fysisk träning på postpartumsmärta i rygg och bäcken : En systematisk litteraturöversikt / The effect of physical exercise on back and pelvic postpartum pain : A systematic literature reviewEmma, Carlsson, Hilda, Linné, Belinda, Lynbech Ström January 2023 (has links)
Bakgrund: Graviditetsrelaterad bäcken- och/eller ländryggssmärta kan bero på hormonella och biomekaniska förändringar som vanligen efter förlossningen. Dock kan kvinnor få ihållande smärtbesvär vilket kan påverka funktion och livskvalitet. Bäckenbottenträning, statisk bålträning och dynamisk bålstabiliserande träning har liknande effektmekanism för smärtlindring. Riktlinjer kring fysisk träning efter förlossning saknar en uppdaterad evidensbild för dess smärtlindrande effekt. Syfte: Syftet var att sammanställa evidensläget samt bedöma evidensstyrkan för den smärtlindrande effekten av bäckenbottenträning, statisk bålträning samt dynamisk bålstabiliserande träning vid smärta i bäcken- och/eller lumbalregion efter förlossning. Metod: En systematisk litteraturöversikt genomfördes med artikelsökning på databaserna PubMed, Cinahl, PEDro och Cochrane. Varje artikel granskades enskilt av respektive författare utifrån en granskningsmall innan en gemensam sammanställning utfördes. Evidensgradering utifrån varje träningsform genomfördes med GRADE. Resultat: Nio randomiserade kontrollerade studier inkluderades med 499 kvinnor där fysisk träning visades ge en smärtlindrande effekt på postpartumsmärta i bäcken- och/eller ländrygg med genomsnittlig metodologisk kvalitet på 50 poäng. Dynamisk bålstabiliserande träning inkluderade sex studier och bäckenbottenträning två studier, samtliga med låg tillförlitlighet (⨁⨁◯◯). Statisk bålträning inkluderade en studie med mycket låg tillförlitlighet (⨁◯◯◯) enligt GRADE. Konklusion: Fysisk träning kan användas som behandling vid postpartumsmärta i bäcken- och/eller ländrygg. Evidensgraden behöver höjas genom fler studier, fler deltagare och blindad resultatuppföljning. / Background: Pregnancy-related pelvic girdle pain and/or low back pain is commonly caused by hormonal or biomechanical changes and tends to disappear after giving birth. However, some women are affected by the pain for an extended period, which will affect their functional status and quality of life. Pelvic floor exercises, static core exercises and dynamic core stabilisation exercises have a similar mechanism behind the pain-relieving effect. Guidelines for physical exercise after childbirth lack an updated picture of evidence for the pain-relieving effect. Purpose: The purpose of this review was to gather evidence and evaluate the strength of the evidence in relation to the pain-relieving effect of pelvic floor exercises, static core exercises, and dynamic core stabilisation exercises on pelvic girdle pain and/or low back pain after childbirth. Method: A systematic literature review was carried out and articles were gathered from the databases PubMed, Cinahl, PEDro and Cochrane. Each article was analysed individually by each author using a review template before a collective assessment was made. GRADE was used to rate the evidence for each form of physical exercise. Results: Nine randomised controlled trials were included with 499 women where physical exercise was used to try and treat postpartum pelvic girdle pain and/or low back pain with a mean methodological quality of 50 points. Six studies evaluated dynamic core stabilisation exercises and two reviewed pelvic floor exercises, all with an overall low reliability (⨁⨁◯◯). Static core exercise was assessed in one study with very low reliability (⨁◯◯◯) according to GRADE. Conclusion: Physical exercise can be used as a treatment for pelvic gridle pain and/or low back pain postpartum. The level of evidence for each form of physical exercise needs to increase through more studies, more participants and blinded outcome follow-up.
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The tail of Ascaphus : a historical resume and new histological-anatomical details / Annals of the University of Stellenbosch, Volume 31, Section A, No.1 (1955)Van Dijk, D. E. (D. Eddie) 12 1900 (has links)
Thesis (MSc)-- University of Stellenbosch, 1954 / Published in the Annals of the University of Stellenbosch, Volume 31, Section A, No.1 (1955) / ENGLISH ABSTRACT: The pelvic girdles of the two anuran genera Ascaphus and Leiopelma
of the family Ascaphidae are very similar. Attached to them by cartilage
(or connective tissue in some Ascaphus specimens) is a cartilaginous, in
Leiopelmu somewhat ossified, epibubis. In Ascaphu8, as in Xenopus, the epipubis
originates from two Anlages, and its muscles are also paired in the Ascaphidae,
while in Xenopus only one is present, although this also appears to originate
(rom two muscles. The cloaca extends behind the pelvic girdle in both sexes
in Al:lcaphus, and it is supported by two rods consisting of strong connective
tissue (Faserknochen?). These rods are attached to the ventral surface of
the pelvic girdle, in the female closely, in the male by means of tendons.
Between the rods and the epipubis a broad tendinous band extends, which is
thick in the male; in the latter the mm. compressores cloacae have their
origins posteriorly on the rods, while in the female the rods are completely
imbedded in these muscles posteriorly. In the female particularly there are
transverse muscle fibres which are not striped although probably derived from
the mm. compressorcs cloacae. Behind the pelvic girdle there is cavernous
tissue in both layers of the tunica muscularis, and ventrally it covers the mm.
eompressores cloacae. The circular and longitudinal muscle layers are
poste riorly separated by gliding planes. The cloaca is supplied by branches
of the a. mcsenterica posterior and the au. pudendae anteriores, and is drained
by the vv. pudendae and a small medial v. eaudalis. The cloaca is innervated
dorsally by the plexus ischio·coccygeus and ventrally by a branch of the n.ischiadicus (the n. pudendus). The cloaca of the male serves as a copulatory
organ. There is internal fertilization. / No Afrikaans abstract available. / The copy we received from the author were pages individually scanned in as JPEG images.
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Effekten av kinesiotejpning på aktivitetsförmåga och smärta hos gravida med pelvic girdle pain – en pilotstudieLind, Karin, Trång, Maria January 2010 (has links)
<p><strong> </strong></p><p>Syftet var att undersöka om kinesiotejpning kunde påverka aktivitetsförmåga och smärta hos gravida kvinnor med pelvic girdle pain. Studien var en single subjekt experimentell AB-design. Fyra kvinnor inkluderades i pilotstudien för behandling av pelvic girdle pain. Smärtan skattades och mättes med visuell analog skala. Aktivitetsförmågan mättes med Roland & Morris disability questionnaire.</p><p>Resultatet visade att gällande aktivitetsförmåga kunde det med 95 % säkerhet ses en förbättring hos tre av kvinnorna. Gällande smärtskattningen kunde endast hos en kvinna på kvällen och hos en annan kvinna på morgonen och kvällen ses en kliniskt signifikant minskad smärta. Resultaten i studien ger underlag för att en mer omfattande randomiserad och kontrollerad klinisk studie bör genomföras.</p>
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Effekten av kinesiotejpning på aktivitetsförmåga och smärta hos gravida med pelvic girdle pain – en pilotstudieLind, Karin, Trång, Maria January 2010 (has links)
Syftet var att undersöka om kinesiotejpning kunde påverka aktivitetsförmåga och smärta hos gravida kvinnor med pelvic girdle pain. Studien var en single subjekt experimentell AB-design. Fyra kvinnor inkluderades i pilotstudien för behandling av pelvic girdle pain. Smärtan skattades och mättes med visuell analog skala. Aktivitetsförmågan mättes med Roland & Morris disability questionnaire. Resultatet visade att gällande aktivitetsförmåga kunde det med 95 % säkerhet ses en förbättring hos tre av kvinnorna. Gällande smärtskattningen kunde endast hos en kvinna på kvällen och hos en annan kvinna på morgonen och kvällen ses en kliniskt signifikant minskad smärta. Resultaten i studien ger underlag för att en mer omfattande randomiserad och kontrollerad klinisk studie bör genomföras.
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Fatores associados à dor na cintura pélvica relacionada com a gestação e ao nível de incapacidade funcional em gestantes adolescentesANDRADE, Carlos Henrique Silva de 28 April 2016 (has links)
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Previous issue date: 2016-04-28 / CAPES / A dor da cintura pélvica apresenta-se como uma disfunção musculoesquelética comum
durante o período gestacional. Devido à imaturidade biológica que ocorre na adolescência,
conjectura-se que os fatores associados ao desenvolvimento dessa dor em adolescentes
gestantes sejam diferentes daqueles encontrados na mulher adulta. O objetivo deste estudo foi
avaliar a associação da dor lombopélvica prévia à gestação com o desenvolvimento da dor na
cintura pélvica, bem como os fatores associados ao nível de incapacidade funcional em
gestantes adolescentes. Foi realizado um estudo do tipo caso-controle com adolescentes
gestantes, atendidas em duas unidades de referência da região metropolitana de Recife,
Pernambuco, Brasil. Foram avaliadas 404 adolescentes (73 casos e 331 controles). No grupo
caso, foram incluídas gestantes com idade entre 10 e 19 anos, idade gestacional entre a 28ª e a
40ª semana de gestação e presença de dor na cintura pélvica. No grupo controle foram
incluídas as gestantes com ausência de dor na cintura pélvica. Um modelo de regressão
logística foi utilizado para identificar os fatores associados à ocorrência de dor da cintura
pélvica. Além disso, foi realizada uma análise no grupo de casos sobre os fatores associados à
incapacidade funcional. A média da intensidade da dor nas 73 adolescentes com dor na
cintura pélvica foi de 58 mm (Desvio Padrão [DP]: 20,13) em uma escala de 100 mm. Em
relação à localização e envolvimento das articulações pélvicas, obteve-se a seguinte
distribuição: 46 (63%) síndrome sacroilíaca bilateral; 17 (23,3%) síndrome da cintura pélvica
e 10 (13,7%) síndrome sacroilíaca unilateral. No modelo de regressão multivariada,
permaneceram associados com a dor na cintura pélvica os seguintes fatores: transtorno mental
comum (Odds Ratio [OR]: 2,27; Intervalo de Confiança 95% [IC95%]: 1,23 a 4,18), dor
lombar na menstruação (OR: 2,10; IC95%: 1,16 a 3,80) e trabalho árduo (OR: 1,95; IC95%:
1,13 a 3,35). No grupo de gestantes com dor na cintura pélvica, o coeficiente de determinação
encontrado no modelo ajustado indica que 22% da variabilidade total da incapacidade
funcional (ODI) em gestantes adolescente são explicadas pelos fatores transtorno mental
comum (SRQ20), intensidade da dor na cintura pélvica (EAV) e idade gestacional (IG),
expressos na seguinte equação: ODI (predito) = -18,2 + 0,81 x SRQ20 + 0,25 x EAV + 0,73 x
IG. Conclui-se, portanto, que não houve associação entre a história de dor lombopélvica
prévia à gestação e a presença de dor na cintura pélvica relacionada com a gestação em
adolescentes. No entanto, a dor lombar na menstruação, o trabalho árduo e o transtorno
mental comum foram fatores que se mostraram associados com a dor na cintura pélvica nessa
população. Também foi evidenciado que a intensidade da dor e a presença de transtorno
mental comum encontram-se associados com a incapacidade funcional dessas adolescentes. / Pelvic girdle pain is a common musculoskeletal dysfunction during pregnancy. Due to
biological immaturity and unfavorable psychosocial conditions, pregnancy in adolescence
may be associated with pelvic girdle pain. The aim of this study was to assess the association
between lumbopelvic pain before pregnancy and level of functional disability and pelvic
girdle pain related to pregnancy in adolescents. A case-control study was conducted with
pregnant adolescents, treated at two specialist units in the city of Recife, Pernambuco state,
Brazil. A total of 404 adolescents (73 cases and 331 controls) were assessed. The case group
included pregnant adolescents between the ages of 10 and 19 years, gestational age between
28 and 40 weeks and exhibiting pelvic girdle pain. The control groups consisted of pregnant
adolescents with no pelvic girdle pain. A logistic regression model was used to identify the
factors associated with the occurrence of pelvic pain. The measure of pain intensity in 73
adolescents with pelvic pain was 58 mm (standard deviation [SD]: 20.13) on a scale of 100
mm. In relation to location and pelvic joint involvement, the following distribution was
obtained: 46 (63%) bilateral sacroiliac syndrome; 17 (23.3%) pelvic congestion syndrome and
10 (13.7%) unilateral sacroiliac syndrome. In the multivariate regression model the following
variables were associated with pelvic pain in pregnant adolescents: common mental disorder
(Odds Ratio [OR]: 2.27; 95% Confidence Interval [95%CI]: 1.23 to 4.18), menstrual back
pain (OR: 2.10; 95%CI: 1.16 to 3.80) and strenuous work (OR: 1.95; 95%CI: 1.13 to 3.35). In
the group of pregnant adolescents with pelvic girdle pain, the coefficient of determination
found in the adjusted model indicates that 22% of total variability in functional disability
(ODI) in pregnant adolescents is explained by the following variables: common mental
disorder (SRQ20), pelvic pain intensity (EAV) and gestational age (GA), expressed in the
following equation: ODI (predictive) = -18.2 + 0.81 x SRQ20 + 0.25 x EAV + 0.73 x GA. It
is concluded, therefore, that there is no association between history of lumbopelvic pain prior
to pregnancy and the presence of pelvic girdle pain related to pregnancy in adolescents.
However, menstrual back pain, strenuous work and common mental disorder were factors
associated with pelvic girdle pain in this population. It was also shown that pain intensity and
common mental disorder in adolescents with pregnancy-related pelvic girdle pain are closely
related to the functional disability of these women.
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Pregnancy-related low back and pelvic girdle pain : with reference to joint hypermobility and treatmentLindgren, Anne January 2020 (has links)
Objectives: To explore if joint mobility, as a measure of connective tissue quality, could be a predictor for pregnancy-related low back pain after pregnancy 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 randomised to either corticosteroid injection or saline injection on one occasion at the ischial spine bilaterally, with a follow-up after four weeks. In both studies, 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 Rating 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. The larger the finger angle and the more pregnancies, the greater the risk of low back and pelvic pain after pregnancy. In the RCT, at follow-up, the women who received corticosteroid injection treatment improved in walking ability, estimated physical ability and isometric trunk extension more than those who received saline injections. Conclusions: Increased joint mobility, as measured by finger joint mobility, together with the number of previous pregnancies, may be an indicator of low back and pelvic pain postpartum. One single corticosteroid injection treatment to intra-pelvic structures improved function in women with persistent PGP which may indicate a source of pain.
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